The fears of presurgical patients derive from theirinsecurities in the areas of anesthesia, bodydisfigurement, pain, and even death. Frequently,religious faith is a source of strength and courage forthese patients. If a patient expresses a desire to see aclergyman, every attempt should be made to arrange avisit.ADMINISTRATIVE PREPARATION .—Except in emergencies, the administrative preparationusually begins before surgery. A step-by-stepprocedure is outlined in Fundamental Skills andConcepts in Patient Care, “Caring for the PatientUndergoing Surgery.” Only the Request forAdministration of Anesthesia and for Performance ofOperations and Other Procedures (SF 522) will beaddressed here. The SF 522 identifies the operation orprocedure to be performed; has a statement written forthe patient indicating in lay terms a description of theprocedure; and includes the signatures of thephysician, patient, and a staff member who serves as awitness. An SF 522 must be completed before anypreoperative medications are administered. If thepatient is not capable of signing the document, aparent, legal guardian, or spouse may sign it. It iscustomary to require the signature of a parent or legalguardian if the patient is under 21 years of age, unlessthe patient is married or a member of the ArmedForces. In these latter two cases, the patient may signhis own permit, regardless of age.Normally, the physical preparation of the patientbegins in the late afternoon or early evening the daybefore surgery. As with the administrativepreparation, each step is clearly outlined inFundamental 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 thetotal preparation. The exact time that preoperativeteaching should be initiated greatly depends upon theindividual 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 einstructions be given as close as possible to the time ofsurgery. Appropriate preoperative instructions givenin sufficient detail and at the proper time greatly reduceoperative and postoperative complications.Operative PhaseThe operative (or intra-operative) phase begins themoment the patient is taken into the operating room.Two of the major factors to consider at this phase arepositioning 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 lprocedure will dictate the general position of thepatient. For example, the lithotomy position is usedfor a vaginal hysterectomy, while the dorsalrecumbent position is used for a herniorrhaphy.Regardless of the specific position the patient is placedin, there are some general patient safety guidelines thatmust be observed. When positioning a patient on theoperating table, remember the following:Whether the patient is awake or asleep, place thepatient in as comfortable a position as possible.Strap the patient to the table in a manner thatallows for adequate exposure of the operativesite and is secure enough to prevent the patientfrom falling, but that does not cut off circulationor contribute to nerve damage.Secure all the patient’s extremities in a mannerthat will prevent them from dangling over theside of the table.Pad all bony prominences to prevent thedevelopment of pressure areas or nerve damage.Make sure the patient is adequately grounded toavoid burns or electrical shock to either thepatient 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 tcontributions to medical science was the introductionof anesthesia. It relieves unnecessary pain andincreases the potential and scope of many kinds ofsurgical procedures. Therefore, healthcare providersmust understand the nature of anesthetic agents andtheir effect on the human body.Anesthesia may be defined as a loss of sensationthat makes a person insensible to pain, with or withoutloss of consciousness. Some specific anesthetic agentsare discussed in the “Pharmacy” chapter of thismanual. Healthcare providers must understand thebasics of anesthesiology as well as a specific drug’susage.The two major classifications of anesthesia areregional and general.Regional Anesthesia.—Regional anestheticsreduce all painful sensations in a particular area of thebody without causing unconsciousness. The followingis a listing of the various methods and a briefdescription of each.2-16
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