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
(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
(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.