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The preoperative assessment carries the patient through the surgical experience
A 0 H N J 0U R N A L
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A P R I L 1984 V O L 39, NO 5
Ambulatorv Suraerv J
U
J
The preoperative assessment carries the patient through the surgical experience
reoperative assessment is a key element in providing care for the ambulatory surgery patient. It begins when working with the surgeon's office, the ambulatory surgery staff schedules the patient and laboratory studies are ordered. A form can be completed when the patient is scheduled and kept on file until preoperative testing is done. From this inforniation, the nurse begins the preoperative assessment that will ultimately carry the patient through his surgical experience. Laboratory results are seen by the staff first, and any abnormalities can be reported to the surgeon and the anesthesiologist. Preoperative testing can be done two to five days prior to surgery or on the morning of surgery. The nurse can explain what laboratory studies are needed and why. During this initial assessment, the nurse can also help determine the patient's physical and psychological status. 1s the patient calm or nervous and agitated'?Is the patient overweight'? Does he have any physical disabilities or limitations'? Is the patient clean and well groomed'?A dirty, unkempt patient could be unwilling to assume responsibility for his care following surgery. These are all details the ambulatory surgery nurse needs to take into consideration when planning patient care. The nurse may also ask some general health questions at this time. These must be worded in a way the patient will understand. Questions might i nc I ude 0 do you take any medication at home'? do you have any allergies or any problems with your breathing'? 770
do you have false teeth or ones that are loose or capped? 0 do you have blood pressure problems'? what major illnesses have you had'? 0 what other surgeries have you had? 0 have you ever had seizures? 0 do you have blackout spells or severe heiidaches'? Asking questions at the time ofthe preoperative testing accomplishes two purposes: it gives the nurse more information with which to plan care for the patient, and it gives the patient achance to talk, relax, ask questions, and get acquainted with the staff. It has been my experience that this results in a calmer patient the day of surgery. If preoperative testing is done two or more days before surgery, preoperative teaching begins at the same time. Preoperative teaching should include the following instructions: 0 notify your physician or the surgery unit immediately if you get acold, cough, fever. or any illness prior to your surgery date 0 arrive on the day of your surgery at the specified time 0 do not eat or drink anything aiter midnight on the day before your surgery 0 do not wear makeup or nail polish 0 wear loose, comfortable clothes and lowheel shoes 0 do not bring valuables o r jewelry brush your teeth the morning of surgery, being careful not to swallow any water plan to have a responsible adult accompany you to the unit and drive you home plan to have someone stay with you for 24 0
APRIL 1984, VOL 39. N O 5
AORN JOURNAL
Fig 1
Patient Evaluation Was the staff courteous and professional? -. Did you receive good instructions before surgery? Were your questions adequately answered? Did you feel the staff was interested in you personally? Were you comfortable in the unit (temperature/furniture)? Were you given good instructions after surgery? Was the waiting room comfortable for your family/friends? After surgery did you feel you were given enough information on where to get help, if needed? Would you prefer to be an outpatient again for any needed surgery? How would you rate your overall experience at the outpatient unit? G o o d FairPoor___ Excellent Do you have any comments on improving patient care?
Date of Surgery: Name (Optional): hours following your surgery. Preoperative assessment continues the day the patient arrives for surgery. It is helpful to have a standard preoperative checklist for each patient. This insures that every patient receives the same quality care. This checklist is dated and signed by the nurse. There are many types of preoperative checklists. What serves the needs of the
Brenda C Mauldin, RN,is a staflnurse in the operating room and outpatient surgery unit at Northside Hospital, Atlanta. She received her associate degree in nwsing from DeKalb College, Clarkston, Ga.
individual unit best should be used. The nurse should report any irregularities found during preoperative assessment to the anesthesiologist and surgeon. Care of the ambulatory surgery patient is a joint effort involving the nurse, the anesthesiologist, and the surgeon. A final important aspect is patient evaluation of care. Patients have little basis to evaluate the actual surgery, so they may base their entire evaluation on the preoperative phase. Patient evaluation forms are a good way to determine how the patient feels about his care (Fig 1). The patient recognizes and trusts a knowledgeable, caring staff. This is important in ambulatory surgery, because the patient will want to return to the place where he was well treated. I had one patient who had two D & Cs in our unit over a period of a few months. This patient later needed a hysterectomy, and she told her physician she wanted to have it in our unit. It is this kind of reward that makes ambulatory surgical nursing different and special. BRENDAC MAULDIN. RN
77 1
~~
-
~
~-
-
A P R I L 1984 V O L 39, NO 5
Ambulatorv Suraerv J
U
J
The preoperative assessment carries the patient through the surgical experience
reoperative assessment is a key element in providing care for the ambulatory surgery patient. It begins when working with the surgeon's office, the ambulatory surgery staff schedules the patient and laboratory studies are ordered. A form can be completed when the patient is scheduled and kept on file until preoperative testing is done. From this inforniation, the nurse begins the preoperative assessment that will ultimately carry the patient through his surgical experience. Laboratory results are seen by the staff first, and any abnormalities can be reported to the surgeon and the anesthesiologist. Preoperative testing can be done two to five days prior to surgery or on the morning of surgery. The nurse can explain what laboratory studies are needed and why. During this initial assessment, the nurse can also help determine the patient's physical and psychological status. 1s the patient calm or nervous and agitated'?Is the patient overweight'? Does he have any physical disabilities or limitations'? Is the patient clean and well groomed'?A dirty, unkempt patient could be unwilling to assume responsibility for his care following surgery. These are all details the ambulatory surgery nurse needs to take into consideration when planning patient care. The nurse may also ask some general health questions at this time. These must be worded in a way the patient will understand. Questions might i nc I ude 0 do you take any medication at home'? do you have any allergies or any problems with your breathing'? 770
do you have false teeth or ones that are loose or capped? 0 do you have blood pressure problems'? what major illnesses have you had'? 0 what other surgeries have you had? 0 have you ever had seizures? 0 do you have blackout spells or severe heiidaches'? Asking questions at the time ofthe preoperative testing accomplishes two purposes: it gives the nurse more information with which to plan care for the patient, and it gives the patient achance to talk, relax, ask questions, and get acquainted with the staff. It has been my experience that this results in a calmer patient the day of surgery. If preoperative testing is done two or more days before surgery, preoperative teaching begins at the same time. Preoperative teaching should include the following instructions: 0 notify your physician or the surgery unit immediately if you get acold, cough, fever. or any illness prior to your surgery date 0 arrive on the day of your surgery at the specified time 0 do not eat or drink anything aiter midnight on the day before your surgery 0 do not wear makeup or nail polish 0 wear loose, comfortable clothes and lowheel shoes 0 do not bring valuables o r jewelry brush your teeth the morning of surgery, being careful not to swallow any water plan to have a responsible adult accompany you to the unit and drive you home plan to have someone stay with you for 24 0
APRIL 1984, VOL 39. N O 5
AORN JOURNAL
Fig 1
Patient Evaluation Was the staff courteous and professional? -. Did you receive good instructions before surgery? Were your questions adequately answered? Did you feel the staff was interested in you personally? Were you comfortable in the unit (temperature/furniture)? Were you given good instructions after surgery? Was the waiting room comfortable for your family/friends? After surgery did you feel you were given enough information on where to get help, if needed? Would you prefer to be an outpatient again for any needed surgery? How would you rate your overall experience at the outpatient unit? G o o d FairPoor___ Excellent Do you have any comments on improving patient care?
Date of Surgery: Name (Optional): hours following your surgery. Preoperative assessment continues the day the patient arrives for surgery. It is helpful to have a standard preoperative checklist for each patient. This insures that every patient receives the same quality care. This checklist is dated and signed by the nurse. There are many types of preoperative checklists. What serves the needs of the
Brenda C Mauldin, RN,is a staflnurse in the operating room and outpatient surgery unit at Northside Hospital, Atlanta. She received her associate degree in nwsing from DeKalb College, Clarkston, Ga.
individual unit best should be used. The nurse should report any irregularities found during preoperative assessment to the anesthesiologist and surgeon. Care of the ambulatory surgery patient is a joint effort involving the nurse, the anesthesiologist, and the surgeon. A final important aspect is patient evaluation of care. Patients have little basis to evaluate the actual surgery, so they may base their entire evaluation on the preoperative phase. Patient evaluation forms are a good way to determine how the patient feels about his care (Fig 1). The patient recognizes and trusts a knowledgeable, caring staff. This is important in ambulatory surgery, because the patient will want to return to the place where he was well treated. I had one patient who had two D & Cs in our unit over a period of a few months. This patient later needed a hysterectomy, and she told her physician she wanted to have it in our unit. It is this kind of reward that makes ambulatory surgical nursing different and special. BRENDAC MAULDIN. RN
77 1