San Miguel, Raedel

BSN 3B2

Preoperative Nursing Care

Preoperative Nursing

- A special field that includes a wide variety of nursing functions associated with the patient’s
surgical experience during the preoperative period.

Preoperative Period

- Begins with the decision to have surgery and ends with clients are on the operating table.
Preoperative preparation may occur several days before the surgery.

A. Preoperative Assessments
1. Nursing History should include current health status; allergies; current medications;
medical history; previous surgeries; understanding and expectations of surgery; use of
alcohol; caffeine, or other drugs; family and social support; occupation; and emotional
health.
2. Physical examination is brief but complete and focuses on systems that could affect the
client’s response to the surgery or to anesthesia. Data from the physical exam provides
an important baseline for comparison during and after surgery.
 vital signs
 head and neck
 skin turgor
 thorqx and lungs
 heart and vascular system
 abdomen
 neurological status
B. Preoperative Screening Tests
1. CBC
2. Serum electrolytes analysis
3. Coagulation study
4. Serum creatinine clearance and BUN
5. Urinalysis
6. Chest X-ray
7. Electrocardiogram
8. Blood typing and cross matching
9. Fasting blood glucose
C. Physical Preparation for Surgery

Most agencies have a preoperative checklist for use on the day of surgery to ensure that all
necessary records are in the chart and that all physical preparation has been done to assure
client safety. Preparation depends on the type of surgery being performed.

1. Nutrition and Hydration

 Diet and order depends on the type of surgery and the anesthesia to be used.
 Measure intake and output
 Usually clients are to have “nothing by mouth” (NPO) for 6-12 hours prior to
surgery because anesthesia decreases gastrointestinal functioning.
 Remove food and fluids from the bedside and place an NPO sign at the bedside.
If the client ingests anything inform the surgeon.
2. Elimination
 Insert a retention catheter, if ordered, to keep the bladder empty and prevent
injury during surgery.
 If the client does not have a catheter, have him/ her empty the bladder before
administering the preoperative medication.
 An enema is necessary if bowel surgery is planned.
3. Rest and Sleep
 Promote Rest and sleep the night before surgery. A sedative is sometimes
ordered for this purpose.
4. Hygiene
 The client may need bathe or shower and shampoo that night or morning
before surgery to reduce the risk of infection.
 Remove cosmetics so that nail beds, skin and lips can be used to assess
circulation during and after surgery.
 Have the client don a surgical cup to cover the hair.
 Remove all hair pins and clips that might cause injury while the client is
unconscious.
 Have the client remove the personal clothing and don an operating room gown
5. Medication
 The client “routine” medications may be temporarily discontinued.
 Preoperative medications are either given on the hospital unit or in the
operating room.
a. Sedatives and tranquilizers to reduce the anxiety and ease anesthetic
induction
b. Narcotic analgesics to sedate the client and reduce the amount of
anesthetic needed
c. Anticholinergics to reduce oral secretions and prevent laryngospasm
d. Histamine-receptor antihistamines to reduce gastric acidity and volume
e. Neuroleptanalgenics create calm sleepiness
 6. Antiembolism stockings
7. Personal valuables
8. Prostheses
9. Special orders
10. Special Skin preparation

D. Preoperative Teaching
1. Surgical events sensation
2. Pain management
3. Physical activities
 deep breathing
 coughing
 incentive spirometry
 leg exercises
 turning in bed
4. Emotional supports

E. Obtaining Informed Consent

Informed consent is when, after receiving and understanding the following information, the
client voluntarily agrees to undergo a particular treatment:

a. A description of the treatment/ procedure

b. Purpose of the treatment
c. The name and qualifications of the person who will perform the treatment
d. Explanation of the risk involved
e. The chances for success
f. Possible alternative treatment/ approaches
g. An explanation that the client has the right to refuse the treatment and the right to
withdraw consent
 The client must sign a consent form before surgery or any invasive treatment.
The surgeon has the legal responsibility for ensuring that the client is giving
informed consent; however, the nurse may witness the client’s signature on the
form. The nurse should ensure that the client understands the procedure and
risks.
 The nurse checks to be sure that a consent form is signed and included in the
chart
 Consent is informed only when: (1) the client understands the information (2) is
not a minor.