Preoperative care: Nursing

Preoperative care is the preparation and management of a client during the preoperative period, which is the time period between the decision to perform a surgery and the beginning of the surgical procedure.

Alright, so the first step of preoperative care starts with the surgeon, with a registered nurse as witness, obtaining informed consent from the client. Then comes the client’s history, asking about current medications, especially the high-risk ones like anticoagulants; alcohol intake; cigarette smoking; illicit drug use; in addition to a personal or family history of complications from anesthesia; as well as allergies; or chronic illnesses, such as hypertension, diabetes, and anemia.

Clients should also be assessed for risk factors of obstructive sleep apnea since this condition can interfere with breathing when the client is under general anesthesia. The risk factors are summarized with the STOP-BANG mnemonic that stands for snoring history, tiredness during the day, observed breathing cessation during sleep, high blood pressure, in addition to a body mass index of higher than 35 kg/m2, age over 50 years, as well as neck circumference larger than 40 centimeters, and gender biological male.

This is typically followed by diagnostic studies as needed like electrocardiogram or ECG; as well as imaging studies. In addition, clients should obtain the indicated laboratory tests, such as a complete blood count or CBC, coagulation profile, blood typing, and pregnancy test as needed.

Lastly, the preoperative care is wrapped up with the client's education, in order to prepare them for the surgical procedure and let them know what to expect after the procedure.

Okay, let’s look at the nursing care you’ll provide to a client during the preoperative period. Your priority goals of care include preparing the client for surgery, establishing a baseline assessment, and providing psychosocial support.

Begin preparing your client for surgery by reviewing the preoperative checklist. Confirm your client has the correct identification and allergy bands on, and that informed consent has been obtained. Then, ask your client about the last time they had anything to eat or drink and keep them NPO, as ordered. Remove any personal items, such as jewelry, glasses, or dentures, and secure them according to your facility policy. Next, insert a urinary catheter and a large bore IV cannula, and administer the prescribed IV fluids and preoperative medications. Also be sure to confirm that the surgical site has been marked by the surgeon.

Then, conduct a thorough baseline assessment, including vital signs, oxygen saturation, heart and lung sounds, peripheral pulses, bowel sounds, and LOC. Remember to apply warm blankets to prevent hypothermia.

Confirm that the surgical history and physical are complete; an anesthesia assessment is documented; results of preoperative laboratory and diagnostic tests are on the client’s chart; blood type and crossmatch has been completed; and that blood products are available if needed.