pre-operative nursing care let's go on our first concept it's under your legal aspect which is your informed consent so we must obtain an or consent or an or permit nothing is a language to undergo a surgery now there are guidelines that we have to follow in obtaining our informed consent first is that the surgeon is responsible for obtaining the consent for surgery second is that no sedation should be administered to the client before he signs the consent and third minors may need a parent or a legal guardian to sign the consent form when we say minors they are your 18 years old and below unless it is an emancipated minor it when you see emancipated minors they are the minors that are working on their own so they are allowed already to sign the consent number four we have your your elder this may need a legal guardian to sign the consent form 60 years old and above the patient will need also another a legal guardian number five the nurse may witness the signing but the nurse must be sure that the client has understood the surgeon's explanation of surgery so anuym nurse before sign before witnessing the signing of your consent that there is no coercional force undergoing surgery that the patient in a sound mind sedation [Music] before signing as a witness is that the operation is understood of both parties the pros and cons plus the complications and that the doctor also must understand the position of the patient now number six under your guidelines is that the nurse needs to document the witnessing of the signing um that you have witnessed the signing of your informed consent now let's see what if the patient is unconscious and need an emergency surgery in a legal guardian these are your possible order who can sign your informed consent first if there is a chaplain or a priest second is the highest ranking official on the organization null chart of your institution and the last will be your physician if emergency cases and we cannot um hold to our to the legal guardian of the patient now let's go to the assessment of your health bursts now the overall goal of during the pre-operative is that to prepare the patient for a successful surgery let's go to your physiologic assessment under your physiologic assessment is your age so if the patient is very young so possible your kidney function is not yet fully developed while for those very old or for our geriatric patient there is already an impaired circulation maybe because of arteriosclerosis and there is also a limited card function and aim they are more sensitive already to morphine and barbiturates in terms the man's nutritional obesity and malnutrition now will increase the risk of your surgical problems for your fluid and electrolyte balanced demand dehydration hypovolemia may predispose the patient to problems during your surgery while your general health if there is a presence of systemic infection such as your upper respiratory infection it may decreases the lung compliance during your mechanical ventilation let's see in a minute your patient is under medication if the medication is an anticoagulant this may put your patient at risk for bleeding during the surgery or if the patient is taking tranquilizer they may be at risk for your hypotension or heroin addicting patient then bahama karan tainan cns depression or even coma and if your patient is taking diuretics there is a risk for your electrolyte imbalance now the other part of your assessment for your facial logic is that you check also for the presence of pain it may magnify or it is it will give you the extent of the deceased and then for your cardiovascular function and pulmonary function is it also manganese before um the patient has to undergo operation let's say they have to make sure that your cardiovascular and your pulmonary function is at its optimum level for the renal function they are checking for the excretion ability of your kidneys to excrete your anesthetic substance or agents in the urine while for the gi function your patient will be put in npo most probably so they are also checking for potential aspiration pneumonia they are mehmed doctors they check also for the liver function this is in conjunction with your kidney and also your liver is responsible in clatting purposes for your endocrine function when they check for your endocrine function it is to check for the proper metabolism and organ functioning when we all assess for the neurologic functional it has to be the motor and the sensory plus the rate of consciousness of your patient when we assess for the hematologic function it should check volume clotting time the rbc wbc bleeding time and the blood type of your patient and then presence of trauma you assess in a particular area second assessment of health factors is your psychological assessment surgery is a powerful stressor so the person may make use of a different defense mechanism to the to deal with their anxiety so you assess for the anxiety level and the effect of this anxiety to your patient so and a extreme anxiety may lead the patient to poor compliance and if your patient boom success assessment of your mental health and attitude you may refer your patient and the patient may need a professional counseling so for our psychosocial aspect um that indeed nothing at all [Music] because it has a major effect very operatively so your psychological distress now has a direct influence with the body functioning therefore it is imperative for the nurse to identify any anxiety the patient is experiencing one's cases in the visa patient undergoing operation or national surgical procedure [Music] [Music] just because they are informed to undergo your surgical operation well this is an anticipatory response demand from a patient because functionality because in the non-surgical operation or nonprocedural patient [Music] [Music] [Music] just because they will be gone for too long increase responsibilities or burden on family member members [Music] may occur because of their previous experiences in the game experience in love with the health care system and or image now our um people tend to express their fears in different ways [Music] and they will deliberately avoid communications still there are some also that they talk about trivialities so consequently the nurse must be empathetic and they should listen well and provide information that would help your and elevate the concerns now our important outcome for the social psychosocial aspect is that to determine the extent and the role of the patient support network besides [Music] be a strong psychosocial aspect of the patient and then the value and reliability of all available support systems are assessed um other information such as your useful level of functioning and typical daily activities may also assess the patient's care and rehabilitation plan so you assess also the patient's readiness to learn and determine the best approach to maximize the comprehension will provide the basis for your pre-operative patient education your spiritual and cultural beliefs this will play an important role in how people cope with the fear and anxiety regardless of the patient's religious affiliation spiritual beliefs can be therapeutic as a medication so every attempt must be made to help the patient obtain the spiritual health that he or she requests and faith has a great sustaining power thus the belief of each patient should be respected and supported for our pre-operative nursing intervention isadito is your pre-operative teaching now your nurses have long recognized the value of your preoperative instruction and each patient is taught as an individual with consideration for any unique concerns or needs the programs of instruction should be based on the individual's learning needs multiple teaching strategies should be used example here is your variable rate and return demonstration this is not limited example it would all depend on your patient's needs and abilities now your preoperative teaching is to be started as soon as possible but the magistana after don't be uh no doctors in abyssa patient undergoing operation or surgical procedure until the patient arrives to your operating room now you when you are teaching make sure that there is a appropriate space or pacing instruction to allow the patient now to ask questions my sibling or that may arise or and also to assimilate in for mission now frequently teaching sessions are combined with your various preparation procedures to allow for an easy and timely flow of information included starting preoperative teaching isadito is your deep breathing caffeine and incentive is parameters is a goal nathan for the pre-operative nursing care is to teach the patient how to promote optimal lung expansion and consequent blood oxygenation after anesthesia now in case the meron thoracic or abdominal incision as a nurse you have to demonstrate now your splinting technique while doing your deep breathing caffeine and incentives parameters this will now minimize your pressure and control pain second is your mobility and active body movement the goal here in promoting mobility post operative is to improve your circulation prevent venous thesis and also to promote your optimal respiratory functions if there is any special position that the individual will need to maintain after surgery example here is your adduction or elevation of the extremity it is also has to be discussed pre-operatively as it is the importance of maintaining as much mobility as possible despite your restrictions so prediadone pretty exercise of your extremities that would include your extension and flexion now let's go to your pain management that is why it is very imperative for nurses to assess for pain either it can be either acute or chronic pain so that the patient now may differentiate now post-operative pain from your chronic conditions at this point also you have to introduce the pain skill that you will be using and also explain how it is used to the patient postoperatively there are medications nama administered to patient to relieve the pain and maintain your comfort without increasing the risk for inadequate air exchange pca or the patient controlled analgesia it is the patient now who controls and delivers pain medication once let's go to our cognitive coping strategists these strategies will be useful to relieve tensions overcome anxiety decrease and fear and of course to achieve relaxations anaya my strategies or examples non-cognitive coping strategies we have our first is your imagery now the patient will concentrate on a pleasant experience or a restful scene second is your destruction the patient will think of an enjoyable story or recites a favorite poem or a song and then our third is the optimistic self-recitation now the patient recites optimistic thoughts example here is your i know all will go well manganon now for the instructions for ambulatory surgical patient the major difference lung is that for the outpatient pre-operative education is your teaching environment so it may be presented in a group meeting on a video tape during night classes at pre-admission testing or by telephone in conjunction with the operative pre-operative interview in addition answering a of questions and describing what to expect the nurse tells the patient when and where to report what to bring um [Music] insurance card list of medication and allergies [Music] watches medication contact lens and animal padding loose fitting comfortable clothes flat shoes now the nurse in the surgeon's office may initiate teaching before the perioperative telephone contact now the last operative phone call is designed to remind the patient not to eat or drink as directed pretty much fascinating patient of eight hours or more depending on your recommend or for a meal that includes fried or fatty foods or meat let's proceed to your general pre-operative nursing intervention first here is your managing your nutrition and fluids so the major purpose now of your withholding the food and the fluid before surgery is to prevent your aspiration but then the american society of anesthesiologists have reviewed this practice and have resulted in a new recommendation for person undergoing elective surgery who are otherwise healthy [Music] undergoing lengthy or mahabang npo status is that those persons who have compromised airway or co-existing diseases or disorders that affect your gastric emptying or fluid volume example here are your pregnant obese diabetic patient patient with gastroesophageal reflux enteral tube feeding ill use or bowel obstruction they are still to have your lengthy restriction of fluid and food um then [Music] you are now recommended not to have a lengthy fluid and food restriction now your the recommendation will depend also on the age of the patient and the type of the food eaten let's say um adults are advised to fast for eight hours after eating fatty foods or four hours after ingesting milk products most patients are currently allowed clear liquids up to two hours before an elective procedure pero always check parenta doctor's order if the doctor would um require the patient to still undergo an npo status second is to prepare the bowel for surgery nms are most commonly ordered preoperatively unless the patient is undergoing your abdominal or pelvic surgery now a cleansing enema or a laxative may be prescribed the evening before your surgery and may be repeated in the morning of your surgery now the goal of this preparation is to allow a satisfactory visualization of the surgical site and also to prevent trauma to the intestine or contamination of the peritoneum by your feces unless a condition of the patient presents some contraindication now the toilet or the bedside commode is to be used when you are evacuating the enema instead of a bedpan if the patient is hospitalized during this time packaging a nurse it's a patient use the toilet or the bedside wagyung bedpan then additionally president namakar on a request on doctor for a antibiotic as a loading dose this is prescribed to reduce your intestinal flora and then last we have you're preparing the skin the goal here is now to decrease your bacteria without injuring the skin if the surgery is not performed as an emergency the patient may be instructed to use a soap containing a detergent germicide to cleanse the skin area for several days before surgery to reduce the number of skin organisms this preparation may be carried out at home generally your hair is not removed pre-operatively unless the hair is or at around the incision side so if it is around your incision site it is likely to interfere with the operation if your hair is to be removed and electric flippers are used for safe hair removal immediately before the operation we don't shave usually they don't require shaving cases a skin break so isa manga roll nuttin as a nurse is to check for a pre-op medication patient gusta nira sila pumuntasa operating room now the purposes of your pre-authentication is to ali anxiety to decrease your pharyngeal secretions reduce the side effect of your anesthesia and to create a temporary amnesia so pre-op medication aguina gamut for your tranquilizer they are used to decrease your anxiety example of here is your volume midazolam and your ativan or your lorazepam for your sedatives it decreases your anxiety and produces an anti-emetic effect example of here is your finger gun signals sodium and steel knocks while for the analgesics they relieve your pain it decreases your anxiety and also they also sedate so example of here is your trauma doll morphine sulfate demerol nubin so for the anticholinergics the month they control or decreases your secretions example of here is your atropine sulfate well for your histamine 2 or your h2 receptor antagonists they inhibits your gastric secretion example here is your tagamet and your cimetidine common preoperative checklist contents check mall prior or scheduled patient for e-surgery is the or consent and treatment sign either the patient or young legal guardian or insignificant others [Music] competition is for tubby so make sure now you impatient a for the procedure and also consent for anesthesia now make sure also that the history has been completed history is your nursing history [Music] nursing history the physical general appearance skin color weight hydration and the energy level of your patient check also for the general physical health mental attitude and patient stress and anxiety level understanding of the surgical procedure was the procedure clearly explained by the surgeon and then previous experience for a certain operation expected outcome non-patient after the surgery or the procedure and then is the patient taking in medication such as your insulin or your anti-convulsants because this might affect or will put your patient on high risk for complications is the patient's is smoker because your general anesthesia now irritates the respiratory system further is the patient a heavy drinker or occasionally drinks alcohol because it um for patients who has a high tolerance of alcohol they are also have a high tolerance to anesthesia and then the coping resources family support um what does the patient do to ali the anxiety and to decrease the stress level and then self-concept self-concept um meron basham poor concept because this might heightens the fear while for the body image these figurements may occur now let's go to your third checklist contents we have your consultation when necessary if the patient has diabetes mellitus or has a cardiac case so irredefined surgeon for a either cardioclearance pulmonary clearance depends on young major doubt volume surgeon na system no patient and then number four you check for the id band on list this will serve as a identification case of the patient and then allergy signs if any on file cover so young nasa file cover mo or chart cover miranda means trip tapas in uh prepare the operative area or have the patient pre-op take pre-op bath shower so malignant impatient vagus and then you also have to prepare the area and then pre-op teaching given your pre-op teaching content will be discussed further and then your pre-sedation or tranquilizers or the pre-op medication last npo fasting [Music] [Music] nothing per or m no food no drinks allowed kapa's conquest make sure maintenance during uh or on the morning of the surgery you check also on the following before sending the patient to or the lab results in the request doctor for the lab results and then old files or charts available minsanka said they need the surgeon need it for comparison and then dentures jewelries contact lens prosthetists are removed and secured now the patient has already has to void already and then patient in hospital gown only no inner wears please and then vital signs one hour before operation back at one arb non-operation at hindi at the time the magi will in natchez or or operating room theater it's because if there is an abnormalities and then pre-op meds given your blood reservation if required doctors that papa stand by for a blood product so make sure name blood and then spiritual needs meth plus your nurse's note must be already completed [Music]