Perioperative roles, post op and Pain Flashcards
Perioperative nursing
- patient advocacy
- scientific nursing interventions
- critical thinking
- clinical reasoning
- caring
- comfort
What does a role of pre operative nurse?
- alterations and consequences for the patient
- identifies intraoperative risk factors and the potential for the prevention of patient injury
- understand the psychosocial implications of surgery for the patient family and caregiver
Design of the operating theater?
= restricted area accessed through semi restricted area with marks and PPE required
- Lighting - UV radiation reduces number of organisms in ai
- temp - 20-22 degrees to inhibit bacterial growth
- humidity - 50-60% inhibits bacterial growth
- positive air pressure
Role of anaesthetic nurse?
- prepares and chest the anaesthetic machines, equipment, intravenous and arterial lines
- participates in time out
- assists the anaesthetist in the. induction and maintenance of the anaesthetic
Role of the scrub nurse?
- reviews anatomy and physiology and surgical procedure
- completes surgical hand and arm scrub gowns/gloves self
- prepares instrument table and organises sterile equipment
- assists with skin prep
- passes instrument to surgeon
- reports medications used by surgeon and monitors irrigation fluids for calculation of blood loss
Role of the circulating nurse?
- plans and coordinates intraoperative nursing care
- assists in preparing the OT
- monitors aseptic technique
- identifies and admits the patient to the operating room
- maintains an accurate count of sponges, needles, instruments and other medical devices that may be retained in the patient
- document intraoperative care
Hand over in operating room?
ISOBAR
- identification
- situation
- obs
- background
- assessment and action to establish an agreed management plan
- responsibility and risk management
Post anaesthesia care PACU nurse role
Stage 1: patient recovery unconscious
- one on one nursing care - Close monitoring of vital signs and A-G - assessment of complications - medications for pain
Stage 2: pt transferred to postsurgical ward to meet requirements for dischargee
- 1:4 nurse ratio
Initial PACU assessment
- Airway
- Breathing – (including oxygen)
- Circulation-ECG
- Neurological- level of consciousness/ orientation
- Gastrointestinal –nausea/ vomiting/intake/ fluids/ irrigations
- Genitourinary –output/ urine/ drains
- Surgical site -dressings and drainage/ per vagina loss/ fundal height/ pain/ incision
What does post operative care include?
- care in recovery
- care in the ward
- care on discharge
Post anaesthetic recovery unit
- close observations, evaluation and stabiles condition
- anticipate and prevent complications
Care in recovery
- anaesthetist gives report to admitting recovery nurse
- monitoring and management of vital functions
- assessing whether the patient is safe to return to ward
- report any concerns
Post op complications immediately
- Respiratory function
- Cardiovascular function
- Neurological function
- Pain & discomfort
- Thermoregulation
- Nausea & Vomiting
Discharge criteria from PACU
= if they score above an 8 to be discharged and no 0 in any categories
Transfer from recovery
- ISBAR handover
- A-G
- check medical records
- make patient comfortable
- N and V
- thermoregulation
- pain
- re-orientation to surroundings
respiratory complications post op and nursing interventions?
- atelectasis and pneumonia
- absence of deep breathing due to pain or reclined position
- lack of coughing leads to development of mucus plugs in lungs
Nurse: respiratory assessment
- encourage deep breathing and coughing
- mobilisation
- splining to reduce pain
- regular repositioning
Cardiovascular complications post op and nursing interventions?
- arrythmias
- reduction in cardiac output –> bleeding or systemic infection
CO= stroke volume X HR
- preload
- hypovolaemia (haemorrhage)
- vasodilation (septic shock, anaesthetic)
- hypovolaemia (haemorrhage)
- contractility
- cardia condution, ventricular failure, hypertension
Fluid electrolyte imbalance
- fluid retention
- fluid overload
- fluid defict
- hypokalaemia (low potassium
Intevention
- Early mobilisation
- Lower leg exercises
- Anti-embolism stockings
- Anti-coagulants
- Repositing
Thermoregulation complications post op and nursing interventions?
- Temp below 36
- Cold operating theatre
- Anaesthesia can lead to vasodilation
- Monitor temp
gastrointestinal complications post op and nursing interventions?
- Nausea and vomiting
- Imbalance nutrition (NBM)
- Assess for active bowel sounds
- Constipation
pressure injury complications post op and nursing interventions?
- Prolonged sedentary positions put pressure on the skin and reduce blood flow to that area
- Post-operative patients are at particular risk of pressure sores due to aesthetic, nutrition, pain, immobility
- Graded in terms of severity
- Common sites
o Occiput
o Elbows
o Ischial tuberosity
o Heels
Urinary retention complications post op and nursing interventions?
• Low urine output may be expected in first 24 hours, min/hour 0.5mls/Kg
- Increased aldosterone & ADH from stress of surgery - Fluid restriction pre-surgery - Fluid loss during surgery
- Patient may have a urinary catheter insitu
- Retention
- Loss of sensation e.g. epidural
- Anaesthetic medications may interfere with ability to initiate voiding
- Pain may inhibit bladder emptying
- Recumbent position
- Renal ischaemia
Signs and symptoms of a local infection
• Redness (vasodilation & increased blood flow)
• Heat (vasodilation)
• Swelling (vasodilation)
• Loss of function (pain & swelling)
- Pain (nociceptor stimulation)
Signs and symptoms of a systemic infection
Signs • Raised temperature (>37.5 C) • Increased HR • Reduction in BP & hypotension • Increased respiratory rate Febrile convulsions (common in paediatrics ) • Sweaty (diaphoretic) Symptoms
- Feeling hot
- Achy joints
- Restlessness
- Pain
Nursing interventions of infection
- If signs of infection, either local or systemic arise, alert surgical team
- Antipyretic medication (paracetamol, ibuprofen)
- Antibiotics (if prescribed)
- Adequate hydration (IV therapy or oral intake)
- Regular monitoring of vital signs according to severity of condition
Define pain
= an unpleasant sensory and emotional experience associated with actual or potential tissue damage (subjective)
- pain is an early identification and recognition of people experiencing pain leads to improved health outcomes and greater patient satisfaction
Types of pain
- acute
- chronic
- neuropathic pain
Pain assessment
PQRST
P - provoking factors (what caused the pain)
Q - quality (what does the pain feel like)
R - radiation (where is the pain)
S - severity (0-10 scale)
T - timing (when did the pain start)
What is the importance of pain assessment?
- First step to providing effective pain management
- Provides a baseline for ongoing assessment
- Nurses are unable to prescribe analgesic medications, however through a comprehensive pain assessment (and documentation) we can assist medical staff in selecting the appropriate class of analgesia, dose, frequency and route
When do you assess pain
- pain assessment
- on all admissions
- baseline
- standard obs
- every time analgesia is required
- before analgesia
- document
What is treatment for acute pain ?
Acute pain = aggressive treatment often involving a multimodal analgesia management including opioids
- Theoretical pain – an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage
- Practical pain – is what the patient says hurts, existing wherever he/she says it does WHEN ASKED
What is treatment for chronic pain
= treatment is non medicated based normally
Pathophysiology of pain?
- When tissue damage occurs a range of chemical mediators, proinflammatory cytokinesis are released
- These substances stimulate the nociceptors which then transmit pain signals via afferent nerves to the CNS
- The signal ascends the spinal cord along the ascending pathways (primarily the spinothalamic tract)
- It is then projected into the medulla, thalamus and cerebral cortex of the brain for higher interpretation
- It is at this point that the signal is greatly influenced by emotion, cognition and behaviour
psychological aspect of pain
= Pain is an individual, multi-factorial experience influenced by culture, previous pain events, beliefs, mood and ability to cope
- Pain can be escalated by psychological/spiritual distress
What are the effects of acute pain on psychological aspect?
= stress response - mediated by metabolic and neuro hormonal mechanisms
Clinical manifestations of stress response
- Hypertension
- Tachycardia
- Splinting
- Ventilation perfusion mismatch
- DVT and PE
- Decreased gastrointestinal motility
- Water and salt retention
Effect of stress response on respiratory system
- Atelectasis
- Decreased cough
- Sputum retention
- Infection
- hypoxemia
Effect of stress response on cardiovascular system
- Tachycardia
- Hypertension
- Increased myocardial oxygen consumption
- Myocardial ischaemia
- DVT
Effect of stress response on gastrointestinal
- decreased gastric and bowel motility
Effect of stress response on genitourinary system
- urinary retention
Effect of stress response on neuroendocrine system
- increased catecholamines, cortisol, glucagon, growth hormone, vasopressin, aldosterone and insulin
What is a PCA?
= patient controled analgesia
= programmable syringe pump, which delivers the opioid infusion according to individualised settings
- Bolus dose, lockout time, dose duration, background infusion
Drugs used in PCA
Drugs used in PCA
- Opioid e.g. morphine, pethidine, fentanyl
What is lockout time?
- Usually 5 mins
- PCA will not deliver a dose during lockout time even if the patient presses the button
- Allows each bolus to reach peak effect before the patient has another bolus
- Reduces risk of overdose\
Good tries = when the PCA delivers the bolus dose of analgesia
Bad tries = when the patient presses the button during lockout time and no bolus is delivered
What are the benefits of PCA?
- Patients control own pain relief
- Less anxiety
- Better pain relief
- Better patient satisfaction
- Less analgesic side effects
Side effects of PCA?
- Sedation
- Respiratory depression
- N and V
- Purities
- Urinary retention
