L2 pre-op care Flashcards
1
Q
what is elective surgery
A
- Booked in advance
- Patients sometimes on a waiting list
- Pre-operative assessment often via a clinic • Includes day (ambulatory)surgery
2
Q
what is emergency surgery
A
- Often admitted via ED
- Surgery occurs on the day of admission or soon after.
- Pre-operative assessment occurs in hospital
3
Q
Stages of the surgical experience
A
- Preparation for surgery (Pre- operative care pre-op checklist)
- Admission to the Operating Suite (surgical safety checklist)
- Anaesthetic
- Time out
- Operation
- Recovery
- Post-operative care
- Discharge
- Rehabilitation
4
Q
Overview of Preparation for Surgery
A
- Diagnosis (treatment includes surgical intervention)
- Patient is assessed by medical officer & anaesthetist to be fit for surgery
- Consent for surgery
- Pre-operative assessment
- Preparation for surgery
5
Q
Pre-operative assessment
A
- Pre-operative assessment:
- Physical assessment
- Psychosocial assessment
- Pain assessment
6
Q
Nursing Assessment in pre-op
A
- Overall goals:
- Identify risk factors
- Plan care to ensure patient safety
- Help the patient develop realistic expectation and coping strategies
- Support the family and offer information
- Establish baseline data
- Identify cultural and ethnic factors that may affect surgical experience
- Determine if the patient has sufficient information to sign the consent form
7
Q
what r included in Pre-operative assessment
A
- Past medical history:
- Ongoing illness/injury, previous significant illness/injury.
- What did parents die from/ significant illnesses (can lead you to understand potential fears the patient may have)
- Allergies
- Any disablement
- Hearing aids
- Visual – wears glasses
- Last ate
- Last drank
- Alcohol/smoking/recreational drug use
- Medication history
- Regular prescribed medication
- Any over the counter medications • Any complementary medications • Allergies/drug reactions
8
Q
what r the physical assessment in pre-op care
A
- Physical assessment review of systems (taught as A-G in NURS5081):
- Cardiovascular
- Respiratory
- Genitourinary
- Neurological • Hepatic
- Integumentary
- Musculoskeletal
- Endocrine
- Immune
- Fluid & Electrolyte status • Nutritional status
9
Q
what r the investigations in pre-op care
A
- Vital signs (Blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, temperature)
- Blood sugar level • 12leadECG
- Blood tests
- Urinalysis
- X-rays
- Computerised tomography(CT)scans • Magnetic resonance imaging (MRI)
- Ultrasound.
10
Q
what r the psychological assessment in pre-op care
A
- Develop rapport
- Determine patients expectations
- Provide and clarify information on procedure (you must understand the procedure and be able to explain it to the patient)
- Assess the patients emotional state and readiness
- Assist the patient in preparing for post-surgery
- Assist the patient in preparing for discharge: may need mobility aids, alteration to own home, altered body image.
- Assess the level of support available to the patient
11
Q
Nursing Assessment: Gordons Functional Health Patterns
A
Health perception – health management Nutritional –metabolic pattern Elimination pattern • Activity-exercise pattern • Cognitive-perceptual framework • Sleep-rest pattern • Self-perception – self concept pattern • Role-relationship pattern • Sexuality-reproductive pattern • Coping-stress-tolerance pattern • Value-belief pattern
12
Q
what to prep for surgery
A
- Pre-operative preparation:
- Patient education
- Legal preparation
- Day of surgery preparation
13
Q
what is included in patient education in pre-op care
A
- Sensory information – sights & smells
- Procedural information – what does the surgery involve, post- operative procedure/ care, IV lines, patient controlled analgesia.
- Process information – general flow of surgery
- Post surgery: deep breathing exercises, expectations on recovery, rehabilitation, likely discharge
14
Q
what r the legal consent
A
- Consent form: signed by surgeon, patient/legal guardian.
- Emergency procedures override the need for consent
- Legally appointed representative of family
- Blood transfusion
- Advanced directive
- Wills
- Patient and family fully understand the procedure
15
Q
Day of surgery preparation – pre-op checklist
A
• Vital signs & weight • Name bands (allergy band) • When patient last ate & drank • Consentform • Old notes with patient • Medication sheet with patient • X-rays & scans with patient • Does patient wear dentures/ have caps/crowns on teeth? • Has operation site been prepared? • Is the patient wearing TED (anti-embolism) stockings? • Nailpolishremoved • Make-up removed • Jewelleryremoved/taped, spectacles/hearing aids • Infection risk documented • Is the patient diabetic
16
Q
Pre-operative fasting
A
- Limited solid food may be taken up to 6 hours prior to anaesthesia and clear fluids totalling not more than 200mL per hour may be taken up to 2 hours prior to anaesthetic (Crisp et al., 2017, p1448)
- Only medications or water ordered by the anaesthetist should be taken less than 2 hours prior to anaesthesia (Crisp et al., 2017, p1448)
- The time period for a patient to be nil by mouth will be documented in the patients clinical notes by the treating anaesthetist
17
Q
Why nil by mouth?
•
A
To avoid pulmonary aspiration
18
Q
Common pre-operative medications
A
- Provide analgesia
- Prevent nausea & vomiting
- Promote sedation & amnesia
- Decrease anaesthetic requirements
- Facilitate induction of anaesthesia
- Relieve apprehension and anxiety
- Prevent autonomic reflex response
- Decrease respiratory & gastrointestinal secretions
19
Q
Pre-operative medication examples
• Benzodiazepines
A
– (e.g. midazolam – induce sedation, reduce anxiety)
20
Q
Pre-operative medication examples
• Histamine H2 receptor antagonists
A
– (e.g. ranitidine – decrease gastric volume)
21
Q
Pre-operative medication examples
• Antacids
A
– (e.g. sodium citrate – increase gastric pH)
22
Q
Pre-operative medication examples
• Antiemetics
A
(e.g. metoclopramide – increased gastric emptying, decrease
nausea & vomiting)
23
Q
Pre-operative medication examples
• Anticholinergics
A
(e.g. atropine – decrease oral/respiratory secretions)
24
Q
Day of surgery preparation
A
- Bowel preparation: laxatives, enema
- Shower, dress in hospital gown
- Site of operation area: marked in skin pen, hair removal may be required using depiliatory cream or clippers (JBI 2007)
- Nil by mouth
- Reinforce specific patient education, reassurance, answer questions, attempt to reduce anxiety (Pittman & Kridli, 2011), tell patient likely time of surgery
- Void
25
Q
Transfer to Operating Theatre
A
- Patient in their bed, side rails up
- Patient wearing a hospital gown
- Pre-operative checklist complete
- Patients notes & medication chart
- X-rays/scans
- Consent form (signed)
26
Q
Handover using ISBAR
A
- Introduction
- Situation
- Background
- Assessment
- Recommendation
27
Q
who are the Patients at higher risk of complications
A
- Elderly: reduced immune capability, potential communication challenges, potential mobility challenges
- Immune-compromised: more susceptible to infection
- Diabetics – poor healing
- Hypertension (HTN): increased risk of thromboembolic events
- Obese – less mobile, more likely to have co-morbidities e.g. HTN, diabetes
28
Q
Reasons why surgery is cancelled
A
- Patient may refuse surgery
- May not be well enough for surgery/anaesthetic
- May not be psychologically ready for surgery
- Appropriate services may not be available (e.g. post operative bed) • Patient may not have fasted
29
Q
Communication is critical
A
- Be aware of tone
- Be aware of body language
- Listen
- Speak clearly
- Translators/interpreters are available for non-English speaking patients
