Preparing Your Patient for Surgery

Linda M. DeLamar, CRNA, MSN, MS

Disclosures

Topics in Advanced Practice Nursing eJournal. 2005;5(1) 

In This Article

History and Physical

A history and physical to provide medical clearance for surgery and anesthesia may be done by the patient's primary care provider or it may be done by the surgeon, depending on the patient's state of health and insurance reimbursement guidelines. This is also a good time to establish or strengthen the patient and healthcare provider relationship and focus on the general health and risk factors of the patient.

A complete history and physical should be obtained at least 1 week before the scheduled surgery for patients who have significant medical conditions. Coronary artery disease, history of a myocardial infarction, poorly controlled hypertension, symptomatic arrhythmias, endocrine disorders, respiratory problems, and diabetes controlled by medication are just a few examples. This will allow time for the patient to be optimally prepared for the procedure both physically and emotionally. Information gathered at this time will determine if further diagnostic testing and specialty consultation are needed.[1] Healthy patients can be seen up to the day of surgery.

The extent of a preoperative evaluation will depend upon the patient's medical condition, the proposed surgical procedure, and the type of anesthesia. If the patient has a significant medical history, has recently had an unstable condition, or is on medication that may need to be modified due to surgery, consultation among the primary care provider, medical specialists, surgeon, and anesthesia staff may be indicated to confirm the patient's current condition and therapy.

Past medical and surgical records can also be invaluable to those involved in the patient's care. If concerns arise during the evaluation process, the anesthesia staff can be consulted. Some examples would be if the patient has asthma or COPD or if there is patient or family history of anesthesia problems such as malignant hyperthermia.

When obtaining a medical history, a checklist may be filled out by the patient. It may be necessary to go over each item with the patient. Sometimes the patient may not understand what is being asked, and information may be omitted. For example, some patients view having had a caesarean section as "childbirth" and not surgery. An example of these questions can be found in  Table 1

Medication History

A detailed medication and drug history is also very important. Many patients are taking numerous over-the-counter and herbal or nutritional products that can affect the surgery and response to anesthesia. Many people believe that herbal and nutritional remedies are harmless because they are "natural" and usually do not mention them unless specifically asked. In one survey, 22% of patients reported using herbal remedies.[2]

The use of herbal remedies and its effects on surgery and anesthesia have been well documented in recent years. An extensive review is beyond the scope of this article; however, some of the more commonly used supplements and their effects are worth mentioning and can be found in Table 2 .

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