A perioperative procedure is a very necessary one that takes place before each surgery. Nurses are responsible for appropriate perioperative procedures as they have to question a patient, consider his/her history of disease and make all the necessary tests aimed at checking the possible risks and problems while surgery. Infection, respiratory and cardiac complications are three main which take place if inappropriate perioperative assessment takes place. Pulmonary edema, cardiac arrest, and myocardial infarction are the most frequently met cardiac complications in case of wrong or inappropriate perioperative assessment (King, 2008). Perioperative is divided into two major groups, assessment for cardiac surgery and assessment for non-cardiac surgery. Depending on the type of surgery, the perioperative assessment differs greatly. The discussion in this evidence-based practice and applied nursing research is going to be based on the necessary changes for perioperative assessment before non-cardiovascular surgery of patients with a low level of cardiac risk.
Generally, perioperative assessment consists of the different procedures depending on the general condition of a patient, such as age, the urgency of surgical operation, absence of presence of chronic diseases, etc. Even though each patient has to be individually assessed, it is a usual practice that all patients are similarly considered. If a person does not need cardiovascular surgery, the preoperative assessment takes place in several steps without heart testing.
Freeman and Gibbons (2009) stress that people with low cardiac risk still need to be tested for cardiac complications before non-cardiac surgery as well. Those patients who have low cardiac risk do not have an appropriate cardiac assessment that may lead to great complications after the surgery or even during it. One of the main limitations, in this case, is the assuredness that people who do not have cardiovascular risk are sure to come through the operation with the lowest risk (Lee, 2007). Such measures are ineffective as the rates of cases of mortality while surgery because of cardiovascular complications increases. Laine, Williams, and Wilson (2009) assure that unnecessary tests may harm people more than bring any good, however, cardiovascular diseases and the risk to patients is to be considered more frequently even if a patient is at the low cardio risk group. 12-lead ECG, non-invasive evaluation of LV function, stress testing, and coronary angiography are the tests that are to be taken as obligatory ones.
The procedure of perioperative assessment can be completed more successfully if the step devoted to cardio risk consideration is taken each time, no matter whether a person is included in the low cardio risk group or not. The general condition is assessed by the nurses. They are responsible for measuring patients’ preparedness for the surgery and possible risks. Freeman and Gibbons (2009) say that nowadays, the absence of the cardiac assessment of patients with a low risk of cardio diseases is a norm. However, trying to provide some arguments in favor of making this test obligatory for all groups of people, the following rationale is to be presented. The number of deaths because of cardiac complications during and after surgery has increased. No matter whether people are put in a group of cardiac risk or not, they may suffer from complications after surgery which could be avoided if appropriate tests were taken before the intrusion. Increased number of days in the hospital, ventricular fibrillation/cardiac arrest, acute myocardial infarction, and pulmonary edema are the most spread complications people suffer from if they fail to be appropriately tested before the surgeon. All these troubles regularly occur both in patients with a high risk of cardiac complications after the surgery and in those who had low risk. Maia and Abelha (2008) say that the number of cardiac complications after the surgery of low cardiac risk patients has increased along with the level of mortality.
What can be done in order to reduce the number of cases that resulted in complications or deaths? First of all, obligatory cardiac testing for all patients is to be implemented. The procedure is important as it may lower the risk of cardiac complications after the surgery. I recommend applying innovative technologies because cardiac testing of low-risk patients is to be conducted with more attention and only computerized strategies can help. Nurses are to be responsible for making notes and analyzing the results of the computerized research (Hert, 2009). Examination and questionnaires are ineffective as patients are unable to judge their heath adequately and on the professional level. These two strategies are to be applied as perioperative procedures as they may reduce the lever of cardio complications after the surgeries even if the non-cardiac operation is planned. Of course, such procedures are costly, but it is possible to conduct research stating the number of complications treated and even deaths because of failure to define the heart problem before non-cardiac surgery. Therefore, the stakeholders of the procedure (patients and nurses) will be informed about the general benefit of the program. The cost of the project is one of the main difficulties of this evidence-based practice. Generally, even if all the research projects are successfully completed, not all hospitals are ready to conduct such cardiac complicated tests due to the absence of necessary equipment. The problem may be solved by means of directing people for testing in bigger hospitals and by creating special testing centers.
References
Freeman, W. K., & Gibbons, R. J. (2009). Perioperative Cardiovascular Assessment of Patients Undergoing Noncardiac Surgery. Mayo Clinical Procedures, 84(1), 79–90.
Hert, S. G. (2009). Preoperative cardiovascular assessment in noncardiac surgery: an update. European Journal of Anaesthesiology, 26, 1-9.
King, M. S. (2008). Preoperative Evaluation. American Family Physician, 15(62), 387-396.
Laine, C., Williams, S., & Wilson, J. F. (2009). Preoperative Evaluation. Annals of Internal Medicine, 151(1), ITC1-1.
Lee, A. F. (2007). ACC/AHA guidelines. Circulation, 116, e418-e500.
Maia, P. C., & Abelha, F. J. (2008). Predictors of major postoperative cardiac complications in a surgical intensive care unit. Revista Portuguesa de Cardiologia, 27(3), 321-328.