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Patient Assessment

Assessment for Surgery

The physician can do this alone or together with a specialist nurse. It is a duty to explain all the elements of the procedure that the patient or their legal guardian cannot be expected to know. The discussion should include the following:

  • The problem to be treated.
  • Likely outcome, complications, e.g. infection, nerve palsy.
  • The nature of the scar and where it will lie.
  • Alternative treatments and their merits.
  • The consequences of doing nothing.
  • The operation will take place in an operating theatre. The patient may need to change from their outdoor clothes into theatre clothes.
  • The operation will take place under local anaesthesia and not general anaesthesia. The patient will therefore be awake throughout the operation.

A consent form should then be signed and a note made in the patient records. A handout may be helpful.

Pre-Operative Assessment

This need not be as detailed as for a patient having a general anaesthetic, but the medical history should seek information about the following:-

Relevant History Reason and Action
Diabetes Timing of operation in relation to meals. The insulin dependent diabetic has to time their food intake carefully.
Epilepsy May limit the dose of Lignocaine or other cerebral stimulants used.
Bleeding Tendency Genetic: Aspirin, Warfarin and prostaglandin inhibitors may be important, as well as vaso-dilators, such as alcohol.
Pace Maker Consider the type of diathermy used, Unipolar v Bipolar.
Myocardial Infarction Operation best deferred until at least six months after a myocardial infarction.
Renal or Liver Failure May affect excretion of drugs.
Excessive Anxiety May require pre-medication.
Hepatitis B or HIV Extra protection needed for staff. Only essential operations should be considered.
Pregnancy First trimester of pregnancy, non-essential intervention should be avoided.
Hypertension May increase superficial oozing and bleeding.
Keloid Scars Discuss likelihood of formation of further hypertrophic or keloid scars.
Allergies Check whether allergic to systemic medicaments, e.g. Penicillin and local anaesthetics or topicals, e.g. Povidone Iodine or colophony in plasters.