PreSurgical Teaching

[pagandeva2000, LPN]

In my clinic, we sometimes send people up for procedures such as D/C, removal of fibroids (you know, the GYN things). I was told that I didn't have to do them in the past, but, now, they may assign this responsibility to me since I am responsible for my own team.

I forgot, folks, please give me basic ideas of what I should teach people before surgery...the only thing I remember from school is not to take anything with aspirin or motrin before their procedures (and forgot how many days that should be for). Any help is appreciated!

[EymieICURN]

Pre surgical instructions of the importance of coughing and deep breathing.

Early ambulation after the procedure, I remember having surgery and being in so much pain I did not want to move...I could have layed in bed for a few days! This also helps with moving the gas after laparoscopic procedures.

Taking pain meds..not trying to tough out the pain.

I believe the aspirin should be held for 7 days before the procedure and 3 days after the procedure.

That is all I can think of...Hope it helps!

[Anisettes, BSN, RN]

Not just ASA and NSAIDS, but also refrain from ingesting ANY blood thinners (like coumadin) - UNLESS specifically told they may take them - they are usually stopped several days before the surgery.

Also NPO midnight before, which includes smoking and chewing gum, I've had Anesthesiologists cancel a case if they found out or caught a patient smoking prior to surgery. Some providers will allow certain maintenance meds to be taken the morning of surgery with a SIP of water, but again - this needs to be clarified with the anesthesia provider. By all means brush their teeth (please!), just don't swallow the water.

Another one seems innocuous, but advise them NOT to shave operative areas themselves unless specifically instructed to do so by surgeon. Simple abrasions allow staph and other bacteria into the site, surgeon will shave (rare these days as most hospitals have gone exclusively to clippers for this reason) or have area shaved in-house immediately prior if required. Again, I've seen cases cancelled - specifically a recent arthroscopic shoulder case where the patient shaved himself (he was REALLY furry) thinking he was helping out. No obvious abrasions, but surgeon cancelled it.

Also, leave all jewelry/valuables AT HOME. Remove ALL metal body piercings (plastic spacers can be left in unless they interefere with access to the surgical site) and remind them to remind the nurse when she interviews them immediately pre-op if they have metal hardware anywhere (screws, pins, rods, plates, etc...) - because of the electrocautery device used during surgery, this helps with placement of the grounding pad as you wouldn't want it placed over that rod in your femur.

It IS NOT acceptable to tape a wedding ring - REMOVE it - taping it doesn't remove the risk of an electricity arc (and subsequent burn), it's still metal. It's rare it would happen, but it's also rare to get run over by a bus, but it happens. If I had a nickel for every wedding band that came to the OR covered with a ridiculous piece of tape, I'd be rich. Somewhere someone got the idea that the practice of taping a hard to remove ring was acceptable - it's NOT, it's STILL a piece of metal and a potential danger.

The anesthesia provider is ultimately responsible for informing patient as to any questions as to take/not take meds morning of - depends on what meds. And they should speak with the patient at least by phone no later than the night prior to surgery. But if this gets dumped on you, you can use this info as general guidelines - for specifics you should contact the provider - they are all different in what they allow and do not.

That's all I can think of at the moment, other stuff you do right before surgery, my mind's numb at the moment. Hope some of this helps.

[pagandeva2000, LPN]

Thank you so much! I plan to make a list of these suggestions keep them available as I gain confidence in this aspect of teaching. Greatly appreciated!!

[roser13, ASN, RN]

No herbal supplements/large-dose vitamins for 10-14 days pre-op. Fish oil and Vitamin E, for example, are considered to be blood thinners. Other herbals have various effects and potential anesthesia interactions. Best to ban all supplements. A multivitamin is considered to be safe.

One absolute is no prescription diet pills for 10-14 days pre-op. Adipex, Meridia, etc., have potentially fatal cardiac effects if taken within 7 days of anesthesia.