Introduction to perioperative nursing Flashcards
Types of surgical setting
1) Elective surgery ( based on choices )
2) Emergency ( urgency, unexpected )
Both can be same day surgery or same day admission surgery
Who are involved in the perioperative team
1) Sterile team: Scrub nurse, Surgeon, Surgical first assistant
2) Non sterile team: Receptor nurse, Circulating nurse, Anaesthetist, Anaesthetic nurse, Recovery room nurse
What is the preoperative phase
Time where decision is made to undergo surgical intervention and ends when patient is transferred to the operating table
Roles involved: Reception, Anaesthetic, Circulating and Scrub Nurse
Role of reception nurse in the preoperative phase
1) Receive patient from ward nurse
2) Prepare patient physically and emotionally
3) Perform pre op checklist and documentations
Pre op Assessment:
- Review of systems
- Anaesthetic records
- Medications
- Psychosocial assessment
- Pre op checklist
Pre op Patient Education:
- Process Information
- Sensory Information
- Procedure Information
Goal of preop assessment (reception nurse)
Goal: Identify risk factors and plan care to ensure patient safety, Early recognition and intervention for any discrepancies identified
Components of preop assessment (reception nurse)
1) Review of systems: To optimise patient for surgery eg - baseline vital signs, cardiovascular, respiratory, nervous system and fluid electrolyte status
2) Anaesthetic records: Past health hx, pre-op investigations
3) Medications: Drugs and herbs may interfere with anaesthesia or surgery.
- Anticoagulant/ antiplatelet (aspirin, warfarin) - may interfere with the clotting process, stop 2 weeks prior to surgery
- Anti-hypertensives: May increase chances of shock due to effects of anaesthetic drugs and should be taken as prescribed unless hypotension
- Oral/SC hyperglycaemic drugs: omit/ decrease dosage to prevent hypoglycaemia
- Prophylaxis antibiotics to be given prior to surgery to prevent infection
4) Psychosocial assessment: Fear and anxious of the surgery as it is perceived as a “frightening event”
- Factors increasing susceptibility to stress: Age, past experience, current health status, socioeconomic status
- Common fears include: Fear oF death, pain and discomfort, anaesthesia, past experiences, disruption to life usual pattern, cost of hospitalisation
5) Pre-operative checklist:
1. Identify correct patient
2. Medical record (lab and diagnostic test results)
3. Consent ( Anaesthesia and surgery )
4. Allergy status (drug, food, dressing products)
5. Blood products
6. Any metal implants, pacemaker
7. Fistula, graft, mastectomy surgery
8. Proper fasting
9. Bowel and skin preparation
10. Remove foreign bodies (jewelleries etc.)
11. LMP for female
Pre op intervention: Patient education (reception nurse, preop)
Informations (process, sensory, procedure)
1) Process information: Visitor information, recovery area
2) Sensory information: OR will be of low temperature (21-23 degree celcius) , OR table is narrow, conversations may be heard but will be distorted with mask on, lights of OR is bright, sounds of machine may be heard
3) Procedure information: Surgery time and any unexpected change to schedule, Fasting protocol, physical preparation, frequency of vital sign assessment, pain control and discomfort, setting up of IV lines, Urinary catheter or NGT as indicated
Roles and responsibilities of Anaesthetic Nurse (preop)
1) Check anaesthetic machines and equipments
2) Ensure anaesthetic drugs, machines and equipments are working in good condition
3) Ready to assist anaesthetist in sedating patient
4) Perform preoperative checks and documentation (anaesthetic procedure consent)
Role and responsibility of circulating nurse (preop)
1) Prepare OR for surgery
2) Check that all surgical equipments are available
3) Asses and Check for right patient
4) Collaborate with surgical team
5) Perform pre-op checks and documentation
6) Reassure patient to optimise comfort level
Roles and responsibilities of scrub nurse (preop)
1) Assess and check for right patient
2) Document peri-op checklist
3) Set up sterile trolley
4) Prepare sterile instrument
What is the intraop phase
Begins with placement of patient of the OR table until the time the patient is transferred to the post-operative area unit (PACU)
Roles involved: Anaesthetic, Circulating and Scrub Nurse
What is the role of anaesthetic nurse in the intraop phase?
1) Assist the anaesthetist in various anaesthetic procedures such as intubation
2) Anticipate for any difficult airway problems or emergency
3) Ensure patient safety in the OR
4) Documentation
What is the role of circulating nurse in the intraop phase?
1) Patient safety:
- Position and transfer patient on OR table
- Time out: correct patient for correct surgery
- Monitor aseptic technique
- Documentation
2) Assist scrub nurse:
- Work very closely with scrub nurse
- Provide/ Opening of sterile items
- Proper label/ handling of specimen
3) Collaboration:
- Surgeon
- Anaesthetist
- Nursing team
- Healthcare assistant
- Vendor
Roles and responsibilities of scrub nurse in intraop phase
1) Patient safety:
- Prevent diathermy burns
- Aseptic practices
- Swabs, sharps and instrument count
- Specimen
2) Assist surgeon:
- Set up sterile trolley
- Care of sterile field
- Prevent contamination of instrument
- Proactive in anticipation
What is the post operative phase?
Begin with transfer of patient from post operative area and ends with surgeon discontinues follow-up care
