Preop
Column
Purpose of a preop nursing assesment
decrease surgical delays
reduce patient anxiety
what the pt knows
reasses what they understand/ fill in the gaps
educate and allow questions from patient and family
how to prep for surgery
ask there restrictions
answer any questions
help patients and families know what to expect
Preop
get health information
allergies?
previous surgeries?
look at readiness for surgery
postop teaching
before surgery what they need to do after surgery to recover best
Nursing assess goals
establish baseline data —> know pt normal
get the data before surgery to compare their norms
Preop 1
get neuro assessment —> mental status and ability to give consent
if pt has dementia if after surgery theyre confused —> theres
understanding
informed consent
Psychosocial assessment
excessive strress response can affect surgery
infleuencing factors
age
past experience
current health
SES
use familiar langauge
Anxiety
can impair cognition, decision-making, coping abilities
may arise from
lack of knowledge
unrealistic expectations
conflicts —> blood transfusion
may not comprehend what youre telling them due to anxiety
—> intervention
provide info and clarify misconceptions
identify beliefs and discuss with surgeon and operative staff
Fears
Preop 2
death/disability
alteration in body image
anesthesia
how surgery may impact their ADL and goals of life
disruption of life functioning
consultations with social worker
Health history
diagnosed medical condition
previous surgeries and problems
familial diseases
reactions/problems to anesthesia (malignant hyperthermia)
usually inherited genetic mutation (could also not be genetic)
when anesthetic is delivered, pt gets a reaction and develops
hyperthermia
symptoms
muscle rigidity
hyperthermia
tachycardia
treatment
mentrsual/obstetric history
is there possibility the pt is pregnant
current medications
herbs may have blood thinners
alcohol
tobacco
—> could have interactions with anesthetic and potential complications
Preop 3
allergies
drug and non-drug allergies ex: latex allergy
need to know specifically what their reaction is
Review of systems: CVS
record baseline VS
lab reports
CBC, electrolytes
bleeding/clotting times (PT/INR)
cardiac ultrasound, ECG
report use of cardiac drugs
Respiratory system
history of dyspnea, coughing, sputum
COPD asthema
do they have obstructive sleep apnea
covid screening
Nervous system
important to know so cognitive decline can be understoood
vision or hearing loss is documente
risk for delirium —> major surger
dehydration, hypothermia, malnutrition
urinary catherers, medications, changes in env
Uriniary system history
Preop 4
—> impacts how much fluid/medicaation we can give them
if renal function is poor its signiticant
Hepatic system
ask it pt ever had jaundice, hepatitis, alcohol use, cirrhosis to consider the
rpesence of liver disease
ppl often underreport alc use
withdrawal?
liver function tests:
ALT, ALP, AST, bilirubin
Integumentary system
history of pressure ulcers
poor wound healing (are they diabetic)
recognize potential mobility restrictions postoperatively
have have mobility issues
MSK
do they have arthritis, decreased ROM, do they have mobility aid
report problems affecting neck or spine
can affect airway managemtn
Endocrine
diabetes
….
Preop 5
Immuen system
cancer pt, transplat pt, HIV pt
autoimmune disesaes
Fluid and electrolyte imbalance
vomiting
need to take if theyre taking diuretics
establish when theyre NPO
Nutritional status/GI system
underweight
provide extra padding to prevent pressure injuries, pressure relief
mastress
obesity
increased risk for cardiac and pulm complications
GI systme
know pt normal GI function —> what they normal eat
Nursing assessment documentation
Preop teaching
document ed and reported to postoperative nruses
Teachig contact
basic info before arrival surgical
postoperative expectation
legal prep
Preop 6
advanced directives
power of attonry
Surgical consent
responsibility of surgeon
make sure pt void before surgery
Prop meds
POST-OP CARE
Preop 7
Post-op journey
operating room
pt receives anesthesia and has the operation completed by surgical team
PACU
pt is closely monitored by the PACU nurse
surgical ward
pt is monitored by a surgical ward nurse
discharged from hospital
Post Anesthesia Care Unit
Priority is monitoring and managing cuz pt (who just had surgery) is at risk esp
for:
ABC
pain
temperature
Preop 8
surgical site
may have drainage → dont want it to spread
client’s response to the reversal of anesthetic
how theyre coming off it
cognition —> can they respond to questions
need to know preop cognitive status
pt is placed in recovery position right after surgery
put pt in semi fowler position once theyre off it
Moving from PACU to the surgical ward
Once PACU discharge is met …
Preop 9
Surgical unit
Level of consiousness
are they drowsy of confused
Alert
Voice
Pain
Unresponsive
Vital signs and pain
bp, hr, rr, temp, o2 sat, pain assessment (QPRSTUV)
Head-to-toe
resp
cardiac
neuro
GI; GU
catheter
drain sites, incision sites, dressings
assess any surgical drains and the surgical incision site
Additional postop management
intravenous therapries
diet orders (NPO, clear fluids, full diet)
accurate intake and output monitoring (measure urine output, drain output,
oral intake)
specific monitoring requirement (vital signs every 4 hours, telemetry
monitoring for 24 hours)
continous pain management
Preop 10
before leaving the pt:
check the support person in the room
have the call bell in reach
provide an emesis basin
Discharge teaching
key topics
new meds
diet restrictions
activity restrictions
wound care/drains/ bathing
need to know about signs of infections
look for any redness/draining etc.
concerning symptoms: go to ER or call the surgeons office
follow up appointment with surgical team
home care referrals
measuring the drain
Potential post-operative problems
Preop 11
Respiratory complications
in the PACU the three most common:
On surgical unit monitor for:
Atelectasis
Preop 12
inceptive spirometer is an incentive for breathing
more likely to breathe deeply is sitting up
make sure that pt is not too dehydrated
Pneumonia
atelectasis can progress into pneumonia
occurs typically within 5 days post surgery
Cardiovascular complication
In PACU
Preop 13
Hypertension not as common
full bladder can cause hypertension
not managing hyperthermia
dysrhythmia
Call the surgeon if you notice:
systomic BP <90 or >160
HR <60 or >120
know the pt’s normal !!!
pulse pressure → differnce between systolic and diastolic pressure
BP gradually decreases during several consecutive readings
could be sign of internal breathing
notice significant changes in BP or HR from preoperative readings
feelings their pulse
In Surgical Ward
Preop 14
abnormal K levels can
impact cardiac function
hypovolemia can cause
syncope common in
geriatric pt
Thrombus Formation - pathology
RBC, WBCs, fibrin and platelets adhere to make a thrombus
as it grows, it can occlude the vein or dislodge into circulation
Stasis
post-operatively pts are less mobile so venous return is comprimised
venous return is aided by muscular contraction and valves
Vascular endothelial injury
damage occurs with bloodwork, intravenous access, and central venous
access post-operatively
hip or leg fractures
previous DVT
IV drug use in community
Hypercoagulability
Preop 15
dehydration, cancer, and surgery cause changes in blood constitients making
thrombus formation more likely
pt in contraceptives
pt with COVID
smoking
Venous thromboembolism
typically occurs in calf (common common and easier to detect) and forms in
association with inflammation of the vein
in thigh its less noticeable → occurs in ppl who are very immobile
can dislodge and move into the lungs = pulmonary embolism = BAD
Prevention: non pharmacological
early mobilization
preop teaching —> they know that they need to move
for GI surgery
exercises for pts on bedrest
Preop 16
elastic compression stockings
decrease distal calf vein thrombosis
encourages blood flow to go upwards
teach pt to apply it correctly
intermittent compression devices
pt with moderate to very high risk for DVT
must be applied correctly
must be worn continously
except: bathing, skin assessment, ambulation
not used when pt has an active DVT
Pharmacological intervention
anticoagulants
prevent DVT and PE formation in high-risk pt
orthopedic pts are usually on this
treat DVT and PE by preventing new clot development, spread of clot,
embolization
some given subcut or orally
Preop 17
low molecular weight heparin —> pt can be taught to use
unfractioned heparin → not at home
Warfarin
based on INR levels
reversal agents: vitamin K, occtaplex, FFP
Rivaroxaban and dabigatran
no anticoagulation monitoring required
no reversing agent available
supportive care with pRBCs and FFP while drug wears off
LMWH
effective for the prevention and treatment of DVT
ex: enoxaparin, ardeparin, ..
do not require anticoagulant monitoring and dose ajustment
UNF H
subcutaenously or IV
requires regular monitoring
reversal agent
Preop 18
Coagulation studies
Sample heparin infusion orders
Gastrointestinal Complications
PACU and surgical unit
Preop 19
Paralytic ileus
impaired intestinal motility for several days post-operatively
Post-operative diets
diet as tolerated
clear fluids
coffe or tea —> no milk
full fluids
milk in tea, cream soup
soft diet
jello, pudding
regular diet
Special diets
low sodium
could be clear fluid low sodium
Preop 20
Urinary complications
min requires 30 ml
oliguria may
indequate
inadquetae renal
perfusion and be a
risk for renal failure
and acute kidney
injury
Urinary retention —> inability to fully empty the bladder or pass
Neurological complications:
Temp changes
Preop 21
if temp up, to a head-to-toe
psychological complications
anxiety and depression
confusion and delirium
Preop 22
