Care of Adults Experiencing Acute & Chronic Illness

A. Psychological factors are significant to obtain during the preoperative period because:
a. Surgery is a stressful event and psychological/physiological reactions to the surgical procedure and anesthesia may elicit the stress response (elevated BP and HR). The stress response enables the body to prepare to meet demands in the perioperative period and if the response to stressors is excessive the recovery phase nay be affected.   Each patient is different and various factors influence a patients susceptibility to stress such as age, past experience with illness and pain, current health, and socioeconomical status.
i. Anxiety: This is a normal survivor mechanism, however if it’s too high: cognition, decision making, and coping abilities are diminished. This can arise from not knowing what to expect during the surgical experience to the uncertainty from lack of knowledge.
1. Due to past experience or experiences of friends, family, and the media. Or if surgical interventions are in conflict with religious or cultural beliefs.
ii. Fear: (MOST COMMON: death or permanent disability), sometimes these fear arise from hearing or reading about the risks during the informed consent.
1. Death: This can be very detrimental and the physician should be notified if patient has strong fear of death. The physician may postpone surgery until the situation improves because attitude and emotional state influence the stress response and surgical outcome.
2. Pain and Discomfort: This is common during and after surgery.
3. Mutilation or Alteration in body image:
4. Anesthesia: May arise from the unknown, personal past experiences, tales of other past experiences. Hazards or complications of anesthesia: brain damage, paralysis. Also, fear of losing control. If fears are present inform ACP (anesthesia care provider) so the patient can talk more with ACP. Inform patient that a nurse and ACP will be present during surgery.
5. Disruption of life functioning or patterns: ADL, loss...