Procedurally-Relevant Focused Assessments

Guidelines:

• RN should have working knowledge of surgical procedure to be performed
• Ensure patient has adequate knowledge of recovery and future care
• Identify risk factors that are increased for impending procedure

Considerations:

• Positioning
  • Joint pain-high lith? Jacknife?
  • Lung status- trendelenburg
• Relevant surgical surgery
  • Virgin abdomen vs adhesions
  • Weeks gestation
• Patient’s expectations
• Due to void?
  • Perineal blocks
  • Foley
• Preoperative imaging
• Insufflation

Nurse’s role:

• Preoperative interview and assessment
  • Identify patient’s needs relative to surgical plan
• Facilitate discussion of surgical plan between surgical team
• Anticipate unique equipment needs
  • Patient history
  • BMI/ OSA

Pitfalls:

• Mismatched plans between anesthesia and surgeon
  • IV fluid
  • Positioning
  • Induction medication
  • BLOCKS
• Nurse turnover
• Stoic patient

Examples:

• ICU patient cannot tolerate trendelenburg effectively (Discuss with team, retraction?
  alternatives?)
• Vascular AV shunt received block (cannot assess for steal – pain is primary indicator)
• Flourescene/IC Green/ methylene (required on hand or take preoperatively)
• Mammography needs (cannot be first case, how placed magseed vs pin vs nuc med)
• Pathology needs (Fresh/frozen! Call ahead)

Linchpins (Key Points):

• Each procedure has unique needs that the RN should anticipate and evaluate for risk
  factors