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 or a 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