The pre-operative nursing stage is a relatively long period. It starts from the moment the patient is informed about the need for a surgical intervention up until they reach the operating theatre. The goal during this period is to prepare the patient in a way that reduces the risk of complications both during and after surgery.
In these notes, we’ll discuss the nursing assessment, diagnoses and interventions required for all surgeries in the pre-operative phase. However, keep in mind that some surgeries might require specific preparation so always look out for additional interventions that may be necessary. Moreover, it would be useful if you also read the notes on Pre-Operative Documentation, as they form a crucial part of nursing care.
Pre-Operative Nursing Assessment
As we mentioned above, the goal in the pre-operative phase is to identify any risk factors that might complicate the surgery or the recovery and then implement strategies to reduce them. There are five main tasks that you need to perform during the pre-operative nursing assessment, these include:
Obtaining the patient’s medical history
Performing a physical examination
Evaluating the patient’s psychosocial factors
Get all the required medical tests
Ensure all pre-operative documentation is in order
If you need more details about the pre-operative nursing assessment you can hop over to the previous notes over here.
Pre-Operative Nursing Diagnoses
Deficient Knowledge
Anxiety and Fear
Dehydration
Pre-Operative Nursing Interventions
1. Managing Knowledge Deficiency
Several studies have shown that patients who were well educated about their surgeries had better outcomes post-operatively. And this makes sense for a couple of reasons, firstly being knowledgeable about the surgery will reduce the patient’s anxiety and fear of the unknown. So take time and use different resources and without going into too much detail explain the surgical pathway.
Start off by explaining what the surgery is, why it is needed and how it will help the patient in the future. Explain when they’ll be admitted, what thing they should bring with them and whether there’s any change in their regular medication or new medication to be started before their admission. Go over the routine that is expected on the day of the surgery, how they will be prepared and if needed when they have to start fasting. Discuss the type of anaesthesia, how long the surgery is expected to be and what they can expect when the surgery is complete.
You should also talk about the post-operative phase and what they can expect. Whether they will have any IV lines, drains, casts or additional equipment. Where the incision site is expected to be and how the post-operative pain will be managed. Having a good understanding of how things will be managed gives the patient a sense of control and decreases their anxiety.
Lastly, you should also educate the patient about exercises that they’ll be required to perform post-operatively including:
Deep breathing exercises to avoid post-op lung complications
Early ambulation to reduce the risk of deep vein thrombosis, improve circulation and avoid bed sores.
2. Managing Anxiety and Fear
Experiencing anxiety and fear before a surgical intervention is extremely common, and in most cases, this stress stems from a lack of understanding. Patients often feel anxious because they have no control over their situation and similarly, they experience fear because they can not anticipate what is about to happen. However, these factors can be controlled through adequate education, support and anxiety controlling techniques.
Start by creating a safe space where your patient feels comfortable voicing their feelings and expressing their concerns. While talking to your patient evaluate their body language, constant fidgeting, avoidance, crying or not talking are all signs that the patient is uncomfortable. Ask the patient what they know about their situation and move on from there educating as necessary. Moreover, assure the patient that the surgical team is professional and they will do their utmost to ensure the best possible outcome.
Encourage your patient to join a support group or look out for other individuals who have previously had the same surgery. Sharing experiences can provide a greater sense of support and motivation for the patient. Lastly, you can use deep breathing techniques, music therapy or imagery to distract the patient and reorient their focus onto something more pleasant.
3. Managing Dehydration
In cases where the surgery requires general anaesthesia, the patient will have to fast (not eat or drink) for a minimum of 6 hours before the surgery. When giving anaesthesia and intubating, the patient is at risk of pulmonary aspiration, and this risk increases drastically if the patient does not have an empty stomach. Despite the more recent studies, showing that patients do not need to be starved for more than 6 hours, and that clear fluids do not impact the risk of aspiration, most patients are still starved for more than they need to be.
In fact, being starved from midnight is common practice amongst many practitioners. To counteract the extended period of starvation, most patients are started on IV fluids that keep their electrolytes balanced. In addition, if the patient is diabetic then their fluid regimen is slightly different and they will be on a diabetic protocol to keep their blood glucose within a normal range.
Pre-Operative Nursing Outcomes
The three points mentioned above are the basic foundation of pre-operative nursing, and the goal is to educate the patient, decrease their anxiety and ensure that they’re sufficiently hydrated. However, most surgeries will require additional interventions ranging from skin preparation, bowel preparation and specific pre-operative medications. So always ensure to look out for any surgery specific protocols.