Preoperative report

Preoperative

Communication, teamwork, and patient assessment are crucial to ensuring good patient outcomes
in the perioperative setting. Professional perioperative and perianesthesia nursing standards
encompass the domains of behavioral response, physiologic response, and patient safety and are
used as guides toward development of nursing diagnoses, interventions, and plans. Perioperative
nursing, which spans the entire surgical experience, consists of three phases that begin and end at
particular points in the sequence of surgical experience events.

The PREOPERATIVE PHASE begins when the decision to proceed with surgical intervention is made
and ends with the transfer of the patient onto the operating room (OR) bed.
The intraoperative phase begins when the patient is transferred onto the OR bed and ends with admission to
the PACU. Intraoperative nursing responsibilities involve acting as scrub nurse, circulating nurse, or
registered nurse ɹrst assistant .

The postoperative phase begins with the admission of the patient to the PACU and ends with a follow-up
evaluation in the clinical setting or home .Each perioperative phase includes the many diverse activities a
nurse performs, using the nursing process, and based on the Standards of Practice of ASPAN (2010). Each
phase of the surgical experience is reviewed in more detail in this chapter and in the other chapters in this
unit.
Preoperative Assessment

Preoperative Assessment The goal in the preoperative period is for the patient to be as healthy as possible. Every
attempt is made to assess for and address risk factors that may contribute to postoperative complications and
delay recovery.

A plan of action is designed so that potential complications are averted. Before any surgical treatment is initiated,
a health history is obtained, a physical examination is performed during which vital signs are noted, and a
database is established for future comparisons (Spry, 2009).

During the physical examination, many factors that have the potential to aʃect the patient undergoing surgery
are considered, such as joint mobility.

Genetic considerations are also taken into account during assessment to prevent complications with anesthesia.
Preoperative Assessment
Preoperative Assessment
Patient teaching/Education
Patient teaching/Education
Patient teaching/Education
Setting Patient ready for Pre-op
Setting Patient ready for Pre-op
Setting Patient ready for Pre-op
Setting Patient ready for Pre-op
Setting Patient ready for Pre-op
Setting Patient
ready for Pre-op
Setting Patient ready for Pre-op
Setting Patient ready for Pre-op
ATELECTASIS

Atelectasis refers to closure or collapse of alveoli and often is described in relation to x-ray ɹndings and/or clinical
signs and symptoms.

• It is one of the most commonly encountered abnormalities seen on a chest x-ray (Stark, 2012). Atelectasis may
be acute or chronic and may cover a broad range of pathophysiologic changes, from microatelectasis (which is
not detectable on chest x-ray) to macroatelectasis with loss of segmental, lobar, or overall lung volume. The
most commonly described atelectasis is acute atelectasis, which occurs most often in the postoperative setting
or in people who are immobilized and have a shallow, monotonous breathing pattern (Lamar, 2012).

• Excess secretions or mucus plugs may also cause obstruction of airfow and result in atelectasis in an area of
the lung. Atelectasis also is observed in patients with a chronic airway obstruction that impedes or blocks the
ɻow of air to an area of the lung (e.g., obstructive atelectasis in the patient with lung cancer that is invading or
compressing the airways).
Pathophysiology
• Atelectasis may occur in adults as a result of reduced ventilation (nonobstructive atelectasis) or
any blockage that obstructs passage of air to and from the alveoli (obstructive atelectasis), thus
reducing alveolar ventilation (Stark, 2012).

• Obstructive atelectasis is the most common type and results from reabsorption of gas (trapped
alveolar air is absorbed into the bloodstream); no additional air can enter into the alveoli because
of the blockage.

• As a result, the affected portion of the lung becomes airless and the alveoli collapse. Causes of
atelectasis include foreign body, tumor or growth in an airway, altered breathing patterns,
retained secretions, pain, alterations in small airway function, prolonged supine positioning,
increased abdominal pressure, reduced lung volumes due to musculoskeletal or neurologic
disorders, restrictive defects, and speciɹc surgical procedures
• Causes of atelectasis include foreign body,

• tumor or growth in an airway,

• altered breathing patterns,

• retained secretions,

• pain,

• alterations in small airway function,

• prolonged supine positioning,

• increased abdominal pressure,

Signs and symptoms include

• increasing dyspnea,

• cough,

• and sputum production.

Prevention

Prevention Nursing measures to prevent atelectasis include

• frequent turning,

• early mobilization,

• and strategies to expand the lungs and to manage secretions.

• Voluntary deepbreathing maneuvers (at least every 2 hours) assist in preventing and treating atelectasis.

• (e.g., deep-breathing exercises, incentive spirometry), and coughing, also serve as the ɹrst-line measures to
minimize or treat atelectasis by improving ventilation.
Hypostatic hypotention (Pneumonia)