13 Surgery (Perioperative Client) Nursing Care Plans

Deficient Knowledge

Deficient knowledge among patients undergoing surgery can arise from a variety of factors, including a lack of education, difficulty in understanding complex medical information, fear and anxiety about the surgery, and language barriers. Patients may also have limited access to reliable health resources or be unable to recall important information due to stress or preoperative medications. As a result, they may not be fully informed about the surgical process, potential risks, and postoperative care. This lack of knowledge can lead to confusion, misunderstandings, and decreased patient satisfaction with the care received. To address this issue, it is important for the registered nurse to proactively educate and communicate with patients, using clear and concise language, and providing access to trustworthy health resources.

Nursing Diagnosis

• Deficient Knowledge

May be related to

• Lack of exposure/recall, information misinterpretation
• Unfamiliarity with information resources

Possibly evidenced by

• Statement of the problem/concerns, misconceptions
• Request for information
• Inappropriate, exaggerated behaviors (e.g., agitated, apathetic, hostile)
• Inaccurate follow-through of instructions/development of preventable complications

Desired Outcomes

• The client will verbalize understanding of disease process/perioperative process and postoperative expectations.
• The client will correctly perform the necessary procedures and explain the reasons for the actions.
• The client will initiate necessary lifestyle changes and participate in the treatment regimen.

Nursing Assessment and Rationales

1. Assess the patient’s level of understanding.
Facilitates planning of preoperative teaching program, and identifies content needs.

2. Review specific pathology and anticipated surgical procedure. Verify that appropriate consent has been signed.
Provides a knowledge base from which patients can make informed therapy choices and consent for the procedure, and presents an opportunity to clarify misconceptions.

Nursing Interventions and Rationales

1. Use resource teaching materials, and audiovisuals as available.
Specifically designed materials can facilitate the patient’s learning.

2. Implement an individualized preoperative teaching program: 

• 2.1. Preoperative or postoperative procedures and expectations, urinary and bowel changes, dietary considerations, activity levels/ transfers, respiratory/ cardiovascular exercises; anticipated IV lines and tubes (nasogastric [NG] tubes, drains, and catheters).
  Enhances the patient’s understanding or control and can relieve stress related to the unknown or unexpected.
  
• 2.2. Preoperative instructions: NPO time, shower or skin preparation, which routine medications to take and hold, prophylactic antibiotics, or anticoagulants, anesthesia premedication.
  Helps reduce the possibility of postoperative complications and promotes a rapid return to normal body function. Note: In some instances, liquids and medications are allowed up to 2 hr before a scheduled procedure.
  
• 2.3. Intraoperative patient safety: not crossing legs during procedures performed under local or light anesthesia.
  Reduced risk of complications or untoward outcomes, such as injury to the peroneal and tibial nerves with postoperative pain in the calves and feet.

3. Expected or transient reactions (low backache, localized numbness, and reddening or skin indentations).
Minor effects of immobilization and positioning should resolve in 24 hr. If they persist, a medical evaluation is required.

4. Inform the patient or SO about itinerary, and physician/SO communications.
Logistical information about operating room (OR) schedule and locations (recovery room, postoperative room assignment), as well as where and when the surgeon will communicate with SO relieves stress and miscommunications, preventing confusion and doubt over the patient’s well-being.

5. Discuss individual postoperative pain management plans. Identify misconceptions patients may have and provide appropriate information.
Increases the likelihood of successful pain management. Some patients may expect to be pain-free or fear becoming addicted to narcotic agents.

6. Provide opportunities to practice coughing, deep breathing, and muscular exercises.
Enhances learning and continuation of activity postoperatively.