Chapter 18 Preoperative Nursing Management
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Before surgical treatment is initiated, health history is obtained, physical exam performed, vitals obtained and database established for future comparison
What percentage of surgeries are now performed in an ambulatory or outpatient setting?
60% of elective surgeries are now performed in an ambulatory or outpatient setting
Pressure to reduce hospital stays and contain costs has resulted in diagnostic preadmission testing (PAT) and preoperative preparation before admission to the hospital
Increasing use of ambulatory, same day or short stay surgery, means that patients leave hospital sooner, which increses the need for teaching, discharge planning, preparation for self care and referral for home care and rehab services.
Perioperative and perianesthesia nursing addresses the nursing roles relevant to the three phases of the surgical experience: pre-op, intra-op and post-op.
Begins when decision to porceed with surgical intervention is made and ends with the transfer of the patient onto the OR table.
- Nursing activities: Establishing a baseline evaluation of patient before surgery by carrying out a preop interview (includes physical and emotional assessment), previous anesthetic and medical history, identification of known allergies or genetic issues, ensuring neccessry tests have been or will be performed in PAT, arrange appropriate consultations and providing education about recovery from anesthesia and post op care.
- On day of surgery patient teaching reviewed, identity and surgical site verified, informed consent confirmed and IV infusion started.
- Begins when patient is transferred onto the OR table and ends with admission to the PACU
- Nursing activities:provide patient safety, maintain aseptic environment, ensure proper function of equipment, provide surgeon with specific instruments and supplies for surgical field and completing appropriate documentation. provide emotional support to patient, assist with positioning of patient on OR table, act as scrub nurse, circulating nurse, or registered nurse first assistant.
- begins with admission fo patient to PACU and ends with follow up evaluatino in clinical setting or home.
- Nursing activities: maintain patient airway, monitor vital signs, assess effects of anesthetic agents, assess patient for complications, provide comfort/pain relief. focus on promoting patients recovery and initiating teaching, follow up care and referrals essential for recovery and rehab after discharge.
- voluntary and written informed consent form patient is necessary before nonemergent surgery can be performed. written consent protect spatient from unsanctioned surgery and protects surgeon from claims of an unauthorized operation.
- Nurse may ask patient to sign form and may witness patients signature
- Responsiblity of surgeon to provide a clear and simple explanation of what surgery will entail. Must also inform patient of benefits, alternatives, possible risks, complications, disfigurement, disability and removal of body parts as well as what ot expect in early and lat post-op periods.
- if patient requests additional information nurse notifies the physician. Nurse ascertains that consent formed signed before administering psychoactive premedication.
When is informed consent necessary?
- Invasive procedures (Ex. surgical incision, biopsy, cystoscopy, paracentesis)
- Procedures requiring sedation/ anesthesia
- Non surgical procedure (Ex. arteriography,that carries more than slight risk to the patient)
- Procedures involving radiation
Who signs the consent form?
- Signed consent form is placed in a prominent place on patients chart and accompanies patient to OR.
- Patient personally signs consent if of legal age and mentally capable.
- If patient is minor, neurologically incapacitated or incompetent permission must be obtained from a surrogate (family preferably next of kin or legal guardian)
- Emancipated minor (married or earning own living) may sign own consent form.
- IN Emergency surgeon may have to operate without consent. every effort must be made to contact patients family.
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