- Preoperative assessment aims to:
- Reduce morbidity and mortality associated with surgery
- Prevent unnecessary cancellations
- Reduce hospital stay
Aim of preoperative planning
- Inform patient of the proposed procedure
- Obtain informed consent for the procedure
- Assess pre-existing medical conditions
- Plan pre and postoperative management of these conditions
Issues that should be discussed
- Time of admission and starving instructions
- Management of usual medication
- Any specific pre-operative preparation that may be required
- Transport to theatre
- Any specific anaesthetic issues
- Anticipated duration of surgery
- Likely recovery period
- Need for drains, catheters
- Likely discharge date
- Need for dressing change or specific postoperative care
- Follow up requirements
- Likely date of return to work or full activity
Important medical diseases that increase morbidity and mortality
- Ischaemic heart disease
- Congestive cardiac failure
- Hypertension
- Cardiac arrhythmias
- Chronic respiratory disease
- Diabetes mellitus
- Endocrine dysfunction
- Chronic renal failure
- Nephrotic syndrome
- Obstructive jaundice
Advantages of pre-admission clinic
- Allows pre-operative optimisation of patients
- Reduces duration of hospital stay
- Reduces risk of unnecessary cancellations
- Guidelines minimise unnecessary preoperative investigations
Bibliography
Bray A. Preoperative nursing assessment if the surgical patient.
Nurs Clin North Am 2006; 41: 135-150. |