Exemplars: Perioperative: Preoperative and Postoperative care Flashcards
What is perioperative patient care
The three phases of perioperative patient care that include the preoperative, intraoperative, and postoperative phases
What is preoperative care
begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed
What are the preoperative phase
preadmission testing, admission to surgical center, in the preoperative area
In the preadmission testing of the preoperative phase, what is involved
- initial assessment
- education
- involve family interview
- Completion diagnostic testing
- complete pre-op therapies
- advance directive?
- Discharge planning
In the admission to surgical center of the preoperative phase, what is involved
- pre-op assessment
- assess risk for post complication
- report abnormal finds
- consent form
- educate and plan of care with team
- reinforce education
- explain phase of perioperative care
- answer family question
In the preoperative area of the preoperative phase, what is involved
- identifies patient
- assess physical, emotion, pain, and nutritional
- review medical records
- surgical site has been marked
- establish IV line
- give medication
- comfort measures
8.psychological support - advocate for patient/ family needs
What is postoperative phase
Period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow-up evaluation in the clinical setting or home
What are the post-operative phases
Transfer of patient to PACU, Postoperative assessment recovery area, surgical Nursing Unit, and home/clinic
PACU phase
- ID
- type of surgery
- amount of agents used
- Vitals/responses
- interoperative factors
- [Physical limitation
- LOC
- Gear needed
- is their family
Postoperative assessment recovery area
- Immediate response to Surgery
- vitals/ physiologic status
- pain levels
- Maintain airway
- give meds/fluids
- provide oral fluid if prescribe
- assess for transfer
Surgical Nursing Unit
- monitor patient
- pain levels
- Provide education
- assists in recovery
- psychological status
- assist with discharge planing
Home or Clinic
- Provide follows up care
- reinforce education
- assess response to surgery
- determine family perception of surgery
What is in a peroopertaive assessmetn
Informed consent/ID bands
Assess for allergies and medical comorbidities.
*Assess the patient’s cognitive and sensory function before the surgeon begins the informed consent process.
Nutritional and fluid status (BMI, NPO, Sugar level) Dentition, Substance abuse, respiratory status (signs of infection. asthma), cardiovascular (CHF, SOB,Arym), Hepatic (excretion of drug) and renal function (they metabolism drug), endocrine (adrenal insufficiency. Thyroid disorcer, DM) immunine function
*Perform a Fall Risk Assessment including the following factors:
*History of previous falls
*Medication use (e.g., preoperative sedatives)
*Level of consciousness (e.g., alert, lethargic)
*Ability to follow directions (e.g., cognitive impairment, language barrier)
*Sensory impairments (e.g., vision, hearing)
*Level of coordination or balance
*Toileting needs (e.g., incontinence, frequency, need for assistance)
*Presence of external devices (e.g., catheters, drains)
*Determine the need for a designated support person or power of attorney to complete the informed consent process.
*Review medications to identify potential polypharmaceutical risks to include the following:
*Multiple medications
*Multiple prescribers
*Several filling pharmacies
*Too many forms of medications
*Over-the-counter medications
*Multiple dosing schedules
-Document baseline physical assessment parameters, including pain, cardiac rhythm, and oxygen saturation level. Respiratory Status, Hepatic and Renal Function, Endocrine Function (), Immune Function
-Document a detailed skin assessment with notation of areas of dryness, lesions, or bruising.
-Document preoperative fasting status and assess for dehydration, malnutrition, and hypoglycemia.
-Perform a psychosocial assessment that addresses fears, anxiety, and feelings of loneliness, Spiritual Cultural Beliefs, educational
-Identify social support to determine whether the patient has home assistance to complete ADLs
What are so nursing invention in post-op
- Assess breath (maybe give O2)
- monitor vital and skin condition
3.assess surgical site - assess level of conscious, oriental, ability to move
- assess pain
- give pain meds
7 place call light, emesis bad, and urinal - position for comfort, and safety
- assess IV
- Urine out put
- breathing and leg exercise
- provide info
What is the purpose of perop interview
-Obtain patient’s health history
-Provide and clarify information about planned surgery
-Assess patient’s emotional state and readiness for surgery
-What are patient’s expectations or surgical outcomes
-Opportunity to ask questions about surgery, anesthesia, and postop care
What is the purpose of the assessment
///Identify risk factors for surgery and ensure patient safety
///Establish baseline data for comparison for intraoperative and postoperative (vital signs, respiratory/cardiovascular status, etc.)
///Determine patient psychologic status and physiological factors that can cause operative risk factors
///Identify and document surgical site per agency protocol
///Review results of preop tests in the patient’s record with hcp
///Identify cultural and ethnic factors that can affect surgical experience
///Review patient’s understanding of information about surgery so they can make an informed consent
///Family history of allergic reaction to anesthesia (malignant hyperthermia)
Preop: subjective data
Psychosocial assessment (anxiety, fears, hope)
Past health history ask about previous health problems or surgeries.
Allergies
Medications/recreational drugs
Review of system for preop
Cardiovascular (heart failure, mi, htn, valve heart disease, defibrillator)
Respiratory (chronic lung disease/infections, sleep apnea)
Neurological (alertness and orientation, ability to follow commands)
Genitourinary (chronic kidney disease, uti, decrease in renal function)
Hepatic system- assess for liver disease, can cause increase and metabolic acidosis if given lactated ringer’s (lr)
Integumentary system (skin breakdown, rashes, pressure ulcers, tattoos, piercings, etc.)
Musculoskeletal system (arthritis, mobility restrictions, neck injuries)
Endocrine system (diabetes, thyroid disease)
Immune system (immunocompromised, corticosteroids)
Fluid and electrolyte balance (vomiting, diarrhea, bowel preps)
Nutritional status (thin, obese, malnourished)
Perop objective data
Abgs
Pulse ox
Blood glucose
Bun, creatinine
Chest x-ray
Cbc
Ekg
Electrolytes
Hcg (pregnancy test)
Liver function test
Coagulation blood work
Albumin level
Type and crossmatch (blood)
Urinalysis
Legal preparation for surgery
Checking that all required forms are correctly signed and in patients chart (surgical form, blood transfusion, advance directive, durable power of attorney)
Patient must be cognitively competent and voluntarily sign informed consent and must be adequately informed about THE SURGERY/procedure
A true medical emergency can override the need to obtain consent from
What is the point of preop teaching
Increases patient satisfaction, decrease fear, anxiety and stress
Reduce postop complications (dvt, pe, pneumonia, ileus, infections)
Decreases length of stay in hospital and recovery time
Preop teaching usually done in physician/surgeon’s office/inpatient and reinforced the day of surgery
Provide written instructions for patient and caregivers
Discharge teaching required for all patients
ASSESS WHAT PATIENT KNOWS AND WANTS TO KNOW AND GIVE PRIORITY TO THOSE CONCERNS
Includes sensory, process and procedural information
Education on deep breathing, coughing and early ambulation unless contraindicated
Pain management
What should be done on the day of surgery preparation
Final preoperative teaching
Assessment and communication of pertinent findings
Ensure preop orders are done and chart is complete and taken to or
Verify informed consents, results of lab test, diagnostics, h&p, consultations, vital signs, skin preparation, completed nursing notes
Identify, mark, and document surgical site (signed by surgeon and patient)
Wear hospital gown (usually no underclothes)
Cosmetics, nail polish and acrylic nails should be removed
Place identification band and allergy band on patient (also blood bank band, restricted extremities, osa band)
Return all patient valuables to caregiver/family or secure according to agency policy
Remove any jewelry, glasses, contact lenses, prothesis, dentures
Hearing aids should be left in to allow patient to better follow instructions
Have patient void before preop meds given and before heading to or
Give preoperative medications
Carefully check preop orders and clarify the orders with the surgeon if there are any questions
How does eldery age after preop
An event that has little impact on a younger adult may overwhelm an older adult
Hospitalization may represent decline in health, mobility and independence
Older patients may have negative perceptions of hospitals
Older adults greater risk for complications after surgery and adverse effects from anesthesia
Older adults can have decreased ability to cope with stress
Older adults may have sensory deficits
to leave PACU
Based on activity, respiration, Circulation, Conscious, O2 saturation
neurological problem
Emergence
Delayed emergence
May be caused by hypoxia, anesthesia, pain, bladder distension, etc
Most common cause is prolonged drug action (opioids, sedatives, inhaled anesthetics, etc.)
Alcohol withdrawal delirium
Restlessness, insomnia, nightmare, irritability
why do fever happen post-op
///Can also have a fever related to lung congestion (incentive spirometer can help)
///Patient could have low grade fever the first 48 hours after surgery related to inflammation process or stress from surgery; healing process (increase in metabolism)
///Fever usually after 48 hours after surgery may indicate infection (surgical site, cauti, pneumonia or dvt)
///Malignant hyperthermia (fast rise in body temperature and severe muscles contraction, tachycardia, muscle or jaw become stiff) is a rare, inherited (genetic) disorder that is potentially fatal
why does hypothermia happen post-op
///Infants (can lose heat 4x faster than adults), older adults, women
///Leads to vasoconstriction which can lead to hypertension, cardiac problems (mi), decreased immune response, reduced organ blood flow
///Anesthesia can drop temperature and or room is kept cold to help prevent bacteria growth/keep staff comfortable
///Shivering can cause increase in o2 demands and increase in hr
Assess post-op test
///MEASURE AND RECORD TEMPERATURE
///MEASURE TEMPERATURE EVERY 15 MINS UNTIL Normal
///Assess vital signs
///Signs and symptoms of hypothermia
//////shivering, exhaustion, confusion, fumbling hands, memory loss, slurred speech drowsiness
//////Infants: bright red, cold skin, very low energy
///O2 therapy
///Demerol can treat shivering
///hypothermia (warm blankets/air warmers, warm iv fluids/heater water mattress)-monitor skin to prevent burns or skin injuries
///Supplies should be readily available for malignant hyperthermia (mh)
///Mh: Ice packs/cooling blanket/cold iv & oral solutions/dantrium
What is important to assess movement post op
///Be mobile and alert to provide self-care when at home/baseline
///Provide discharge teaching to patient and family
///Patient cannot drive, must have someone drive them home
///Follow-up appointments
///Discharge Medication list
Post op discharge teaching
///Patient is prepared for self-care
///Knows what symptoms to report and what are expected
///Medication regimen/prescriptions/side effects
///Incision care/dressing changes (no swimming or soaking in tub)
///Know what activities are allowed and not allowed
///Dietary restrictions
///Follow-up appointments
///Answer patients questions thoroughly
///Adequate pain management before being discharge
///Involve case management for (finances, long-term care, home health, pt, ot)
///Document teaching in patient’s chart
What must you remember about the elderly
///Pneumonia is a common postop complication in older adults
///Cardiac problems due to decrease in vascular function caused by stiffening of vessels or plaque build up in vessels
///Drug toxicity potential problem
///Changes in mental status is important to assess
///Pain control can be challenging due to fear, lack of education, cognitive deficits, etc.
