As we explained in the previous notes, the pre-operative stage is a relatively long period. The immediate pre-operative nursing care however is referring to the day of the surgery or the last few hours leading up to it. At this stage, the nurse re-evaluates the patient’s case and ensures that all protocols have been completed.
In these notes, we’ll be going over the nursing care given in the last few hours before the surgery. But before you study this, make sure that you have understood:
Immediate Pre-Operative Nursing Care Part 1: Introduction
Assuming that you haven’t met the patient before, start by introducing yourself and your role. Ask the patient their name and identification number, and place an ID Bracelet around their wrist. This will come in handy when the patient is unconscious and can not confirm their identity. In addition, ask the patient about their allergies and place an Allergy Bracelet if needed, as well as note if the patient has any limbs which can not be used for venous cannulation. This can occur in patients who previously had surgery on that side, stroke or other conditions. And if that is the case, most hospitals have a bracelet for that too. You should also ask the patient if any special considerations need to be taken when ambulating them.
Lastly, ask the patient to confirm the type of surgery they will be having and the anaesthesia type, and you can cross-reference this with the patient’s consent form and pre-op documents.
Immediate Pre-Operative Nursing Care Part 2: Vital Signs
Once the patient has settled in and the introduction has been complete, you should record their vital signs including:
Oxygen Saturation
Respiratory Rate
Blood Pressure
Pulse
Temperature
Blood Glucose for diabetic patients
Level of consciousness
Checking their vital signs pre-operatively serves several functions. Firstly it identifies any abnormal values and allows enough time to correct them before initiating surgery. Secondly, they will be used as baseline parameters to monitor the patient during the surgery and after. For example, if the patient’s blood pressure is normal before surgery, but during the immediate post-op, their blood pressure is insanely high it can indicate severe pain. However, if the patient already was hypertensive then the post-op nurse would know that it is likely a chronic condition.
Immediate Pre-Operative Nursing Care Part 3: Physical Preparation
Before going to the operating theatre, the patient must change into a hospital gown. Ask your patient to remove all personal clothing from underneath the gown, and close it at the backside. Any prosthetic devices including dentures must be removed. In addition, all jewellery, contact lenses, make-up, hair extensions, nail polish, hair ties and hairpins must be removed. Provide a hair net for your patient, and a pair of hospital shoes if available.
Once the patient is finished changing into the hospital gown, you should assess the surgery site. Check if the patient requires shaving to remove excess hair, and note down any bruises, dryness or skin irritations as necessary. You should also encourage the patient to void their bladder before the surgery.
Immediate Pre-Operative Nursing Care Part 4: Pre-op Medications
For the majority of the cases, pre-anaesthetic medication is not prescribed however, if the patient is extremely anxious a calming agent might be indicated. Such agents will most likely be controlled drugs (DDAs), so make sure to chart them correctly when retrieving the medication. And once administered, pay close attention to the patient’s safety as they can inhibit certain reflexes leaving the patient at a higher risk of injury.
Administering Antibiotics preoperatively has been shown to decrease the risk of surgical site infections. The time of administration depends largely on the surgeon’s preference. Some might prescribe it hours before the surgery while others prefer to have it administered minutes before cutting through the patient’s skin.
Keep an eye out for pre-operative medications that are surgery specific such as immunosuppressants in patients receiving an organ transplant, or bowel preparation in patients undergoing general surgery. In addition, the patient’s regular medication regimen is to be reviewed and adjusted accordingly. Certain medications such as blood-thinning agents or hypoglycaemic agents are often omitted before the surgery to avoid intra-op complications.
Since the patient will most likely be starved for the surgery, their fluid levels will need additional support. An IV hydration is typically set up, to keep the patient’s electrolytes balanced and a specific Diabetic IV Protocol is used for patients with diabetes.
Immediate Pre-Operative Nursing Care Part 5: Documentation
The Pre-operative documentation should have been completed earlier in the pre-op phase, and you can find all the details about it over here. But during the immediate pre-operative phase, you should confirm that the following documents are present:
Medical History
Medical Assessment
Informed consent
Fill out the ward pre-operative checklist, and keep any empty copy of the WHO surgical safety checklist which will be done in the operating theatre. Moreover, make sure that you have documented the:
Baseline vital signs
Signed all administered medication
Wrote the nursing report
Immediate Pre-Operative Nursing Care Part 6: Psychosocial Support
As the surgery time gets closer, the patient will likely get more anxious and giving attention to their psychological needs is vital in the pre-operative phase. Studies have shown that increased anxiety pre-operatively was linked to higher complications post-operatively. So ask your patient how they’re feeling and if they have any concerns or worries that they’d like to discuss.
Without going into too much detail, explain to the patient what they can expect and what will happen when they’re taken into the operating theatre. Use simple words according to their level of education, and reassure the patient that the benefits outweigh the risks of the surgery. You can also use deep breathing techniques, music or distractions to calm down the patient’s nerves. And ask them about their spiritual beliefs, saying a prayer might not mean anything to you but would go a long way in comforting the patient.
Immediate Pre-Operative Nursing Care Part 7: Attending to the patient’s relatives
Once the patient is taken in for surgery, you should shift your focus onto their caregivers and relatives. Those who truly care for their loved ones can sometimes be just as anxious as the patient themselves, and with a few small interventions, you could greatly help with that. Keep them informed about what is happening, and if need be take time to educate them about the surgery and what they can expect in the post-op phase.
Offer them supportive services, and encourage them to look after their well-being too as the primary caregivers often feel a large burden and neglect themselves. Moreover, offer them a space where they can wait for the patient and ensure that you have a contact number to call them when the patient is ready for visitation again.