Intro to preoperative nursing Flashcards
Definition of preoperative nursing
Delivery of patient care in preoperative, intraoperative and postoperative periods of patients’ experience during operative or other invasive procedure using the framework of the nursing process,
Types of surgical setting
Elective Surgery - subject to choice based on medical condition
Emergency surgery - unexpected, urgency, deal with acute threat
Both can be Day Surgery (stay in Hospital for less than 24h) or Same Day Admission (don’t admit in advance)
Sterile team
Surgeons, surgical first assist, scrub nurse
Non-sterile team
Reception nurse, anaesthetist, anaesthetic nurse, circulating nurse and recovery room nurse
Perioperative nursing
Communication, teamwork and patient assessment are crucial in ensuring good outcomes in perioperative period
It is made up of various healthcare professionals
Preoperative Phase
Begins when the decision is made to undergo a surgical intervention and ends when the patient is transferred to operating room table.
Pre-op visit (counselling clinic)
Pre-op checklist
Made up of
a) Pre-operative assessment
b) Pre-operative nursing intervention - patient education
Preoperative Roles
Reception, anaesthetic, scrub and circulating nurse
Role of reception nurse #1
Prepare the patient for surgery physically and emotionally.
Perform pre-operative checks and documentation.
Role of reception nurse #2
- Receive hand over report from ward nurse
- Verification process
- Preop checklist
- Ensure patient dignity and privacy
- Provide psychological support to patient and their family members
- Early recognition and intervention for any discrepancies identified
What are the 5 pre-operative assessment and what is the goal for pre-operative assessment
Review of systems, Anaesthetic review, medication, psychosocial and preoperative checklist.
Identify risk factor and plan care to ensure patient safety
Pre-operative assessment #1
Review of system - To optimised patient for surgery such as the cardiovascular, nervous system, respiratory and fluid electrolytes status
Pre-operative assessment #2
Ensure anaesthetist review - current prescribed medications and any over counter drugs
Past health history
- Any problems with previous surgery
- Menstural cycle
- Possible inherited condition if not known (HTN)
Pre-operative assessment #3 (Medications)
Some drugs and herbs may interfere with anaesthesia or affecting clotting process (Eg, anti platelet - aspirin should be stopped 2 weeks prior to surgery)
Pre-operative assessment #3 (Medications)
Anti-hypertensive drug may increase patient chances of developing shock due to effect of anaesthesia
Pre-operative assessment #3 (Medications)
Oral hypoglycaemic drugs will need adjustment secondary to increased body metabolism - NBM
Pre-operative assessment #3 (Medications)
Any chronic alcohol use - increased risk for liver damage & metabolism anaesthetic agent may be prolonged
Pre-operative assessment #3 (Medications)
Drug tolerance and allergy status
Pre-operative assessment #4
Psychological assessment - surgery is a “frightening event”
Factors that increase susceptibility to stress
Age, socioeconomic, past experience, Curren health status
What are the common fears of surgery
Fear of death, past experience, fear of pain and discomfort, alteration in body image, cost of hospitalisation
Pre-operative assessment #5
Pre-op checklist
- Psychological factors - baseline vital signs
- Preparation of patient
- Preparation of documents - consent form
- Pre-operative lab and diagnostic tests
- Transfer of care to OT and ensure patient safely
Others: cultural and ethnic consideration
What are the 3 preoperative nursing intervention (patient education)?
Process information, sensory information and procedure information.
What are the process information?
Visitors information and recovery area
What are the sensory information?
- OR temperature is low
- Talking may be heard while lying on the OR table but can be distorted with mask on
- Patient bed and OR table is narrow
- Lights in OR is bright
- Sounds of patient can be heard
What are the procedure information?
- Types of clothes to bring and wear after day surgery
- Surgery time and any unexpected changes to schedule
- Fasting protocols
- Physical preparation (bowel or skin)
- Frequency of vital sign assessment
- Pain control and other discomfort management
- Deep breathing and coughing exercise
- Intravenous line
When does the intraoperative phase begin and ends?
Begins with the placement of patient on the OR table and continues until the patient is in the transferred to the postoperative area
Who are involved in the intraoperative phase?
Circulating nurse, scrub nurse and anaesthetic nurse
What is the role of a circulating nurse during intraoperative period #1
a) Patient safety
i. Time out - Correct patient for the correct surgery
ii. Positioning
iii. Monitor aseptic technique
iv. Documentation
What is the role of a circulating nurse during intraoperative period #2
b) Assist scrub nurse - work very closely with scrub nurse
i. Provide/ open sterile item
ii. Proper label/ handle specimen
What are the role of a circulating nurse during intraoperative period #3
c) Collaboration
With surgeon, anaesthetist, health care assistant and vendors
What are the roles of a scrub nurse? #1
Patient safety
- prevent diathermy burnt
- Swabs, sharp and instrument count
- Aseptic practice
- Specimen
What are the roles of a scrub nurse? #2
Assist surgeon
- Proactive in anticipation
- Care the sterile field
- Prevent contamination of instruments
- Set up the sterile trolley
What are the roles of a anaesthetic nurse?
- Assist anaesthetist in various anaesthetic procedure such as intubation
- Ensure all anaesthetic drugs, machine and monitoring equipment are available
- Anticipate for any difficult airway problem or emergency
- Ensure patient safety in OT
When does post-operative phase begin?
Begins with transfer of patient to the post-operative area and ends when surgeon discontinues follow-up care
