Perioperative

Question 1

Preoperative considerations

Answer 1

• Vital signs
• Preop checklist guiding document for before patient goes to surgery
• NBM status nil by mouth status (have to have fasted 6 hours before surgery)
• Medications (what they can and cant have, blood thinners is a no)
• Consent
• Weight and height (if necessary, necessary for anastatic/medications) (important for appropriate dosing of medication, especially for anastatic)
• Specific physical assessments (how well they are physically will determine how well they will do during surgery)
• Neurovascular
• Neurological (GCS/ PERRLA/ limb strength)
• Respiratory / cardiovascular
• Wound assessment
• Pain (acute/chronic) (all patients will have some sort of pain, especially with acute patients, chronic pain with other injuries like back injuries, both can occur together if someone has chronic pain they will also have acute pain after surgery)

Question 2

preoperative assessments

Answer 2

• medical/surgical/family history
• blood tests/ scans/x-rays
• nutritional/ fluid status
• drugs (OTC/recreational)
  alcohol use
• respiratory status
• cardiovascular status
• hepatic/ renal function
• past and current medication use
• endocrine function
• allergies
• psychosocial factors
• cultural beliefs
• spiritual beliefs

Question 3

Returning to the ward from the post anesthetic care unit (PACU)
- Nursing priorities on return to the ward

Answer 3

• Airway- regular observations (patient has just had anastatic important)
• Vitals (EWS score) (determined by EWS but also by protocol on how often you check them)
• Pain (checking in on pain is very important!!! Patients will have pain, well managed pain shouldn’t turn into chronic pain)
• AVPU
• Orientation to time place person (TPP) (medications can make you hallucinate, you can be alert but confused, )
• Nausea and vomiting (anastatic can make you feel sick after, antinausea medication given after surgery they may need more, are you feeling sick at all)
• Wound check for strikethrough (though the dressing) (wound checking important bleeding)

Question 4

potential complications for surgery

Answer 4

• May be general or specific to type of surgery
• Highest incidence of post-op complications is between 1-3 days post op
• Neish things depending on what type of surgery
  Immediate complications
• Hemorrhage, atelectasis, shock, low urine output
  Early complications
• Pain, acute confusion syndrome, nausea and vomiting, fever, secondary hemorrhage (bleeding later one days after surgery). DVT, paralytic ileus (ileus of the small intestine stops working, asking if they have passed wind, which determines there is peristalsis), AKI
  Later complications
• Bowel obstruction due to adhesions, infection, incisional hernia (hernia that is caused by them having to cut through stomach muscle), keloid scar formation (extra scar tissue)

Question 5

preventing perioperative complication - preoperative

Answer 5

Pre operative (starts from admission, what risks specifically do they have)
- Pre-assessment clinic
- Fitness/risk assessment
- Addressing comorbidities
Continue/stop relevant medication

Question 6

Preventing perioperative complication - intraoperative

Answer 6

Intra operative
- Correct timely antibiotics
- Cardiovascular optimization (having a close focus on patients cardiovascular status, by monitoring and adequate fluids)
- Specific drugs (I.e. anti-emetics)

Question 7

preventing perioperative complication - post operative

Answer 7

Post operative
- Enhanced recovery programs (don’t keep patients resting in bed, breathing optimized, walking around, prevents pressure injury, blood flow)
- Analgesia (
- Early mobilization
Regular post op ward rounds regularly being seen by surgical team)

Question 8

Considerations for the older people

Answer 8

Hazards of surgery for the elderly are proportion to
- The number and severity of co-existing health conditions
- The nature and duration of the surgery
The older patient has less physiological reserves than a younger person
- Lower cardiac reserve
- Decreased renal/hepatic function
- Decreased gastrointestinal function
- Sensory limitations
- Dehydration, constipation, malnutrition may be evident

Question 9

Bariatric considerations

Answer 9

Obesity increases the risk and severity of complications
During surgery, fatty tissues are especially susceptible to infection
- Wound dehiscence, deep vein thrombosis when supine, increasing the risk of hypoventilation and postoperative pulmonary complications
- Physical characteristics of short thick necks, large tongues, recessed chins associated with an increased oxygen demand and decreased pulmonary reserves- impedes intubation
- Difficulties associated with positioning, bariatric equipment required