01.05 Preoperative (Preop) Nursing Priorities

Hey guys!  I am excited to talk to you today about preoperative nursing priorities of the surgical patient!

So let’s first take a look at our goals.  The most obvious preoperative nursing priority is to prepare the patient for surgery by focusing on patient safety and patient-centered care.

So why are nursing priorities in the preoperative setting important?  Well as you can see here there are a number of risks associated with the surgical patient, these include the most obvious injury, infection, and complications but risks can also lead to emotional issues in the surgical patient.  By focusing on the preoperative nursing priorities we are keeping our surgical patients safe and happy!...and what is better than that?!

Ok guys lets take a closer look at the specific preoperative nursing priorities of the surgical patient.  As a perioperative nurse one of the most important things we focus on in the surgical patient is preventing wrong-site surgery. So how do we do this? Well of course we are going to identify our patient by name and birthdate. We're also going to verify with the patient that they know the procedure they're having as well as the site that will be operated on.  The site will also be marked if there is laterality involved by the surgeons initials. So obviously if a patient is having their gallbladder removed….that obviously cannot be marked and there is only one of those after all!

Another really important nursing priority preoperatively will be decreasing the knowledge deficit that can happen in our patients which can cause them a lot of stress and anxiety!  So how do we focus on this priority? We do this as perioperative nurses with the informed consent process. We verify that patients know all the reasons, risks, side effects, as well as benefits and alternatives of their surgery or procedure.  Please check out the specific lesson we have on informed consent to get more information on this topic!

Another critical nursing priority of the preoperative patient is decreasing the risk of aspiration during the surgical procedure.  We do this by making sure the patient hasn’t consumed anything by mouth after a specific given time. Keep in mind that sometimes patients will be asked to take a specific medication with a small drink of water.  We also want to decrease the risk of any type of allergic reaction so be sure to confirm any allergies that your patient may have. Be sure to ask about latex and even metal allergies, for patients undergoing an orthopedic procedure with implants, which is super important for the surgery staff to know.  We want to confirm with our patients the medications that they have been instructed to continue and discontinue up until the day of surgery. For instance typically for surgical patients they are instructed to discontinue any anticoagulants or aspirin for risk of excessive bleeding during their surgical procedure.  Guys make sure you check out the lessons we have on the preoperative education of the surgical patient for some more details!

The results of labwork helps to increase our patients safety by ensuring they are physically prepared to go through surgery at all….or it can throw up a red flag if surgery may not be a good idea!  So just the other day I had a patient who was scheduled for a tubal ligation. As a facility we have a protocol for pregnancy testing of all females of a certain age, as there are obvious risks to all in these instances, well in this case the patient was pregnant!  Goes to show the importance of labwork! Of course guys with surgery we are always thinking of the possibility of infection. With this preoperative nursing priority the focus would be on administering the appropriate antibiotic at the appropriate time and also preparing the surgical site, for example clipping and prepping the area.

Because the patient is under anesthesia and could be motionless for quite some time we always want to consider the risk of blood clots.  So to decrease the risk of this we often will use DVT prophylaxis, things like sequential compression devices or SCDs or TED hose which are applied before surgery.  Anesthesia is another big issue so preoperatively we want to confirm the patient is receiving the appropriate type of anesthesia for their procedure and of course this is confirmed by the surgical provider and the anesthesiologist.

Finally guys with consideration of preoperative nursing priorities we want to make sure that we are supporting our patients emotionally.   Surgery can be very scary to patients no matter how many times they have gone through it or how many people they know that have experienced it.  We want to make sure we are meeting all of their needs, anything from of course their physical needs but also religious and cultural needs too! Just doing these simples things can help patients to not feel so fearful.

Preoperatively it is so important that patients have the ability and encouragement to ask questions.  Make sure you let them know any and all questions are encouraged no matter how silly they may think they are!  And also guys it is critical that the patient follows given instructions as they are all to keep them safe! In some instances not following instructions will cause the patient’s procedure to be cancelled.

When we think of specific nursing concepts that we can apply to the preoperative nursing priorities definitely clinical judgement, patient safety, and patient-centered care come into mind.  All of the preoperative nursing priorities that were previously discussed focus primarily on patient safety by reducing certain possible risks….and we get to this point by using our clinical judgement skills!

Okay guys let's wrap it all up. The goals of preoperative nursing priorities will be to prepare the patient for a safe surgery through patient-centered care. We're going to decrease the risk of infection by the proper use of antibiotics as well as preparing the surgical site. We're going to decrease a knowledge deficit by increasing our patients knowledge with informed consent. We are going to increase our patient’s safety by performing labs, DVT prevention with SCDs and TED hose, we will make sure the anesthesia type is appropriate for the patient, also confirm allergies, medications, the NPO status of the patient and finally that the patient agrees with the scheduled procedure and surgical site.  We are also going to confirm that the surgical site is marked by the provider to prevent wrong-site surgery. Finally we can't forget about providing emotional support to our patients to decrease any fear that they may have going into their surgery.

Okay guys I hope you enjoyed this lesson on the preoperative nursing priorties!  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!