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Chapter 20

Interventions forPreoperativeClients 

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Collaborative ManagementAssessment

History and data collection

Age

Drugs and substance use

Medical history, including cardiac and

pulmonary histories

Previous surgery and anesthesia

Blood donations

Discharge planning

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Physical Assessment/ClinicalManifestations

Obtain baseline vital signs.

Focus on problem areas identified by the

client’s history on all body systemsaffected by the surgical procedure.

Report any abnormal assessment findingsto the surgeon and to anesthesiology

personnel.

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System Assessment

Cardiovascular system

Respiratory system

Renal/urinary system

Neurologic system

Musculoskeletal system

Nutritional status Psychosocial assessment

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Laboratory Assessment

Urinalysis Blood type and crossmatchComplete blood count or hemoglobin level and

hematocritClotting studies Electrolyte levels Serum creatinine level Pregnancy testChest x-ray examination

Electrocardiogram

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Deficient Knowledge Interventions

Preoperative teaching

Informed consent

The surgeon is responsible for obtaining signed consent

before sedation is given and surgery is performed.

The nurse’s role is to clarify facts presented by thephysician and dispel myths that the client or family

may have about surgery.

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Implementing Dietary Restrictions

Client is given nothing by mouth (NPO) for6 to 8 hours before surgery.

NPO status decreases the risk foraspiration.

Failure to adhere can result incancellation of surgery or increase the

risk for aspiration during or after surgery.

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Administering Regularly ScheduledMedications

Consult the medical physician andanesthesia provider for instructions about

drugs, such as those taken for diabetes,cardiac disease, glaucoma, regularlyscheduled anticonvulsants,antihypertensives, anticoagulants,

antidepressants, or corticosteroids.

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Preparing the Client 

Possible placement of tubes, drains, andvascular access devices

Teaching about postoperativeprocedures and exercises:

Breathing exercises, incentive spirometry,coughing and splinting

(Continued)

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Preparing the Client (Continued) 

Leg procedures and exercises,

antiembolism stockings and elastic wraps,

early ambulation, and range-of-motionexercises

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Anxiety Interventions

Preoperative teaching

Encouraging communication

Promoting rest

Using distraction

Teaching family and significant others

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Preoperative Chart Review

Ensure all documentation, preoperativeprocedures, and orders are complete.

Check the surgical consent form andothers for completeness.

Document allergies.

Document height and weight.

(Continued)

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Preoperative Chart Review (Continued) 

Ensure results of all laboratory anddiagnostic tests are on the chart.

Document and report any abnormalresults.

Report special needs and concerns.

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Preop Client Prep

Client should remove most clothing andwear a hospital gown.

Valuables should remain with familymember or be locked up.

Tape rings in place if they can’t beremoved.

Remove all pierced jewelry.

(Continued)

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Preop Client Prep (Continued) 

Client wears an identification band.

Dentures, prosthetic devices, hearing aids, contactlenses, fingernail polish, and artificial nails must beremoved.

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Preoperative Medication

Reduce anxiety.

Promote relaxation.

Reduce pharyngeal secretions.

Prevent laryngospasm.

Inhibit gastric secretion.

Decrease amount of anesthetic neededfor induction and maintenance ofanesthesia.

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