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Subjective Data
Preoperative Assessment
Question | Answer |
---|---|
How can we prevent preoperative stress from becoming distress? | Understand the patient’s real and perceived stressors and provide information and support. |
Explain why the nurse uses “common language”, familiar terms, and avoids medical jargon in preparing a patient for surgery? | Words and language that are familiar to the patient increase understanding of surgical consent and the surgical experience. |
What is our role is preparing the patient psychologically for surgery? | assess the patient for potential stressors that could negatively affect the surgery and communicate these concerns to the appropriate surgical team members |
What are the most common psychologic factors associated with surgery? | Anxiety, Fear, and hope |
What happens if a patient’s anxiety level is too high? | It will affect their cognition, ability to make decisions, and coping abilities |
What kinds of things cause anxiety related to surgery? | not knowing what to expect; uncertainty about the surgical outcome; worrying about potential findings of diagnostic surgery; inaccurate information, scary surgery stories from friends or TV; conflict with religious/cultural beliefs, blood transfusions |
How can we help with patient’s anxiety? | Provide accurate information |
Name 5 common fears associated with surgery. | Fear of…… death, pain and discomfort, mutilation of alteration in body image, of anesthesia, of disruption of life functioning or patterns |
Why do we need to tell the surgeon if we find that the patient has a strong fear of death? | because attitude and emotional state influence the stress response and therefore the surgical outcome. The surgeon may opt to postpone the surgery. |
Who should we notify if the patient seems to have an extreme fear of pain and why? | The ACP so that an appropriate preoperative medication can be given. |
What points should we make clear to a patient who is fearful about pain? | there are drugs for surgery, drugs for after surgery, Okay to ask for pain med, won’t get hooked |
What kind of things might cause a person to be fearful of anesthesia? | unknown, past experience, scary stories, real information about risks associated with anesthesia, fear of losing control |
What should we do if we determine our patient has a fear of anesthesia? | inform the ACP immediately so that they can talk with the patient and reassure the patient that both the nurse and ACP will be present during surgery |
What kind of concerns might a patient have related to life changes due to surgery? | disability; loss of life; inability to play, work, or fulfill a role; being away from famiy; how spouse and children will manage; loss of income; surgery costs |
What are some avenues we could offer to help patients with fears about life changes related to surgery? | consultation with….social worker, spiritual/cultural advisor, psychologist or family members, hospital financial advisor about financial support for the uninsured/Medicaid |
Name 6 areas of subjective data that we will assess. | Psychosocial, past health history, medications, allergies, review of systems, functional health patterns |
What psychological factor may be the patient’s strongest method of coping? | Hope |
What kinds of surgeries might patients anticipate with hope? | surgeries that …repair, rebuild, or save and extend life |
What should we do if we assess that the patient has hope? | support it |
Generally speaking, what will we be asking the patient about in the past health history portion of our assessment? | medical conditions diagnosed in the past as well as current problems |
What is one of the initial determinations we should make in an assessment of the patients health history in preparation for surgery? | If they understand the reason for the surgery |
What sort of things do we need to document in regards to the patient’s past hospitalization? | reason they were in the hospital, previous surgeries and dates of surgeries, any problems with surgery (reactions/infections etc) |
What kind of things do we ask women specifically? | menstrual and obstetric history, are they pregnant |
How could we facilitate more accurate communication with a teen about reproductive information? | Ask the questions while parents are not present |
What kind of family history should be documented? | reaction to anesthesia, cardiac and endocrine disorders like HTN, cardiac death, MI, CAD, Diabetes |
Why do we care about family history of cardiac or endocrine disorders? | because the patient may have inherited tendencies toward these disorders that may be exacerbated during surgery |
Patient with family history of what condition may be genetically predisposed to death from anesthesia? | malignant hyperthermia |
Generally speaking, what do we need to know about a patient’s medications before surgery? | Their current routine and intermittent medication use including prescription, OTC, self prescribed, herbs, and supplements,, their drug intolerances and allergies |
How could we ensure the correct documentation of both the name and dosage of a patient’s home medications? | Ask the patient to bring their bottles of medication with them when reporting for surgery |
Name some types of medication that may interact with anesthesia. | medications for heart disease, HTN, Immunosuppression, seizure control, anticoagulation, and endocrine replacement. |
What problematic interaction may happen with tranquilizers and anesthetics? | tranquilizers my potentiate the effect of opioids or barbiturates used as anesthetics |
What problematic interaction might result from a combination of antihypertensive medication and anesthesia? | the additive effects may predispose the patient to shock |
What do we need to think about for our diabetic patients? | Insulin and hypoglycemic agents may require dose adjustments due to increased metabolism, reduced calorie intake, stress, and anesthesia |
Why do surgeons often require the patient to cease aspirin or NSAIDs for two weeks before surgery? | Aspirin and NSAIDs may inhibit platelet aggregation and may contribute to postoperative bleeding. |
Why do we need to know about recreational drug use before our patient has surgery? | Recreational drug use may affect the type and amount of anesthesia that will be needed |
What damage from chronic alcohol use puts a surgical patient at risks? | lung, gastrointestinal, liver damage |
If our surgical patient has liver damage what dangers must we be alert for? | Metabolism of anesthetic agents in prolonged, nutritional status is altered, and the potential for postoperative complications is increased |
If our patient is an alcoholic and in the hospital for a lengthy stay what potentially life threatening situation may arise if appropriate planning does not take place? | Alcohol withdrawal |
Give some examples of the effects of drug intolerance. | nausea, constipation, diarrhea, or idiosyncratic reactions |
What’s the difference between reactions due to intolerance and true allergic reactions? | Drug intolerance reactions are unpleasant but not life threatening. |
What are some potential allergic reactions? | hives and/or anaphylactic reaction, causing cardiopulmonary compromise, including hypotension, tachycardia, bronchospasm, possible cardio edema |
How can we identify a patient who has an allergy that could endanger them while they are admitted for surgery? | They should be given an allergy wristband |
Why does the APC need to know if the patient has a sulfur allergy? | many drugs contain sulfur |
Why would we need to know about a patient’s non drug allergies? | A patient with hypersensitivity reactions to other chemicals is more likely to have a hypersensitivity reaction to anesthesia |