Aspect of Care

Nursing Action

Rationale

Identification verification

Verify that identification band corroborates with patient’s and family’s statement and chart documentation.

The identification band functions as a safety measure so that the proper patient receives the correct surgery.

Preoperative workup within hospital parameters (often 72 hour)

Check that laboratory values are in the chart. Assess laboratory values for relationship to normalcy and identify any values that lie outside normal ranges. Notify the healthcare prescriber of outliers.

Special attention should be paid to potentially significant outliers that may indicate change in patient’s status or electrolyte imbalance.

Consents completed: General consent Surgical consent

Confirm that all required consent forms are completed, with dates, proper procedure identified, and witness.

Lack of properly signed consents can result in litigation and refusal of reimbursement to the institution.

Surgical attire

Dress the child per facility’s policy regarding perioperative attire.

Some facilities allow the children to wear underwear to the operating room (OR) to reduce anxiety.

Family notification

Verify that the family/guardian is informed regarding location of surgical waiting room, anticipated length of surgery, and areas to obtain amenities such as coffee and refreshments.

Concerned family members generally want to remain nearby when possible to be notified as to the ongoing status or outcome of surgery as soon as possible.

Allergy status

Prominently note known or suspected allergies in the medical record. If available, place allergy wristband on the child.

Patient or family members should be asked about any allergies, including episodes of hives and food or medication allergy.

Familial history of problems with anesthesia

Elicit family history of reaction to anesthesia.

Intolerance or adverse reactions to anesthesia can be life threatening and may be hereditary.

Vital signs

Document current vital signs; identify any unusual trends or values outside the norm.

Unusual patterns or change in vital signs may indicate change in patient’s status.

Body weight and height

Document current height and weight.

Height and weight are the primary parameters that are used to determine drug dosages, blood volume, and fluid requirements.

Elimination: urine

Encourage the child to void before surgery, and document; note any changes or unusual appearance in urine.

The opportunity to void in the OR may be limited, and the child will receive generous amounts of IV fluids intraoperatively.

NPO (nothing by mouth) status

Keep the child NPO as ordered; inform the family of underlying rationale.

Stomach contents may be aspirated during intubation. Anesthesia may reduce gastric motility as well as cause nausea and vomiting.

Removal of foreign objects or personal belongings

Check for and ask the child about the possible presence of hairpins, jewelry, and so forth. Remove these before transport to the OR. If items (such as a ring) are not removable, the OR nurse should be notified of their presence so that any hazard that these may produce can be minimized.

Metal or other materials may be a risk factor for burns from the cautery used in the surgery or form pressure sores during prolonged surgery. Check even infants for earrings; older children may have other body areas pierced, such as umbilicus.

Removal of prostheses

Remove contact lenses, eyeglasses, and orthodontic appliances before transport to the OR. Note any exceptions.

Items such as contact lenses and orthodontic appliances are commonly encountered in the pre-adolescent and adolescent population.

Nail bed assessment

Remove any nail polish from fingers and toes before transportation to the OR.

Nail polish can obscure the ability to accurately assess for oxygenation and capillary refill.

Dentition

Examine the mouth, and inquire about potentially loose teeth. If identified, note and report to the OR nurse or anesthetist.

Children intermittently loosen their “baby teeth,” which can pose a hazard should the child be intubated.

Preoperative medication

Administer any prescribed medications before transport to OR. If IM medications are ordered, check with anesthesia care practitioner to give by a different route.

Light sedation is often desirable to allay anxiety associated with the surgery. Medication should be administered with enough time to achieve desired effect, and the patient is monitored or observed for any adverse reactions.

Operative site preparation

Comply with facility standards for skin preparation for cleansing or shaving of operative skin.

The skin at the operative site should be as free of oil and debris as possible to reduce the risk for infection.