01.03 Preoperative (Preop)Assessment

Hey guys I would like to talk to you today a little about the preoperative assessment of the surgical patient that is performed by the preoperative nurse.   So just as a broad overview before we get into the lesson a little deeper, the goals of the preoperative assessment are to prepare your patient for surgery while looking for issues that would make surgery risky like comorbidities or issues with the patient’s mental status.  Remember the preoperative nurse will be the one completing this assessment and as the preoperative nurse you will want to pay special attention to any specific or special needs your patient may have.  So special needs could include things that relate to a patient’s culture or religion or any specific physical or psychological needs that they might have.  Also, a super important part of the preoperative assessment is to share the information that you gather like critical values with the other perioperative team members.  Perioperative nursing is a team approach for sure!  And one last goal would be to begin the planning process for the patient to go home.   Of course with the preoperative assessment you will first identify your patient, complete vital signs, a pain assessment, and also tests like x-rays, blood sugars, pregnancy tests.  A patient's age, although it may seem obvious is definitely important to assess because as you can imagine if a patient is a baby there are going to be different things in surgery required or needed than a patient who is older.  A super important part of the preoperative assessment is making sure that informed consent is complete.  Check out the lesson on informed consent for more details!   Also guys with the preoperative assessment a thorough patient history is super important.  When we talk about history we want to ask the patient about their medical, surgical, and social history.  We can find out a great deal of information that will be important to the surgery and if the patient is at risk for issues during and after the procedure.  We need to assess our patient’s for any cognitive issues meaning they should be able to describe and understand what they are having done.  If this is not the case there may need to be a surrogate decision maker present.  Medical issues or chronic diseases like diabetes can delay the healing process and previous surgeries could also be risky if the patient has had an issue with anesthesia in the past like malignant hyperthermia.  Check out the lesson we have specifically on malignant hyperthermia.   If the patient has a history with substance abuse, smoking, alcohol, drugs, all these things can delay healing times, can create breathing issues during surgery, and increase anesthesia needs.  Be sure you check out the lessons we have on the different types of the anesthesia for more information!   If you’ve had surgery in the past I’m almost certain you have been told “nothing by mouth” after a certain time!  Aspiration during surgery because of anesthesia is a huge concern we have in perioperative nursing, so assessing this in your patient is critical.  You may think this is an easy task but probably at least once a day where I work a patient’s surgery is cancelled because they ate ribs for breakfast….I’m not kidding that really happened!  Allergies are another very important assessment when it comes to surgery, one that we pay very close attention to is latex.  If a patient has a true latex allergy this can cause a load of issues for the patient!  Keep in mind certain foods like bananas, kiwi, and avocado are said to be associated with latex allergy, so keep an eye out for patients with these allergies!  Because we do use medications in surgery like local anesthetics and antibiotics we need to know what medications the patient is allergic to.  Finally be sure to ask your patient what medications they are on and when they last took them, meds like aspirin and anticoagulants can increase the bleeding risk in the patient.  And don’t forget to ask about vitamins and herbal supplements….patients do not often consider these “medications” but they can cause bleeding issues too!      So guys we also need to know if the patient has any metal implants, this is because during surgery electrocautery is often used to cauterize or in other words seal a vessel closed and stop something from bleeding.  With this, a grounding pad must be used and it can’t be placed over a metal implant which can cause a burn in your patient….no time for that!  Your patient’s weight needs to be assessed, we will pay close attention to extremely low BMI’s and high BMI’s, both can increase complications in the patient, issues with temperature control, anesthesia needs, and increase postoperative complications.   Another important part of the preoperative assessment is checking out your patient's skin, what does it look like?  Do they have any bruises, cuts, scrapes near the surgical site that could prevent the surgery from happening?  Often times if the patient is having a surgery where implants are involved like a total knee or total hip replacement, something like an abrasion can cause the patient’s surgery to be cancelled.   Also guys a lot of  patients are going to have some type of sensory impairment, hearing or vision issue.  Patients who wear contacts should remove them as they can cause corneal abrasions.  With things like glasses and hearing aids we need to be sensitive to the fact that these devices can increase the mental status or support for patients, especially elderly patients, but we also do not want to cause harm to the patient or lose any patient belongings.  Always check with the provider and/or anesthesia if a patient feels super strong about keeping contacts or hearing aids in.  And last but not least, we want to check with the patient to see if they have family support with them, during and after surgery.   Okay so with patient education and the preoperative assessment we really want to encourage patients to ask questions.  We also want to, in the most comforting way possible, encourage them to give us information and to be truthful...what we don't know can definitely hurt them.  Finally, let's encourage our patients to express any needs that they have.   So when we think of the different nursing concepts that pertain to the preoperative assessment we definitely think clinical judgment because we are assessing our patients for risk factors to surgery, we think about patient-centered care because our main focus is our patient, and most definitely safety as the preoperative assessment has the main purpose of keeping patients safe!   Okay so a few key points to wrap this lesson up.  First, the goal of the preoperative assessment is going to be to prepare the patient for surgery and identify surgical risk factors.  A complete patient history will be assessed which would include things like their medical history or chronic conditions, surgical history, and psychosocial history. We are also going to focus on their current status meaning, age, BMI, NPO status, current medications, allergies, vital signs, pain and the completion and understanding of their informed consent.   Also any patient impairments should be assessed including skin, hearing, vision issues and not lets not forget cognitive issues...they must know what is going on!  And finally we're going  to assess their discharge plan or concerns meaning is family support available and what follow-up should include.    Okay guys I hope you enjoyed this lesson on the preoperative assessment of a surgical patient!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!