Pre-operative patient

Doing pre-operative checks

Giving pre-operative patient
information 9,
Preparing a patient for surgery
Allaying anxiety in a patient
Using Pre-operative Checklists

Doing pre-operative checks

In pairs, discuss the followingquestions.
1 What is your experience of pre-operative
(pre-op) checks?
2 Why are pre-op proceduresimportant?
3 What problems can occur if a pre-op check is not done accurately?

b Nancy Clarke, a 58-year-old, is booked for elective bowel surgery. Last

week,
three polyps were discovered in her colon during a diagnostic colonoscopy
—the examinationof the bowel through an endoscope.Alexandra, the Ward
Nurse, prepares Mrs Clarke for her operation by telling her about the pre-
operative routine.
Listen to the conversation and answer the following questions.
I What pre-op hygieneinstructionsdoes the nurse give Mrs Clarke?
2 Why isn't she allowedto eat or drink before the operation?
3 Why does she have to wear the stockings?
C >8.1 Listen again and complete the following sentences.
Yes. look at the operation list
when it comes out later today
2 Now, get you to take off your nail polish later today
3 And also need to shower with this antiseptic wash.
4 my tummy be shaved before the operation?
5 . for a few days. order you clear
fluids for today.
6 That means I be able to eat or drink anything after midnight,

7 No, not at all. get you to take a special bowel preparation

drink later to clean out your bowel. also need a small
enema .

62 Unit 8 Pre-operative patient assessment

 d In pairs, practise
explaining
questions. Student A, you pre-operativepreparations
are a nurse; and asking
Student B, you are a
pre-operative
Giving pre-operative
patient education
2 a In pairs, discuss the following
1 What is your experience
questions.
2 Do you use different of pre-operative
patient education?
strategies when dealing
different cultural backgrounds? with children or patients
from
3 What are the benefits
of pre-operative
and for the healthcare patient education, both for
system? patients
b Match the medical terms (I —5)
to their meanings (a—e).
1 thrombus a the process of blood
clotting
2 anti-embolic b deep vein thrombosis
3 DVT c usually refers to a
medication which inhibits the
thromboses formationof
4 anticoagulant d solid mass which forms in
blood vessels; also called a bloodclot
5 coagulation e stops an embolus from forming

C In pairs, read the post-op information

sheet and the typical patient
questions (1—7). Practise asking and
answering the
A, you are a patient; ask the questions. Student questions. Student
B, you are a nurse; find
answers to the questions using the information sheet.
Swap roles and
practise again.
Is this something to do with clots?
2 How do I put the stockings on?
3 Are they different from ordinary stockings?
4 When do I have to start wearing them?
5 I won't have to wear these permanently,I hope?
6 Will I have to walk on my own?
7 How long will I have to have the injections?

Post-operative instructions: mobilisation post-op

There are some important things which will be part of your post-operative recovery. You'll
wear
anti-embolic stockings, mobilise gradually and be on anticoagulanttherapy.These measuresare
important in order to prevent blood clots (also called DVTs, or Deep Vein Thromboses).

a Anti-embolic stockings
• Graduated compression stockings which provide varying pressure to your lower limbs
• Worn two hours pre-op and post-op until you return to full mobility
• Must be put on smoothly (no bunching of the stocking)

b Early ambulation
• You will be encouraged to get moving again soon after your operation
• Frequent short walks around the ward with assistance if necessary

c Anticoagulant therapy
• Subcutaneous injections of heparin twice a day
• Anticoagulant therapy continues until fully mobile

Unit 8 Pre-operativepatient assess.•nt

 Preparing a patient for surgery
Research suggests that patients whoare physically and psychologicallyprepared
for surgery tend to have better outcomes after surgery.
3 a In pairs, discuss the following questions.
1 What would you talk toa patient about before surgery?
2 Do you have any experienceof working in a surgical ward?
What are the challengesof working in a surgical ward?
4 What changes have there been in abdominal surgery in recent years?
5 How are patients prepared for abdominal surgery?

b Match the medical terms (I —6)to their meanings (a—O.

i gallbladder a drug which blocks pain and other sensations
before an operation is performed
from continually obtaining analgesiaby .
? laparosccpe b safety measurewhich prevents patients
patient-controlbutton
3 anaesthetic c patient-controlledanalgesia
4 PCA the abdomen to visualise the abdominal
d surgical instrumentwhich is inserted into
5 overdose e abdominalorgan which stores bile
serious health consequences
6 lock-out time f taking excess amounts of medication with

C In pairs, take turns to say a term and ask your partner to define it.
d Ms Emma Slade, a nervous 45-year-old, is booked for an elective
the
cholecystectomy (removal of the gallbladder) tomorrow. Listen to Alva,
Ward Nurse, explaining what Emma can expect when she returns to the ward
after her operation, and answer the following questions.
How is Emma feeling about her operation?
2 What kind of surgery is she going to have?
3 What is the name of the instrumentthe surgeon will use to visualise her
gallbladder?
4 Why won't she have a large scar after her operation?
5 How long will the mini-drainstay in after the operation?
6 What will the nurses check before she can eat and drink after her operation?
7 When will the nurses remove her urinary catheter?

64 perative patient assessment

 e Before Alva talks to Emma about
help her remember everything she her operation, she makes some notes to
needs to say. Listen again and match Alva's
notes (1—8)to her explanations (a—h).

No+es Sade: a You'llcome back with an IV and some fluids running,

just until you can eat and drink again.
keyhole b It can be taken out when you're back on the ward and
think you can void again —I mean, pass urine.
c We check that you can swallowagain by trying you with
Si+es a few Ice chips.
3 dressin d It's a small plastic container attached to some tubing
8 which takes away any excess blood from your wound.
5 IV - ou+ when ea+in e ... also called minimallyinvasive surgery because it's
8 performed with the use of a laparoscope, using small
drinkin incisionsor surgical cuts.
6 swallow x-eQex - ice f These are just small holes made near your navel.
chips g As soon as you can manage the ice chips, we'll give you
small sips of water.
7 Sies h It's just a light covering to keep the area clean until it
8 Gen Pa heals.

Communicationfocus: allaying anxiety in a patient

4 a In pairs, discuss the following questions.
1 What strategies have you used successfullyto allay anxiety in a patient?
2 Wouldyou use differentstrategies for differentage groups?
3 What strategies might also be useful for a child?
4 What strategies would you use for a patient who didn't speak English?
b Completethe following strategies for allaying anxiety in a patient using the
words in the box.
involve rap-pott normal anxiety reassuring avoid

Establish a with the patient, as this helps to decrease the

feeling of depersonalisation and isolation.
2 Use a calm, approach.
3 Explain that anxiety is a reaction.
4 Help identify situations which cause , for example fear of
an aesthesia.
5 Try to words which increase anxiety; for example, use
discomfort rather than pain.
6 Try to the patient in decision-making wherever possible, as
this decreases the sense of loss of control.

Unit 8 Pre-operativepatient assessment 65

 and
C Listen to the rest of the conversation betweenAlva and Emma
answer the following questions.
I What concern does Emma have about using the PCA?
2 What safety measure on the machinedoes Alva explain?
3 What will the nurses check frequentlyafter the operation?
4 How often will Emma use her tri-ball after the operation?
5 What do you think Alva's second poseoperative instruction might be?
d Alva used several strategies to allay anxiety in response to Emma's concerns.
Match the concerns (1—5)to the responses (a—e).
for
I Is everything all right? There's nothing a No, not much, but I can make a note
for
wrong, is there? the rest of the staff to cover the drain
you so you don't see any of it.
2 1 feel silly being so worried. I'm not
normally like this. b No, don't worry. We program the pump so
there's a lock-out time.
3 There won't be lots of blood, will there? I
can't stand the sight of blood. c No, not at all, everything's fine.
d Tha€s0K, Emma.IVs quite normalto feet
4 What about pain? I'm worried that I'll be
in a lot of pain.
a bit apprehensive.
e You'll have a PCA machine to use for any
5 But what if I keep pushing the button? discomfort after the operation. Tha€s
Won't I give myself an overdose? what I wanted to show you

e In pairs, discuss whichstrategies Alva used when talking to Emma. Can you
think of any other strategies?
f Nashida Hussein, a 24-year•o/d universitystudent, has been admitted for an
elective appendicectomy. She is very anxious about the operation.
In pairs, practise allaying patient anxiety. Student A, you are Nashida; read
the questions on page 90 and be ready to ask the nurse for the information
you need. Student B, you are the nurse; read the patient information sheet
on page 89 and be ready to answer Nashida's questions. Remember to use
strategies to allay anxiety. Swap roles and practise again.

Share your knowledge

In small groups, discuss the followingquestions and then feed back your
group's ideas to the class.
/ • Is patient education an important nursing focus in your country?
• Have you been involved in patient education in your country? If so. what
did you find challengingabout delivering patient education? What did
you find rewarding?

66 Unit 8 Pre-operative patient assessment

 Medical focus: blood circulation
pairs, look at the picture and discuss the
followingquestions.
1 What does the picture illustrate?
2 Do you have experience of caring for patients
with this medical condition?
b Mr Vitellis, a 56-year-old teacher, has
recently been hospitalised for
orthopaedic surgery following a skiing accident.
Listen to a conversation
between Mr Vitellis and Nasreen, the Ward Nurse,
and mark the following
statements True (T) or False (F).
1 Mr Vitellis underwent an orthopaedic operationwhich took several hours.
2 He showed no signs of having a blood clot after his operation.
3 His condition is being treated with anticoagulantmedication.
4 He had both anti-embolic stockings removed after the operation.
5 He has developed a pulmonaryembolism.
6 He is free from pain and leaving the hospitaltoday.

C Match the medical terms (l —5)to their meanings (a—e).

1 venodilation a the condition which is caused when a blood clot blocks blood flow
2 embolus b the pooling of bloodin the veins
3 embolism c stretching or wideningof a vein
4 venous stasis d a blood clot which breaksoff and movesfreely along a blood vessel

d Underline the stressed syllable in words 1—4.

e Label the following diagram using the words in the box.

order. Listen again and

f Put the following stages of DVT in the correct
check your answers to this and Exercise 5e.
C] Formation of an embolus
CJ Venous stasis caused by immobility
easily
Blood becomes stickier and coagulates more
walls of the veins
CD Venodilationcauses small tears in the inner
An embolus blocks blood flow

Unit 8 Pre-operativepatient assessownt 67

 medication used to treat
g Complete the followingexplanations of the
using the words in the box.
warfarin pulmonaryembolism filter eneieoagulønt
INR DVTs subcutaneous heparin lifelong dose
given
1 When a DVT forms in a patient's lee, they are
medication.
whilst in hospital.
2 Most patients Start treatment With
given as a
Heparin, an anticoagulant medication,is
oral anticoagulant called
4 As well as heparin injections,patients start on the
for three to
5 Patients will probably have to take the warfarin tablets
had problems with
six months after leaving hospital unless they've
the past, In these cases, they may require
or in
warfarintherapyL adjustment and
6 Warfarin therapy Oftenrequires frequent
regular monitoringof the through a blood test.
the doctor may
7 If anticoagulant therapy is not effectiveor contra-indicated,
talk to patients about having an IVC implanted.
recently
h Mrs Heather Perry is taking the oral contraceptivepill and has for
returned from a long-haul flight. Mrs Perry has two of the risk factors
pill, and long
getting DVTs:hormone therapy, such as the oral contraceptive
with a suspected
periods of sitting immobile.She has been admitted to hospital
DVTin her right calf and is very concerned about her condition.
In pairs, practise explaininghowDVTsform, including some of the risk
factors, and the likely treatment plan. Student A, you are the nurse;
Student B, you are Heather Perry. Rememberto use strategies to allay
anxiety in a patient. Swap roles and practise again.

Charting and documentation:

Pre-operative Checklist
Doing pre-operative checks
Before a patient is transferred to the Operating Theatres. all relevant charts
and X-rays are gathered before a final ward check is made

6 a In pairs, look at the chart on page 90 and discuss the following questions.
1 When is this chart used?
2 Are you familiar with this type of chart?

b Viki, the Ward Nurse, is checking Belinda Mainwaring for surgery.

Listen to the conversation and complete the blue shaded parts of the
Pre-operative Checklist. Tick in the appropriate boxes marked YES or NO
or N/A (Not Applicable).

68 unit 8 Pre-operativepatient »sessn•nt

 pass the care ot one person
to another se•.eroitimes on the
surgcru. and pre-operative information js ChecÅed bu
vanous staff members
's in the Operating Theatrehoi0yngarea before sne rs taken in to have
opcmt'on performed.
Wendy, the Theatre Nurse, checks the patient details and details
relating to the operation. She uses the ereen shaded area in the column
marked OÄ (Operating Theatre). Listen to the conversation and tick the
sections of the Checklist on paee 90 that Wendydouble-checks.

d Listen again and put the following extracts in the correct order.
I already answered many of these questions but we Oke
te check everytmne.
the Checklist. and you •e already got a theatre cap to cover
your hair,
have quick look at your identificationbracelets may?
Can tell me your full name. please?
senature on the consent form?
J': Is this your
Did you Sign a consent form for the operation?
cm going to check you in today.
Have you had a pre-med?
again.
I'm lust going to eo through this Checklist
operation youTe havingtoda•,?
Can you tell me what
going through the Pre-operative Checklist.Student A,
e In pairs practise Nurse; Student B, you are the patient. swap roles
and
you are the Theatre
practise again.

A,

and then feed back your

following questions
discuss the
small groups,
with?
you familiar
procedures are
pre-operative an
1 What before the patient has
having several checks
benefits of
3 What are the 69
operation? patient assessment
Unit 8 Pre-operative