Module 2: Perioperative care Flashcards
What are 6 common purposes for surgery?
give examples.
1) Diagnosis:
- presence & extent of disease / pathology
(eg. endoscopy, biopsy)
2) Cure:
- elimination or repair of pathology
(eg. tumour removal)
3) Palliation:
- alleviation of symptoms without cure
(eg. GI bypass)
4) Prevention:
- prevent pathology or deterioration
(eg. mastectomy)
5) Exploration:
- examination to determine nature / extent of disease
(eg. laparotomy, biopsy)
6) Cosmetic:
- improvement or repair
what does perioperative mean and what are the phases?
Perioperative pertains to the time of the surgery.
Includes;
- Preoperative
- Intraoperative
- Postoperative
What does critical think involve?
The process of actively and skilfully conceptualising, applying, analysing, synthesizing, and evaluating information to reach an answer or conclusion.
what does preoperative assessments involve?
- Patient interview:
- ID, operation, allergies
- Determine risk factors
- Determine the psychological state of the patient
- Establish baseline data
- Admission / health assessment
- Preoperative checklist
- Preoperative observations
- Fasting status
- Allergies
- Medications (given/withhold)
- BSLs (for diabetics)
- Current infections
- Risk assessments - falls, VTE, pressure injury, PIVAS)
- Preoperative pathology (lab results)
What are the 5 key points for ‘Nil by mouth’ ?
- check time of Pt last meal
- NBM approx. 6-8 hrs
- Includes food, fluids, gum/lollies
- Medications - check Drs orders
- Risk of - aspiration= resp. arrest
- post-op nausea & vomiting
What are the 6 steps that the nurse should ensure that the patient can explain, which will demonstrate that they have given informed consent?
1) what treatment they have consented for
2) what surgical procedure they are having
3) why they are having the procedure
4) what risks are involved
5) what alternative treatments are available
6) what post-op care/rehab will include
What the mnemonic VIRCA stand for?
V: voluntary I: informed R: risk aware C: consent A: aware
What are the 3 areas of the intraoperative setting? what is the dress code required in each area? Who has access to each of these areas?
1) Unrestricted:
2) Semi-restricted (limited to operating (OT) staff)
- scrub attire & hair coverings
3) Restricted ( clean core, scrub area, OTs)
- full surgical attire & masks
What are the 4 ways that an intraoperative setting is controlled? explain each.
1) Geographically (OR located next to PARU & ICU)
2) Environmentally ( Lighting, temperature)
3) Bacteriologically (Sterile, filters / air ventilation)
4) Restricted personnel ( surgical staff only)
Who is involved in the intraoperative team?
- Surgeon ( & assistant)
- Anaesthetist (& assistant)
- Instrument (or scrub) nurse
- Circulating (or scout) nurse
What is the Holding bay nurse responsible for?
- Admission & care of patients who are brought into the preoperative environment
- Obtaining & communicating vital information to the surgical team
- ID, fasting status, allergies, pathology results, admin of meds.
What is the responsibilities of the: Anaesthetic nurse
- works under direct supervision of anaesthetist
- assist in the admin of anaesthetic during surgery
- provides support to the patient & anaesthetist prior and during the surgery
What is the responsibilities of the: Instrument (scrub) nurse
- responsible for supplies used within the OT with the goal of anticipating the surgeons & teams needs
- ensure all needed supplies are sterile & functional
- remain vigilant throughout the procedure
What is the responsibilities of the: Circulating (scout) nurse
- ensure all supplies provided to the OT team are in an aseptic manner
- management & documentation of all supplies
- collection of patient specimens
- verify patient consent forms
- preparation of surgical equipment
What does ‘time out’ in the intraoperative setting involve?
- Guideline for implementation of the universal protocol for the prevention of wrong site, wrong procedure & wrong patient.
- Conducted immediately before starting procedure
- Involves the entire team using active communication to check against documentation the correct patient ID, correct side & site and agreement on the procedure to be done.
