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Preoperative

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mattisensept's version from 2017-06-01 02:14

Section 1

Question Answer
What is the nurse's responsibility regardless of the surgery? Safety! Using the nursing process- father data- subjective and objective
InterviewBe prepared, take time, open-ended, BEST by the nurse, psychosocial (use teaching- therapeutic to reduce stress)
Psychosocial Teach as you go, use conversation questions, make the unknown- KNOWN
Common fearsPain & discomfort, the unknown, mutilation, death, anesthesia, disruption of life pattern
Preoperative interview History (family/patient), Meds (what and when), Nutrition (What and when), allergies
Herbs Ideally should stop 2-3 weeks before surgery
Head to toe physical assessment get a baseline, ask questions as you go, wear the interview the with hands on.
Other dataAll ordered lab work, such as labs, diagnostics (CXR, PFT, EKG)
AllergiesRe-inquire. change over time
After subjective and objective data is gathered Assessment- any gaps or potential gaps, check info due to H&P possibly being done a while ago
Info that can change decision making regarding notification of surgeon/anesthesia New Diagnosis, Ned med/herb, significant change (pregnancy, terminally ill)
Latex allergy May also have avocado and banana allergy.
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Section 2

Question Answer
Pt. has a URI- what are you thinking?Increased risk of laryngospasm or bronchospasm, decreased Sa02, procedure should probably be canceled
Pt. has hx. of dyspnea, coughing, hemoptysis Bring it to the attention of the operative team.
Pt. has hx. of COPD Increased risk of atelectasis. teach and demonstrate coughing, deep breathing, incentive sperometer before sx.
Pt. who smokes Try to get them to quit 6 weeks prior to decrease complications, more pack year=more risk
Pt. has hx or urinary or renal disease Increased potential for F & E imbalances, coagulopathies, risk for infection, impaired wound healing, possibly get renal function tests, share with OP team, watch voiding carefully
Pt. has hx of skin ulcers Extra padding, may impact post op healing
Pt. has hx of arthritis Post op positioning, ambulation, spinal anesthesia problems, airway management
Pt. has hx of valve replacement Risk for endocarditis assoc. with invasive procedures and may need antibiotic prophylaxis. Let surgeon know.
Pt. has abnormal K, what elevates this to a larger concern?Takes Diuretic & beta blocker to control BP, low K level may increase the risk for intraoperative complications such as dysrhythmias,
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Section 3

Question Answer
Teaching What to expect, Pre-op regimen, where will they be when they wake up?, what happens immediate post op, Demonstrate things, Pain (re-assure intervention), elderly may require more time, Unknown to known
Pre Op consent Very legal, plain language, surgeons responsibility- nurse witnesses, do not have them sign if not voluntary or under the influence
Adequate disclosure Diagnosis, nature and purpose of treatment, risks and consequences, probability of successful outcome, availability - benefits - and risks of alternatives, prognosis
Preoperative assessment- multidisciplinary
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