The fears of presurgical patients derive from their
insecurities in the areas of anesthesia, body
disfigurement, pain, and even death.
Frequently,
religious faith is a source of strength and courage for
these patients. If a patient expresses a desire to see a
clergyman, every attempt should be made to arrange a
visit.
ADMINISTRATIVE PREPARATION .—
Except in emergencies, the administrative preparation
usually begins before surgery. A step-by-step
procedure is outlined in Fundamental Skills and
Concepts in Patient Care, “Caring for the Patient
Undergoing Surgery.” Only the Request for
Administration of Anesthesia and for Performance of
Operations and Other Procedures (SF 522) will be
addressed here. The SF 522 identifies the operation or
procedure to be performed; has a statement written for
the patient indicating in lay terms a description of the
procedure; and includes the signatures of the
physician, patient, and a staff member who serves as a
witness. An 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 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 outlined in
Fundamental Skills and Concepts in Patient Care,
“Caring for the Patient Undergoing Surgery.”
P R E O P E R AT I V E I N S T R U C T I O N S . —
Preoperative instructions are an important part of the
total preparation. The exact time that preoperative
teaching should be initiated greatly depends upon the
individual patient and the type of surgical procedure.
M o s t e x p e r t s r e c o m m e n d t h a t p r e o p e r a t i v e
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 intra-operative) phase 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.
P O S I T I O N I N G. — T h e s p e c i f i c s u rg i c a l
procedure will dictate the general position of the
patient. For example, the lithotomy position is used
for a vaginal hysterectomy, while 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 a position as possible.
Strap the patient to the table in a manner that
allows for adequate exposure of the operative
site and is secure enough to prevent the patient
from falling, but that does not cut off circulation
or contribute to nerve damage.
Secure all the patient’s extremities 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.
A N E S T H E S I A . — O n e
o f
t h e
g r e a t e s t
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, healthcare 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 “Pharmacy” chapter of this
manual. Healthcare providers must understand the
basics of anesthesiology as well as a specific drug’s
usage.
The two major classifications of anesthesia are
regional and general.
Regional Anesthesia.—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 of each.
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