⚠️ 风险降低 · 第1课，共6课 · 6 min
术前核查清单：NPO、知情同意、首饰、排尿
The Pre-op Checklist: NPO, Consent, Jewelry, Void
📝 患者躺在担架上，知情同意书已签署，IV正在输液，一切准备就绪。然后护士注意到一枚婚戒、丙烯酸指甲，以及她在0600吃了一个松饼这一事实。这台手术被取消了。清单上的每一项都源于一台被取消或酿成灾难的手术。
📝 The client is on the stretcher, consent signed, IV running, ready to go. Then the nurse notices a wedding ring, acrylic nails and the fact that she ate a muffin at 0600. The case is cancelled. Every item on the checklist exists because of a cancelled or catastrophic case.
💡 核心要点
镇静前完成知情同意，按医嘱执行NPO，取下首饰和义齿，排空膀胱，标记手术部位，完成手术暂停核对，并在术前而非术后教会呼吸锻炼。
Consent before sedation, NPO as ordered, jewelry and dentures out, bladder empty, site marked, time-out done, and teach breathing exercises before, not after.
🧠 为什么重要
在给予任何镇静剂之前，确认知情同意书已签署。核实NPO（禁食）状态：通常指导为固体食物禁食6至8小时，清流质可至麻醉前2小时，具体遵循机构的医嘱。取下首饰（包括穿孔饰品）、义齿、隐形眼镜，按指示取下助听器，并去除至少一根手指上的指甲油或丙烯酸指甲以便进行脉搏血氧监测。让患者在术前用药前排尿。佩戴身份腕带和过敏腕带，与患者一起核实外科医生标记的手术部位，并在切口前完成手术安全核查并进行手术暂停核对。审查用药情况：抗凝剂和抗血小板药通常按医嘱在术前数天停用，metformin在手术当天停用，insulin需调整，beta blockers通常用一小口水继续服用。在手术前患者还能认真听讲时，教会其咳嗽、深呼吸、使用激励式肺量计、固定切口和腿部锻炼的方法。报告体温升高、新发咳嗽或异常化验结果，如钾偏高或血红蛋白偏低；这些情况可能导致手术取消。
Confirm INFORMED CONSENT is signed before any sedative is given. Verify NPO status: typical guidance is no solid food for 6 to 8 hours and clear liquids until 2 hours before anesthesia, following the facility's orders. Remove JEWELRY (including piercings), DENTURES, contact lenses, hearing aids as instructed, and NAIL POLISH or acrylics on at least one finger for pulse oximetry. Have the client VOID before pre-medication. Apply the ID band and allergy band, verify the surgical SITE is marked by the surgeon with the client, and complete the surgical safety checklist with a TIME-OUT before incision. Review MEDICATIONS: anticoagulants and antiplatelets are usually held days before per order, metformin is held on the day of surgery, insulin is adjusted, and beta blockers are usually continued with a sip of water. Teach coughing, deep breathing, incentive spirometry, splinting and leg exercises before surgery, when the client can listen. Report an elevated temperature, a new cough or an abnormal lab such as a high potassium or a low hemoglobin; these can cancel a case.
🏥 真实场景
🍞 吃了松饼的患者被重新安排了手术时间。她很恼火，问为什么。护士解释说，麻醉会使气道反射松弛，饱胃的食物可能被吸入肺部。NPO规则不是医院带来的不便；它决定了这是胆囊手术还是吸入性肺炎。
🍞 The client who ate the muffin is rescheduled. Annoyed, she asks why. The nurse explains that anesthesia relaxes the airway reflexes, and a full stomach can be aspirated into the lungs. The NPO rule is not a hospital inconvenience; it is the difference between a gallbladder surgery and an aspiration pneumonia.
📌 要点总结
- 知情同意书必须在术前用药前签署Consent must be signed before pre-medication
- 取下首饰、义齿、隐形眼镜；去除指甲油以便进行脉搏血氧监测Remove jewelry, dentures, contacts; nail polish off for pulse oximetry
- 按医嘱停用抗凝剂，手术当天停用metformin；标记手术部位并进行手术暂停核对Hold anticoagulants per order and metformin the day of surgery; mark the site and time out
✅ 自我测试
一名术前患者已经接受了IV midazolam，此时护士发现知情同意书尚未签署。护士应该怎么做？A pre-operative client has already received IV midazolam when the nurse notices the consent form is unsigned. What should the nurse do?
- 让配偶代患者签署Have the spouse sign for the client
- 通知外科医生Notify the surgeon
- 继续进行，因为患者之前已口头同意Proceed because the client agreed verbally earlier
- 让患者现在趁药物尚未完全起效时签署Have the client sign now before the drug takes full effect
答案: B · 通知外科医生
已镇静的患者无法给予知情同意。必须通知外科医生，手术可能需要延迟。
Sedated clients cannot give informed consent. The surgeon must be notified and the case may need to be delayed.
护士应在患者进入手术室前向外科医生报告哪项术前发现？Which pre-operative finding should the nurse report to the surgeon before the client goes to the operating room?
- 血红蛋白为14 g/dLA hemoglobin of 14 g/dL
- 钾水平为4.2 mEq/LA potassium level of 4.2 mEq/L
- 体温为38.6 °C（101.5 °F）A temperature of 38.6 °C (101.5 °F)
- 对手术操作有轻度焦虑Mild anxiety about the procedure
答案: C · 体温为38.6 °C（101.5 °F）
发热可能提示感染并可能导致手术取消；其他发现均属正常或预期之内。作为备选的钾水平在正常范围内，不是延迟手术的理由。
A fever may indicate infection and can lead to cancellation; the other findings are normal or expected. The potassium level offered as the alternative is within the normal range and is not a reason to delay surgery.
什么时候是教患者使用激励式肺量计的最佳时机？When is the best time to teach a client to use an incentive spirometer?
- 仅在患者出现发热时Only if the client develops a fever
- 手术前，在术前宣教期间Before surgery, during pre-operative teaching
- 手术后立即在恢复室Immediately after surgery in the recovery room
- 术后第二天On the second post-operative day
答案: B · 手术前，在术前宣教期间
患者在手术前学习效果最好，那时他们没有疼痛或镇静，之后能正确进行锻炼。在恢复室手术后立即教学太晚了，因为那时的疼痛和镇静会妨碍学习和练习。
Clients learn best before surgery, when they are not in pain or sedated, and can then perform the exercises correctly afterward. Teaching immediately after surgery in the recovery room is too late because pain and sedation at that point interfere with learning and practice.
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