CHAPTER 13 Perioperative Care^479
associated risks, and the risks associated with anesthesia are all explained to the
patient. It is the surgeon’s responsibility to make sure this information is explained
to the patient. The patient must be a competent adult in order for his or her signa-
ture to be valid. If the patient has been given medications that alter his or her abil-
ity to reason or to make judgments, the consent will not be valid. The nurse witnesses
the patient’s signature on the consent form.
PREOPERATIVE TEACHING
Explaining normal preoperative routines to the patient can be very helpful, so the
patient knows what to expect. The nurse needs to be familiar with the types of
surgical procedures and what the expected postoperative course will entail. The
extent of the procedure, type of incision, presence of any tubes or drains, and antic-
ipated pain level after the surgery will help guide the type of teaching necessary
for the patient.
Preoperatively the patient can expect to be NPO, or not allowed to eat or drink
anything for several hours prior to the procedure. The time frame will depend on
the extent and location of procedure, the type of anesthesia, and the scheduled time
of surgery. An exception to this nothing-by-mouth rule would be for patients who
need to take oral medications the morning of surgery. Cardiovascular, diabetic, and
certain other medications may need to be taken even though the patient is not to
eat or drink anything else.
An intravenous access site will be obtained prior to the surgery. Fluids can be
administered to the patient in this way. The access also allows for giving the patient
medications intravenously for rapid action. Fluids are routinely given in the oper-
ating room and in the immediate recovery period. The patient may have continued
intravenous fluids for more extensive procedures.
Skin preparation may only involve washing of the surgical site in the operating
room with an antimicrobial solution. Other patients may need to have removal of
hair from the surgical site. This may be with a razor or a depilatory agent. It is
important not to cut the skin if you are shaving a surgical site; small cuts or abra-
sions on the skin allow for potential sites of infection. Depilatory agents can be
caustic on the skin of some patients, causing irritation or a rash. A small spot test
away from the surgical area is a good idea in a patient with known skin sensitiv-
ity or history of allergies.
For patients having planned surgery involving the intestinal tract, a bowel
preparation will be completed prior to the surgery. This is done to decrease the bac-
terial count within the intestinal tract. Cleansing of the bowel is also completed to
empty the intestine of stool before the surgeon plans on cutting into either the small
or large intestine. Both of these preparations help to reduce the possibility of