Presentation on preoperative nursing care to help nurses manage patients before any surgery.

1. PRE-OPERATIVE NURSING CARE
CONTENTS
1. DEFINITION OF TERMS.
2. AIMS OF PRE-OPERATIVE NURSING
CARE.
3. ROLE OF THE NURSE IN THE PRE-
OPERATIVE PHASE / PERIOD.
3.1. Pre-operative Assessment.
3.2. Obtaining Informed Consent.
3.3. Pre-operative Teaching.
3.4. Physical Preparation Of Patient.
3.5. Psychological Preparation Of Patient.

2. 1. DEFINITIONS OF TERMS
• Pre-operative phase/ period: begins with the
decision to perform surgery and continues
until the client has reached the operating area
( operating room) or surgery begins.
• Pre-operative nursing care : is care given
before surgery when physical and
psychological preparations are made for the
operation, according to the individual needs
of the patient.

3. 2. AIMS OF PRE-OPERATIVE NURSING CARE.
The aims of pre-operative nursing care are :
 T o reduce the risks associated with surgery
and anesthesia.
 To obtain the patient’s informed consent for
both surgery and anesthesia.
 To restore the patient to the desired level of
function.
 To increase the quality of intra-operative care.

4. 3. ROLE OF THE NURSE IN THE PRE-OPERATIVE PHASE
/ PERIOD.
3.1. Pre-operative Assessment
Here, co-morbidities that may lead to patient complications during
the anesthetic, intra-operative or post-operative period are
identified. And if any, it needs to be treated before the surgery. This
is done as follows:
I. Review of preoperative laboratory and diagnostic studies:
•Full blood count.
•Blood group / rhesus and cross match.
•Serum electrolytes.
•Urinalysis.
•Chest X-rays.
•Electrocardiogram.
•Other tests related to procedure or client’s medical condition, such
as: prothrombin time, partial thromboplastin time, blood urea
nitrogen, creatinine, and other radiographic studies.

5. II. Review the client’s health history:
•History of present illness and reason for surgery.
•Past medical history.
•Medical conditions (acute and chronic).
•Previous hospitalization and surgeries.
•History of any past problem with anesthesia.
•Allergies.
•Present medications.
•Social history ( substance use): alcohol, tobacco,
drugs.
•Review of system.

6. III. Assess physical needs:
•Ability to communicate.
•Vital signs ( blood pressure, pulse , temperature,
oxygen saturation)
•Level of consciousness (Confusion, Drowsiness or
Unresponsiveness ).
•nutritional status (weight ,height and BMI)
•Ability to move/ ambulate.
•Circulatory status ( auscultation, vein
observation)

7. IV. Assess psychological needs:
•Emotional state.
•Level of understanding of surgical procedure,
preoperative and postoperative instruction.
•Coping strategies.
•Support system.
V. Assess cultural needs:
•Language-need for interpreter

8. 3.2 OBTAINING INFORMED CONSENT
• Before surgery, the client must sign a surgical consent form or
operative permit.
• Clients must sign a consent form for any procedure that requires
anesthesia and has risks of complications.
• If an adult client is confused/unconscious, a family member or
guardian must sign the consent form.
• If the client is younger than 18 years of age, a parent or legal
guardian must sign the consent form.
• In an emergency, the surgeon may have to operate without
consent, health care personnel, however, makes every effort to
obtain consent by telephone, or fax.
• Clients must sign the consent form before receiving any
preoperative sedatives.
• The nurse is responsible for ensuring that all necessary parties
have signed the consent form and that it is in the client’s chart
before the client goes to the operating room (OR).
N.B:
Each nurse must be familiar with hospital policies and state laws
regarding surgical consent forms.

9. 3.3. Pre-operative Teaching.
• Teaching clients about their surgical procedure and
expectations before and after surgery is best done
during the preoperative period.
• Clients are more alert and free of pain at this time.
It also reduces apprehension and fear thus
increasing cooperation and participation in the
post-operative phase, and decreases the incidence
and severity of post-operative complications.
• Information in a preoperative teaching plan varies
with the type of surgery and the length of the
hospitalization.

10. PRE-OPERATIVE TEACHING PLAN INCLUDES
Pre-operative medication:
• In general, patients taking cardiac drugs, including β-blockers and
antiarrhythmics, pulmonary drugs such as inhaled or nebulized
medications, or anticonvulsants, antihypertensives, or
psychiatric drugs are advised to take their medications with a sip
of water on the morning of surgery day when the patient is Nil
By Mouth.
• Some drugs are associated with an increased risk for
perioperative bleeding(e.g. anticoagulants) and are withheld
before surgery. Drugs that affect platelet function are withheld
for variable periods: aspirin and clopidogrel are withheld for 7 to
10 days. In High risk cases, Clopidogrel is stopped and Aspirin is
continued.
• The use of estrogen and tamoxifen has been associated with an
increased risk for thromboembolism, they probably need to be
withheld for a period of 4 weeks preoperatively.

11. Pre-operative medication cont’d
• Non–insulin-dependent diabetics need to discontinue long-acting sulfonylureas
such as chlorpropamide and glyburide because of the risk for intra-operative
hypoglycemia; a shorter-acting agent or sliding-scale insulin coverage may be
substituted in this period.
• Patients who are on Rapid-acting (Lispro) and short-acting (Regular) insulin
preparations, these are usually withheld when the patient stops oral intake
(NBM/NPO).
• Withhold long-acting insulin preparations; lower dosages of intermediate-acting
insulin are substituted on the morning of surgery.
• Patients who take oral hypoglycemic agents typically withhold their normal dose
the day of surgery. The use of metformin is stopped pre-operatively because of its
association with lactic-acidosis in the setting of renal insufficiency(*If the patient
has altered renal function, metformin needs to be discontinued until renal function
either normalizes or stabilizes).
• Coverage for hyperglycemia is with a short-acting insulin preparation based on
blood glucose monitoring.
N.B:
* Patients can resume their oral agent once diet is resumed.
• The use of estrogen and tamoxifen has been associated with an increased risk for
thrombo-embolism, they probably need to be withheld for a period of 4 weeks
preoperatively.
• Surgery is postponed for 6 weeks if Hormone Replacement Therapy(HRT) is being
given.

12. PRE-OPERATIVE TEACHING PLAN INCLUDES cont’d
• Post operative pain control.
• Discussion of the frequency of checking dressings and
assessing vital signs and use of monitoring equipment.
• Orientation of patient to the surroundings.
• Deep breathing and coughing exercises.
• How to support the incision for breathing exercises and
moving.
• Early ambulation in order to stimulate gastrointestinal
motility, enhance lungs expansion, mobilize secretions,
promote venous return and prevent rigidity of joints.
• Position changes.
• Feet and leg exercises.
• Informing the family of surgery time, if known, and of any
schedule changes.
• Postoperative IV lines and tubings ex: NG tube etc.

13. 3.4. Physical Preparation Of Patient.
Preoperative preparation includes the following areas:
I. Nutrition and fluids
II. Elimination
III. Hygiene
IV. Medications
V. Sleep
VI. Care of valuables
VII. Prostheses
VIII. Special orders
IX. Surgical skin preparation
X. Safety protocols
XI. Vital signs
XII. Anti embolic stockings

14. I. Nutrition and fluids
• Adequate hydration and nutrition promote healing.
• Usually “NPO after midnight” followed because it
anesthetics depress gastrointestinal functioning and
there was a danger the client would vomit and aspirate
during the administration of a general anesthetic.
 The current guidelines allow for:
i. The consumption of clear liquids up to 2 hours.
ii. The consumption of breast milk 4 hours before
surgery.
iii. A light breakfast (e.g., formula, milk, light meal such as
tea and toast) 6 hours before the procedure .
iv. A heavier meal 8 hours before surgery.

15. ll. Bowel and bladder Elimination:
• Enemas may be ordered if bowel surgery is
planned.
• The enemas help prevent contamination of the
surgical area (during surgery) by feces.
• Prior to surgery an indwelling Foley catheter
may be ordered to ensure that the bladder
remains empty.
• This helps prevent injury to the bladder,
particularly during pelvic surgery.

16. lll. Hygiene:
• In some settings, clients are asked to bathe or
shower the evening or morning of surgery (or
both).
• The purpose of hygienic measures is to reduce the
risk of wound infection by reducing the amount of
bacteria on the client’s skin.
• The client’s nails should be trimmed and free of
polish, and all cosmetics should be removed so
that the nail beds, skin, and lips are visible when
circulation is assessed during the perioperative
phases.

17. IV. Pre operative Medications:
• preoperative medications are given to the
client prior to going to the operating room.
• Commonly used preoperative medications
includes:
 Antiemetics
 Anticholinergics
 Sedatives
 Antibiotics

18. V. Sleep:
• Nurses should do everything to help the client
sleep the night before surgery. Often a sedative is
ordered. EG: ALPRAZOLAM (0.5mg) or
TRANXENE(10mg)
• Adequate sleep helps the client manage the stress
of surgery and helps healing.
VI. Care of valuables:
• Valuables such as jewelry and money should be
sent home with the client’s family or significant
other.
• If valuables/money cannot be sent home, they
need to be labeled and placed in a locked storage
area per the agency’s policy.

19. VII. Care of Prostheses:
• All prostheses (artificial body parts) such as
partial or complete dentures, contact lenses,
artificial eyes, and artificial limbs and
eyeglasses, wigs, and false eyelashes must be
removed before surgery.
VIII. Special Orders:
• The nurse checks the surgeon’s orders for
special requirements (e.g., the insertion of a
naso-gastric tube prior to surgery, the
administration of medications, such as insulin,
or the application of anti-emboli stockings).

20. IX. Skin Preparation.
• The surgical site is cleansed with an
antimicrobial to remove soil and reduce the
resident microbial count to sub pathogenic
levels.
• REMOVE THE HAIR at the site of surgery.
X. Safety Protocols:
INCLUDES:
• Identifying the patient and surgery to be
performed.
• Surgical site marking.

21. XI. Vital Signs:
• In the preoperative phase the nurse assesses
and documents vital signs for baseline data.
The nurse reports any abnormal findings, such
as elevated blood pressure or elevated
temperature.
XII. Antiembolic Stockings:
• Antiembolic (elastic) stockings are firm elastic
hose that compress the veins of the legs and
thereby facilitate the return of venous blood
to the heart. Especially in patients with deep
venous thrombosis, to reduce oedema and
pain.

22. 3.5. Psychological Preparation Of Patient.
• Careful preoperative teaching can reduce fear and anxiety of the clients.
N.B:
 IV access is placed by the nurse or anesthesia personnel for all clients
undergoing surgery.
 The IV line is usually placed in the arm or the posterior aspect of the
hand using a large ( 16 or 18- G) catheter. This type of catheter provides
the least resistance to fluid or blood infusion, especially in an emergency
when rapid infusions may be necessary.
 Depending on the individual client’s needs and the facility’s policies and
practices, the IV access can be placed before surgery when the client is
in the hospital room, in the admission area of the OR, or in the OR.
 The nurse reviews the client’s chart to ensure that all documentation,
pre-op procedures, and orders are completed.
 The nurse also confirms that the scheduled procedure, including the
identification of left versus right when necessary , is what is listed on the
consent form.
 Any abnormal results( lab/ VS) are documented and reported to the
surgeon or anesthetist.