Physical Preparations

• Medical & surgical history
• Baseline head-to-toe assessment + VS, height, weight
• Review provider orders
• Skin prep: clippers (not shaving) to remove hair; antiseptic cleanse
• Remove makeup, nail polish, jewelry, dentures, prosthetics, glasses, contacts, hearing aids
• Shower/bathe the evening before
• Ensure large-bore (18-gauge) IV access — for easier infusion of IV fluids or blood products ⚡
• Cover client with lightweight cotton blanket heated in a warmer to prevent hypothermia — hypothermia increases surgical wound infections, alters medication metabolism, and causes coagulation problems and cardiac dysrhythmias
• Withhold anticoagulants at least 48 hrs before surgery ⚡
• If client was on a beta-blocker, administer it prior to surgery to prevent a cardiac event and mortality ⚡
• Have client void before preoperative medications are administered
• Check medication orders — some (antihypertensives, anticoagulants, antidepressants) can be withheld until after procedure
• Determine if autologous blood or direct family donation is available if needed

Psychological Support

• Assess fears, anxieties, coping mechanisms, support system
• Goal: decrease the body's stress response
• Establish trusting relationship with client & family
• Primary nursing intervention in preoperative phase: education
• Focus of preoperative phase: prepare client mentally & physically for surgery
• Minimize anxiety while waiting: distraction techniques (watching TV, reading, listening to music)
• Severe anxiety/panic: reassurance; sedation medications as prescribed; nonpharmacological interventions (distraction, imagery, music therapy)

What it must include (Provider obtains)

• Actual procedure being performed
• Potential risks of procedure
• Type of anesthesia and its risks
• Other procedures that could occur during surgery
• Postoperative plan of care & potential complications
• Description of professionals performing/participating
• Anticipated benefits of the treatment/procedure
• Options for other treatments; right to refuse treatment

Roles

• Surgeon/Provider — responsible for obtaining consent; reviews procedure, risks, benefits with client; documents verbal consent
• Nurse — verifies and witnesses consent; can clarify information already given, but cannot provide new information not previously given by provider
• If client unconscious or incompetent — legal guardian or health care surrogate may consent
• Surgery cannot proceed without consent (except emergent)

Client must be legally capable ⚡

• 18 years of age or emancipated
• Mentally capable of understanding risks, reason, and options
• Free from influence of medications that affect decision-making (opioids, benzodiazepines, sedatives)
• Consent given voluntarily — no coercion involved ⚡
• Has received enough information to make a decision based on understanding

Two witnesses required when ⚡

• Client can only sign with an "X"
• Client has vision or hearing impairments
• Language barrier present
• Provide a trained medical interpreter (not a family member or friend); document use of interpreter in medical record

Common Tests

• CBC (Hgb, Hct, platelets)
• PT, INR, aPTT
• Electrolyte levels
• Serum creatinine & BUN
• Blood type & crossmatch — in case transfusion required; some clients may request autologous donation
• Pregnancy test (hCG) if applicable ⚡
• Urinalysis — renal function, rule out infection
• ABGs — oxygenation status
• Chest X-ray — heart and lung status
• 12-lead ECG — baseline rhythm, dysrhythmias; performed on all clients older than 40 years ⚡

Key Abnormals to Report Immediately ⚡

• Positive hCG — possible pregnancy; elective surgery postponed until confirmed negative or after pregnancy
• Low platelet count (<150,000/mm³) — increased bleeding risk
• Abnormal results may cause surgeon/anesthesiologist to delay or postpone surgery
• Type & crossmatch ordered for procedures with high blood loss risk (e.g., total hip replacement)

Key Nursing Interventions

• Know type of surgery and anesthesia used
• Place client in correct position for surgery
• Assist surgeon or anesthesiologist as needed
• Maintain aseptic environment
• Monitor client for developing complications
• Complete documentation

Types of Anesthesia / Sedation

• General anesthesia — loss of all sensation and consciousness
• Local/regional — loss of sensation in one area; client usually conscious
• Minimal sedation — responds to verbal commands; may have impaired cognition/coordination
• Moderate sedation — deeper state; cognitive/coordination impaired but airway maintained ⚡
• Deep sedation — cannot be awakened easily; IV or inhalation

Immediate Priorities

• Patent airway — #1 priority
• Immediate vital signs assessment; repeated for stability
• Monitor level of consciousness
• Pain assessment begins preoperatively (baseline)
• VS every 5–15 min for first hour; then per orders/protocol
• If temp <36°C (96.8°F) → rewarming measures (warming blanket, forced-air)

Postoperative Care Elements

• Ensure respiratory & cardiovascular stability
• Manage postoperative pain
• Maintain adequate fluid balance (document I&O) ⚡
• Provide surgical site/wound care
• Monitor bowel function
• Assist with early ambulation

Airway & Breathing

• Monitor O₂ sat; supplemental O₂ as prescribed
• Assist with coughing & deep breathing q1hr while awake; use pillow to splint
• Contraindications to coughing: cosmetic, eye, or intracranial surgeries ⚡
• Incentive spirometer q1–2hr while awake
• Reposition every 2 hr; early ambulation

Kidney Function ⚡

• Output should equal intake within 3 days postoperatively
• Report urinary output <30 mL/hr
• After indwelling catheter removal: client should void within 8 hr
• Use bladder scan to monitor for suspected urinary retention

Bowel Function

• Maintain NPO until return of gag reflex (aspiration risk) and peristalsis (paralytic ileus risk)
• Monitor bowel sounds in all four quadrants; ability to pass flatus
• Advance diet as prescribed (clear liquids → regular)
• Encourage gum chewing — stimulates gastric secretions and promotes return of intestinal peristalsis ⚡
• Irrigate NG suction tubes with saline as needed to maintain patency
• Do not move NG tubes in clients post gastric surgery (risk to incision)

Nausea & Vomiting ⚡

• Check bowel sounds first, then administer prescribed antiemetic
• Position client on their side to reduce aspiration risk
• Do not quickly elevate HOB — change positions slowly (nausea from opioids)

Fluid Status & Oral Comfort

• Administer prescribed IV solution based on client's hydration and electrolyte needs
• Encourage ice chips and fluids as prescribed/tolerated
• Provide frequent oral hygiene

Effective Strategies

• If prescribed, use patient-controlled analgesia (PCA) pump; epidural and intrathecal infusions also used
• Around-the-clock scheduling is more effective than PRN delivery during the first 24–48 hr postoperatively ⚡
• Encourage client to ask for pain medication before pain gets severe
• Provide analgesia 30 min before ambulation or painful procedures ⚡
• Monitor for effectiveness after administration

Assessment & Nonpharmacological

• Monitor pain level frequently using a standardized pain scale
• Manifestations of pain: increased pulse, respirations, or BP; restlessness; wincing or moaning during movement ⚡
• Monitor for opioid adverse effects: respiratory depression, nausea (change positions slowly), urinary retention, constipation
• Nonpharmacological approaches: massage, relaxation techniques, meditation, diversion (listening to music), noise reduction

Monitoring Drainage & Wound

• Drainage progression: sanguineous → serosanguineous → serous ⚡
• Expected wound findings: pink wound edges, slight swelling under sutures/staples, slight crusting of drainage
• Report: redness, excessive tenderness, purulent drainage (infection signs)
• Monitor wound drains with each VS check; empty closed-suction devices as needed
• Report increases in drainage (possible hemorrhage)
• Surgeon performs the first dressing change ⚡; subsequent changes by nurse using surgical aseptic technique
• Use abdominal binder as prescribed for obese or debilitated clients with abdominal incision
• Remove sutures or staples in 5–10 days as prescribed ⚡
• Wound closure tape (Steri-strips) — instruct client to keep in place until strips fall off on their own

Wound Healing & Nutrition

• Encourage diet high in calories, protein, and vitamin C ⚡
• If client has DM — maintain appropriate glycemic control

DVT Prevention — Key Details ⚡

• Causes: dehydration, stress response (hypercoagulability), immobility, obesity, trauma, malignancy, history of thrombosis, hormones, indwelling venous catheter
• Avoid pressure behind the knee with pillow/blanket — constricts blood vessels, decreases venous return ⚡
• Do not elevate the knee gatch on the bed — decreases venous return ⚡
• Avoid dangling legs for long periods
• Prophylactic measures: low-molecular-weight heparin, low-dose heparin, or warfarin; anti-embolism stockings; pneumatic compression devices; ROM exercises; early ambulation
• Adequate hydration to reduce venous stasis
• Monitor extremities for calf pain, warmth, erythema, and edema ⚡