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.

Okay, once the solutions have been generated, you’ll take action to implement the solutions. For patients with anxiety, you can provide time for them to discuss their feelings and fears surrounding the procedure, answer their questions, and provide reassurance.

You may also collaborate with a counselor or spiritual advisor depending on your patient’s preferences, or administer preoperative anxiolytics, as prescribed.

Now, if your patient is at risk for injury due to a pre-existing condition, like chronic pain, monitor their pain and symptoms and reposition them as needed.

Be sure to inform the surgical team about the patient’s pre-existing condition to minimize the risk for injury intraoperatively or postoperatively.

Lastly, you'll evaluate whether the expected outcomes have been met by reassessing your patient. For example, you'll monitor their anxiety level to determine whether their condition is improving, declining, or remaining unchanged.

If their condition is declining or hasn’t changed, you’ll revise the plan of care, and take additional actions to address your patient’s condition.

So, if you notice your patient is still experiencing moderate anxiety after intervening, you'll bring this to the attention of the surgical team.

Alright, as a quick recap... The preoperative phase of surgery starts when your patient’s surgery is confirmed and ends with the start of their surgery.

When caring for your patient during this phase, you'll go through the steps of the Clinical Judgment Measurement Model to make clinical decisions about patient care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating