Overview
This lecture covers the legal, psychological, physiological, and procedural aspects of pre-operative nursing care, highlighting informed consent, patient assessment, teaching, and pre-operative interventions.
Legal Aspects: Informed Consent
- Informed consent must be obtained before surgery; the surgeon is responsible for securing it.
- Consent is invalid if the patient has been sedated prior to signing.
- Minors (under 18) require a parent or guardian's signature unless emancipated.
- Elderly patients (over 60) may need a legal guardian to sign.
- The nurse may witness the consent, ensuring the patient understands and is not coerced.
- Nurses must document their witness to the signing of informed consent.
- In emergencies, if no legal guardian is available, a chaplain, highest-ranking official, or physician may sign.
Pre-Operative Patient Assessment
- Assess physiological factors: age (risk varies for young vs. elderly), nutrition (obesity/malnutrition increase risk), hydration, organ function, medications, pain, and presence of infection.
- Cardiovascular, pulmonary, renal, GI, liver, endocrine, neurological, and hematological functions must be evaluated.
- Psychological assessment includes anxiety level, coping mechanisms, mental health, and support systems.
- Assess readiness to learn and cultural/spiritual beliefs which impact coping and recovery.
Pre-Operative Education & Nursing Interventions
- Start pre-operative teaching early, tailored to individual needs and learning abilities.
- Teach deep breathing, coughing, and use of incentive spirometers to promote lung expansion post-anesthesia.
- Demonstrate splinting techniques for patients with thoracic/abdominal incisions.
- Instruct on mobility and extremity exercises to prevent complications.
- Introduce and explain pain scales and strategies for pain management post-operatively.
- Provide cognitive coping strategies, such as imagery or optimistic self-talk.
- For ambulatory surgeries, give specific instructions about what to bring, fasting, and when/where to report.
General Pre-Operative Interventions
- Withhold food and fluids pre-operatively to prevent aspiration; fasting duration depends on patient status and type of food.
- Prepare the bowel with enemas or laxatives when ordered, especially for abdominal/pelvic surgeries.
- Skin preparation may involve antiseptic washes and, if needed, hair removal with electric clippers.
- Pre-op medications may include tranquilizers, sedatives, analgesics, anticholinergics, and H2 antagonists.
Pre-Operative Checklist & Documentation
- Verify informed consent, medical history, physical status, medications, allergies, and support systems.
- Confirm consultations for comorbid conditions (e.g., diabetes, cardiac issues).
- Ensure patient ID bands, allergy alerts, and pre-op teaching are completed.
- Remove prosthetics, dentures, jewelry, and confirm fasting status.
- Check pre-op lab results, vital signs one hour before surgery, and administer pre-op medications as ordered.
Key Terms & Definitions
- Informed Consent — Legal process ensuring patient agrees to the procedure after understanding risks, benefits, and alternatives.
- NPO — Nil Per Os; nothing by mouth (no food or drink before surgery).
- Splinting Technique — Supporting an incision site during coughing to minimize pain or injury.
- Patient Controlled Analgesia (PCA) — Method allowing the patient to self-administer pain medication post-operatively.
- Anticholinergics — Medications that reduce bodily secretions.
Action Items / Next Steps
- Review patient charts and ensure all pre-op documentation and labs are complete.
- Perform and document patient education and assessments.
- Confirm fasting status, medication administration, and completion of the pre-op checklist before transfer to the OR.