Pre Operative Testing

The relevance of pre-operative assessment cannot be overstated when it comes to the clearance of patients for elective surgeries – particularly in the further enhancement of both patient safety and care. The article, Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery, by Akhtar, MacFarlane, and Waseem comes in handy in not only the elaboration of “pre-operative assessment in elective orthopedic surgery and shoulder surgery,” but also in the review of “the essentials of peri- and post-operative care” (p. 316). From the onset, the authors point out that pre-operative assessment helps in not only the enhancement of patient safety, but also in the aversion of complications arising from surgical procedures deemed inappropriate. As a nurse practitioner student in a pre-surgical testing unit, I did assess a patient who was to undergo a shoulder surgery. The patient, referred to herein as Patient X, was a young healthy adult. Akhtar, MacFarlane, and Waseem point out that as far as pre-operative assessment is concerned, “detailed history and clinical examination must be conducted, and additional tests and investigations be requested which are specific to the needs of an individual” (p. 321). The authors back up their assertion with the relevant evidence. In my case, it was no different. In my assessment of Patient X, who was to undergo a shoulder surgery due to an injury sustained during a sporting event, I did conduct the relevant clinical examinations and investigations.
One of the most important points to be noted with regard to a patient’s history is if they have any conditions that could impact upon the planned surgery adversely. Regarding Patient X, I focused on whether he had any undesirable reactions to agents to be used in the forthcoming surgery and related care thereafter. I also reviewed his surgical history and made an enquiry on whether he was on any medications. It is important to note that some medications, i.e. some anti-inflammatory drugs such as Naproxen and Ibuprofen, could increase bleeding at the time of surgery. An inventory of the patient’s lifestyle, specifically with regard to their drinking patterns and smoking history, was taken. In the words of Akhtar, MacFarlane, and Waseem, taking a patient’s smoking history is of great relevance given that “smokers are difficult to anaesthetize”, while alcohol documentation is important “as induction of liver enzymes by alcohol may shorten the action of anesthetic drugs…” (p. 316).
According to the authors of this particular article, there are various conditions that could adversely affect peri-operative care. These, in the words of the authors, include “ischaemic heart disease, diabetes mellitus and liver or renal dysfunction” (p. 316). In this case, no order was made for tests such as ECD or biochemistry. These were not necessary considering the age and health status of Patient X. It is, however, important to note that were Patient X to be older and present some health concerns, some of the tests that could have been ordered include a biochemistry (to minimize risk of cardiac arrest by detecting serum potassium concentration deficits), a full blood count, and an electrocardiogram (ECD) (to investigate underlying ischaemic heart disease). Coagulation testing was also deemed unnecessary in the case of Patient X as an assessment of the patient did not reveal any history of a bleeding disorder. The exclusion of some tests that do not add value is supported by Akhtar, MacFarlane, and Waseem who point out that the absence of tests such as pre-operative chest radiographs “has not been shown to be associated with an increase in post-operative morbidity or mortality” (p. 317).
In the final analysis, it is also important to note that the article by Akhtar, MacFarlane, and Waseem also discusses post-operative care. In so doing, the authors point out that “the mainstays of post-operative care in general are regular assessment, selective monitoring and timely documentation” (p. 318). The other key factors of the said care, as the authors further point out include, but they are not limited to, renal, cardiovascular, as well as respiratory systems. The need to control sepsis and ensure that pain is contained is also emphasized. Overall, the article was both informative and of great relevance in connecting theory to practice.








































References
Akhtar, A., MacFarlane, R.J. & Waseem, M. (2013). Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery. The Open Orthopaedics Journal, 7(3), 316 – 322.