Preoperative Care Health Article

Definition

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

Purpose

Patients who are physically and psychologically prepared for surgery tend to have better outcomes after surgery. Preoperative teaching meets the patient's need for information regarding the surgical experience, which in turn may alleviate most fears the patient has. Knowing what to expect after the surgery, and enlisting the patient's input about goals and expectations, often helps the patient 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 major surgery.

Precautions

There are no contraindications to preoperative care. Even in an emergent situation, the patient must be physically prepared and should be prepared psychologically to the degree possible, as indicated by the patient's physical status. If the patient is unresponsive, emotional and psychological preparation should be focused on the family.

Preoperative teaching must be individualized for each patient, since some people want as much information as possible while others want only the minimum. For some patients, receiving too much information increases their anxiety. Patients have different capabilities in understanding medical procedures; if printed materials are used for teaching, the nurse must ascertain the patient's literacy level in order to provide appropriate material. The health care professional must maintain a balance between relaying essential information and meeting the patient's information needs.

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 should include obtaining a complete history and physical, including the patient's surgical and anesthesia history. It should be determined if the patient has ever had an adverse reaction to anesthesia (such as anaphylactic shock), or if there is a family history of malignant hyperthermia. Such laboratory tests as CBC, electrolytes, prothrombin time, activated partial thromboplastin time, or urinalysis may be done. An EKG should be done if the patient has a history of cardiac disease or is over 50 years of age. A chest X-ray should be taken if the patient has a history of respiratory disease. The patient should be assessed for risk factors that might impair healing, such as nutritional deficits, steroid use, radiation or chemotherapy, drug or alcohol abuse, or such metabolic diseases as diabetes. The patient should also provide a list of all medications, vitamins, and herbal or food supplements that they use. Supplements are often overlooked, but some can cause adverse effects when used with general anesthetics (e.g. St John's wort, valerian root) and others can prolong bleeding time (e.g. garlic, gingko biloba).

Latex allergy merits mention because it is becoming a public health concern. Latex is found in most sterile