Download PREOPERATIVE CARE OF THE PATIENT

PREOPERATIVE PATIENT NEEDS
BY: MICHAEL FRIEDMAN CST
BIOPSYCHOSOCIAL NEEDS
physical considerations
psychological considerations
psychosocial considerations
BIOPSYCHOSOCIAL NEEDS
physical considerations
– completion of activities on the
preoperative checklist
– skin preparation
shaving
shower/bath
reduction of flora at the operative site
BIOPSYCHOSOCIAL NEEDS
physical considerations
– bowel preparation
chemical - antibiotics
mechanical - enema
BIOPSYCHOSOCIAL NEEDS
physical considerations
– NPO
GOALS:
– decreased gastric motility related to the
stress of surgery
– prevent aspiration of gastric contents
age/condition appropriate
– adults - greater than 8 hours
– children - based on feeding schedule
H2 antagonists/antacid
BIOPSYCHOSOCIAL NEEDS
physical considerations
– pre-operative medication
Sedative/tranquilizer
Anticholinergic
– dry secretions
– increase heart rate
BIOPSYCHOSOCIAL NEEDS
psychological considerations
– fear
death
pain
anesthesia
mutilation/alterations in body image
cancer
BIOPSYCHOSOCIAL NEEDS
psychological considerations
– fear
external influences
–
–
–
–
job
money
finances
family
BIOPSYCHOSOCIAL NEEDS
psychological considerations
– dependence
lack of knowledge
– surroundings
– personnel
– procedures
– special considerations/needs of children
age-related issues
BIOPSYCHOSOCIAL NEEDS
psychosocial considerations
– support systems
significant others
– spiritual/religious needs
visits by clergy or religious
special objects
prayer
THE PREOPERATIVE
CHECKLIST
EDUCATION
 the OR experience
 the surgical intervention
 orientation to personnel in other
units
 patient’s psychosocial needs
PATIENT TEACHING
 the OR experience
 the PACU experience
 IV therapy
 Foley catheterization
 post-operative drainage systems
 dressings
 oxygen
PATIENT TEACHING
 NPO status
 pre-operative medications and
their effects
 postoperative pain control
 postoperative exercises
 postoperative restrictions
 ICU/CCU
PHYSICAL PREPARATION OF
THE PATIENT
 skin preparation
 bowel preparation
 removal of jewelry/nail polish
MEDICAL STAFF VISITS
 surgeon
 anesthesia personnel
 OR team
CHART DOCUMENTATION
CHART DOCUMENTATION
history and physical
– written documentation of the
patient’s preoperative conditions
– each patient should have a
completed history and physical
done within the last two weeks or
sooner, if indicated
CHART DOCUMENTATION
history and physical
– information include:
illness history
social history
allergies
past medical history
a review of the organ systems
current physical examination
CHART DOCUMENTATION
consultations
– expert opinions from practitioners
specializing in an area of medical care
or rehabilitative services
– the report should be on the patient’s
chart prior to coming to the Operating
Room
CHART DOCUMENTATION
laboratory testing
– basic testing includes CBC and UA
– may include other blood test,
depending on the patient’s age,
medical condition, and other medical
diseases
CHART DOCUMENTATION
laboratory testing
– CBC (complete blood count)
counts the number of each type of cell in
the blood
includes:
– RBC - red blood count - the number indicates
the blood’s ability to carry oxygen
– WBC - white blood count - the number indicates
the presence/absence of systemic infection
CHART DOCUMENTATION
laboratory testing
– CBC (complete blood count)
counts the number of each type of cell
in the blood
includes:
– H&H - Hemoglobin and Hematocrit - the
number indicates the ability to carry
oxygen and nutrients
– Diff - differential - counts the specific types
of white blood cells, indicating certain types
of infections
CHART DOCUMENTATION
laboratory testing
– UA
gives information regarding the body’s
metabolism and kidney function
includes:
– specific gravity - indicates how well the
kidneys save water and concentrate urine,
and the hydration state of the body
– pH - indicates the acid/base balance of the
body and the mechanisms that regulate acid
removal from the body
CHART DOCUMENTATION
laboratory testing
– UA
gives information regarding the body’s metabolism
and kidney function
includes:
– RBC/WBC - their abnormal presence indicates
infection/bleeding within the Urinary System
– protein/albumin - their abnormal presence indicates
poor kidney filtration/function
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
tests serum chemical levels in the
body, liver function, glucose
metabolism and essential electrolytes
in the body
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
includes:
– BUN - blood urea nitrogen - general indicator
of the kidney's ability to remove waste from the
blood stream
– Creatinine - a more specific indicator of
kidney function
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
includes:
– FBS - Fasting Blood Sugar - indicates the
circulating level of sugar available for cell
metabolism, and indirectly indicates the level
of insulin available for glucose transportation
into the cells
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
includes:
– SGOT/SGPT - Serum Glutamic Oxaloacetic
Transaminase and Serum Glutamic Pyruvic
Transaminase / Liver Enzymes - indicate liver
functioning and point to diseases such as
hepatitis, gallbladder disease, liver damage, and
cirrhosis
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
includes:
– LYTES - Electrolytes - sodium, chlorides,
potassium, and carbon dioxide - indicates
correct levels of these essential chemicals in
the blood which are necessary for normal
cell function
CHART DOCUMENTATION
laboratory testing
– Blood Chemistry or SMA-12
includes:
– Cholesterol and Triglycerides - indicate the
potential to form plaque within the
cardiovascular system
CHART DOCUMENTATION
laboratory testing
– PT/PTT
prothrombin time and partial
thromboplastin time
indicates the blood’s ability to clot,
indirectly indicating the potential to
bleed
CHART DOCUMENTATION
laboratory testing
– Type and Screen/Type and Crossmatch
identifying the factors in patient’s blood for
potential matching with replacement blood
units
laboratory matching of the patient's blood to
compatible units of replacement blood when a
blood transfusion is necessary
CHART DOCUMENTATION
laboratory testing
– other
thyroid screening (T3, T4, TSH)
medication levels - digoxin,
antibiotics, dilantin
CHART DOCUMENTATION
chest x-ray
– evaluates the lung’s ability to transfer
oxygen, carbon dioxide and
anesthetic gasses
EKG
– measurement of the heart’s electrical
conduction to indicate cardiac muscle
action and function
CHART DOCUMENTATION
vital signs
– body temperature
– blood pressure
– pulse
– respirations
CHART DOCUMENTATION
consent
– valid consent - see notes
PATIENT CHECKLIST
removal of prosthetics
– dentures
– artificial limbs
– contact lenses/eyeglasses
– hearing aides
– wigs
– rings/watches/jewelry
PATIENT CHECKLIST
voiding
pre-operative medications
patient identification
– identification bracelet
– allergy bracelet
PREOPERATIVE CARE
THE PATIENT
OF