Preoperative Phase of Surgery

The preoperative phase of surgery starts when your patient’s time of surgery is confirmed and ends with the start of their surgery. When caring for your patient during this phase, you’ll promote patient safety by following the steps of the Clinical Judgment Measurement Model to make clinical decisions regarding patient care.

Alright, as the preoperative nurse, you’ll ensure patient safety by recognizing important cues. These cues can be gathered from the patient or their family members during your assessment. Important cues may include your patient’s medical history such as medication allergies, previous response to anesthesia and pain medications, surgical history, prescription and over-the-counter medications; as well as underlying health conditions that could potentially lead to complications during the surgery and postoperative recovery like atherosclerosis, cardiac dysrhythmias, or diabetes mellitus.

Other important cues can include results of preoperative tests, such as clotting factors or blood glucose. You’ll also ensure that consent for surgery has been signed. Also, evaluate your patient and their family members’ understanding of the surgical procedure and ensure their questions have been answered. Lastly, perform a psychosocial assessment to identify emotional support needs prior to surgery.

Next, you'll analyze these cues by determining the relationship between the cues and linking them to your patient’s history and clinical presentation. For example, you'll determine if your patient’s elevated heart rate and respirations are related to anxiety about their upcoming procedure or if they’re related to an underlying cardiovascular condition.

Next, you’ll determine a priority hypothesis related to the preoperative phase such as anxiety or risk for injury. You'll rank the hypotheses according to urgency or likelihood, as well as considering whether they’re potentially life-threatening, like a new onset cardiac dysrhythmia, or an immediate concern like anxiety about the upcoming surgery.

Based on this information, you’ll address the most serious or relevant hypothesis first, and then generate solutions. So, if your patient is exhibiting signs and symptoms of anxiety, such as irritability, restlessness, and expressing concern about their surgical procedure, you would generate a solution like, my patient’s anxiety will be managed to an acceptable level within one hour of intervention.