(^478) Medical-Surgical Nursing Demystified
The Preoperative Period
The preoperative period, the time prior to surgery, is used to prepare the patient for
surgery both physically and psychologically. Ideally there is time to correct as many
abnormalities as possible prior to the surgical procedure. For patients having a
scheduled procedure with a significant anticipated blood loss, this is the time to
donate blood to be banked for use in their surgery and begin to take iron, folic acid,
vitamin B 12 , and vitamin C to aid in red blood cell production. Preoperative clear-
ance is given, informed consent is obtained, and preoperative teaching occurs dur-
ing this time.PREOPERATIVE CLEARANCE
The patient’s primary care provider typically gives preoperative clearance for sur-
gery. This physician, nurse practitioner, or physician’s assistant is familiar with
the patient’s medical history and current medications and is able to adequately
assess the impending risk of the surgery to the patient. Things to consider when
providing clearance for the patient include the type of surgical intervention planned,
the potential for blood loss during surgery, the patient’s age, general health
and comorbidities, past medical and surgical history, current medications, use of
herbal remedies or supplements, alcohol use, smoking history, substance use,
allergies, family history including problems with surgery, and diagnostic testing
results. Diagnostic studies often include a CBC (to identify anemia or signs of
infection), a chemistry panel (to identify electrolyte imbalance, abnormal glu-
cose, liver or renal function), a urinalysis (to identify infection, protein, glucose),
PT/INR/PTT (to identify blood clotting disorders), an EKG (to identify abnormal
cardiac rhythms or damage to myocardium), chest x-ray (to identify pulmonary
pathology or enlargement of cardiac silhouette), or pulmonary function testing
(for patients with respiratory disorders such as asthma or emphysema). CT scans,
MRIs, PET scans, or stress testing may be ordered for individual patients depend-
ing on their medical history, type of surgical procedure planned, and results
of other diagnostic studies.INFORMED CONSENT
An informed consent is obtained prior to any invasive or dangerous procedure.
The reason for the surgery, type and extent of surgery to be performed, the risks of
the procedure, the person to perform the procedure, alternative options and their2