BAKERSFIELD COLLEGE

LICENSED VOCATIONAL NURSING PROGRAM

1ST SEMESTER FUNDAMENTALS

CLIENTS WITH SPECIAL NEEDS

CHAPTER 50 - THE SURGICAL CLIENT: PREOPERATIVE CARE

INTRODUCTION

The goal of this module is to assist you in providing adequate emotional and physical
support to clients and family members during a clients surgical experience. The
anticipation of surgery produces considerable fear in the client who faces many
unknowns.

OBJECTIVES

Upon completion of this unit, the student will be able to:

A. Theory
1. Define Perioperative nursing.
2. List four pathological processes responsible for most surgical conditions
and give an example of a surgical condition for each process.
3. List the three major classifications for all surgical procedures.
4. List and describe the five purposes of surgery.
5. Describe three conditions that increase a persons surgical risk.
6. Identify and state the purpose of lab work and tests that might be ordered
preoperatively.
7. List factors to include in the preoperative assessment of the surgical client.
8. Identify who is responsible to provide information for the informed
consent.
9. State what the nurses signature on a consent form means.
10. Identify who can sign a surgical consent.
11. Describe how fear and anxiety is expressed by the surgical client.
12. List each step of the preoperative check list.
13. Identify medications and their purpose that are used as preops.

B. Laboratory
1. Demonstrate postoperative exercises: diaphragmatic breathing, coughing,
turning, and leg exercises.
ASSIGNMENT

A. Read Chapter 50- Potter & Perry pgs. 1365 1390, omit N/Gs, Critical
Thinking Exercise # 2 and Review Questions

B. Study Guide for Chapter 50

Chapter 50 The Surgical Client

Preoperative Care
o The goal of this unit is to assist you in providing adequate emotional and
physical support to clients and family members during a surgical
experience
The anticipation of surgery produces considerable fear in the client who faces
many unknowns

History of Surgical Nursing

Nursing played a major role in disease prevention.
Early surgical nurses
o Cleaned rooms and equipment, obtained supplies, cared for clients
postoperatively
Association of Operating Room Nurses
o Established 1956
Ambulatory surgery

o Perioperative Nursing
Refers to the role of the operating nurse during the preoperative, intraoperative,
and postoperative phases of surgery
In some institutions this is the way it is done and in others different nurses care
for the client during each phase of the surgical experience

Four Pathological Processes Responsible for Surgical Conditions

Obstruction
o blocks flow of body substances
Perforation
o Rupture of body part
Erosion
o Result of continuous irritation; infection
Tumors
o Benign or malignant
 Classification of Surgery
Seriousness
o Major
Length of procedure
Blood loss
Risk of post-op complications
o Minor
Brief procedure
Minimal risk

Urgency
o Elective
Performed for clients well being
Not absolutely necessary
o Urgent
Necessary for clients health
Prevent additional problems
o Emergency
Immediate need to save a life
Preserve a body part

Purpose Why it is done

o Diagnostic
To confirm diagnosis
o Ablative
Excise or remove diseased body part
o Palliative
Relieve symptoms
o Reconstructive
Restores function or appearance
o Transplant
Replace organs
o Constructive
Restores function lost from congenital anomalies
- Cosmetic
To improve appearance

Preoperative Surgical Phase

Surgical clients enter the health care setting in different stages of health
Some enter with a planned surgery and some through the emergency department

Assessment
History
o client age
o Past illnesses and surgeries
 o Medical conditions
Review client and family members understanding and perception of surgery
Medication history
Smoking habits
o Risk for respiratory complications
Alcohol ingestion
o Reactions to anesthesia
o Need more analgesia post-op
Family support
o Provide assistance during recovery
Occupation
o May not be able to return to former job
Review of emotional health
o Verbalize fears and feelings

Physical exam
o Focus on body systems affected by surgery
o Monitor vital signs

Estimation of Surgical Risk

Physical and Mental Condition
o Clients at risk
Age
Obesity
Fluid or electrolyte imbalance

Extent of Disease
Magnitude of Operation
Resources and Preparation of:
o Surgeon, nurses, hospital

Nursing Diagnosis
Preoperative diagnoses:
o Fear
o Knowledge deficit
o Risk for ineffective airway clearance

Planning and Implementation

o Informed consent
Client must understand procedure and risks
Physician responsibility to inform client
Client must be alert and oriented
Client signature implies he is informed
Witnessed by member of health care team
 Nurse verifies consent with client
Check for time limit on signed consent
Nurse witness verifies only client signed consent

Who can sign the consent form?

Legal age
Underage but married
Emancipated minor
Without legal guardianship
Parent or guardian of minor
Spouse or next of kin for unconscious or mentally incompetent
Telephone consent obtained by 2 witnesses or telegram
Court order
Emergency situations the surgeon can perform without a consent

Preoperative Teaching
Office or home setting
o Printed literature
o Video tapes
Admission or pre-admission nurses
o Educate clients and family members
Better prepared and less anxious
AORN Criteria

Client sites reasons for each of preop instructions

o Diaphragmatic breathing
Improves lung expansion
o Incentive spirometry
o Controlled coughing
Removes secretions
o Turning
Improves blood flow
o Leg exercises
Prevents clots

The client states the time surgery is scheduled

The client states the unit to which he will return to after surgery
The client discusses anticipated monitoring and therapeutic devices
The client describes the scheduled procedure and treatment plan
The client describes anticipated recovery steps
The client verbalizes expectations of pain and pain relief measures
The client expresses feelings regarding the surgical intervention and the expected
outcome
 Physical preparation
Maintenance of normal fluid and electrolyte balance
o NPO at midnight
o May brush teeth and rinse without swallowing water
o Notify MD if client eats or drinks during NPO period
Minimize the risk of surgical wound infection
o Bath evening before surgery with antimicrobial soap
o Skin prep or shave
Prevent bowel and bladder incontinence
o Absence of peristalsis for 24 hrs >
Promote rest and comfort
o Provide a quiet environment
o Administer sedative-hypnotic
o Day of Surgery
pre-op checklist
Check the chart
Check and record vital signs
Provide hygiene
Check hair and cosmetics
Remove prosthetics
Void before pre-op medications
o Empty foley or insert one if ordered
Check anti-embolic stockings
Promote client dignity
Perform special procedures
o Start IV
o NG
o Foley
Safeguard valuables
Preop Medications
o Barbituates
Decrease anxiety, BP and pulse
o Tranquilizers
Decrease anxiety and BP
o Narcotic analgesics
Provide sedation
Reduce pain
Decrease amount of anesthesia
o Anticholinergics
Decrease mucous secretions
o On call
Meds may be given on call to OR
o After administration of preops
Side rails up
 Lights low
Bed in low position
Family may remain quietly with patient