MS Preoperative Part 2

Sophia Loraine D.
Jesura BSN-3D
Medical Surgical Nursing
3rd Year 1st Sem
S.Y 2020-2021
PART 2
➪ instruction for clients undergoing ambulatory surgery

Major difference in outpatient preop education is the
ENVIRONMENT.
 Give proper discharge instruction to the patient who is undergoing
ambulatory surgery.
 Preop education content may be presented in a:
 group class
 Media presentation
 PAT
 Telephone
In conjunction with the preop interview.
 In addition to answering the questions and describing what to expect,
nurse should also tell the patient:
 when and where to report
 What to bring (insurance card, list of medications and
allergies)
 What to leave at home(jewelry, watch, medications, contact
lenses)
 What to wear(loose-fitting, comfortable clothes;flat shoes)
 During final preop telephone call - education is completed or
reinforced as needed and last-minute instruction are given.
 The patient is reminded not to eat and drink for specified period of
time preoperatively.
Providing psychosocial interventions
a. Reducing anxiety and decreasing fear
 Nurses in preop dept have a limited amount of time to acquire

information and establish trust.
 Nurses must introduce themselves, giving their titles and a brief
synopsis of their professional role and background.
 Each preop patient should be acknowledge as an individual, and each
patient`s needs and desires must be assessed.
 Patients should also be thank for choosing that particular hospital or
surgical center.
These methods facilitate establishing positive nurse-patient relation ship.
 Discussion of the surgical experience, its length, and explanation of

what will happen may diminish the patient`s anxiety.
 assist client identify coping strategies
 Discussion with the client to help determine the cause of fear that can
help with expression of concerns.
 Patient`s can benefits from knowing when family and friends will be
able to visit after surgery.
 discuss regarding postop routines, tubes and equipment (so that they
would already know that from the recovery room they would have
this tubes in their body)
 There may also times that patient does not only have the foley
catheter but they may have tubes attached in their abdomen(if they
know this before hand they will not have anxiety and fear after the
surgery because they will be expecting this)
 respecting cultural, spiritual, and religious belief
Maintaining patient safety

 Protecting clients from injury is one of the major roles of preop nurse.
 Once preop meds are given in the ward nurses need to maintain
the safety of the patient by putting up the side rails.
 If the patient is disoriented or confuse even without the preop
meds it is expected to the nurse to also put up the side rails most
of the time.
 Refer to 2009 national patient safety goals - p. 437
Managing nutrition and fluids

Purpose:
 Minimize negative protein balance
 Maintain the muscle tone, immune and cognitive function
 Enhance postop recovery.
 On npo status (prevent aspiration)

Dependent on the type of surgery that needs to be done to the client. And
also to the doctor.
 If major abdominal surgery - doctors may order for the npo
status the night before the surgery.
 If surgery is scheduled late in the afternoon - patient may have
a light breakfast in the morning the npo.
 New recommendations for healthy clients having surgery may also be
depend on the age of the patient and type of food eaten.(doctor may
not advice for the npo status)
 Adults may be advised to fast for 8 hours after eating fatty
foods and 4 hours after ingesting milk products.
 There are times that the healthy patient may be given a clear
fluid 2 hours before the surgery(water- not too much jest small
amount)
 Some alterations in the client’s usual medication schedule
Preparing the bowel

Purpose of bowel or gi prep
 Allow satisfactory visualization of the surgical site
 Prevent trauma to the intesineor contamination of the
peritoneum by fecal material. (Prevent infection)
 Enemas are not commonly prescribed preoperatively.

 unless for clients undergoing abdominal or pelvic surgery,
cleansing enema or laxative may be prescribed the evening
before surgery, and maybe repeated the early morning of
surgery. (Check for the return flow
 Oral laxatives - fosfosoda once taken followed by ta water
 Antibiotics may be prescribed to reduce intestinal flora.
Preparing the skin

Purpose of skin prep
 Decrease bacteria without injuring the skin.
 Instruct client to use germicidal detergent
 Hair removal is not done in the clinical area or in the ward not unless
ordered by the doctor
Who is responsible in removalof hair? (Site of the operation)
 The nurse should do the skin prep (in mission nursing aid ang ga
himo. Nurse responsibility to see to it that the area shaved is the
exact site of the surgery)
 Hair is not removed preop unless the hair at or around the incision site
is likely to interfere with the operation.
 If hair must be removed, electric clippers are used for safe hair
removal before transferring the patient to the OR. (Early Morning)
 To ensure the correct site, the surgical site is typcally marked by the
patient and the surgeon prior to the procedure.
 Immediate preop nursing interventions

• awaken early for the preparation
• nurse makes assessments
• client to remove all clothing, hair covered
• remove all jewelries - tight wedding bands
• religious emblems may bepinned or securely fastened to the
Client’s gown
• client wears an id band
• dentures, including partial dental plates, all prosthetic devices
Are removed.
 hearing aids
• hairpins and clips, wigs and toupees are removed.
• removal of fingernail polish - the policy of the facility is
Followed.
• the nurse asks the client to empty his or her bladder
• measurement of vs before the administration of preop meds and
transfer of the client to the surgical suite.
 Administering preanesthetic medication

Goals:
= to facilitate the administration of any anesthetic
 to minimize respiratory tract secretions and changes in heart
rate
 to relax the client and reduce anxiety
➪ commonly used preoperative medications:

 tranquilizers – decreases anxiety and apprehension
 diazepam (valium)
droperidol (inapsine)
 sedatives
 midazolam hcl
 promethazine hcl (phenergan)
 secobarbital sodium (seconal sodium)
 pentobarbital sodium (nembutal sodium)
 analgesics
 morphine sulfate
 fentanyl citrate (sublimaze)
 meperidine (demerol)
 anticholinergics – control secretions
 atropine sulfate
 glycopyrrolate (robinul)
 h2 receptor antagonist – inhibits hcl acid production
 cimetidine (tagamet)
➪ “on call to or”

➪ nursing care after administering
 maintaining the preop record
➪ completes chart and checklist
 Transporting the client to the presurgical area

• most clients are transferred to the surgical suite on a
Stretcher with thesiderails up, or theclient is transferred
In bed.
 Attending to family needs

➪ direct client’s family to the waiting room
➪ teach family about the surgery, schedule or any changes,
Intraop and postop procedures.
 Expected patient outcomes

➪ the nurse evaluates the care of the preop client according to
The identified nursing diagnoses.
It may include the following: The client will:
■ verbalizes understanding of the informed consentas it applies
To surgery
■ states an understanding of the preop dietary restrictions ■
verbalizes understanding of and the reason for bowel prep
■ demonstrates the use of incentive spirometer (chart 18-9 p.
440)

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Sophia Loraine D.

➪ instruction for clients undergoing ambulatory surgery

Providing psychosocial interventions

a. Reducing anxiety and decreasing fear

 Nurses in preop dept have a limited amount of time to acquire

 Discussion of the surgical experience, its length, and explanation of

Maintaining patient safety

Managing nutrition and fluids

 On npo status (prevent aspiration)

Preparing the bowel

 Enemas are not commonly prescribed preoperatively.

Preparing the skin

 Immediate preop nursing interventions

 Administering preanesthetic medication

➪ commonly used preoperative medications:

➪ “on call to or”

➪ completes chart and checklist

 Transporting the client to the presurgical area

 Attending to family needs

 Expected patient outcomes

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