What is preoperative phase in the perioperative nursing care of the patient?
The Perioperative period is used to describe the three phases of any surgery which includes the preoperative phase , intraoperative phase and the postoperative phase. Show The first phase, the preoperative phase starts with the decision of having surgery and ends with the beginning of surgery. This can be usually considered as preparative period as the goals of the surgery must be attained. During this period the mental state of the patient is also stabilized and the anxiety is reduced. Preoperative preparation of the patient includes a number of factors related to the avoidance of complications such as surgical site infections (SSI) and deep venous thrombosis (DVT). The second phase, the intraoperative phase, involves the surgery itself. It starts with surgery and ends when the patient is shifted to the post-anesthesia care unit (PACU). During this phase, the patient is given some form of anesthesia, either general anesthesia or local anesthesia or regional anesthesia. As the surgery begins patients body conditions like heart rate, respiration, and blood oxygen, blood sugar level will be examined. The final phase, the postoperative phase starts immediately after the surgey. Once the patient is ready to leave PACU and the poastoperative procedure starts. This stage is mainly focused on the patients physiological health and surgical recovery of the individual. It may include ensuring hydration, monitoring urination or bowel movements, assisting with mobility, providing appropriate nutrition, managing pain, and preventing infection. Each surgical patient presents with his/her own unique set of risk factors and comorbidities. In addition to the risks of surgery and anesthesia common to all patients, every procedure that a surgeon performs carries its own set of specific management issues and potential complications. There is no “standard” preoperative workup that fits all patients. Not every patient should be sent for the same set of tests such as laboratories, imaging, or other studies prior to surgery. Preoperative malnutrition increases the risk of complications after surgery, particularly related to wound healing and development of post-operative infections and increases length of stay. Abuse of tobacco, alcohol, and illicit drugs is frequently identified in surgical patients. Although, ideally, all patients should be enrolled in smoking cessation or detoxification programs, this is clearly not possible in the preoperative setting. Smokers may suffer from postoperative nicotine withdrawal that requires treatment with nicotine replacement and may also have poor wound healing. Smoking cessation for at least 4 weeks preoperatively may mitigate the effects of smoking. Author InfoSambhaji Govind Chintale 1Department of Otorhinolaryngology, jiius iimsr warudi tq badnapur dist jalna, IndiaPublished: 21-Jun-2021 , DOI: 10.35248/2684-1290.21.4.e103 Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The patient who consents to have surgery, particularly surgery that requires a general anesthetic, renders himself dependent on the knowledge, skill, and integrity of the health care team. In accepting this trust, the health care team members have an obligation to make the patient's welfare their first consideration during the surgical experience. This lesson consists of your duties as a practical nurse to provide preoperative care for the surgical patient. 1-2. DEFINITIONS a. Anesthesia. A partial or complete loss of sensation, with or without loss of consciousness, as a result of a disease, an injury, or administration of a drug. b. Cyanosis. A Greek word for the slightly bluish-gray or purple discoloration of the skin due to a deficiency of oxygen and an excess of carbon dioxide in the blood. (Oxygen in the blood makes it look red and gives the skin a pink tone.) c. Narcotics. A group of drugs producing stupor, sleep, or complete unconsciousness; used to allay pain. Narcotics are regulated by federal laws. d. NPO. Nothing by mouth (Latin, nulli per os). e. Perioperative Period. The period extending from the time of hospitalization for surgery to the time of discharge (see Figure 1-1). f. Preoperative Phase. That phase of the perioperative period during which the nurse admits the patient to the surgical unit and helps the individual prepare physically and emotionally for the operation. Refer to Figure 1-1. g. Prosthesis. An artificial organ or part; for example, an artificial limb, eyeglasses, or dentures. h. Thrombophlebitis. Inflammation of a vein associated with thrombus formation. i. Thrombus. A blood clot. Figure 1-1 NOTE: Figure 1-1 shows: A. Teaching the patient and spouse during the preoperative phase B. Nurse handing sponge to surgeon in the operative phase C. Patient being observed and monitored during the recovery phase; and nurse checking patient's bandage during the postoperative phase.1-3. PREOPERATIVE PHASEAlthough the physician is responsible for explaining the surgical procedure to the patient, the patient may ask the nurse questions about the surgery. There may be specific learning needs about the surgery that the patient and support persons should know. A nursing care plan and a teaching plan should be carried out. During this phase, emphasis is placed on:a. Assessing and correcting physiological and psychological problems that may increase surgical risk. b. Giving the patient and significant others complete learning and teaching guidelines regarding the surgery. c. Instructing and demonstrating exercises that will benefit the patient postoperatively. d. Planning for discharge and any projected changes in lifestyle due to the surgery. 1-4. SURGICAL EXPERIENCE Surgery is an important event in any individual's life. It represents a serious decision involving the patient's body and his health. It also produces physical and psychological stress on the body relative to the extent of the surgery and injury to the tissue involved. The patient must understand what is proposed, understand all the risks, and give his consent. a. Physical Stress. Surgery produces actual physical damage to tissues of the body.
b. Psychological Stress. The physical stress of surgery is greatly enhanced by the psychological stress of anxiety and worry, which uses up energy that is needed for healing of tissues in the postoperative period. When surgery is needed, one's deepest and worst fears are often felt. A preoperative patient may experience a number of fears. However, the following fears are common among surgical patients:
c. Managing Preoperative Fears. Psychological preparation of the patient before surgery can not be overlooked. Along with other members of the health care team, the practical nurse must show warmth, sensitivity, and caring to the patient. Each patient may express his fears in different ways. You may find that a patient may not talk about his fears. He may be quiet and withdrawn, cry, or talk constantly. Some patients may prefer pacing, be extremely cheerful, or, on the other hand, exhibit unusual behavior. You, as a practical nurse, must recognize these fears and deal with them properly. You can help to manage preoperative fears by:
1-5. PREOPERATIVE TEACHING PRINCIPLESa. The value of preoperative instruction to the patient is very important. Each patient should be taught as an individual, in terms of his anxieties, need, and hope. Patients should be taught postoperative exercises they will be required to do and their role in preventing complications. The postoperative exercises include turning, deep breathing, coughing, and extremity movement.
Figure 1-2 A. Patient turned away from the nurse with arms and legs crossed. B. Patient turned toward the nurse with arms and legs crossed. C. Patient on side in middle of bed with a pillow in front of the bottom leg with the top leg on the pillow in flexed position, a pillow against the back, a small pillow supports the arm and hand, pillow under head and shoulder.
b. Time of Instruction. The best time to teach patients is relatively close to the time of surgery, which is usually the afternoon or evening before the surgery. (1) If instruction is given several days in advance, the patient may forget.
1-6. NURSING IMPLICATIONS FOR PREPARING A PATIENT FOR SURGERYa. Patient's Chart. The preoperative patient's chart must be complete before the patient leaves the nursing unit. It will contain all the information that may be needed by the physicians and nurses in the operating room or later in the recovery room. The chart should be prepared by using DD Form 1924, Surgical Checklist (see Figure 1-6). DD Form 1924 is attached to the front of the patient's chart for easy access by all involved hospital staff. It contains the following information: Figure 1-7. SF 522, Request for Administration of Anesthesia and for Performance of Operations and Other Procedures. (1) Patient's identification. (2) Checklist for pertinent health records. (3) Block for recording the most current set of vital signs taken prior to preoperative medications. (4) Block to indicate allergies. (5) Block to document all preoperative nursing measures. (6) Block to document comments. Any special comment that indicates something very special about this particular patient will go in this block (hard of hearing, removal of a prosthesis, etc.). (7) Block for signature of release when all actions are completed. b. Procedures Used to Prepare the Patient's Chart. You will use DD Form 1924, Surgical Checklist, as a checklist to assemble the patient's chart and to document compliance as each step is completed. (1) DD Form 1924. Enter the patient's identifying information in the patient's identification block. This information may be entered by using the addressograph plate or by hand. If you enter the information by hand, enter the patient's ward, room, and bed in the appropriate block. (2) Patient's chart. Ensure that all required forms are included, complete as necessary, and in order dictated by local policy. Document compliance or insert form(s) as necessary.
(c) The witness must NOT be anyone on the surgical team.(d) The date and time that the patient signed must be written on the form. (e) Minors (patients under legal age) cannot sign for themselves; it must be signed by a parent or legal guardian. NOTE: Legal age is established on a state-by-state basis. (f) Legal consents must be signed PRIOR to the preoperative administration of narcotics or any type of mind altering medication, or the form is not legally binding. (6) History and Physical, SF 511 (T.P.R. Graphic), SF 510 (Nursing Notes), and Doctor's Orders. Check the patient's health record for inclusion of these forms and document compliance.
(3) Acquire required x-ray reports and films as necessary, insert reports into patient's chart, and document compliance.
(4) Acquire laboratory reports as required, insert reports into the patient's chart, and document compliance.
(5) Acquire EKG report as required, insert the report into the patient's chart, and document compliance.
c. Final Preparation of the Preoperative Patient. Document compliance on DD Form 1924 and on SF 510, Nursing Notes.
d. Communication. Good communication between all members of the health care team will ensure that the patient is well prepared and ready to undergo surgery. All shifts and nursing personnel must be an active participant in the preoperative phase of the surgical patient. 1-7. THE MORNING OF SURGERYa. Awaken the patient early enough so that he may:
b. Take and record vital signs. c. Recheck accuracy of DD Form 1924. d. Administer preoperative medication if ordered. This medicine:
e. Provide for the patient's security by placing side rails in the up position and by placing a call bell within the patient's reach once preoperative medication is given. f. Assist the operating room technician to position the patient on the OR litter and make the patient comfortable. g. "Sign out" the patient on SF 510, Nursing Notes, to include:
h. "Sign off" in the appropriate block on DD Form 1924, Surgical Checklist. Continue with Exercises The Brookside Associates Medical Education Division is dedicated to the development and dissemination of medical information that may be useful to medical professionals and those in training to become medical professionals. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., any governmental or private organizations. All writings, discussions, and publications on this website are unclassified. What is pre operation phase?Definition: The preoperative phase is the time period between the decision to have surgery and the beginning of the surgical procedure.
What are the phases of pre operative care?The scope of activities during the preoperative phase includes the establishment of the patient's baseline assessment in the clinical setting or at home, carrying out preoperative interview and preparing the patient for the anesthetic to be given and the surgery.
What is the preoperative nursing care?Preoperative care refers to the physical and psychosocial care that prepares a patient to undergo surgery safely. The preoperative period begins when the patient is booked for surgery and ends with their transfer to the theatre or surgical suite.
What is the main goal in the preoperative phase?Risk assessment anticipates the potential positive and negative consequences the patient may experience related to anesthesia and the surgical procedure. The ability to conceptualize and anticipate potential perioperative consequences and provide intervention is the goal of the preoperative assessment.
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