Pre and post operative care Flashcards
Palliative Surgery purpose
Performed to alleviate symptoms of a disease, but does not cure e.g. colostomy
Cosmetic surgery purpose
Performed to correct cosmetic problems e.g. Rhinoplasty
Curative surgery purpose
For removing diseased tissue. Often used for cancer.
Diagnostic surgery purpose
To determine aetiology (the cause) of the disorder. e.g. biopsy
Exploratory surgery purpose
To determine a diagnosis and\or evaluate the extent of a lesion
Purpose of general anaesthesia
- Promote unconsciousness
- Analgesia (inability to feel pain)
- amnesia
- muscle relaxation
- inhibit involuntary reflex action
can be given through IV
or through inhalation
What is Local/regional anaesthesia and why is it used?
The patient is conscious; the aim is to block the conduction of nerve impulses to and from specific sites in the body.
Pre Operative Preparation assessment:
Who is going to theatre? When? What procedure? Has the individual been in hospital before, previous surgery Do they understand the procedure Is there any special preparation needed?
Purpose of Anti-embolic or TED stockings
Support blood vessels
Prevent stasis
Prevent thrombus (clot) formation
Physical prep for surgery
Baseline data - TPR, BP, urinalysis and weight, reporting any sign of infection.
Skin preperation - Clipping, shower, total body wash.
Removal of - makeup, nail polish, hair clips, jewellery. Tape wedding ring
Gastro-intestinal preparation -
Fasting prior to surgery - NBM (generally 6 - 8 hours, for young children it may only be for 4 hours)
Pre-Operative Check
Vital signs, weight, height Identification - check arm/leg bands, notes, stickers Operation Consent - signed and witnessed Allergies - noted and arm band Pre-medication - time given Voiding - when last voided
Early Post-Operative Care Preparing the environment
Preperation of bed IV pole Hanger for urinary catheter, drain Water, glass and straw Equipment for post-op wash
Handover from recovery staff should include:
Operation Anaesthetic - type Special orders Pain relief and medications given IV, catheter, drain, wound Patients notes Any belongings of the patient
Post op Obs
Check once an hour for the first 4 hours. Looking at: TPR BP Colour Level of consciousness Circulation checks Neurobs Fluid balance
What is a primary haemorrhage?
Bleeding which occurs within the first 24 hours
What is a secondary haemorrhage?
Bleeding which occurs 7-10 days post operatively
Presenting problems of haemorrhage
Obvious bleeding around incision site or may be none externally.
Signs of shock, tachycardia, hypotension
Presenting problems - respiratory
Dyspnoea Cyanosis Pyrexia Tachycardia Limited chest expansion on affected side
Nursing actions for respiratory problems
Monitor respirations Position to enhance breathing Deep breathing and coughing exercises Chest physiotherapy, suction if required Use of incentive devices - tri flow Monitor oxygen therapy if ordered - nasal, oxygen mask
Venous Thrombosis, what is it?
Venous thrombosis - is the formation of a clot or clots within a vein as a result of venous stasis. Most commonly affects saphenous and femoral veins of leg (DVT)
What is an Embolism
Embolism is the condition whereby a clot is dislodged and travels in the bloodstream. It can also consist of air or fat.
Symptoms of DVT
May be asymptomatic
Pain, swelling and tenderness of affected limb
Positive Homan’s sign (pain in calf on dorsiflexion)
Peripheral Arterial Embolism symptoms
Total arterial occlusion - Loss of pulse and pallor distal to the obstruction, pain
Partial arterial occlusion - Numbness or weakness of the limb
Presenting problems of PE
Sudden onset of dyspnoea Severe chest pain Cough, blood streaked sputum Cyanosis Sudden circulatory collapse
Nursing actions towards PE
Assessment of physical and vital signs to observe for respiratory and circulatory complications.
Encourage deep breathing and coughing regularly
Encourage early ambulation
If ambulation is contra-indicated, regular change of position
Encourage active, passive and leg exercises
Maintain adequate hydration
Apply anti-embolic stockings on individuals at risk
Intermittent external pneumatic compressions system
Medications as ordered - anticoagulants
Abdominal distention what is it and symptoms?
Distention results from the accumulation of gas in the intestines due to failure of the intestines to propel gas by peristalsis
Symptoms include
Sharp abdominal pain
Swollen abdomen
Inability to pass flatus
Paralytic Ileus What is it and symptoms?
Paralysis of intestines, thus absence of peristalsis. May be due to trauma of surgery, handling during surgery, post anaesthetic effect, mechanical obstruction
Symptoms Absence of bowel sounds Abdominal pain and/or distension No passage of flatus Nausea and vomiting
Nursing actions for Abdominal distention and paralytic ileus
Observe and record passage of flatus Detect presence of bowel sounds Give measurements Early ambulation Adequate fluids May require insertion of nasogastric tube on low suction
What is urinary retention and what are the symptoms?
Accumulation of urine in the bladder that occurs post-operatively, usually due to the effect of anaesthesia on bladder muscle tone or due to decreased sensation to void as a result of operative trauma
Symptoms
Suprapubic discomfort or pain
Inability to void
Nursing actions on urinary retention
Fluid balance chart Adequate fluids Early ambulation Commode instead of pan\urinal Catheter care if catheterisation indicated Bladder scan
Wound infection Symptoms?
Pain, tenderness, redness and swelling, heat around the wound.
Purulent wound discharge.
Pyrexia
Wound Dehiscence What is it and what are the symptoms?
Poor tissue healing causing the wound to open. Commonly due to wound infection, anaemia, early postoperative removal of sutures/clips/staples or stress on the unhealed incision
Symptoms
Separation of wound edges
Leakage of serosanguineous fluid from the wound
Nursing Actions
Observe for signs of wound infection, dehiscence, evisceration
Maintain appropriate wound management - aseptic technique
Check wound before removal of sutures
For evisceration do not push organs back into abdomen - cover with dressing moistened with warm sterile normal saline and report to RN immediately as wound needs to be closed in OT
