preoperative lec
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Chapter 20
Interventions forPreoperativeClients
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Collaborative ManagementAssessment
History and data collection
Age
Drugs and substance use
Medical history, including cardiac and
pulmonary histories
Previous surgery and anesthesia
Blood donations
Discharge planning
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Physical Assessment/ClinicalManifestations
Obtain baseline vital signs.
Focus on problem areas identified by the
client’s history on all body systemsaffected by the surgical procedure.
Report any abnormal assessment findingsto the surgeon and to anesthesiology
personnel.
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System Assessment
Cardiovascular system
Respiratory system
Renal/urinary system
Neurologic system
Musculoskeletal system
Nutritional status Psychosocial assessment
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Laboratory Assessment
Urinalysis Blood type and crossmatchComplete blood count or hemoglobin level and
hematocritClotting studies Electrolyte levels Serum creatinine level Pregnancy testChest x-ray examination
Electrocardiogram
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Deficient Knowledge Interventions
Preoperative teaching
Informed consent
The surgeon is responsible for obtaining signed consent
before sedation is given and surgery is performed.
The nurse’s role is to clarify facts presented by thephysician and dispel myths that the client or family
may have about surgery.
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Implementing Dietary Restrictions
Client is given nothing by mouth (NPO) for6 to 8 hours before surgery.
NPO status decreases the risk foraspiration.
Failure to adhere can result incancellation of surgery or increase the
risk for aspiration during or after surgery.
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Administering Regularly ScheduledMedications
Consult the medical physician andanesthesia provider for instructions about
drugs, such as those taken for diabetes,cardiac disease, glaucoma, regularlyscheduled anticonvulsants,antihypertensives, anticoagulants,
antidepressants, or corticosteroids.
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Preparing the Client
Possible placement of tubes, drains, andvascular access devices
Teaching about postoperativeprocedures and exercises:
Breathing exercises, incentive spirometry,coughing and splinting
(Continued)
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Preparing the Client (Continued)
Leg procedures and exercises,
antiembolism stockings and elastic wraps,
early ambulation, and range-of-motionexercises
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Anxiety Interventions
Preoperative teaching
Encouraging communication
Promoting rest
Using distraction
Teaching family and significant others
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Preoperative Chart Review
Ensure all documentation, preoperativeprocedures, and orders are complete.
Check the surgical consent form andothers for completeness.
Document allergies.
Document height and weight.
(Continued)
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Preoperative Chart Review (Continued)
Ensure results of all laboratory anddiagnostic tests are on the chart.
Document and report any abnormalresults.
Report special needs and concerns.
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Preop Client Prep
Client should remove most clothing andwear a hospital gown.
Valuables should remain with familymember or be locked up.
Tape rings in place if they can’t beremoved.
Remove all pierced jewelry.
(Continued)
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Preop Client Prep (Continued)
Client wears an identification band.
Dentures, prosthetic devices, hearing aids, contactlenses, fingernail polish, and artificial nails must beremoved.
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Preoperative Medication
Reduce anxiety.
Promote relaxation.
Reduce pharyngeal secretions.
Prevent laryngospasm.
Inhibit gastric secretion.
Decrease amount of anesthetic neededfor induction and maintenance ofanesthesia.
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