Preoperative Phase

The preoperative phase begins when the patient decides to have surgery and ends when the patient enters the operating room (OR).

This phase includes all preparations for the surgery, such as obtaining informed consent, performing diagnostic tests, providing patient education, assessing physical and psychosocial status, identifying potential risks and complications, planning care and interventions, administering preoperative medications, and transferring the patient to the OR.

Informed consent

Informed consent is the surgeon’s responsibility to obtain from the patient before performing any invasive procedure.

It involves giving the patient the necessary information about the procedure, its benefits and risks, alternatives, and consequences of refusal.

The nurse’s role is to witness the patient’s signature on the consent form and ensure that the patient understands what they are signing.

Preoperative Nursing intervention

Review preoperative lab and diagnostic studies

Diagnostic tests are done to assess the patient’s baseline status and identify any abnormalities that may affect the surgery or anesthesia.

Some common tests are blood tests (such as complete blood count [CBC], coagulation studies [PT/INR], electrolytes [Na+, K+, Cl-, HCO3-]), urine tests (such as urinalysis [UA], urine culture), chest x-ray (CXR), electrocardiogram (ECG), pulmonary function tests (PFTs) and imaging studies (such as computed tomography [CT], magnetic resonance imaging [MRI], ultrasound [US]).

Patient education is essential to prepare the patient for the surgery and postoperative recovery.

It includes providing information about the procedure, anesthesia options, expected outcomes, potential complications, pain management, wound care, activity restrictions, dietary modifications, medication instructions, and discharge planning.

It also involves addressing any questions or concerns that the patient may have.

Assess physical needs

Physical assessment is done to evaluate the patient’s general health status and identify any risk factors or contraindications for surgery or anesthesia.

It includes obtaining vital signs (such as temperature [T], pulse [P], blood pressure [BP], respiratory rate [RR], oxygen saturation [SpO2]), height and weight, and examining the systems related to the surgery (such as cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurological, integumentary).

Review the patient’s health history and preparation for surgery

It also involves reviewing the patient’s medical history (such as allergies, medications, chronic conditions, and previous surgeries) and family history (such as genetic disorders, and bleeding tendencies).

Psychosocial assessment is done to evaluate the patient’s emotional and mental status and coping abilities.

It includes assessing the patient’s level of anxiety, fear, stress, depression, anger, or denial, and providing emotional support and reassurance.

It also involves assessing the patient’s cultural and spiritual beliefs and preferences and respecting their values and choices.

Potential risks and complications are identified based on the patient’s physical and psychosocial status, type of surgery and anesthesia, and other factors.

Some common risks and complications are bleeding, infection, thromboembolism, hypothermia, hypoxia, nausea and vomiting, allergic reaction, nerve damage, or paralysis.

The nurse should inform the patient about these risks and complications and explain how they will be prevented or managed.

Care and interventions are planned based on the patient’s needs and goals.

They include implementing nursing diagnoses (such as risk for infection, anxiety, impaired skin integrity), establishing expected outcomes (such as no signs of infection, reduced anxiety level, intact wound healing), selecting appropriate interventions (such as administering antibiotics, providing relaxation techniques, applying sterile dressings) and evaluating the effectiveness of the interventions.

Preoperative medications are administered to the patient before surgery to achieve the desired effects.

They include antibiotics (to prevent infection), anticholinergics (to reduce secretions), antiemetics (to prevent nausea and vomiting), antihistamines (to prevent allergic reactions), benzodiazepines (to induce sedation and amnesia), beta-blockers (to lower heart rate and blood pressure), narcotics (to relieve pain), opioids (to enhance anesthesia) and steroids (to reduce inflammation).

The nurse should verify the medication orders, check for allergies, follow the six rights of medication administration (right patient, right drug, right dose, right route, right time, right documentation), and monitor for adverse effects.

Transfer to the OR is done when the patient is ready for surgery.

The nurse should verify the patient’s identity using two identifiers (such as name and date of birth), check the surgical site marking (if applicable), ensure that the consent form is signed and attached to the chart, remove any jewelry or dentures from the patient, apply identification and allergy bands to the patient’s wrist, cover the patient with a warm blanket to prevent hypothermia, transport the patient on a stretcher or wheelchair to the OR holding area or preoperative suite, and report any pertinent information to the OR nurse.