O1 · Fear before surgery
Actual Surgery and intensive care
Definition
Worry about pain, anaesthesia, outcomes, or loss of control before an operation.- Anesthesia
- pain
- the unknown
- outcomes
- loss of control
- Tense
- many questions
- sleeplessness
- sweating
📋 Scenario
A patient is afraid he will not wake up after anesthesia.
Subjective (S): "I'm afraid I won't wake up."
Objective (O): Before surgery; heart rate 102/min; sweating; asks repeated questions.
Assessment tools for this scenario: CP-SURG Post-op & Critical Care Check
Validated scales to consider: RASS, CPOT, Aldrete
**CarePath diagnosis:** Fear before surgery related to anesthesia, as evidenced by tense and many questions.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Explain the steps. | Knowing what will happen and when lowers fear of the unknown and gives him a sense of control. |
| Allow questions. | Answering his questions fully corrects wrong ideas and shows that his worries are taken seriously. |
| Teach breathing. | Slow, deep breathing lowers heart rate and muscle tension and helps him cope with anxiety, and it is useful after surgery too. |
| Reassure. | Calm, honest reassurance, including that the anesthetist monitors him throughout, eases fear without making promises that cannot be kept. |
| Involve family. | Familiar family members give emotional comfort and help him feel safe and supported and their presence can make the hospital setting feel less threatening. |
**Expected outcomes**
- Anxiety 3/10 or lower before surgery.
- States understanding.
- Calm entering theater.
**Linking the data to the diagnosis**
The patient says, 'I'm afraid I won't wake up.' Before surgery, his heart rate is 102/min, he is sweating and asks repeated questions. Fear is already present and affecting his body, so this is an actual problem and not a risk. It rests on fear of anesthesia, with tension and many questions as evidence. It is chosen over a general anxiety statement because the fear is tied to the operation. The plan aims for anxiety of 3/10 or lower, a stated understanding of what will happen and a calm patient entering theater.
CarePath diagnosis
Fear before surgery related to anesthesia, as evidenced by tense and many questions.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Explain the steps. | Knowing what will happen and when lowers fear of the unknown and gives him a sense of control. |
| 2. Allow questions. | Answering his questions fully corrects wrong ideas and shows that his worries are taken seriously. |
| 3. Teach breathing. | Slow, deep breathing lowers heart rate and muscle tension and helps him cope with anxiety, and it is useful after surgery too. |
| 4. Reassure. | Calm, honest reassurance, including that the anesthetist monitors him throughout, eases fear without making promises that cannot be kept. |
| 5. Involve family. | Familiar family members give emotional comfort and help him feel safe and supported and their presence can make the hospital setting feel less threatening. |
Expected outcomes
- Anxiety 3/10 or lower before surgery.
- States understanding.
- Calm entering theater.
Linking the data to the diagnosis
The patient says, 'I'm afraid I won't wake up.' Before surgery, his heart rate is 102/min, he is sweating and asks repeated questions. Fear is already present and affecting his body, so this is an actual problem and not a risk. It rests on fear of anesthesia, with tension and many questions as evidence. It is chosen over a general anxiety statement because the fear is tied to the operation. The plan aims for anxiety of 3/10 or lower, a stated understanding of what will happen and a calm patient entering theater.