Preparing Your Patient for Surgery

Linda M. DeLamar, CRNA, MSN, MS

Disclosures

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

In This Article

Diagnostic Testing

There is often controversy regarding laboratory studies. Routine preoperative laboratory screening is not cost-effective or predictive of postoperative complications, according to most studies.[3] Most institutions have guidelines in place for diagnostic testing to be done preoperatively based upon age, gender, and medical history rather than a standard list of diagnostic tests for all patients. Generally, most findings are considered current if done within 60 days of the scheduled surgery, if the results were normal, and if there have been no changes in the patient's health status.

For certain individuals, specific diagnostic tests may need to be more current. For example, in patients using diuretics or digitalis, a serum potassium level should be obtained within 7 days of surgery, and blood glucose levels should be obtained on the day of surgery for diabetics who are controlled with medication.[1] Patients who are on dialysis should have had serum chemistry, hemoglobin and hematocrit, BUN and creatinine, PT/INR and PTT since the last dialysis, and preferably on the day of surgery. A complete blood count as well as serum chemistry would be warranted in someone who has recently received chemotherapy. Other laboratory studies should be ordered as indicated by the patient's condition and/or medications.

Routine pregnancy testing is done at most institutions for women of childbearing age who continue to have menstrual periods, even if they have had a tubal ligation or are on other forms of birth control.

Chest radiography is of minimal predictive importance and not cost effective as a screening test for postoperative respiratory problems, so it is not recommended without specific indications from the medical history and physical examination.[4] Some specific indications for chest radiography[1] would be:

  • History of malignancy, in which pulmonary metastasis might alter surgical therapy;

  • History of tuberculosis or a positive skin test, for which no treatment was given;

  • History suggestive of a pulmonary infection;

  • Suspected intrathoracic pathologic condition;

  • History of congenital heart disease;

  • Severe obstructive sleep apnea (may have cardiomegaly); and

  • Symptomatic or debilitating respiratory or cardiovascular disease.

An electrocardiogram is indicated in patients who have or are at risk for cardiovascular disease (drug abuse, hypertension, renal disease, circulatory disease, thyroid disease, diabetes, significant pulmonary disease), if there is a history of unevaluated murmur or palpitation, a history of moderate to severe sleep apnea, or chronic airway obstruction (may be at risk for right-sided heart strain).[1]

Based upon the history, physical, and any pertinent diagnostic tests, an assessment is made and risk factors are identified and addressed. Consultations are ordered if indicated. Patients with electrocardiogram changes may be referred to a cardiologist. Patients who have multiple medical problems may need to be medically cleared by their specialists or primary care provider.

In addition, not all patients are candidates for surgery outside of the hospital, such as at a freestanding surgery center. Patients who have serious medical problems such as cardiac disease, severe respiratory problems, or bleeding disorders that are not adequately managed should have procedures done in the hospital setting.[5] Ideally, the primary care provider should coordinate the entire preoperative evaluation, communicate with the surgeon and the anesthesia department, and fax everything to the surgery department for final clearance. Comprehensive communication and coordination are essential.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....