Question

Nurse Harry Potter is conducting preoperative teaching for patient Ali who will undergo an appendectomy next week. Patient Ali’s medical record shows that he has diabetes mellitus type 2. He monitors his blood glucose levels religiously. In addition to his oral hypoglycemic agent, patient Ali reports that he is presently on aspirin 325 milligrams one time a day for chronic joint pain. He is also taking multivitamins. Nurse Harry Potter advises patient Ali to ask the anesthesiologist if he should drink his medication the morning of the surgery.

a. Nurse Harry Potter teaches the patient Ali to stop drinking the aspirin. What is the rationale for this action?

b. Why is it essential to assess the patient Ali for the use of herbal products prior to surgery?

Patient Ali asks how surgery might affect his blood glucose; how should the nurse Harry Potter answer?

Answer 1

1.

1.Concern for increased bleeding led to a generally accepted practice of stopping antiplatelet therapy 5-10 days before a surgical or invasive procedure. While surgical bleeding may be increased with ongoing aspirin therapy, the risk of associated hemorrhagic morbidity and mortality remains modest for most procedures.

2. Many health organizations advise that all herbal supplements be stopped 2 to 3 weeks before surgery. They advise you stop the supplements because these herbs can have side effects that could make surgery more dangerous for you.

Taking herbs in the weeks before surgery could cause a bad reaction with anesthesia medicines. Or they may cause too much bleeding during and after surgery. This is dangerous because many people taking herbal supplements don't tell their surgeon or anesthesiologist about them.
The best advice is to talk with your healthcare provider about all OTC medicines and herbal supplements you’re taking. If you have any surgery planned, have this talk right away. Also, plan to stop these herbs in the weeks before your surgery.
3.Having surgery can mean loads of added stress on the body, thanks to both the procedure itself and the anesthesia. The effects of this stress may result in elevated blood sugar (glucose) levels, and people with a diagnosis of diabetes are especially likely to experience complications following a surgical procedure.
The stress of an operation, along with what can be significant changes in lifestyle, diet, and exercise before and after surgery, can dramatically change your glucose levels. While everyone's at risk for high blood sugar levels after surgery, people with diabetes face even greater risks.
This is likely due to several factors. The physical trauma associated with surgery can result in an increase in the stress hormone cortisol, along with catecholamines (neurotransmitters released into the bloodstream when you're stressed), both of which may result in increased insulin resistance—a lack of sensitivity to normal levels of insulin, requiring more and more insulin to remove glucose from the bloodstream.
Additionally, high levels of insulin often seen in diabetes can make arteries and veins less flexible, restricting blood flow that leads to slower healing times and poor circulation to the heart and other organs.