Preoperative nursing care is of utmost importance to ensure that patients are both physically and psychologically prepared for surgery. Nurses have a crucial role in this phase by educating patients about what to expect in the surgical room. In this blog, we will explore the various aspects of preoperative nursing care, including its significance, preparation steps, nursing responsibilities, and diagnostic procedures.
What is Preoperative Nursing Care?
Preoperative nursing care encompasses the interventions provided by nurses before surgery, starting from the patient’s decision to undergo the procedure up until the commencement of the surgery. It involves preparing the patient physically and mentally for the upcoming surgical experience to alleviate fear and improve outcomes.
The Importance of Preoperative Care
Preoperative care is indispensable for all surgical procedures, whether major or minor, as it helps reduce immobility and aids patients in coping with pain by enlightening them about the surgery’s objectives and expectations. Even in emergency cases where the patient is unresponsive, preoperative nursing care is crucial, and in such situations, the family should be informed about the preparations.
Personalized Care Approach
Since different patients have varying information needs and anxiety levels, preoperative care should be tailored to each individual. Nurses must assess patients’ literacy levels to determine the suitability of printed materials. Preoperative care may involve multiple aspects and is often conducted a day before the scheduled surgery.
Preoperative Nursing Diagnosis
To achieve preoperative goals, nurses conduct comprehensive patient assessments, provide patient education, and establish nursing diagnoses during the preoperative phase. The following are nursing diagnoses commonly encountered during this stage:
1. Anxiety related to surgical outcomes, anesthesia, or pain.
2. Risk of ineffective therapeutic management due to inadequate knowledge about preoperative and postoperative procedures.
3. Fear related to the perceived threat of the surgical procedure and separation from family.
4. Insufficient knowledge about the surgical process.
5. Fear associated with the risk of death.
6. Disturbance of sleep patterns due to psychological stress and hospital routines.
Diagnostic Tests in the Preoperative Phase
To ensure proper preoperative care, various diagnostic tests are conducted during this phase. These tests aid in determining the patient’s health status, potential risks, and overall preparedness for the surgery. The diagnostic tests may include:
1. Blood analysis, which involves assessing sedimentation rate, blood count, serum protein, C-reactive protein, alkaline phosphate, calcium, etc.
2. MRI and CT scans.
3. X-ray examinations.
4. Bone scans.
5. Stool studies.
7. Tissue biopsy.
Nursing Responsibilities During the Preoperative Phase
Nurses play a critical role in ensuring successful preoperative care, starting from the patient’s decision to undergo surgery until they enter the operating room. Their responsibilities include:
1. Evaluating and addressing psychological issues that could impact surgical outcomes.
2. Conducting comprehensive patient assessments, both physical and psychological.
3. Devising individualized care plans based on the patient’s specific needs.
4. Supporting cardiovascular and respiratory health.
5. Instructing patients on postoperative exercises for better recovery.
6. Educating patients about lifestyle changes post-surgery.
7. Addressing patients’ fears, concerns, and worries.
8. Explaining methods to manage postoperative pain.
9. Managing nutrition and fluid intake, including timing of meals after surgery.
10. Providing psychological support to patients.
11. Supporting renal or hepatic function.
12. Encouraging mobility and active body movement after surgery.
13. Informing patients about what to expect in the surgery room.
14. Teaching patients deep breathing and coughing exercises post-surgery.
15. Obtaining informed consent from patients after explaining all risks and benefits of the surgery.
What is Involved in Pre-operative Care?
Preoperative care encompasses all the preparations made from the moment the patient consents to undergo surgery until they are transferred to the operating room. This phase aims to assess the patient’s readiness for the surgical procedure. Preoperative preparations include general steps that are applicable to all surgeries, as well as specific practices depending on the type of operation and diagnosis. Patient assessments during this phase should cover the following aspects:
1. Identification of patients, including name and date of birth.
2. Evaluation of the patient’s psychological and mental status.
3. Assessment of the patient’s functional status and ability to perform daily tasks.
4. Evaluation of respiratory and cardiovascular health.
5. Examination of the patient’s skin condition.
6. Assessment of the patient’s nutritional status.
7. Identification of sensory impairments, cultural needs, language barriers, etc.
8. Review of the patient’s previous experiences with surgery and anesthesia.
9. Identification of anxiety levels.
10. Investigation of medications, nutritional supplements, herbs, and drug use.
11. Determination of any allergies.
Goals of Preoperative Care
Preoperative care is geared towards reducing anesthetic and surgical mortality rates and facilitating a smooth recovery for patients. The primary goals of preoperative care include:
1. Documenting the patient’s need for surgery.
2. Assessing the patient’s overall health status.
3. Identifying any health conditions that could lead to complications during or after surgery.
4. Determining the patient’s preoperative risk level.
5. Improving the patient’s medical condition to minimize the risks associated with surgery and anesthesia.
6. Creating a suitable preoperative care plan for each patient.
7. Educating patients about intraoperative care, anesthesia, and postoperative pain management to alleviate anxiety.
8. Reducing hospital costs, minimizing hospital stays, and enhancing patient satisfaction.
Steps in Pre-operative Preparations
The success of patients’ preoperative phase heavily relies on the competence, knowledge, and integrity of nurses. The preoperative phase encompasses patient assessments, interviews, and preparations for anesthesia and surgery. Types of pre-operative nursing care involve:
1. Physical Preparation:
This step entails obtaining a thorough patient history, including their experiences with anesthesia and previous surgeries. Specific lab tests may be performed, such as urinalysis, prothrombin time, partial thromboplastin time, electrolyte tests, or complete blood count (CBC).
For patients over 50 years old or with a history of cardiac disease, an EKG may be conducted. Additionally, a chest X-ray may be taken if a patient has a respiratory disease history. Risk factors that could hinder healing, such as steroid use, nutritional deficits, radiotherapy, metabolic disorders, alcohol abuse, or drug use, should be evaluated.
Patients should disclose all vitamins, medications, food supplements, and herbal products they are using. Furthermore, assessment for latex allergy is essential to determine appropriate interventions.
2. Psychological Preparation:
Patients often experience anxiety before surgery. Nurses can help alleviate this anxiety by empathetically addressing their concerns and providing answers to their questions. This type of communication is especially crucial for patients facing high-risk procedures or those with chronic illnesses. Involving family members or guardians in the preoperative care process is also beneficial.
In cases where patients express intense fear of mortality during surgery, it may be necessary to inform the surgeon, and in some instances, postponing the procedure could be considered. For children, allowing them to have their parents present and bringing their favorite toys can help create a more
comfortable environment. These preparations aid patients in coping with pain and contribute to positive outcomes.
3. Informed Consent:
Obtaining written consent is a crucial aspect of preoperative care. Nurses must thoroughly explain the risks and benefits of the surgery and any alternative treatment options available. Patients should sign the consent form only after fully understanding and agreeing to the procedure. Patients who are mentally impaired, critically ill, or heavily sedated cannot provide consent; in such cases, the next of kin should act on their behalf.
4. Preoperative Teaching:
Preoperative teaching involves educating patients about the preoperative, intraoperative, and postoperative periods. Instructions should cover when to arrive for surgery, the designated location, and how to prepare for the procedure. For example, patients should be informed about the time-frame for their last meal before surgery and whether they need to take or bring specific medications, such as inhalers.
Information about the surgery should include details about the surgical room environment and the expected duration of the procedure. Family members should also be informed about where they can wait during the surgery, the anticipated duration, and whom to contact for progress updates.
Postoperative expectations, such as coughing and deep breathing exercises, should be thoroughly explained to patients. Early leg exercises may also be demonstrated to reduce the risk of blood clots. Additionally, patients should be informed about various tubes and equipment, such as drainage tubes, monitoring devices, IV lines, and dressings.
5. Pain Management:
Preoperative instructions should incorporate pain management strategies. Nurses should encourage patients to take or request pain medication before the pain becomes unbearable. Other pain control methods, such as positioning, distractions, imagery, music therapy, and meditation, should also be discussed. Patients should be informed about their expected discharge time, resumption of solid food intake, and when they can return to work.
Postoperative preparations involve ensuring that all necessary supplies are available. Teaching materials, such as handouts or videos, should be provided to patients. The consent form should be ready for the patient to review and sign. Patients have the right to include or exclude specific items on the consent form. Sufficient time should be allotted before surgery to avoid rushing the patient through the process.
Preoperative nursing care is a critical aspect of any surgical procedure, regardless of its scale. It involves thorough physical and psychological preparation of the patient, helping them understand the upcoming surgical experience and alleviating their fears. Utilize the information provided in this blog to deliver the best possible nursing care to patients during the preoperative phase, ultimately leading to improved patient outcomes.