Assignment

English Lesson 2nd

By :

Fina Aprilia (181560111080)

Herlina (181560111082)

Maudy Damayanti (181560111085)

Mulhayana (181560111089)

Vingka Anba Luthfi (181560111107)

Bachelor of Nursing

Pre-operative Assessment

Question

1. Doing pre-operative checks

2. Giving pre-operative patient education
3. Preparing patient education
4. Allying anxiety in a patient and use pre-operative checklists

Answering

1. Preoperative nursing is the initial stage of perioperative nursing. Preoperative care is

the first stage of perioperative care that begins when the patient is admitted into the
receiving room and ends when the patient is transferred to the operating table for
surgery (Mirianti, 2011). An integral assessment of the patient's function including
physical, biological and psychological functions is very necessary for the success and
success of an operation. In this case preparation before surgery is very important to
support the success of surgery. Preparations for surgery that can be done include
physiological preparations, where these preparations are preparations made from
physical preparation, supporting preparation, examination of anesthesia status to
informed consent. In addition to physiological preparation, psychological preparation
or mental preparation is no less important in the process of preparation for surgery
because the patient's mentality is not ready or can affect the physical condition of the
patient (Smeltzer, et al., 2008). Client preparation in the care unit, including (Surgery,
2010):
a. Physical preparation
Various physical preparations that must be performed on the patient before
surgery include:
1) General Physical Health Status
Before surgery, it is important to examine the general health status,
including the client's identity, history of diseases such as past health,
family health history, complete physical examination, including
hemodynamic status, cardiovascular status, respiratory status, kidney and
hepatic function, endocrine function, immunological function, and others.
In addition, patients must get adequate rest because with adequate rest the
patient will not experience physical stress, the body is more relaxed so for
patients who have a history of hypertension, their blood pressure can be
stable and female patients will not trigger menstruation earlier.
2) Nutrition Status
Nutritional requirements are determined by measuring height and
weight, triceps skin fold, upper arm circumference, blood protein levels
(albumin and globulin) and nitrogen balance. All forms of nutritional
deficiencies must be corrected before surgery to provide enough protein
for tissue repair. Poor nutritional conditions can result in patients
experiencing various postoperative complications and resulting in patients
being treated longer in hospital.
3) Fluid and Electrolyte Balance
Fluid balance needs to be considered in relation to fluid input and
output. Likewise, serum electrolyte levels must be within the normal
range. Fluid and electrolyte balance is closely related to kidney function.
Where the kidneys function to regulate the mechanism of acid-base and
metabolic excretion of anesthetic drugs. If kidney function is good then
surgery can be done well.
4) Shaving the Operations Area
 Shaving in the operating area is intended to avoid infection in the area
under surgery because unshaved hair can be a hiding place for germs and
also disrupt / inhibit the process of healing and wound care. However there
are certain conditions that do not require pruning before surgery, for
example in patients incision wounds to the arm. Shaving measures
(scheren) must be done carefully not to cause injury to the shaved area.
Often patients are given the opportunity to shave themselves so that
patients feel more comfortable. The area to be shaved depends on the type
of operation and the area to be operated on.
5) Personal Hygiene
Cleanliness of the patient's body is very important for the preparation
of surgery because a dirty body can be a source of germs and can cause
infection in the operating area. In patients with strong physical condition it
is recommended to bathe themselves and clean the operating area more
thoroughly. Conversely, if the patient is unable to meet the needs of
personal hygiene independently, the nurse will provide assistance to meet
the needs of personal hygiene.
6) Emptying the Bladder
Bladder emptying is done by installing a catheter. In addition to
emptying the contents of the bladder catheterization measures are also
needed to observe the fluid balance.
7) Preoperative Training
Various exercises are needed in patients before surgery, this is very
important as a preparation for patients in dealing with post-operative
conditions, such as: pain in the operating area, coughing and a lot of
mucus in the throat. Exercises given to patients before operations,
including:
a) Deep breathing exercises
Deep breathing exercises are very beneficial for patients
to reduce pain after surgery and can help patients relax so that
patients are better able to adapt to pain and can improve sleep
quality. In addition this technique can also improve pulmonary
ventilation and blood oxygenation after general anesthesia. By
doing deep and effective breathing exercises the patient can
 immediately practice this immediately after surgery according
to the conditions and needs of the patient.
b) Effective Cough Exercise
Effective cough training is also very necessary for
clients, especially clients who undergo surgery with general
anesthesia. Because patients will experience the installation of
breathing aids while in anesthetized conditions. So that when
conscious the patient will experience discomfort in the throat.
With feeling a lot of thick mucus in the throat. Effective cough
exercises are very beneficial for patients after surgery to
remove the mucus or secretions.
c) Joint Exercise Exercises Joint motion exercises are very
important for patients so that after surgery, patients can
immediately make the various movements needed to accelerate
the healing process. Patients / family of patients often have
wrong views about the patient's movements after surgery.
Many patients do not dare to move their bodies because they
are afraid that the stitches will be torn or the surgical wound
will heal. This view is clearly wrong because precisely if the
patient completes the operation and moves immediately, the
patient will more quickly stimulate the intestine (intestinal
peristalsis) so that the patient will fart faster / flatus. Another
advantage is to avoid the accumulation of mucus in the
respiratory tract and avoid joint contractures and the occurrence
of pressure sores. Another goal is to facilitate circulation to
prevent venous stasis and support optimal respiratory function.
d) Supporting Preparation
Supporting preparation is an inseparable part of the
surgical procedure. Without the results of supporting
examinations, the surgeon may not be able to determine the
operation that must be done on the patient. Supporting
examinations in question are various radiological, laboratory
and other examinations such as ECG, and others. Before the
doctor makes the decision to operate on the patient, the doctor
 conducts various examinations related to complaints of the
patient's disease so the doctor can deduce the patient's illness.
After the surgeon decides to operate, the anesthesiologist has a
role in determining whether the patient's condition is
appropriate for surgery. For that, the anesthesiologist also
requires a variety of laboratory examinations, especially
examining the bleeding period (bledding time) and the clotting
time (clotting time) of the patient's blood, serum electrolytes,
hemoglobin, blood proteins, and radiological examination
results in the form of chest radiograph and ECG.
e) Anesthesia Status Check
Examination of physical status for anesthesia needs to
be done for safety during surgery. Before anesthesia is
performed for the sake of surgery, the patient will undergo an
examination of the physical status needed to assess the extent
of the risk of anesthesia on the patient. Examination that is
commonly used is examination using the ASA (American
Society of Anasthesiologist) method. This examination is done
because drugs and anesthesia techniques in general will
interfere with respiratory function, blood circulation and
nervous system.
f) Inform Consent
In addition to carrying out various kinds of supporting
examinations on patients, another very important thing is
related to the legal aspects and responsibilities and
accountability, namely Inform Consent. Both the patient and
his family must be aware that medical procedures, even the
smallest operation has risks. Therefore, every patient who will
undergo medical treatment, must write a written statement of
consent for medical treatment (surgery and anesthesia). Inform
Consent as a manifestation of the hospital's efforts to uphold
the ethical aspects of the law, the patient or person responsible
for the patient is obliged to sign a letter of approval of the
operation. This means that any action taken on a patient is
 related to surgery, the family knows the benefits and goals and
all the risks and consequences. Patients and their families
before signing the statement will get detailed information
related to all kinds of examination, surgery and anesthesia
procedures that will be undertaken. If the officer has not
explained in detail, then the patient / family has the right to ask
again until they really understand. This is very important to do
because if not, the regrets will be experienced by the patient /
family after the surgery is not in accordance with the family
description.
g) Mental / Psychological Preparation
Mental preparation is no less important in the process of
preparation for surgery because a patient's mentality that is not
ready or unstable can affect his physical condition Surgery is a
potential or actual threat to someone's integrity that can evoke
physiological and psychological stress reactions (Barbara C.
Long, 2000 ). Example: physiological changes that arise due to
anxiety and fear for example a patient with a history of
hypertension if experiencing anxiety before surgery can cause
the patient to have difficulty sleeping and his blood pressure
will increase so that the operation can canceled. Fear and
anxiety that patients may experience can be detected by
physical changes such as: increased heart rate and breathing
frequency, blood pressure, uncontrolled hand movements,
moist palms, restlessness, asking the same questions over and
over, difficult sleep, and urinate frequently. Nurses need to
review coping mechanisms commonly used by patients in
dealing with stress. Besides that nurses need to study things
that can be used to help patients deal with these problems of
fear and anxiety, such as the presence of a close person, the
level of patient development, supporting factors / support
system .
 Pre-op is the time before your surgery. It means "before operation."
During this time, you will meet with one of your doctors. This may be your
surgeon or primary care doctor

 Clearly mark the site to be operated on with the patient’s agreement while the
patient awake and prior to premedication. Ensure that the mark is visible when
draped.
 Verify the operation to be undertaken by checking the records, including
images and consent form and, where possible, with the patient, rather than
relying solely on the printed operating list for the procedure being performed.
 Ensure that the written consent and the notes include, when appropriate, the
side to be operated on using the words ‘left’ or ‘right’ in full.
 Ensure that digits on the hand are named and on the foot numbered and
similarly marked with the patient’s agreement while they are awake and prior
to premedication.
 Ensure that any instruction to withhold or withdraw treatment (for example,
resuscitation categorisation) is taken in consultation with the patient or family
and authorised by the appropriate senior clinician.
 Establish the views held by individual patients regarding their position in
relation to transfusion, in case certain forms of transfusion may be
unacceptable to them.

2. Health education before surgery is very important to be done by nurses. Before the
operation, the nurse carries out a review of the client's health history. As an
assessment of physical examination, vital signs, psychological, and spiritual. One of
the roles of nurses is to provide important explanations. In addition, the nurse in
charge of the Informed Consent is the approval of the consent given by the doctor and
the client and family who has previously given an explanation of the surgery and the
risks. Preoperative counseling is defined as a supportive and educational measure
performed by nurses to assist surgical clients to improve their own health before and
continuing surgery. Client demands will assist nursing in the area of decision making,
additional knowledge, skills, and behavior change. In providing clients who need
surgery, if necessary, the client must give a long time before the surgery allows the
 client to forget, likewise if too close to the time of surgery the client cannot facilitate
learning because it requires help or the effect of drugs before anesthesia.

3. Preparing patient education

a. Give information to the patient and family the date, time and location of the
surger
b. Give information to the patient and the closest person how long the operation
will be
c. Review previous surgical experience and client's level of knowledge related to
surgery
d. Assess patient / family anxiety related to surgery
e. Give the patient time to ask questions and discuss matters of concern
f. Describe the routine that was carried out before the operation (anesthesia, diet,
etc.)
g. Explain preoperative medication, effects that will occur and rationalization of
usage
h. Give information to the closest person about the place where the surgery is
waiting for
i. Provide information about what will be heard, felt, smelled and seen during
the incident
j. Discuss possible pain management
k. Explain the purpose of the post operative assessment
l. Provide an explanation of the post operative routines / equipment that might
be used (dressing changes, medication etc.) and provide an explanation of
each other's goals.
m. Give the patient an explanation of the technique of changing the position of
the bed appropriately
n. Evaluate the patient's ability to demonstrate how to change positions
appropriately
o. Give the patient an explanation on how to use spirometry incentives
 p. Evaluate the patient's ability to demonstrate the ability to use spirometry
incentives appropriately
q. Give the patient an explanation of how to suppress the surgical site, effective
cough and deep breathing
r. Evaluate the patient's ability to demonstrate the ability to suppress the surgical
site, effective cough and deep breathing appropriately
s. Give the patient an explanation of the technique of leg training
t. Evaluate the patient's ability to repeat leg exercises
u. Emphasize the importance of early ambulation and pulmonary care
v. Give information about how they can help in the recovery period
w. Support the provision of information by other health providers appropriately
x. Identify patient expectations after surgery
y. Improve patient expectations that are not realistic
z. Give the patient time to explain the event that will occur &Involve family and
closest people
4. A pre -oprative visit refers to communicationbetween a surgical patient and a theatre
nurse inthe period before the patient is taken to theatre.Hayward (1975), in his classic
research publicationInformation: A Prescription Against Pain, statedthat it is an
unfortunate truth that most patientsenter hospitals and operating rooms with unnec-
essary fears and anxieties. A great part of the appre-hension stems from a lack of
knowledge concerningtheir illness and the operative procedure that is tobe performed
on them. He also highlights that thepersistence of these anxieties often interferes
greatlywith smooth post-operative results. Kalideen (1991) concluded that Hayward’s
studyindicated that good psychological preparation pre-operatively contributed
greatly to reduced analge-sia requirements in the post-operative period. Egbertet al
(1963) showed that the pre-operative visit byan anaesthetist reduced anxiety and
related signsand symptoms, for example, fear of pain, fear ofthe anaesthetic and fear
of perhaps not wakingup. The patient’s ability to understand and retaininformation
depends greatly on the communica-tion skills and experience of the medical
attendant(Egbert et al 1963). Weschler-Evans (1990) sug-gested that by having made
contact with a mem-ber of the theatre staff, patients were often anxiousto retain the
relationship as emotional support.The combination of essential physical aspects
ofcare, lack of time, the increasing complexity of surgery,shorter hospital stays and an
increased turnover haslargely prohibited the introduction of formalised careplans to
address the more marginal issues, such aseffective anxiety management (Cahill 1999).
Numerous research studies have suggested waysin which the management of anxiety
can be improved(De Groot et al 1997, Linden and Engberg 1996,Mitchell
2000).Martin (1996) in a quasi-experimental design study,evaluated the effect of pre-
operative visits by the-atre nurses on pre- and post-operative levels of anx-iety in two
groups of general surgical patients, tosee if the outcome was reflected in the level of
post-operative pain, nausea, mobility or length of hos-pitalisation. A combination of
qualitative andquantitative research was used. Rees (1997) states:‘Qualitative research
believes that if we are to under-stand a topic, we need to look at it through theeyes of
those who experience it, and try to under-stand it from their point of view.’
Quantitative research is defined as a formal, objective, system-atic process in which
numerical data are used toobtain information about the world (Burns and Grove1995).
The outcome of any research project is depen-dent on the reliability of the method
used and thetype and quality of the sample on whom the resultsare based (Rees 1997).
The sample consisted of 40elective general surgical patients of both sexes in alocal
general hospital. The criteria to be met werethat the patients were over the age of 16,
willingto take part in the study, able to comprehend ver-bal instruction and expected
to stay in hospital forat least 24 hours. One group received pre-operativevisits, but the
other group did not.Three of the most common ways of collectingquantitative data are
to observe behaviour using astandardised checklist, to survey a sample of
thepopulation using a standardised questionnaire, orto measure performance
following some experi-mental manipulation (Tarling and Crofts 1998).Questionnaires
must produce data that are reliableand valid for the information to be of use to
nursesand healthcare professionals (Jack and Clark 1998). Polit and Hungler (1997)
state that the reliability ofa questionnaire refers to the consistency with
whichrespondents understand and respond to all thequestions. Validity is the extent to
which a ques-tionnaire measures what it is supposed to measure(Polit and Hungler
1997). The results of Martin’s (1996) study demonstrateda significant decrease in
anxiety 24 to 72 hours post-operatively for the visited group. A positive rela-tionship
was also found between pre-operativeanxiety levels and the level of pain, nausea and
lackof independence experienced by both groups. Lengthof hospitalisation was
unaffected in either group.The study concluded that patients who are proneto feelings
of anxiety might demonstrate increasedpre-operative anxiety, and that all surgical
patientsshould receive a visit from the theatre nurse to informthem about the
forthcoming surgical experience.

5. Feature N%
Male gender 131 (29.5)
Age in median years (range) 50 (18–91)
Level of education
Less than middle school 63 (14.2)
SMA 126 (28.4)
Colleges 197 (44,4)
University 58 (13.1)
Number of previous surgical
operations 52 (11.7)
 0 64 (14.4)
 1 71 (16.0)
 2 58 (13.1)
 3 32 (7.2)
 4 36 (8.1)
 5 31 (7.0)
 6 21 (4.7)
 7 14 (3.2)
 8 5 (1.1)
 9 8 (1.8)
 10 52 (11.7)
>10 161 (36.3)
Previous error in treatment: Yes 58 (13.1).
Active as a clinician (doctor or
nurse)