1-32
1-32. PREOPERATIVE CARE
a. Most patients scheduled for cardiovascular surgery enter the hospital several days prior to surgery. This allows for adequate time to prepare the patient for what lies ahead and adequate time for the staff to develop a rapport with the patient. Establishing a trusting relationship with the patient will provide him with emotional support.
b. A thorough assessment of the patient must be made. Many members of the health care team will be involved in this phase of preparation.
(1) The physician must complete a thorough physical examination and patient history. He orders the lab work, X-rays, ECGs, and other studies that must be done to obtain baseline data on the patient's immediate preopcondition.
(2) A nursing assessment of the patient must be done. This involves assessing the physical, psychological, social, and spiritual needs of the patient.
(3) The dietician may visit the patient to do a nutritional evaluation and teach the patient about his new postoperative diet.
(4) The physical therapist may visit the patient to instruct him in the postoperative procedures for his rehabilitation. Explanations will be given regarding the importance of advancing activity under the supervision of the staff, and exercise routines will be taught.
(5) An assessment must be made of the patient's coping mechanisms. This may be done by the chaplain, the psychologist, or most commonly, by the nursing personnel. Poor coping mechanisms mean increased anxiety for the patient, and increased anxiety leads to a slower recovery. Early identification of this problem will allow the nursing staff to make provisions for it in the nursing plan of care.
c. The nursing considerations in preoperative management include the following areas.
(1) The nursing staff executes the physician's orders, gathers data, and keeps the physician up to date regarding the patient's status.
(2) Patient education is implemented. The patient is instructed about his postoperative routine and the importance of his participation and cooperation during the postoperative course.
(3) The patient must be fully oriented to the postoperative environment. This includes familiarization with the monitors, machines, and equipment that will be used during the postoperative period. If possible, give the patient a tour of the CCU and allow him to meet some of the nursing personnel.
(4) Reduce patient anxiety by establishing a friendly informative, caring relationship with the patient.
