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There has been an increase in the number of patients requiring surgery who also have complex medical needs. Factors such as being overweight, the presence of significant comorbidities and an ageing population increase the risks associated with surgical procedures for these individuals. As a result, nurses involved in assessing patients and providing preoperative care require knowledge and understanding of the latest evidence in this area to optimise patient care and outcomes following surgery. This article suggests that optimal outcomes can be achieved by preparing patients for surgery in a holistic manner. It also discusses the role of enhanced recovery after surgery (ERAS) programmes. Nursing Standard. doi: 10.7748/ns.2018.e11170 Citation Liddle C (2018) An overview of the principles of preoperative care. Nursing Standard. doi: 10.7748/ns.2018.e11170 Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software @CatherineLiddl5 Correspondence
Conflict of interest None declared Published online: 24 August 2018 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
Subscribe RCN student member? Try Nursing Standard StudentAlternatively, you can purchase access to this article for the next seven days. Buy now Or DefinitionThe patient who consents to have surgery, particularly surgery that requires a general anesthetic, renders himself dependent on the knowledge, skill, and integrity of the health care team. In accepting this trust, the healthcare team members have an obligation to make the patient’s welfare their first consideration during the surgical experience. The scope of activities during the preoperative phase includes the establishment of the patient’s baseline assessment in the clinical setting or at home, carrying out preoperative interview and preparing the patient for the anesthetic to be given and the surgery. GoalsAlthough the physician is responsible for explaining the surgical procedure to the patient, the patient may ask the nurse questions about the surgery. There may be specific learning needs about the surgery that the patient and support persons should know. A nursing care plan and a teaching plan should be carried out. During this phase, emphasis is placed on:
Physiologic AssessmentBefore any treatment is initiated, a health history is obtained and a physical examination is performed during which vital signs are noted and a data base is establish for future comparisons. The following are the physiologic assessments necessary during the preoperative phase:
Gerontologic Considerations
Nursing DiagnosisThe following are possible nursing diagnosis during the preoperative phase:
Diagnostic TestsThese diagnostic tests may be carried out during the perioperative phase:
Significant physical findings are also noted to further describe the patient’s overall health condition. When the patient has been determined to be an appropriate candidate for surgery, and has elected to proceed with surgical intervention, the pre-operative assessment phase begins. The purpose of pre-operative evaluation is to reduce the morbidity of surgery, increase quality of intraoperative care, reduce costs associated with surgery, and return the patient to optimal functioning as soon as possible. Psychological AssessmentPsychological nursing assessment during the preoperative period:
Psychological Nursing Interventions
Informed consent
An informed consent is necessary to be signed by the patient before the surgery. The following are the purposes of an informed consent:
Criteria for a Valid Informed Consent
Nursing InterventionsReducing Anxiety and Fear
Managing Nutrition and Fluids
Promoting Optimal Respiratory and Cardiovascular Status
Supporting Hepatic and Renal Function
Monitor patient for signs of adrenal insufficiency.
Promoting Mobility and Active Body Movement
Respecting Spiritual and Cultural Beliefs
Providing Preoperative Patient Education
Teaching the Ambulatory Surgical Patient
Teaching Deep Breathing and Coughing Exercises
Explaining Pain Management
Preparing the Bowel for Surgery
Preparing Patient for Surgery
Remove jewelry, including wedding rings
Transporting Patient to Operating Room
Attending to Special Needs of Older Patients
Attending to the Family’s Needs
Spiritual Considerations
See Also
What should you assess before surgery?Common tests that your surgeon may ask you to have if you have not had them recently are: Blood tests such as a complete blood count (CBC) and kidney, liver, and blood sugar tests. Chest x-ray to check your lungs. ECG (electrocardiogram) to check your heart.
What should a nurse do to a patient before surgery?Working with patients prior to surgery to complete paperwork, and help answer questions or calm fears about surgery. Monitoring a patient's condition during and after surgery. Selecting and passing instruments and supplies to the surgeon during operation (sometimes referred to as a scrub nurse)
What are the aims of preoperative care?The aims of preoperative assessment are to reduce the risks associated with surgery and anaesthesia, to increase the quality (thus decreasing the cost) of peroperative care, to restore the patient to the desired level of function, and to obtain the patients' informed consent for the anaesthetic procedure.
What are three things a nurse should always ask a patient before surgery?10 Questions to Ask. Why do I need this operation?. How will the operation be performed?. Are there other treatment options, and is this operation the best option for me?. What are the risks, benefits, and possible complications for this operation? ... . What are my anesthesia options? ... . What can I expect before the operation?. |