perioperative care Flashcards
preoperative journey
3 phases;
1. pre op
- informed consent and choice by patient and the performing surgical consultant
- with elective surgery this may occur within weeks or months
- for acute surgery occur immediately or within days
2. intra op
- patient is now in theatre, anaesthesia induction and surgical procedure- nursing care by theatre nurses
3. post op
- PACU- immediate care after anaesthesia
- Ward- maintain care and comfort until discharge
children and consent
- there is no age of consent. All consumers are presumed competent to make an informed choice and to give informed consent.
- The care of children act 2004 sets out the age at which a child can consent or refuse to consent to medical treatment. It provides that if a child of or over the age of 16 years consents or refuses to consent to any donation of blood or any medical, surgical or dental treatment, the consent or refusal to consent has the same effect as if the child were of full age.
- The new Zealand bill of rights act 1990 says everyone has the right to refuse medical treatment, of course there will be exceptions where there is life threatening circumstances
what nursing processes will be undertaken in the preoperative stage
- establish a therapeutic relationship with patient and family
- establish baseline evaluations
- vital signs
- physical- range of movement, falls risk
- known allergies
- medical history
- mental state
- previous anaesthetic/ surgery history
- tests- bloods, x-rays
patient now ready for theatre- preoperative care prior to going in for surgery
- new observations
- verifies patients fasting status (6 hours for food and 2 hours for fluid, children is 45 mins- 1 hour for fluid)
- review patients health history, physical, psychological and cultural needs
- risk assessment (you might put TED stockings on, falls, pressure injuries e.g waterlow scale)- what could be involved?
- re check health history (confirm allergies)
- check consent has been obtained, what forms need to be available?
- special considerations- what does this look like for the patient based on their age
- preoperative teaching if required
- physical preparation of patient? what does this look like for the patient
- psychological preparation. what does this look like for the patient?
special considerations for patients based on what they need
- emergency surgery
- ED- resuscitation and pre op checklists
- blood groups
- consent, who consents for the patient when the patient cannot- EPOA/ 2 medical officers - bariatric surgery
- obstructive sleep apnea, frequently diagnosed in obese patients, treated with continuous positive airway pressure (CPAP)
- special equipment? - patients with disabilities
- ? mobility devices or additional bowel mix (opiates)
- patients with intellectual disabilities (ID) may have heightened anxiety/ carer separation - children
- what could help? toys, watch vidoes, parent involvement - older people
- could have chronic illness/ health problems (medical history)
- polypharmacy- what medications are they likely on? hypertensive, arthritis, high blood pressure, blood thinners, steroids, bronchodilators
-mobility? may be limited from disability or arthritis
- risk of pressure injury/ blood clots
arrive to theatre- intraoperative
- check in with the anaesthetist nurse or technician
- identify correct patient through documentation
verify: - allergies
- recheck consent
- documentation completed
- re check health history
- special considerations
- cultural/ disability needs
- mental status
- surgical site
- a brief head to toe assessment- bruises, cuts, scratches etc
- take measures to ensure patient comfort, psychological support
- what will you communicate about the patient to the anaesthetic technician and nursing team- movement limitations, emotional and allergy status
intra operative care- in the operating room
- collaborative team performance is required to maintain patient safety and produce high quality outcomes
- minimise risks and prevent complications
- surgical safety checklist
- circulating nurse- monitors breach in sterile fields; infection prevention; equipment/ instruments available; anticipates surgical team needs
- scrub nurse- assists and anticipates surgeon/ registrar needs; has a good understanding of instruments and surgical procedure; implants
intra operative nursing process
throughout the surgical procedure nurses
- assess/plan for safety and well-being of patient
- Manage the perioperative environment
- Coordinate OR personnel
- Nurse responsibilities in allocated roles
- Primary focus
- Identify real/potential risks that may harm the patient
for an older person
- Patient positioning – he’s 82 years old, what position will he be in, how long for, what are the risks to pressure injury
- Range of movement
- Potential error of wrong side/site surgery – must be identified prior to knife to skin through the safety surgical checklist
- Equipment malfunction – cables not securely connected, is there another readily available
Environmental hazards – cables, too many personnel in theatre
- Protect and respect patient dignity
- Maintain perioperative nurses’ standards (Australian College of Operating Room Nurses, ACORN, 2016)
- be a patient advocate
below 10,000 feet- patient safety measure
in operating theatres- noise and distraction are two leading causes of ‘never events’
10,000 feet is said to stop all unnecessary noise in the theatre when required e.g when patients arrive in theatre and when they are being anaesthetised.
It comes from the airline industry where during take off and landing before the aircraft passes 10,000 feet pilots must be fully focused
intra operative complications
- airway complications
- allergic reactions
- anaphylaxis
- bleeding
- cardiac
- hypothermia
- CNS changes
- electrosurgical burns
- positioning
- thrombosis- risk increases with time on the table
- malignant hyperthermia
infection prevention controls
- purpose build theatres- recommended sizes for theatre
- restricted access- only perioperative staff allowed in
- laminar airflow
- strict cleaning regimes
- personal protective equipment
- surgical asepsis;
- sterile instruments
- sterile surfaces
- audit compliance
postoperative care- PACU
- initial assessment- ABCDE
A- airway
B- breathing
C- circulation
D- disability
E- exposure - perform handover from theatre nurse to PACU nurse using ISBAR- Identify, Situation, Background, Assessment and Recommendation
PACU nurse assesses; - pain
- surgical site/ wound
- nausea/ vomiting
- fluid balance
- level of consciousness
- normothermia
- gerontological considerations
what assessment charts are in clinical placements
- waterlow pressure injury
- SSKIN
- fluid balance
- falls risk
- EWS
