General Preoperative Nursing Care

 General Preoperative Nursing Care. ]

{Suggested format  of your write up when attempting surgery questions}

 

The questions may appear in the following forms; asking you

 

ü  The general preoperative  nursing care 

ü  Specific preoperative  nursing care

ü  Immediate preoperative  nursing care

ü  Emergency nursing care

 

ü  It important that you begin by giving a brief introduction of the kind of preoperative nursing care you are going to describe i.e.

 

ü  Preoperative nursing care is the care that I will give my patient from the time of admission to a surgical unit up until the time immediately before the patient is transferred to the operating dept.

 

ü  Or

ü  The immediate preoperative nursing care is the care that I will give to my client immediately {30min to one hr} before transferring him to the operating dept.   

 

ü  Specific preoperative nursing care focuses on special preoperative nursing activities which MUST be done before the patient is taken to Theatre i.e. a patient going for rectal surgery will need to have an enema done, a patient going for repair of the ureters will need to be catheterized, but these will not be as necessary as in a patient going for amputation of a finger or cataract extraction.

 

Consideration however needs to taken also on the type of anesthesia to be used.

 

Remember your write up should be in an active form. Put your self as the person who is going to carry out the nursing activities instead of referring to what the other nurse would have done

 Then you need to write your objectives of care {most of these objectives apply to a number of surgical conditions, so you can use them generally} i.e.

 The general objectives of my care during this period are as follows;

 

ü  To prepare the patient;

ü  physically, psychologically, emotionally spiritually so as to be enable him withstand the effects of surgery and administration of anesthesia and to ensure that he recovers rapidly and safely from the surgical procedure.

ü  Anticipate and prevent potential complications during surgery

 

ü  To achieve these objectives, I will provide my nursing care in the following manner;

ü  History {Data collection}.

ü  On admission, I will obtain subjective and objective information from my patient. This will help me identify my patient, identify the immediate needs of my patient and thus be able to give a refocused nursing care plan based on the needs as well as provide an opportunity for giving I.E.C

ü  {Note history taking is often omitted in many cases, but it forms an integral part in your nursing care plan}

 

ü  2. Psychological care

ü  This care will help my patient's mind to be ready for surgery.

ü  I will provide him information on the type of surgery he is to undergo, for example where and how that surgery will be done, some expectations of that surgery particularly, its benefits in comparison to other forms of treatment without causing undue anxiety. This will be done using a simple language which he clearly understands.

ü  I will provide him an opportunity to ask questions, express his fears or anxiety, as verbalizing can help reduce tension prior and during surgery.

ü  If there are any patients nearby who have had  similar operations, I will introduce these patients to him so that they can have a one to one chart and share there experiences

ü  I will also consider the relatives and significant others in the care plan for the patient so as to promote a sense of belonging .This will  help him uplift his self concept and feel loved

ü  All procedures to be done him will be explained to him in advance to gain his cooperation

ü  Privacy will be maintained at all times and all his realistic wishes respected 

ü  An informed consent will be obtained after providing him with all the necessary information concerning his surgery.

ü  3. Physical preparations of my client/patient

 

ü  Bowel preparation.

 

ü  I will begin the bowel preparations, where I will starve my patient at least 8 hours from solid foods, 6 hours semi solid foods, and 2 hours from fluids before the operation.

ü  For operations involving the GIT laxatives and enema will be given a day before the operation.

ü  In an emergency, I will insert an N.G tube o aspirate the contents of the stomach so as to prevent vomiting and aspiration, which can lead to aspiration pnuemonia

ü  I will also administer prescribe antibiotics for sterilizing the abdomen.

 

ü  {Countercheck with the Doctors orders}

 

ü  Skin preparation.

 

ü  I will give an antiseptic bath or shower a day prior to surgery or in the morning of the day of surgery to cleanse him of micro bacteria from the body.

ü  The site of operation will be shaved, being cleaned with an antiseptic solution and left dry

ü  I will provide a clean gown to be worn over the body to allow the skin to remain clean

 

ü  Bladder care

 

ü  In Situ

 

ü  I will ask my patient to empty the bladder in the  morning before surgery

ü  I will also put an indwelling catheter to allow continuous drainage of the urine. This is important as it prevents accidental perforation of the bladder in abdominal surgery .It also helps to monitor the status of urinary output during surgery

 

ü  Observations

o   Do vital signs of TPR to for base line data

o   Observe the patient reaction to the idea of surgery

o   Observe the pain threshold.

 ü  Intravenous infusion

ü  I will put an intravenous infusion line for administration of solutions and medicines during surgery.

ü  An intravenous line also provides a quick access of the veins when you want to resuscitate the patient

ü  It also provides a means of providing nutrition post operatively

 

ü  Gowns

ü  I will give a gown and a head dress to cover the hair. this is to limit micro organism from the head and body contaminating the incision site

 

ü  Name tag

ü  A name tag or identity band will be placed on the patient forehead or arm bearing his name ,sex age ,and type of operation to be done

 

ü  Removal of valuables

ü  I will remove the entire valuables such as ring hair pieces dentures or jewelry as some of theses may easily ignite static electricity in an environment where there will be high concentration of oxygen.

ü  some metal valuables also can cause accidental burns or electric shock to the patient where a diathermy machine is in use

ü  Medical records

ü  I will arrange all the necessary medical records for the patient, all the lab and x-ray results which were ordered, the doctors and nurses documents will accompany the patient as he will be transferred to the theatre

 

Care of the relatives

ü  I will inform the relatives of the impending transfer of the patient to theatre and ask them to wait in the waiting lounge for the return of their relative.

·                  Once every thing is in place, i will inform the O.T dept that patient is ready for surgery and arrangement to have him transferred made.

·                  Soon after the patient has being transferred , I will make a post operative bed in anticipation of his arrival with all the necessary bed accessories

  Consent form.

ü  Sufficient information needs to be given to the client/patient through out the preparation.

 

ü  Refer the notes below on the physical preparation of a pt undergoing elective surgery

 ü  Preparing the client just prior to surgery {immediate preoperative care

ü  Consult the physician’s orders for preoperative instructions.

ü  Examine the patient's health record to confirm that all essential information is included such as

ü     The physician's medical history and physical examination

ü      Nurses’ documentation

ü     Urinalysis report

ü     Blood type and cross match

ü     Chest X-ray and electro cardiogram

ü     Other pertinent diagnostic tests

ü     Medication administration record

ü     Confirm that an informed consent has been signed by the    client

ü     Use the check list to see what has been done for the patient

ü     Check the patients identity

ü    Take and record the vital signs

ü    Instruct the client to take a shower or an antiseptic bath  {follow hospital policy}

ü    Instruct client to remove all make -up and nail polish

ü    Provide the client with a clean hospital gown after the bath

ü   Ask the client to remove all jewelry and other valuables and    place them in a secured place, if client refuses to remove ring, secure it with a tape. Don’t cover nail beds with  tape

ü    Remain alert to the clients anxiety  or questions

ü   Carry out the prescribed orders such as;

ü  Insertion of I.V line, solutions and medications

ü  Urinary catheterization

ü  Naso gastric intubation

 ü  Before giving the preoperative medication

ü  Instruct the patient to empty his bladder

ü  Remove all  prosthesis from the patient such as

ü  Dentures

ü  Eye glasses or contact lenses

ü  Artificial limbs

ü  Administer the preoperative medications

ü  Explain to the patient that they may feel sleepy or have a dry mouth

ü