Physiological Response

Physiological Response - caused by:

Anxiety – for some it is so high, they can't cope

Lack of emotional response – can't express, can be angry, resentful, confused, depressed, vulnerable

to psychiatric reaction, denial, (moderate anxiety is good helps you study/perform well on exams)

Common fears & concerns

1. fear of unknown (primary one) can take pt to recovery room before surgery to meet nurses, tell pt

what to expect

2. fear of malignancy

3. fear of anesthesia ("truth serum")

4. loss of control – not able to bear pain

5. disfigurement / disability (paralyzed)

6. sex loss

7. job security

8. insurance limits

9. disruption of life pattern (family care ♀ )

Voluntary & Informed Consent (LeMone pg. 55-56)

voluntary – not persuaded or coerced in any way

informed – Dr. responsible for giving info & explaining to pt about surgery

consent – need a witness (nurse frequently)

diagnostic procedure – anything with sedation needs consent

if not have surgery – what consequences are (complications & changes in body function)

Criteria for informed consent (*nurse needs to get signed consent form*)

nature of the procedure to be performed

available options

risks & benefits associated with each option

time alloted for questions

pt may withdraw at any time – up to anesthesia administration time

Voluntary & Informed Consent - con't

physician & nurse responsibilities

minor or incompetent can't sign – need legal guardian to sign

emancipated minor (married, or earning own livelihood & keeping earnings can sign)

parenthood – parenthood does not emancipate you

next of kin – can't have girlfriend / boyfriend sign unless have a POA in writing & notarized

emergency – children can get treatment (child in intensive care – Dr. can get court order & go

against parents

can do a 3-way call & Dr. & nurse sign in emergency

check mark (for illiterate person) must be witnessed by two witnesses

pt can't sign consent once sedative given

Assessment

knowledge of events

psychological readiness

physiological status

Patient Knowledge

past surgical experience – what type

understanding of proposed surgery - "Tell me what Dr. told you about surgery."

knowledge of preop events – diagnostic tests

knowledge of postop events – going to PACU

knowledge of exercises to be carried out – deep coughing, teach before surgery, incentive spirometry

Psychological readiness – degree of anxiety, let Dr. talk to them if anxiety severe

Subjective

concerns or fears about surgery

usual coping methods

cultural / religious beliefs & practices – call chaplain or offer to pray

support system – family & close friends

changes in sleep patterns

urinary frequency