performed, has a statement written by the patient
indicating in lay terms a description of the pro-
cedure, and includes signatures of the physician,
patient, and a staff member who serves as a
witness. SF 522 must be completed before any
preoperative medications are administered. If the
patient is not capable of signing the document,
a parent, legal guardian, or spouse may sign it.
It is customary to require the signature of a parent
or legal guardian if the patient is under 21 years
of age, unless the patient is married or a member
of the Armed Forces. In these latter two cases,
the patient may sign his or her own permit,
regardless of age.
Normally, the physical preparation of the pa-
tient begins in the late afternoon or early evening
the day before surgery. As with the administrative
preparation, each step is clearly stated in the Nurs-
ing Procedures Manual. Also, listed under Skin
Preparation, you will find a description of both
the purpose and procedure for performing the
Preoperative teaching is an important part of
the total preparation. The exact time that pre-
operative teaching should be initiated greatly
depends upon the individual patient and type of
surgical procedure. Most experts recommend that
preoperative instructions be given as close as
possible to the time of surgery. Appropriate
preoperative instructions given in sufficient detail
and at the proper time greatly reduce operative
and postoperative complications.
The operative, or intraoperative phase as it is
sometimes called, begins the moment the patient
is taken into the operating room. Two of the ma-
jor factors to consider at this phase are position-
ing and anesthesia.
The specific surgical procedure will dictate the
general position of the patient. For example, the
lithotomy position is used for a vaginal hysterec-
tomy; whereas, the dorsal recumbent position is
used for a herniorrhaphy. Regardless of the
specific position the patient is placed in, there are
some general patient safety guidelines that must
be observed. When positioning a patient on the
operating table, remember the following:
Whether the patient is awake or asleep,
place the patient in as comfortable posi-
tion as possible.
. Strap the patient to the table in a manner
. allows for adequate exposure of the
. is secure enough to prevent the patient
from falling, but does not cut off cir-
culation or contribute to nerve damage.
. Secure all extremities of the patient in a
manner that will prevent them from dangl-
ing over the side of the table.
. Pad all bony prominences to prevent the
development of pressure areas or nerve
. Make sure the patient is adequately
grounded to avoid burns or electrical shock
to either the patient or the surgical team.
One of the greatest contributions to medical
science was the introduction of anesthesia. It
relieves unnecessary pain and increases the poten-
tial and scope of many kinds of surgical pro-
cedures. Therefore, health care providers must
understand the nature of anesthetic agents and
their effect on the human body.
Anesthesia may be defined as a loss of sensa-
tion that makes a person insensible to pain, with
or without loss of consciousness. Some specific
anesthetic agents are discussed in the Phar-
macology and Toxicology chapter of this
manual. Health care providers must understand
the basics of anesthesiology as well as the specific
REGIONAL ANESTHESIA. The two ma-
jor classifications of anesthesia are regional and
general. Regional anesthetics reduce all painful
sensations in a particular area of the body without
causing unconsciousness. The following is a listing
of the various methods and a brief description:
. Topical anesthesia is administered topically
to desensitize a small area of the body for
a very short period.
. Local blocks consist of the subcutaneous
infiltration of a small area of the body with
a desensitizing agent. Local anesthesia
generally lasts a little longer than topical.