NCM 116 LESSON 3 RLE  Grieving 

Providing Preoperative Patient Care  Risk for Spiritual Distress

 Impaired Physical Mobility 

Preoperative Phase  
 Risk of Imbalanced Fluid Volume 
 period of time from when the decision for surgical
intervention is made to when the patient is  Fear
transferred to the operating room table. 
 Deficient Knowledge
Purposes of Surgery:
 Risk for Infection
1. Diagnosis
 Risk for Aspiration
2. Cure
 Hypothermia
3. Palliation 

4. Transplant
 PLANNING 
5. Cosmetic Improvement 
 The patient will proceed to surgery. 
6. Prevention  
 The patient will be free from anxiety and fear.

 The patient will demonstrate an understanding of

Preoperative Phase: the need for surgery and the measures to
 Preoperative Assessment minimize the postoperative risks associated with
surgery. 
 Surgical Consent

 Preoperative Teaching
 IMPLEMENTATION
 Psychosocial Preparation

 Physical Preparation 

 Preoperative Medications 1. Check the patient’s chart for the type of surgery and
review the medical orders. Review the nursing database,
 Preoperative Checklist  history, and physical examination. Check that the
baseline data are recorded; report those that are
abnormal.
Providing Preoperative Patient Care
2. Check that diagnostic testing has been completed and
 ASSESSMENT results are available.  

 Determine the medical and surgical history Common tests done before surgery:
including allergies, medications, as well as  Chest x-ray
emotional, socioeconomic, cultural, and spiritual
factors that may influence the patients’ care.  Electrocardiogram (ECG)

 Laboratory & diagnostics studies.  Urinalysis

 Physical examination / vital signs.  WBC

 Glucose

 NURSING DIAGNOSIS  Potassium

 Anxiety  CBC
  Coagulation Studies (PT/PTT) 9. Provide preoperative teaching. 

 Blood typing & cross matching (screening)

 Pregnancy test for women of childbearing age & no

history of hysterectomy

3. Gather the necessary supplies and bring to the bedside

stand or overbed table. 

4. Perform hand hygiene and put on PPE, if indicated. 

5. Identify the patient. 

6. Close curtains around bed and close the door to the

room, if possible. Explain what you are going to do and
why you are going to do it to the patient. 

7. Explore the psychological needs of the patient related to

the surgery as well as the family.

8. Identify learning needs of patient and family. Ensure that

the informed consent of the patient for the surgery has
been signed, witnessed, and dated. 

Information Needed for Informed Consent

Parameters:

o Name of procedure/surgery

o Approximate length of time for procedure/surgery

o Description of procedure/surgery

o Approximate length of time needed for recovery 

o Person performing procedure/surgery

o Alternative treatments  10. Provide intestinal preparation, as appropriate. In certain

situations, the bowel will need to be prepared by
o Benefits of procedure/surgery
administering enemas or laxatives to evacuate the bowel
o Consequences of refusing treatment  and to reduce the intestinal bacteria.

o Potential risks and adverse effects of 11. Check administration of regularly scheduled
procedure/surgery medications. 

12. Remove PPE, if used. Perform hand hygiene. 

CLINICAL DECISION POINT: Patient who are illiterate can sign

with a mask if properly witnessed. Minors unless married or
declared emancipated. And individuals considered
incompetent cannot legally sign a consent form. Parent or
legal guardian must provide consent. Some culture do not Providing Preoperative Patient Care
allow female members to give consent. Refers to each states
and agency protocol for implementing informed consent. DAY-OF-SURGERY
 ASSESSMENT 4. Identify the patient. 

 Assessment on the day of surgery involves taking 5. Close curtains around bed and close the door to the
vital signs and reporting any abnormalities in vital room, if possible. Explain what you are going to do and
signs, as well as any abnormalities in laboratory and why you are going to do it to the patient.
diagnostic results to the surgeon. Also, the nurse will
6. Check that preoperative consent forms are signed,
review and complete the preoperative checklist and
witnessed, dated and correct.
inquire if the patient or family members have any
questions.  7. Check vital signs.

8. Provide hygiene and oral care. Assess for loose teeth and
 NURSING DIAGNOSIS caps. Remind patient of food and fluid restrictions before
surgery.
 Anxiety
9. Instruct the patient to remove all personal clothing,
 Fear 
including underwear, and put on a hospital gown. 
 Risk for Infection
10. Ask patient to remove cosmetics, jewelry including body-
 Impaired Physical Mobility  piercing, nail polish, and prostheses (e.g., contact lenses,
false eyelashes, dentures, and so forth). Some facilities
 Risk for Latex Allergy Response 
allow a wedding band to be left in place depending on
 Grieving  the type of surgery, provided it is secured to the finger
with tape. 
 Deficient Knowledge
11. If possible, give valuables to family member or place
 Fatigue valuables in appropriate area, such as the hospital safe, if
 Risk for Imbalanced Fluid Volume this is not possible. 

 Risk for Aspiration 12. Have patient empty bladder and bowel before surgery. 

13. Attend to any special preoperative orders, such as

starting an IV line. 
 PLANNING 
14. Complete preoperative checklist and record of patient’s
 The patient will proceed to surgery.  pre- operative preparation. 

 The patient will be free from anxiety and fear. 15. Question patient regarding the location of the operative
site. Document the location in the medical record
 The patient will demonstrate an understanding of
according to hospital policy. The actual site will be
the need for surgery and the measures to
marked on the patient when the patient arrives in the
minimize the postoperative risks associated with
preoperative holding area according to the hospital
surgery. 
policy.  

16. Administer preoperative medication as prescribed by

 IMPLEMENTATION physician/anesthesia provider. 

1. Check the patient’s chart for the 17. Help move the patient from the bed to the transport
type of surgery and review the medical orders. Review stretcher, if necessary.
the nursing database, history, and physical examination.
18. Reconfirm patient identification and ensure that all
Check that the baseline data are recorded; report those
preoperative events and measures are documented. 
that are abnormal.
19. Tell the patient’s family where the patient will be taken
2. Gather the necessary supplies and bring to the bedside
after surgery and the location of the waiting area where
stand or overbed table. 
the surgeon will come to explain the outcome of the
3. Perform hand hygiene and put on PPE, if indicated.  surgery. If possible, take the family to the waiting area. 
20. After the patient leaves for the operating room, prepare  Determine if the patient has received
the room and make a postoperative bed for the patient.
Anticipate any necessary equipment based on the type of
surgery and the patient’s history. 

21. Remove PPE, if used. Perform hand hygiene. 

 EVALUATION

 The expected outcome is met when the patient

proceeds to surgery, is prepared for surgery so that
he or she is free from anxiety and fear, and
demonstrates understanding of the importance of
pre- and postoperative instructions. Family members
exhibit knowledge of what to expect over the
remainder of the preoperative course.

Additional Information

 The overall goal of the preoperative assessment is to

identify risk factors and plan care to ensure patient
safety throughout the surgical experience. 

 Goals of the assessment are to: 

 Determine the patient’s psychologic status in order

to reinforce the use of coping strategies during the
surgical experience.  adequate information from the surgeon to make an
 Determine physiologic factors directly or indirectly informed decision to have surgery and that the
related to the surgical procedure that consent form is signed and witnessed. 
may contribute to operative risk factors. 

 Establish baseline data for comparison in

the intraoperative and postoperative period. 

 Participate in the identification and documentation

of the surgical site and/or side (of body) on
which the surgical procedure will be performed. 

 Identify prescription drugs, over-the--

counter medications, and herbal supplements taken
by the patient that may result in drug interactions
affecting the surgical outcome. 

 Document the results of all preoperative laboratory

and diagnostic tests in the patient’s record
and communicate this information to appropriate
health care providers. 

 Identify cultural and ethnic factors that may affect

the surgical experience. 
Pre-operative Assessment: Surgical Risk Factors and Potential

Table 18-4 Health Assessment and physical

examination of preoperative patient

Complication
 2. Antiemetics:

3. Tranquilizers (Hypnotics)

Drug Category: Examples Mechanism of action

Side effects Nursing consideration

3. Sedatives

4. Opioids

Drug Category: Examples Mechanism of action

Common preoperative medications:

1. Anticholinergics

Side effects Nursing consideration