What preoperative teaching should the perioperative nurse include prior to the patient undergoing surgery?
ReassuranceIt almost goes without saying that most patients are anxious about their upcoming surgery. Recognition of this fact and a kind word will make a big difference to a wary patient. Show
AdviceAll pre-operative patients should be given advice regarding fasting*:
*Fasting ensures that the stomach is empty of contents. This reduces the risk of pulmonary aspiration, which can occur during the perioperative period, which can lead to both aspiration pneumonitis (inflammation caused by very acidic gastric contents, leading to desquamation) and aspiration pneumonia (due to secondary infection following pneumonitis or direct aspiration of infected material). PrescriptionsThe management of the pre-operative drug regime falls into three categories; prescriptions to stop, prescriptions to alter, and prescriptions to start. In certain patients, bowel preparation and blood productions may also need to be considered. Drugs To StopThese commonly stopped medications can be remembered as ‘CHOW’.
Drugs To Alter
Pre-Operative Steroid PrescribingA patient undergoing surgery will elicit a stress response in proportion to the extent of trauma and metabolic insult. A key part of the stress response is activation of the HPA axis, resulting in an increase in the release of endogenous corticosteroids. Patients on steroid therapy (more than physiological replacement) for over two weeks may experience HPA axis suppression. Patients with confirmed (or suspected) HPA axis suppression (through Short Synacthen testing) are therefore at risk of acute adrenal insufficiency peri-operatively due to their attenuated ability to mount a sufficient endogenous steroid response. In such patients, peri-operative stress-dose corticosteroid therapy is warranted. No definitive guidelines exist regarding the exact amounts of steroid that should be given, however the decisions around specific dosing is often dependent on the type of surgery being performed and patient pre-operative steroid prescription. Drugs To Start
Diabetes MellitusThe perioperative care of patients with diabetes mellitus (DM) is becoming increasingly common. The exact pre-operative management varies between patients, but the following can be used as a basis. Type I Diabetes Mellitus All patients with Type I DM should be first on the morning list and they may need admitting on the night before the operation (depending on how major the procedure is)
Type II Diabetes Mellitus Management is dependent on they way that their Type II DM is controlled. If diet controlled, no action is required peri-operatively. If, however, the patient is controlled by oral hypoglycaemics, metformin should be stopped on the morning of surgery, whilst all others should be stopped ~24 hours before the operation. These patients will then be put on IV variable rate insulin infusion along with 5% dextrose as described above and managed peri-operatively the same as a Type I diabetic. Bowel PreparationPatients having colorectal surgery may need bowel preparation (laxatives or enemas) to clear their colon pre-operatively. Bowel preparation is used less frequently, as the fluid shifts can be harmful to patients who are elderly or have cardiac or renal disease. Additionally it has been shown that use of bowel preparations can prolong patient recovery and length of stay. By Würfel [CC-BY-SA-3.0], via Wikimedia Commons Figure 1 – Blood products are required to correct heavy blood loss and must be x-matched before use. The exact protocol will vary between hospitals but a general guide is:
Blood ProductsIt is essential to ensure all patients undergoing major GI, HPB, vascular, gynaecological or orthopaedic surgery have a group and save requested. Others will need blood cross-matching in advance. Read more about prescribing blood products here. ReferralConsider where the patient may need a HDU or ITU bed to be booked. Any concern, it is best to discuss this with your senior. InvestigationsThere are a range of pre-operative investigations that can be requested. The nature of the exact investigations required depends on a number of factors, including co-morbidities, age, and the seriousness of the procedure. Read more about pre-operative investigations here. Patient Understanding and Follow UpEnsure that the patient is fully informed and understands the plan for their care and discharge. Most major surgical patients will require an appointment in the follow-up clinic, so ensure that this done at a time which your consultant wishes. Patients undergoing day-case surgery will receive telephone follow-up from a nurse specialist only or may not require follow-up. What are preoperative teachings?(2003), preoperative teaching is defined as 'an interactive process of providing information and explanations about surgical processes, expected patient behaviours, anticipated sensations and providing appropriate reassurance and therapeutic listening to patients who are about to undergo surgery' (p. 563–564).
What do you instruct a patient before surgery?What should you expect right before surgery?. Follow pre-surgery directions and diet. Unless you're having only local anesthesia, you may be told not to eat or drink anything after midnight before your procedure. ... . Bring a friend. ... . Wear comfortable clothing.. What is preoperative phase in the perioperative nursing care of the patient?The preoperative phase begins when the patient, or someone acting on the patient's behalf, is informed of the need for surgery and makes the decision to have the procedure. This phase ends when the patient is transferred to the operating room bed. the patient for surgery.
Which topic is included in preoperative patient teaching?The background of preoperative teaching for the outpatient surgical patient involves nursing staff providing education that includes expectations of the surgical procedure, medication and food restrictions before the procedure, as well as providing instructions for aftercare once a patient is discharged home.
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