Pre And Post Op Care 143t29

Pre and Post op Care By Elaine Jones + Anne Wright.

Definitions.  Perioperative

nursing is a term used to describe the nursing functions in the total surgical experience of the patient, pre operative, intra operative, and post operative (Lipincott Manual of Nursing Practice edition)

6th

Pre operative phase. This

is from the time the decision is made for surgical intervention to the transfer of the patient to the operating room.

Intra operative phase. This

is from the time the patient is received in the operating room until transferred to the recovery room.

Post operative phase. From

the time of transfer to the recovery room to transfer back to ward.

Types of surgery. optional Required

Day Surgery

Urgent

Elective Emergency

Criteria for day surgery selection.  



    

Surgery for short duration ( up to 60 minutes). Type of operation in which post operative complications are predictably low. Age (based on biological/physiological age rather than chronological). BMI. at home for 24 hrs within 1 hours journey from hospital access to telephone Adequate toilet facilities (inside)

Exercise 1.

On

ission for surgery patients undergo an assessment, what factors need to be considered

Answers.          

Reason for ission Biographical information Current health status/illness Medications Symptoms/complaints/disabilities Previous medical problems Chronic illness Family medical history Nutritional status Integrated Care Pathway

Continued>>>>  Baseline

observations.  Specimen collection.  Mobility Assessment.  Nutritional assessment.  Cardiovascular assessment  Respiratory assessment.  Urinary assessment.  Social assessment  Risk assessment

Psychological Assessment. Patient

may be anxious for numerous reasons……..

Suggestions….  Fear

of the unknown  Anaesthetic + side effects / not waking up  Unrelieved pain  Restricted in bed post op.  Use of bed pan  Body image /effect on relationship, family  Dependant relatives.  Financial problems if sole provider for family.

In what ways can the nurse alleviate anxiety in the pre op patient?  Pre

operative education:Patient information leaflets, diagrams, posters Pre op visit from recovery nurses. Specialist nurses- pain control team, surgical nurse specialist.

Consent. >Legal requirement. >Informed consent Written consent should be obtained identifying that the subject has received and understood: The procedure offered  Reasonable alternatives to the procedure  Possible benefits of the procedure to the patient.  Risks, inconveniences, and discomforts of the procedure.  Answers to all patient's questions. (DOH 2001)

Immediate pre operative preparation. What

are the fasting requirements for a patient pre operatively?

 It

is routine to fast patients for a minimum of four hours before a general anaesthetic, to empty the stomach and avoid peri-or post operative vomiting, or regurgitation, which increases the risk of aspiration.

 2hrs

Preop for water (tap not fizzy)

Gastrointestinal preparation. Is

this required for all types of surgery?

 1. 2.



Bowel evacuation is carried out :To prevent defaecation during surgery To reduce the risks of accidental damage to the colon during abdominal surgery. It is not required for all types of surgery, and should not be seen as routine.

Skin preparation. Why

is skin preparation necessary pre op?

 It

is necessary to remove dirt and transient micro organisms from the area.  Local procedures should be followed.

Hair removal. Is

this necessary pre op?

 Controversial

area of discussion!!

 Against  Pre

operative shaving increases risk of post operative wound infection.  In favour of shaving: Avoidance of hairs trapping in the incision  A clear field of vision.

Pre op check list. Exercise  Discuss

each item on the checklist, and provide a rationale for its importance.  to group.

Premedication. 



   

Prior to any pre medication being given, the nurse must :Ensure identity bands are worn and labelled correctly. Consent form is signed by patient and doctor. Patient has voided urine. Check all other items on the checklist. Premedication to be given as prescribed at appropriate time, with explanation to the patient.

Final check  Ensure

checklist is with patients notes, along with consent form, x-rays, laboratory results, nurses records.

 Patient

is transferred to theatre.

POST OPERATIVE CARE  What

factors should you consider when caring for a patient post operatively (this starts from accepting the patient from the recovery room)

Post op care Answers  Handover

from recovery nurse to determine post op instruction from surgeon/anaesthetist  Observations ( Airway patency, level of consciousness,BP, pulse, respirations)  Temperature  Wound check ( e.g per vagina, per rectum)  Fluid balance (catheter, IVI, naso gastric tube, catheter, wound drain)  Pain (pain score, positioning, analgesia)  General appearance (colour, pallor, sweating, shivering)

Common post operative complications  Respiratory

complications Airway obstruction, chest infection

 Cardiovascular

complications shock, haemorrhage, DVT, PE

 Gastrointestinal

vomiting, constipation, paralytic ileus, retention of urine  Wound

infection

ANY QUESTIONS !