Preoperative care





Definition

Preoperative care is the preparation and management of a patient prior to surgery. It includes both physical and psychological preparation.


Purpose

Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. Preoperative teaching meets the patient's need for information regarding the surgical experience, which in turn may alleviate most of his or her fears. Patients who are more knowledgeable about what to expect after surgery, and who have an opportunity to express their goals and opinions, often cope better with postoperative pain and decreased mobility. Preoperative care is extremely important prior to any invasive procedure, regardless of whether the procedure is minimally invasive or a form of major surgery.

Preoperative teaching must be individualized for each patient. Some people want as much information as possible, while others prefer only minimal information because too much knowledge may increase their anxiety. Patients have different abilities to comprehend medical procedures; some prefer printed information, while others learn more from oral presentations. It is important for the patient to ask questions during preoperative teaching sessions.


Description

Preoperative care involves many components, and may be done the day before surgery in the hospital, or during the weeks before surgery on an outpatient basis. Many surgical procedures are now performed in a day surgery setting, and the patient is never admitted to the hospital.


Physical preparation

Physical preparation may consist of a complete medical history and physical exam, including the patient's surgical and anesthesia background. The patient should inform the physician and hospital staff if he or she has ever had an adverse reaction to anesthesia (such as anaphylactic shock), or if there is a family history of malignant hyperthermia. Laboratory tests may include complete blood count , electrolytes, prothrombin time, activated partial thromboplastin time, and urinalysis . The patient will most likely have an electrocardiogram (EKG) if he or she has a history of cardiac disease, or is over 50 years of age. A chest x ray is done if the patient has a history of respiratory disease. Part of the preparation includes assessment for risk factors that might impair healing, such as nutritional deficiencies, steroid use, radiation or chemotherapy, drug or alcohol abuse, or metabolic diseases such as diabetes. The patient should also provide a list of all medications, vitamins, and herbal or food supplements that he or she uses. Supplements are often overlooked, but may cause adverse effects when used with general anesthetics (e.g., St. John's wort, valerian root). Some supplements can prolong bleeding time (e.g., garlic, gingko biloba).

Latex allergy has become a public health concern. Latex is found in most sterile surgical gloves, and is a common component in other medical supplies including general anesthesia masks, tubing, and multi-dose medication vials. It is estimated that 1–6% of the general population and 8–17% of health care workers have this allergy. Children with disabilities are particularly susceptible. This includes children with spina bifida, congenital urological abnormalities, cerebral palsy, and Dandy-Walker syndrome. At least 50% of children with spina bifida are latex-sensitive as a result of early, frequent surgical exposure. There is currently no cure available for latex allergy, and research has found that the allergy accounts for up to 19% of all anaphylactic reactions during surgery. The best treatment is prevention, but immediate symptomatic treatment is required if the allergic response occurs. Every patient should be assessed for a potential latex reaction. Patients with latex sensitivity should have their chart flagged with a caution label. Latex-free gloves and supplies must be used for anyone with a documented latex allergy.

Bowel clearance may be ordered if the patient is having surgery of the lower gastrointestinal tract. The patient should start the bowel preparation early the evening before surgery to prevent interrupted sleep during the night. Some patients may benefit from a sleeping pill the night before surgery.

The night before surgery, skin preparation is often ordered, which can take the form of scrubbing with a special soap (i.e., Hibiclens), or possibly hair removal from the surgical area. Shaving hair is no longer recommended because studies show that this practice may increase the chance of infection. Instead, adhesive barrier drapes can contain hair growth on the skin around the incision.


Psychological preparation

Patients are often fearful or anxious about having surgery. It is often helpful for them to express their concerns to health care workers. This can be especially beneficial for patients who are critically ill, or who are having a high-risk procedure. The family needs to be included in psychological preoperative care. Pastoral care is usually offered in the hospital. If the patient has a fear of dying during surgery, this concern should be expressed, and the surgeon notified. In some cases, the procedure may be postponed until the patient feels more secure.

Children may be especially fearful. They should be allowed to have a parent with them as much as possible, as long as the parent is not demonstrably fearful and contributing to the child's apprehension. Children should be encouraged to bring a favorite toy or blanket to the hospital on the day of surgery.

Patients and families who are prepared psychologically tend to cope better with the patient's postoperative course. Preparation leads to superior outcomes since the goals of recovery are known ahead of time, and the patient is able to manage postoperative pain more effectively.

Informed consent

The patient's or guardian's written consent for the surgery is a vital portion of preoperative care. By law, the physician who will perform the procedure must explain the risks and benefits of the surgery, along with other treatment options. However, the nurse is often the person who actually witnesses the patient's signature on the consent form. It is important that the patient understands everything he or she has been told. Sometimes, patients are asked to explain what they were told so that the health care professional can determine how much is understood.

Patients who are mentally impaired, heavily sedated, or critically ill are not considered legally able to give consent. In this situation, the next of kin (spouse, adult child, adult sibling, or person with medical power of attorney ) may act as a surrogate and sign the consent form. Children under age 18 must have a parent or guardian sign.


Preoperative teaching

Preoperative teaching includes instruction about the preoperative period, the surgery itself, and the postoperative period.

Instruction about the preoperative period deals primarily with the arrival time, where the patient should go on the day of surgery, and how to prepare for surgery. For example, patients should be told how long they should be NPO (nothing by mouth), which medications to take prior to surgery, and the medications that should be brought with them (such as inhalers for patients with asthma).

Instruction about the surgery itself includes informing the patient about what will be done during the surgery, and how long the procedure is expected to take. The patient should be told where the incision will be. Children having surgery should be allowed to "practice" on a doll or stuffed animal. It may be helpful to demonstrate procedures on the doll prior to performing them on the child. It is also important for family members (or other concerned parties) to know where to wait during surgery, when they can expect progress information, and how long it will be before they can see the patient.

Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient's outcome. Instruction about expected activities can also increase compliance and help prevent complications. This includes the opportunity for the patient to practice coughing and deep breathing exercises, use an incentive spirometer, and practice splinting the incision. Additionally, the patient should be informed about early ambulation (getting out of bed). The patient should also be taught that the respiratory interventions decrease the occurrence of pneumonia, and that early leg exercises and ambulation decrease the risk of blood clots.

Patients hospitalized postoperatively should be informed about the tubes and equipment that they will have. These may include multiple intravenous lines, drainage tubes, dressings, and monitoring devices. In addition, they may have sequential compression stockings on their legs to prevent blood clots until they start ambulating.

Pain management is the primary concern for many patients having surgery. Preoperative instruction should include information about the pain management method that they will utilize postoperatively. Patients should be encouraged to ask for or take pain medication before the pain becomes unbearable, and should be taught how to rate their discomfort on a pain scale. This instruction allows the patients, and others who may be assessing them, to evaluate the pain consistently. If they will be using a patient-controlled analgesia pump, instruction should take place during the preoperative period. Use of alternative methods of pain control (distraction, imagery, positioning, mindfulness meditation, music therapy) may also be presented.

Finally, the patient should understand long-term goals such as when he or she will be able to eat solid food, go home, drive a car, and return to work.


Preparation

It is important to allow adequate time for preparation prior to surgery. The patient should understand that he or she has the right to add or strike out items on the generic consent form that do not pertain to the specific surgery. For example, a patient who is about to undergo a tonsillectomy might choose to strike out (and initial) an item that indicates sterility might be a complication of the operation.


Normal results

The anticipated outcome of preoperative care is a patient who is informed about the surgical course, and copes with it successfully. The goal is to decrease complications and promote recovery.

See also Pediatric concerns ; Postoperative care .


Resources

BOOKS

Beauchamp, Daniel R., M.D., Mark B. Evers, M.D., Kenneth L. Mattox, M.D., Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. London: W. B. Saunders Co., 2001.

Lawrence, Peter F., Richard M. Bell, and Merril T. Dayton, eds. Essentials of General Surgery, 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins, 2000.

Lubin, Michael F., H. Kenneth Walker, and Robert B. Smith, eds. Medical Management of the Surgical Patient, 4th ed. Cambridge, UK: Cambridge University Press, 2003.

Ponsky, Jeffrey, Michael Rosen, Jason Brodsky, M.D., Frederick Brody, M.D., and Jeffrey L. Ponsky. The Cleveland Clinic Guide to Surgical Patient Management, 1st ed. Philadelphia, PA: Mosby, 2002.

Switzer, Bobbiejean, M.D., ed. Handbook of Preoperative Assessment and Management. Philadelphia, PA: Lippincott Williams & Wilkins, 2000.


PERIODICALS

Dean, A., and T. Fawcett. "Nurses' use of evidence in pre-operative fasting." Nursing Standard 17, no.12 (December 2002): 33-7.

ORGANIZATIONS

National Institutes of Health. 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. Email: NIHInfo@OD.NIH. GOV. http://www.nih.gov/ .


Abby Wojahn, RN , BSN , CCRN Crystal H. Kaczkowski, M Sc



User Contributions:

hind
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Apr 28, 2006 @ 6:18 pm
thanks for the article it was so useful. I just want to make sure if preoperatice care is the same with preoperative ansethesia record or there is a diffrence ?
ondari joshua
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May 11, 2006 @ 2:14 pm
this is a very nice article. it has covered well all the essenial things in pre-op care.
Wesmosis
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Jun 24, 2006 @ 5:05 am
thanx for this awesome article, I'm gonna have a talk the next week about the Preoperative care
Soniya Joseph
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Sep 1, 2006 @ 5:05 am
This is very useful article.Just I want to know what all are the cases will do in day surgery unit?How will give pre operative care there?
Shena
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Jan 22, 2007 @ 9:09 am
i found this article especially helpful for my project on preoperative and post operative teaching to clients. thank you very much for the well presented and well explained article. my caps off to you.
momen kharraz
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Jan 30, 2007 @ 11:11 am
thanks for the nice and useful article,I hope support us with more articles
Daisy Democrito
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Feb 16, 2008 @ 11:11 am
thanks for the educational article.. it helps me to get a relevant information in regards my new corse.
Fayth
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Sep 4, 2008 @ 10:10 am
Thank you! it had all the information that i needed and gave it straight forward!
gNeLL
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Sep 18, 2008 @ 3:03 am
tHanx a lot for the very useful information,.. ^_^
zaid
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Nov 21, 2008 @ 1:01 am
thank so much . its realy nice , that really help me in my work and study
thanks again
mark
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Dec 20, 2008 @ 4:04 am
thanks a lot for this info..it helps me with my studies...
KRANTHI
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Apr 21, 2009 @ 11:11 am
THANKS FOR ABOVE ARTICLE IT HEPLED ME ALOT IN SURGERY
kristen
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Jun 6, 2009 @ 11:23 pm
great! i have learned a lot of things here. it's such a useful info and am pretty sure it will greatly help a lot of students like me! thanks!
Obunga
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Jun 26, 2009 @ 10:10 am
Thank am a final year student clinical medicine KMTC Kenya ,your article has realy inspired me . keep it up
JONATHAN AND ABASS(ABUTH)
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Jul 8, 2009 @ 6:06 am
THE ARTICLE IS QUITE USEFUL.MORE EMPHASIS ON OPERATIVE CARE IN TROPICAL PATIENTS.
suja rose paul
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Aug 1, 2009 @ 9:09 am
clear and concise article.helped me to have a quick look at pre-op care.good work
rubie ann
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Jan 14, 2010 @ 5:17 pm
thanx for the info. i'll be discussing this topic today.. this thing is a great help..
tammy
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Jan 14, 2010 @ 10:22 pm
i really benfit from this article...this article helped me pass my exam.
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Feb 7, 2010 @ 2:02 am
i am having this lecture on pre operative care and post operative care a month from now and i found this article so vivid... simple and very clear... thanks... i will appreciate more if you could send me more articles about pre and post op preparations on my email.
Zahid
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May 23, 2010 @ 10:10 am
That is fabulous article... it is really so beneficial for me... thanks a lot.
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Jul 28, 2010 @ 10:10 am
it is a nice article but it lacks some information..i would like to have more knowledge about everything that is related operations.
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Nov 14, 2010 @ 9:09 am
thanks a lot..very nice article..very informative, it really helped me a lot..thanks again :D
sls
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Dec 12, 2010 @ 7:19 pm
do patients have the right to revoke consent at any time before surgery?
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Aug 11, 2011 @ 7:07 am
A VERY GOOD ARTICLE IT HAS HELPED ME AS A STUDENT.
zoshan
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Sep 8, 2011 @ 10:22 pm
its a really good articles..it has helped me on my project of preoperative care, thankx alot..
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Oct 7, 2011 @ 2:02 am
Yaa,i benefited a lot from ths article when i was doing my reaserch.BE BLESSED.
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Nov 27, 2011 @ 7:07 am
its very nice article,very informative,thanks a lot.
sandhya Arun
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Mar 14, 2012 @ 2:02 am
It is very useful article ,helped me a lot as anurse.
marija
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May 1, 2012 @ 9:09 am
could you please tell me when was this article published?
thank you for your time.
marija
Achola
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May 10, 2012 @ 8:08 am
This article is very inspiring, i believe it will be of great help for me at school. Thanks for the work well done
Rosa
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Aug 14, 2012 @ 3:15 pm
This article is very useful and beneficial.However i would like to know when this article was published.
talebat_3lm
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Oct 9, 2012 @ 4:16 pm
i need paper and books about preoperative teaching
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Oct 12, 2012 @ 8:20 pm
This article is useful,beneficial,helpful and explanatory.Tanx so much and well done
christelle
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Oct 25, 2012 @ 12:12 pm
this article is very interesting but i will need more details on the nurses role.thanks
kusum
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Oct 28, 2012 @ 1:13 pm
thanks for this good piece of article.It's really helpful
ashlin
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Dec 16, 2012 @ 11:23 pm
nice article it helpd me a lot as a nurse. we hope more from u side regarding surgery. thank you
Ibrahim Kanu
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Jan 18, 2013 @ 1:13 pm
thanks for this powerful and helpful piece of article. after reading this article on preoperative care procedures i became the best nursing student of the week in my school. thanks again
imtiyaz
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Mar 18, 2013 @ 11:11 am
THANKS FOR THE TOPIC



I will be thankful. Always






Thank again
kakooza moses
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Jul 30, 2013 @ 6:06 am
good work done, your nice article it helpd me a lot as a nurse. we hope more from u side regarding surgery. thank you
adebayo
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Oct 26, 2013 @ 8:20 pm
Actually love the article n its explicit enough butt it doesn't talk about geting patent ready about the cost implication and the nursing process as additional care to be rendered. Very good for presentation.
modika remi masombe
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Apr 23, 2014 @ 9:09 am
the article is very educative.It has helped to broadened my knowledge in the perioperative care rendered to my patients.thks alot for the knowledge.
dhanyakrajeev
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Jun 12, 2014 @ 11:23 pm
Very helpful actually dis very help for knowing the surgical preparations and care of theclient

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