The operating department practitioner (ODP) should be alert to any fears or apprehensions expressed by the patient and transmit such information to the surgeon (Lyons, 1997). The patient and his family should be encouraged to communicate freely with the physician.
The preparation and care of the patient before surgery has one major goal to promote the best possible physical and psychological state of the patient prior to surgical therapy. To achieve this goal, the patient's individual needs must be ascertained and his strengths and limitations evaluated. A plan of care can then be developed to assist the patient in adjusting physically and emotionally to the surgical experience.
Preparation for surgery should begin as soon as the patient is told that an operation is necessary. The anticipation of any surgical procedure will result in an emotional reaction of some kind, and much can be done to alleviate fears prior to admission as well as during hospitalization. The patient's reaction will depend on many factors, including his personality structure and his pattern of reaction to stressful events in the past. A surgical operation is a stressful situation in which the patient may believe that he is in danger of acute pain, serious damage to the body, disability, and death. In addition there is a fear of the unknown. This can be complicated by fear of anesthesia or fear of separation from activities, family, and friends. The average patient also worries about financial problems, family responsibilities, and employment status. Anxiety will usually increase as the time for surgery draws near. The ODP can assist the patient, his family, and surgical personnel by listening to the patient and helping him to verbalize his fears. Often the patient only wants the opportunity to acknowledge his fears to a caring, understanding, and accepting person (Saylor, 1975).
The evening before surgery the ODP will write the preoperative orders for the patient. Hospitals and physicians will vary in the kind of preoperative preparation desired; however, certain routine procedures are fairly common.
It is essential that the patient be optimally nourished prior to surgery. However, during the immediate preoperative period neither food nor water should be allowed. Usually nothing is allowed by mouth after the midnight preceding surgery. This minimizes the chances of vomiting and aspirating vomits into the lungs during or immediately after the surgery.
For some types of surgery the physician may request that the patient be catheterized and that a catheter be left in place to keep the bladder empty. For example, a distended bladder can complicate operative procedures on the lower abdomen and increase the chances of bladder trauma during surgery. If the patient is not catheterized, the patient should void before surgery. Most surgical patients are given an enema preoperatively; however, the procedure is not uniform. The enema may consist of soapsuds, saline, or tap water. Bisacodyl (Dulcolax) suppositories may be ordered instead of enemas (Boore, 2002). When bowel surgery is to be performed, "enemas until clear" may be ordered, that is, enemas must be given until no fecal matter