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1MODULE 3:
Care of the Adult in the Perioperative Setting
Case study
• J.D., a 45-year-old female, presents to the surgeon’s office for presurgical workup for right breast lumpectomy.
• Ambulatory/Outpatient setting and elective goal is cure.
Nurses Role in the pre-op setting
• Knowledge of disorder that requires the surgery along with comorbidities.
• ID patient’s response to stress of surgery
• Knowledge of the results of appropriate preoperative diagnostic tests.
• ID risks and complications
• Knowledge of documentation and communicating of important preoperative assessment findings are essential
for quality care.
• Avoid repetition, know pre-surgery needs
• Interview – one of the most important
• Communicate findings to others
Case Study continued…
• J.D. is accompanied by her husband.
• She tells you she has two school-age children.
• She states that she is here because her breast biopsy was positive for cancer and she anticipates that the
lumpectomy will remove all cancer.
• The nurse should (in the interview)
• Obtains patients’ health history including drug and food allergy
• Provides information and clarifies info about surgery including anesthesia
• Assess the patient’s emotional state and readiness for surgery, including his or her expectations
about the surgical outcome
Case Study Assessment
• J.D. tells you she has a history of hypertension, for which she takes HCTZ daily.
• She recently was diagnosed with type 2 diabetes and is currently controlled with an oral agent and diet.
• The nurse should establish baseline data (vitals, blood sugar, and if she took her meds today or not?)
• Psychological status – reinforce coping strategies
• Physiological status – factors contributing to risk
• Plan of care **safety
Nursing Assessment Goals
** Overall goal is to identify risk factors and plan care to ensure patient safety throughout the surgical experience.
• Establish baseline data for comparison in the intraoperative and postoperative period
• Determine the patient’s psychological status to reinforce the use of coping strategies during the surgical
experience
• Determine physiological factors directly or indirectly related to the surgical procedure that may contribute to
operative risk factors
• Identify and document surgical site
• Identify drugs, OTC medications, and herbs taken that may affect surgical outcome
• Review results of preoperative diagnostic studies
• Identify cultural and ethnic factors that may affect surgical experience
• Determine receipt of adequate information from surgeon to sign informed consent
• Determine that consent form is signed and witnessed and if given enough info
Psychosocial assessment
• Excessive stress response can be magnified and affect recovery
• Influencing factors
, 2
• Age
• Past experiences
, 3
• Current health
• Socioeconomic status
• Use common language & avoid medical jargon
• Use translators if needed because familiar language…
• Decreases level of anxiety
• Communicate all concerns to surgical team
• Nurse’s role is to assess the patient for potential or actual stressors that could negatively affect surgery.
• Most common psychological factors are ANXIETY, FEAR, AND HOPE
• Anxiety can impair cognition, decision making, and coping abilities
• Anxiety can arise from
• Lack of knowledge
• Unrealistic expectations
▪ Stories heard in media and/or by friends
• Information lessens anxiety
• Inform the physician if any further information is needed or if anxiety is excessive
• Anxiety may arise from conflict with interventions (i.e., Jehovah’s witness and blood transfusions) and religious
or cultural beliefs
• Identify beliefs and discuss with surgeon and operative staff
Case study continued…
• J.D. states that her mother and aunt have a history of breast cancer resulting in mastectomy.
• She appears anxious and you note constant fidgeting.
• J.D. states that she is here because her breast biopsy was positive for cancer.
• She anticipates that the lumpectomy will remove all cancer.
• She has had no other surgeries.
Psychosocial Assessment continued…
• Fears
• Death or disability
▪ Notify the HCP if severe because it may prompt postponement
▪ Influence outcome
• Pain
▪ Consult with ACP
▪ Reassure the patient that drugs are available for anesthesia and analgesia during surgery – will
not lead to addiction
▪ Confirm drugs will be available and encourage patient to ask before pain becomes severe!
▪ Teach the patient how to use a pain intensity scale.
• Mutilation/alteration in body image
▪ Assess concerns nonjudgmentally
▪ Can happen in both radical (amputation) and minor (breast biopsy) surgeries.
• Anesthesia
▪ ACP for consult
▪ May arise from fear of the unknown, personal experiences, or tales of other bad experiences.
▪ Many fear losing control while under anesthesia, or brain damage/paralysis
• Disruption of life functioning
▪ Range from fear of permanent disability to temporary loss
▪ Include family and financial concerns
▪ Consultations PRN w/ caregiver, social worker, psychologist or financial advisor
• Hope
• May be strongest positive coping mechanism
• Never deny/minimize b/c it could negate positive mental attitude necessary for a quick and full recovery
• Repair (plastic surgery for burns), rebuild (total joint replacement) or save/extend a life (repair of an
, 4
aneurysm or transplant)
• Assess and support
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