Goal: The patient proceeds to surgery physically and psychologically prepared.
1. Check the patient’s chart for the type of surgery and review the medical orders. Review the nursing database, history, and physical examination. Check that the baseline data are recorded; report those that are abnormal.
2. Check that diagnostic testing has been completed and results are available; identify and report abnormal results.
3. Gather the necessary supplies and bring to the bedside stand or overbed table.
4. Perform hand hygiene and put on PPE, if indicated.
5. Identify the patient.
6. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why youc are going to do it to the patient.
7. Explore the psychological needs of the patient related to the surgery as well as the family.
a. Establish the therapeutic relationship, encouraging the patient to verbalize concerns or fears.
b. Use active learning skills, answering questions and clarifying any misinformation.
c. Use touch, as appropriate, to convey genuine empathy.
d. Offer to contact spiritual counselor (priest, minister, rabbi) to meet spiritual needs.
8. Identify learning needs of patient and family. Ensure that the informed consent of the patient for the surgery has been signed, witnessed, and dated. Inquire if the patient has any questions regarding the surgical procedure. Check the patient’s record to determine if an advance directive has been completed. If an advance directive has not been completed, discuss with the patient the possibility of completing it, as appropriate. If patient has had surgery before, ask about this experience.
9. Provide teaching about deep breathing exercises. Refer to Skill 6-2.
10. Provide teaching regarding coughing and splinting (providing support to the incision). Refer to Skill 6-2.
11. Provide teaching regarding incentive spirometer. (Refer to Skill 14-2, Chapter 14, Oxygenation for specific information.)
12. Provide teaching regarding leg exercises, as appropriate. Refer to Skill 6-3.
13. Assist the patient in putting on antiembolism stockings (Refer to Skill 9-11, Chapter 9, Activity, for specific information) and demonstrate how the pneumatic compression device operates (Refer to Skill 9-12, Chapter 9, Activity, for specific information).
14. Provide teaching regarding turning in the bed.
a. Instruct the patient to use a pillow or bath blanket to splint where the incision will be. Ask the patient to raise his or her left knee and reach across to grasp the right side rail of the bed when turning toward his or her right side. If patient is turning to his or her left side, he or she will bend the right knee and grasp the left side rail.
b. When turning the patient onto his or her right side, ask the patient to push with bent left leg and pull on the right side rail. Explain to patient that you will place a pillow behind his/her back to provide support, and that the call bell will be placed within easy reach.
c. Explain to the patient that position change is recommended every 2 hours.
15. Provide teaching about pain management.
a. Discuss past experiences with pain and interventions that the patient has used to reduce pain.
b. Discuss the availability of analgesic medication postoperatively.
c. Discuss the use of patient controlled analgesia (PCA), as appropriate. Refer to Skill 10-4, Chapter 10, Comfort.
d. Explore the use of other alternative and nonpharmacologic methods to reduce pain, such as position change, massage, relaxation/diversion, guided imagery, and editation.
16. Review equipment that may be used. a. Show the patient various equipment, such as IV pumps, electronic blood pressure cuff, tubes, and surgical drains.
17. Provide skin preparation. a. Ask the patient to bathe or shower with the antiseptic solution. Remind the patient to clean the surgical site.
18. Provide teaching about and follow dietary/fluid restrictions. a. Explain to the patient that both food and fluid will be restricted before surgery to ensure that the stomach contains a minimal amount of gastric secretions. This restriction is important to reduce the risk of aspiration. Emphasize to the patient the importance of avoiding food and fluids during the prescribed time period, because failure to adhere may necessitate cancellation of the surgery.
19. Provide intestinal preparation, as appropriate. In certain situations, the bowel will need to be prepared by administering enemas or laxatives to evacuate the bowel and to reduce the intestinal bacteria. a. As needed, provide explanation of the purpose of enemas or laxatives before surgery. If patient will be
administering an enema, clarify the steps as needed.
20. Check administration of regularly scheduled medications. Review with the patient routine medications, over-thecounter medications, and herbal supplements that aretaken regularly. Check the physician’s orders and review with the patient which medications he or she will be permitted to take the day of surgery.
21. Remove PPE, if used. Perform hand hygiene.
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