Preoperative Patient Care ST210 Concorde Career College, Portland.

Preoperative Patient Care

ST210Concorde Career College, Portland

Preoperative Patient Care

Objectives:Objectives:

Identify reasons for surgical interventionIdentify reasons for surgical intervention

List and describe the elements of the List and describe the elements of the preoperative patient care routine and state preoperative patient care routine and state the rationale that relates to each elementthe rationale that relates to each element

State the purpose of proper patient State the purpose of proper patient identification and describe the identification identification and describe the identification process in the surgical settingprocess in the surgical setting

Preoperative Patient CareObjectives:

List the type of information that must be contained List the type of information that must be contained in the patient’s chart and describe the importance in the patient’s chart and describe the importance of each itemof each item

Define the term informed consent, list the contents Define the term informed consent, list the contents of the consent form, and describe guidelines that of the consent form, and describe guidelines that apply to obtaining informed consentapply to obtaining informed consent

Review basic handwashing and perform skills Review basic handwashing and perform skills assessmentassessment

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There are many indications as to why thousands of There are many indications as to why thousands of people people in the United States, as well as the world undergo surgeryin the United States, as well as the world undergo surgeryevery year. every year.

Surgery and the way it is conducted today, takes an aim Surgery and the way it is conducted today, takes an aim at faster recovery through the advancement of at faster recovery through the advancement of technology.technology.

Though this is true, surgery is only considered as a last Though this is true, surgery is only considered as a last resort when all conservative investigative measures or resort when all conservative investigative measures or treatment of any disease process have failed.treatment of any disease process have failed.

The goal of surgery is to assist the body with the healing The goal of surgery is to assist the body with the healing process, either by removing something, repairing a process, either by removing something, repairing a defective structure within the body, or by cleaning out a defective structure within the body, or by cleaning out a wound. wound.

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Prophylactic (Prophylactic (preventive)preventive) – To prevent the – To prevent the occurrence of a disease or illness.occurrence of a disease or illness.

Restorative (Restorative (curative)curative) – – To regain patient’s health To regain patient’s health and strength.and strength.

PalliativePalliative – To relieve or alleviate symptoms, – To relieve or alleviate symptoms, without curing the underlying cause or disease.without curing the underlying cause or disease.

DiagnosticDiagnostic – To investigate and identify the cause – To investigate and identify the cause or nature of a condition, illness, or disease.or nature of a condition, illness, or disease.

Goals of Surgical Intervention

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Reasons for Surgical Intervention

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Indications for Surgery

DiagnosisDiagnosis TraumaTrauma Metabolic DiseasesMetabolic Diseases InfectionInfection Congenital DefectsCongenital Defects NeoplasmsNeoplasms ObstructionObstruction ReconstructionReconstruction

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Diagnosis – Direct visualization may be needed, within a body cavity, orifice, or joint (endoscopy). Pathological specimens may need to be taken either by endoscopy or an open incision. An example would be Exploratory Laparotomy (an opening into the abdomen to determine the cause of a problem not evident by other methods.)

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Trauma – Also defined as injury, trauma can be caused by burns or accidents. Procedures may include repair of broken bones, removal of foreign bodies, debridement of burns, or reimplantation of limbs.

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Metabolic Diseases – Removal of tissues or organs which are malfunctioning, are often a good indication for surgery. Some examples are splenectomy for thrombocytopenia, or a thyroid gland that is over producing.

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Infection – Some infections, such as appendicitis, cholecystitis, or abscesses that do not respond to conventional therapy may require surgery.

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Congenital Defects – Birth defects that require or are helped by surgery call for such procedures as herniorrhaphy, cleft lip repair, or a condition known as talipes equinovarus just to name a few.

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Neoplasms – Surgical procedures may be performed for both benign and malignant neoplasms. Cancer may be treated by irradiation, chemotherapy, or en-bloc (as a whole) resection.

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Obstruction – Tubes, vessels, ducts, or intestines can become obstructed by stones, growths, blood clots, twisting (volvulus), or intussusception (telescoping in on itself).

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Reconstruction – Body parts may be reassembled to make them more functional or attractive. Degenerative disease of a joint may be corrected by arthroplasty, or breasts may be enlarged by augmentation mammoplasty.

Surgical Technologist Responsibilities

PreoperativePreoperative IntraoperativeIntraoperative PostoperativePostoperative

Preoperative Case Management Prepare the ORPrepare the OR Assemble necessary suppliesAssemble necessary supplies Don PPEDon PPE Prepare and maintain the sterile fieldPrepare and maintain the sterile field Scrub, gown, and gloveScrub, gown, and glove Organize supplies and equipmentOrganize supplies and equipment CountCount DrapeDrape

Intraoperative Case Management

Maintain the sterile fieldMaintain the sterile field AnticipateAnticipate Pass instruments, supplies as neededPass instruments, supplies as needed Prepare and handle medicationsPrepare and handle medications Specimen careSpecimen care DressingsDressings

Postoperative Case Management

Maintain sterile Maintain sterile field until patient is field until patient is transportedtransported

Transport used Transport used instruments and instruments and equipment to equipment to decontamination decontamination areaarea

Prepare OR for Prepare OR for next patientnext patient

Dispose of sharpsDispose of sharps

Five Steps to Critical Thinking

Identifying the goal or problemIdentifying the goal or problem Gathering and evaluating informationGathering and evaluating information

Use A POSitive CARE ApproachUse A POSitive CARE Approach Generating one or more responsesGenerating one or more responses Implementing the best responseImplementing the best response Assessing the resultsAssessing the results

A POSitive CARE Approach

CARECARE CCaring attitudearing attitude AApplicationpplication RRoleole EEnvironmental nvironmental concernconcern

A POSitiveA POSitive AAnatomynatomy PPathology athology OOperative perative procedureprocedure

SSpecific pecific variationsvariations

Preoperative Patient Care Routine

Patient PreparationPatient Preparation

Psychological - usually occurs prior to Psychological - usually occurs prior to admission to the health care facilityadmission to the health care facility

Physiological - usually begins upon admission Physiological - usually begins upon admission to the health care facilityto the health care facility


Routine ProceduresRoutine Procedures

Diagnosis - often occurs prior to admission to Diagnosis - often occurs prior to admission to the healthcare facility for surgical interventionthe healthcare facility for surgical intervention Signs/symptomsSigns/symptoms H&PH&P Diagnostic testsDiagnostic tests


If surgery is necessary…If surgery is necessary…

Informed consent must be obtainedInformed consent must be obtained Patient is admitted for surgery (if not Patient is admitted for surgery (if not

already admitted) and ID band is appliedalready admitted) and ID band is applied Patient information is obtained and chart Patient information is obtained and chart

assembledassembled Patient changes to hospital attire and Patient changes to hospital attire and

belongings are cared forbelongings are cared for

© 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved.

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Surgical Consent

Informed Informed ConsentConsent

Pre-op Pre-op MedicationMedication

Who can sign?Who can sign? ““Emancipated Emancipated

Minor”Minor”


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Patient Possessions

Patient should leave Patient should leave valuables at homevaluables at home

What if they What if they don’t/emergency?don’t/emergency?

ProsthesisProsthesis Wedding RingWedding Ring WigsWigs Why/when must Why/when must

dentures be dentures be removed?removed?

Hearing aidsHearing aids


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Common Admissions Process for the Surgical Patient

Patient arrives at the hospital/OP Patient arrives at the hospital/OP surgery center (evening before or surgery center (evening before or morning of procedure)morning of procedure)

ALLALL required paperwork is completed required paperwork is completed ID bracelet affixedID bracelet affixed Vital signs are takenVital signs are taken Patient changes clothesPatient changes clothes IV is startedIV is started Pre-op medication is givenPre-op medication is given Time is allowed with the family/friendsTime is allowed with the family/friends Patient is transported to the O.R.Patient is transported to the O.R.


If surgery is necessary (continued)…If surgery is necessary (continued)…

Patient is placed in a bed or on a gurneyPatient is placed in a bed or on a gurney Patient’s vital signs are obtainedPatient’s vital signs are obtained Preoperative education occursPreoperative education occurs Physician’s orders are carried out (e.g., Physician’s orders are carried out (e.g.,

enema, shave)enema, shave) Patient is transported to the OR and Patient is transported to the OR and

transferred to the operating tabletransferred to the operating table


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Pre-operative Education

What questions What questions should be asked?should be asked?

Purpose of pre-op Purpose of pre-op education?education?

Facility pre-op?Facility pre-op? Can family/friend Can family/friend

be present during be present during a pre-opa pre-op

Need, type & Need, type & extent of the extent of the procedureprocedure


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Patient Identification

Extremely Extremely importantimportant

ID bracelet not ID bracelet not removed until removed until dischargedischarge

Confirmed by all Confirmed by all personnelpersonnel

““Time Out”Time Out” ProcedureProcedure

Patient Identification

Methods of Patient IdentificationMethods of Patient Identification Verbal (patient or other individual)Verbal (patient or other individual) Visual (prior knowledge)Visual (prior knowledge) WrittenWritten

ChartChart Surgery scheduleSurgery schedule Wrist bandWrist band

(all must match)(all must match)

Patient’s Chart

Components of the Patient’s ChartComponents of the Patient’s Chart Face sheet (billing information)Face sheet (billing information) H&PH&P Results of diagnostic examinationsResults of diagnostic examinations Physician’s ordersPhysician’s orders Progress notesProgress notes Nursing notesNursing notes Medication sheetMedication sheet ConsentsConsents Reports of procedures performedReports of procedures performed


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What Happens Before Surgery??

EnemasEnemas Nail Polish Nail Polish (pulse oximeter)(pulse oximeter) SedationSedation Pre-op HygienePre-op Hygiene Pre-op ShavePre-op Shave Diet Diet (NPO)(NPO) Make-up & DressMake-up & Dress Call to the O.R. Call to the O.R.

Pre-op AssessmentPre-op Assessment Vital SignsVital Signs VoidingVoiding Catheter?Catheter? Pt. IDPt. ID


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Patient Transport to the Operating Room

Guardrails are up & Guardrails are up & securesecure

Safety belt is secureSafety belt is secure Wheels are in correct Wheels are in correct

positionposition Transport the patient Transport the patient

slowly with feet firstslowly with feet first Enter an elevator Enter an elevator

head first & exit feet head first & exit feet firstfirst

Be certain all parts of Be certain all parts of the patient are within the patient are within the guardrailsthe guardrails

Use good body Use good body mechanicsmechanics

NEVER LEAVE THE NEVER LEAVE THE PATIENT ALONE!!!!!PATIENT ALONE!!!!!


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Patient Transfer to the Surgical Table

The mobile patient may be able The mobile patient may be able to transfer themselvesto transfer themselves

What to do when the mobile patient can What to do when the mobile patient can transfer themselvestransfer themselves

The immobile patientThe immobile patient How to transfer the immobile patientHow to transfer the immobile patient How would you help this patient move?How would you help this patient move?


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Patient Positioning

Refer to pp Refer to pp 342-354 ST for 342-354 ST for the STthe ST

Sorry dear, but I still couldn't understand what you're Sorry dear, but I still couldn't understand what you're talking about. talking about.


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Important Concepts… Access must be provided toAccess must be provided to

Surgical siteSurgical site AirwayAirway IVsIVs Monitoring devicesMonitoring devices

Compromise to body systems must be Compromise to body systems must be preventedprevented


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Heat Loss During Surgery Effects up to 60% of all surgical patientsEffects up to 60% of all surgical patients

Most of the patient’s heat loss occurs within Most of the patient’s heat loss occurs within the early stages of the procedure when the the early stages of the procedure when the patient’s environment changespatient’s environment changes


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Intraoperative Heat Loss

Occurs through:Occurs through:• RadiationRadiation (from the pts. body to the (from the pts. body to the

environment)environment)• Convection Convection (loss from the pts. body to (loss from the pts. body to

a cooler surface)a cooler surface)• Evaporation Evaporation (loss of heat via (loss of heat via

respiration or perspiration)respiration or perspiration)


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What does Hypothermia do?

VasoconstrictionVasoconstriction Which leads to:Which leads to:

Increased blood pressureIncreased blood pressure Tissue hypoxiaTissue hypoxia CNS DepressionCNS Depression Slows metabolism of medication (anesthetic)Slows metabolism of medication (anesthetic)

How to Control Hypothermia

Warmed Warmed blanketsblankets

Warming Warming blankets blankets (water (water circulating)circulating)

Forced-air Forced-air BlanketsBlankets

Basic Handwash NOT the same as the surgical scrub Handwash lasts 30-60 seconds Used MANY times per day to:

Mechanically remove transient bacteria Chemically reduce and prevent growth of resident

bacteria

Preoperative Patient Care ST210 Concorde Career College, Portland.

Documents

portland slide

surgical setting slide

skills assessment slide

goal of surgery

neoplasms surgical procedures

surgical intervention

disease process

identification process