performed, has a statement written by the patient indicating in lay terms a description of the procedure, 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 patient begins in the late afternoon or early evening the day before surgery. As with the administrative preparation, each step is clearly stated in the Nursing Procedures Manual. Also, listed under “Skin Preparation,” you will find a description of both the purpose and procedure for performing the preoperative shave.

Preoperative teaching is an important part of the total preparation. The exact time that preoperative 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.

OPERATIVE PHASE

The operative, or intraoperative phase as it is sometimes called, begins the moment the patient is taken into the operating room. Two of the major factors to consider at this phase are positioning and anesthesia.

Positioning

The specific surgical procedure will dictate the general position of the patient. For example, the lithotomy position is used for a vaginal hysterectomy; 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 position as possible.

Strap the patient to the table in a manner that

allows for adequate exposure of the operative site.

is secure enough to prevent the patient from falling, but does not cut off circulation or contribute to nerve damage.

Secure all extremities of the patient in a manner that will prevent them from dangling over the side of the table.

Pad all bony prominences to prevent the development of pressure areas or nerve damage.

Make sure the patient is adequately grounded to avoid burns or electrical shock to either the patient or the surgical team.

Anesthesia

One of the greatest contributions to medical science was the introduction of anesthesia. It relieves unnecessary pain and increases the potential and scope of many kinds of surgical procedures. 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 sensation that makes a person insensible to pain, with or without loss of consciousness. Some specific anesthetic agents are discussed in the ‘‘Pharmacology and Toxicology” chapter of this manual. Health care providers must understand the basics of anesthesiology as well as the specific drug’s usage.

REGIONAL ANESTHESIA.— The two major 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.