a. Patient's Chart. The preoperative patient's chart must be complete before the patient leaves the nursing unit. It will contain all the information that may be needed by the physicians and nurses in the operating room or later in the recovery room. T
b. Prepare the Patient's Chart. You will have a checklist to assemble the patient's chart and to document compliance as each step is completed.
c. Final Preparation of the Preoperative Patient.
(1) Preoperative care. Implement doctor's orders for preoperative care.
(a) Administer an enema the night before surgery, if ordered. An enema is used to cleanse the colon of fecal material, thus reducing the possibility of wound contamination during surgery.
(b) Ensure that the operative site skin prep is done. An operating room technician or other designated person will clean and shave the area surrounding the side of the planned incision(s).
1 The skin prep is done to make the skin as free of microorganisms as possible, thus decreasing the possibility of microorganisms entering the wound from the skin surface during surgery.
2 A wide area of skin around the site of the incision is shaved and cleansed to further reduce the possibility of infection.
(2) Personal hygiene. Assist the patient with personal hygiene and related care.
(a) Bathe or shower. This is done to remove excess body dirt and oils. It gives the patient a sense of relaxation. Depending upon the extent of surgery, it may be several days before a patient may take a "real bath."
(b) Shampoo hair. This is also done for the same reasons as in the previous paragraph.
(c) Remove nail polish and make-up. During surgery, numerous areas must be observed carefully for evidence of cyanosis to include the face, lips, and nail beds. Make-up and nail polish hide true coloration.
(3) Mouth care. All preoperative patients should have thorough mouth care before surgery. A clean mouth makes the patient more comfortable and prevents accidental aspiration of food particles. Chewing gum must be removed before the patient goes to the operating room.
(4) Attire. Give the patient a clean hospital gown. The wearing of his own gown or pajamas to surgery is not permitted because of potential loss or damage.
(5) Prostheses. Ask the patient to remove his dentures, contact lenses, and artificial limbs. Be sure to place all items in a container labeled with the patient's name and room number. Take extra care not to break or loose patient's prostheses. If possible, send the prostheses home with a relative.
(6) Jewelry. Jewelry should be removed for safekeeping. Do NOT store in bedside stand -- give the jewelry to a relative. The patient may wear a wedding band to surgery secured with tape or gauze wrapping. Do not secure it so tightly as to impair circulation.
(7) Food and fluids. Follow the doctor's orders for type of diet preoperatively. Usually, the patient will be NPO from midnight on. Remove the patient's water pitcher. Place an NPO sign outside patient's room (see Figure 1-8). Mark the diet roster.
(8) Offer emotional support. Answer questions concerning surgery. Provide explanation of each preoperative nursing measure. Ask the patient about spiritual needs. Provide family members with information concerning their role the morning of surgery, waiting room location, postoperative visit by surgeon, rational for stay in recovery room, and presence of any special tubes or machines attached to their loved one.
(9) Sedative. Administer the patient a sedative for a good night's sleep, if ordered.
d. Communication. Good communication between all members of the health care team will ensure that the patient is well prepared and ready to undergo surgery. All shifts and nursing personnel must be an active participant in the preoperative phase of the surgical patient.
Figure 1-8. Typical NPO sign.