L4 perioperative care Flashcards
2 types of surgery
- Elective surgery: wait > 24 hrs (more elective than emergency) - Emergency surgery: within 24 hrs
Appendectomy is the most common emergency procedure
T
Most common elective surgical procedure:
Cataract extraction
pt journey
The pt journey - Periop: pre, intra, post - Start with admission to the hospital - DPC: daily procedure centre: planned/elective surgery - ED: emergency - Inpatient By the time the pt arrives in the priop suite, all necessary prep and documentation should be completed.
prep for surgery
Prep for surgery
Pre-op assessment
Information to consider
General health/fitness
Concurrent illness
Family history
Previous surgery/previous anesthetics
Psychological status
Allergies or biohazards
Medications
Airway-smoker/non-smoker, obese
Size/weight - where do they carry their weight?
Diagnostic tests
Routine related to procedure/anaesthetic
Related to other diseases/comorbidities etc
X-rays: chest, location of surgery
Blood tests: cross match, biohazards (HIV, HepC)
12 lead ECG
the periop suite
The perioperative suite
The department includes:
Reception
Pt receiving area
Main corridor
Anesthetic bays
Scrub bays
Operating theatres X9
Sterile processing centre
Equipment rooms
Post anesthetic recovery unit
Change rooms and tea rooms
Nursing offices and resource rooms
Fire exit
peri op attire
Perioperative attire
Attire-scrubs are not just a uniforms
Laundered to meet Australian standards
Infection control & pt protection
Not to be worn around the hospital
Scrub suit (top and bottom)
Warm up jacket
Footwear (protective, non slip) ad shoe covers
Hair covers
Identification on display at all times
Jewelry - bare below elbows
the surgical pt
The surgical pt
decision to have surgery: what is your pt thinking?
Dr google: how does the internet effect the pt decision?
Pt anxiety: why? How can we as nurses reduce this? Strategies
pre-op checks
Preoperative check
The pt arrives at theatre reception and is checked in by the anaesthetic nurse
pt identity
Consent
Surgical site mark
Fasting
Allergies
Xrays
Prostheses
Belongings
anaesthetic phase
Anaesthetic phase
After pre-op checklist, pt transferred to anaesthetic bay
Reassurance and comfort measures
PIVC (Peripheral intravenous catheter) inserted
Anaesthetist assessment: pt history and anaesthesia plan
types of anaesthesia
Anaesthesia
Types of anaesthesia:
General (GA)
Regional
Local
Sedation
Depends on pt condition and surgical procedure
Medications
GA - requires artificial airway (ETT=Endotracheal tube, LMA=laryngeal mask airway)
Extra’s (invasive monitoring)
Pt warming
DVT prophylaxis (=prevention of deep vein thrombosis)
intraoperative phase
Intraoperative phase
Intraoperative nurses have been preparing the operating theatre during anaesthesia
Creating sterile fields
Preparing supplies used for surgery
Setting up equipment
Documentation
Completing surgical count and checking instruments
Pt transferred to operating table
Anaesthetic machine connected
Positioned for surgery
Team time out
Surgeons scrub in
Procedure commences
the surgical count
The surgical count
To ensure no items used during surgery are retained inside of the pt
Sponges, raytec, blades, sutures etc
Responsibility of the nurses
clinical procedure safety
Clinical procedure safety
Correct pt
Correct procedure
Correct site
intraoperative phase
Intraoperative phase:
Types of procedure
During surgery, we constantly monitor pt safety
Vital signs/anaesthesia
Positioning
Warmth
DVT prophylaxis
Bleeding
Wound closure
Counts
Drains
Dressing
instrument and circulating nurse
nstrument and circulating nurse
Assess and plan pt care
Prepare appropriate equipment and supplies
Create and maintains sterile fields, trolleys, prepping and draping the pt
Ensure a safe environment for the pt (e.g. positioning, medication handling)
Check sterility, integrity and availability of instruments
Assist the surgical team to complete procedure
Responsibility for the count
Maintain infection control
Teamwork
Communication
terminology
- ectomy
- ostomy
- otomy
- oscopy
- plasty
Terminology
Ectomy: removal of.. E.g. Appendicectomy
Ostomy: opening into.. E.g. colostomy
Otomy: incision into e.g. craniotomy
Oscopy: looking into. E.g. cystoscopy
Plasty: reconstruction of e.g. mammaplasty
e.g. of theatre list
OR1
ENT
THACHEOSTOMY
Opening into trachea
OR2
ORTHO
KNEE ARTHROPLASTY
Reconstruction of knee
OR3
UROLOGY
CYSTOSCOPY
Looking into bladder
OR4
GENERAL
GASTROSCOPY
Looking into stomach
OR5
PLASTIC
MAMMOPLASTY
Reconstruction of breasts
OR6
NEUROSURGERY
CRANIOTOMY
Incision into the cranium
OR7
GYNAECOLOGY
HYSTERECTOMY
Removal of the uterus
people in OR
People in the OR
Surgical medical
- Surgeons - students, interns, residents, registrars, consultants
Anaesthetic medical
- Students, registrars, consultants
Nurses
- Students, EN’s, RN’s, CAN, NE, managers
Various role: anaesthetic, scrub/scout (instrument/circulating) and recovery
Radiographers (1)
Perfusionists - CT bypass
Admin staff
Porters/orderlies/wardsmen
Company representatives
after surgery
After surgery
Pt is cleaned
Skin assessment
Transferred to their bed
Post anaesthesia management
Transferred to recovery
Documentation transferred with pt
post op phase
Post operative phase
PACU=post-anesthesia care unit/recovery room
A-G assessment:
Airway
Breathing
Circulating
Disability
Exposure
Fluids
Glucose
Handover
PONV = Postoperative nausea and vomiting
Pain management
PARS score (post anesthetic recovery score)
nurse role
The nurses role
Advocacy
Infection control
Accountable items
Clinical procedure safety
Documentation
what is important to us
What is important to us?
Pt preparation and timely arrival to OR
Pt ID and procedure matching - clinical procedure safety
Infection control practices
Aseptic technique
Standard precautions
Transmission based precautions
Hand hygiene
The surgical count
Accurate information and handovers
Safe anaesthesia/surgery/recovery
