PREOPERATIVE TEACHING

术前宣教

Assessment

评估

1. Ask about client's previous experiences with surgery and anesthesia.

1、询问病人以前的手术和麻醉经历。

2. Determine client's and family's understanding of surgery.

2、确定病人和家属是否了解手术情况。

3. Identify client's cognitive level, language, and culture.

3、评价的认识水平、语言和文化背景。

4. Assess client's anxiety related to surgery.

4、评估病人是否对手术感到焦虑。

Implementation

实施

1. Use Standard Protocol.

1、按标准程序开始操作。

2. Inform client and family of date, time, location of surgery, and where to wait.

2、告知病人及家属手术日期、时间和、位置及等待区。

3. Inform client and family about the anticipated length of time of surgery.

3、告知病人及家属预计手术时间。

4. Answer questions client and family ask.

4、回答病人及家属所提问题。

5. Describe perioperative routines.

5、说明围手术期常规。

6. Describe preoperative medications.

6、说明围手术期用药情况。

7. Review which routine medications are to be discontinued before surgery.

7、检查术前应停用何种药物。

8. Describe perioperative sensations to expect (sights, sounds, touch).

8、说明手术期间可能有的感觉(视觉、听觉、触觉)。

9. Describe pain-control methods. Many clients have a patient-controlled analgesia (PCA) pump.

9、说明止痛方法。很多病人有病人自控镇痛泵。

10. Describe what client will experience postoperatively.

10、说明病人可能的术后感觉。

11. Have client practice splinting. Hold pillow to abdomen for support while sitting up or coughing.

11、病人练习夹板疗法，以起坐或咳嗽时用枕头支撑腹部。

12. Have client practice turning and sitting up.

12、病人练习翻身和起坐。

Flex knees.

Splint incision with left arm and pillow.

Push on the mattress with right arm and swing feet over the edge of the bed.

屈膝。

用左臂和枕头夹住切口。

右臂按床垫，摆动两腿至床沿。

13. Have client practice deep breathing and coughing.

13、病人练习深呼吸和咳嗽。

• Assist client to sitting position.
• Instruct client to place palms of hands over the lower border of the rib cage with third fingers touching.
• Have client take slow, deep breaths and feel fingers separate.
• Have client hold the breath for 3 seconds and exhale through the mouth slowly, as if blowing out a candle.
• Instruct client to cough forcefully.
• Have client practice several times.
• Have client perform turn, cough, and deep breathing every 2 hours.

• 协助病人起坐。
• 指导病人将两手手掌置于肋下缘，中指相接。
• 病人慢、深呼吸，感觉手指分开。
• 病人屏气3秒钟，慢慢用口呼气，如吹蜡烛。
• 指导病人用力咳嗽。
• 病人反复练习上述动作。
• 病人每2小时练习翻身、咳嗽和深呼吸一次。

14. Have client practice use of an incentive spirometer

14、病人练习使用诱导性肺量器。

• Position in a sitting or reclining position.
• Instruct client to exhale completely, then place mouthpiece so that lips completely cover it and inhale slowly, maintaining constant flow.
• After maximum inspiration, client should hold breath for 2 to 3 seconds, then exhale slowly.
• Instruct client to breathe normally for a short period, then repeat process.

• 病人处坐位或拱垂位。
• 指导病人呼气，放置衔嘴，嘴唇完全封闭，慢慢吸气，速度均匀。
• 至无法吸气时屏气2-3秒钟，然后慢慢呼气。
• 指导病人正常呼吸，然后重复上述动作。

15. Have client practice leg exercises.

15、病人进行腿部练习。

• Rotate each ankle in a complete circle. Draw imaginary circles with the big toe five times.
• Alternate dorsiflexion and plantar flexion while instructing client to feel calf muscles tighten and relax. Repeat five times.
• Instruct client to alternate flexing and extending knees one leg at a time. Repeat five times.
• Instruct client to alternate straight leg raises. Repeat five times.
• Instruct client to perform these leg exercises every 2 hours while awake.www.lindalemus.com

• 全方位旋转脚踝，想象用大拇指画圈五次。
• 交替屈、伸足部，指导病人体会小腿肌肉紧张和放松的感觉，重复五次。
• 指导病人分别交替屈、伸两腿膝部。重复五次。
• 指导病人交替练习直腿抬起，重复五次。
• 指导病人在醒时每2小时做腿部练习一次。

16. Verify that client's expectations of surgery are realistic. Correct expectations as needed.

16、确认病人对手术有较为现实的预期。必要时应纠正其想法。

17. Reinforce therapeutic coping strategies. If ineffective, encourage alternatives.

17、强化治疗应对方法，如方法无效，可鼓励采用其他方法。

18. Use Completion Protocol.

18、按标准程序完成操作。

Evaluation

评价

1. Evaluate client's understanding of and ability to participate in preoperative teaching.

1、评价病人对术前教育的理解程度及参与能力。

2. Ask family where they will be waiting.

2、询问病人家属在何处等候病人。

3. Determine readiness to care for client after discharge.

3、确定是否已经作好病人出院护理准备。

4. Observe emotional support provided and coping strategies.

4、遵守情感护理要求和应对策略。

5. Identify Unexpected Outcomes and Nursing Interventions

5、确认意外结果和护理措施。

Record and Report

记录与报告

1. Record on preoperative instruction flow sheet.

1、在术前指导流程表上作好记录。

2. Report any concerns about follow-up care to appropriate personnel.

2、向适当人员报告有关随访护理的问题。

Revised