Pre/Intra/Post Operative Nursing Care Flashcards
What does a surgical referral for a non-acute surgical patient look like?
- It is usually made by a General Practitioner (GP) or specialist - The patient is evaluated for their eligibility of accessing a range of treatments using Clinical Priority Access Criteria, & in some areas, a Clinical Priority System is used in the outpatient clinic by the specialist (it’s about umbers/scoring) - The patient is put on the elective waiting list: e.g. joint replacement, cataracts surgery, cosmetic surgery
What does a surgical referral for an acute surgical patient look like?
- The patient is usually admitted through the Emergency Department - The patient may also be referred by the GP - The patient is urgently referred due to an urgent or emergency surgical condition. - The patients may further classified as - Either an acute elective case: ORIF for fractured neck of femur - Or an emergency case that can be life threatening and needs immediate treatment. e.g. obstetric emergencies, bowel obstruction, ruptured aneurysm, lifethreatening trauma
A surgical proceduse is determined according to why a patient needs surgery. What are some examples of these surgeries?
1) Diagnostic: e.g. biopsy; exploratory laparotomy
2) Curative: e.g. appendectomy; cholecystectomy
3) Restoration: e.g. joint replacement; herniorrhaphy
4) Ablative: discectomy
5) Palliative: tumour resection; coronary artery bypass
surgery
6) Cosmetic: breast augmentation; face lift
A surgical procedure is determined according to how a surgical procedure is done. What are some of these surgical procedures?
1) Laser surgery: cataract/day surgery
2) Cryosurgery
3) High frequency sound waves – ultrasound
4) Endoscope: laparoscopy, day surgery
5) Transplantation surgery: major organs
6) Skin/tissue graft: burn
A surgical procedure is determined according to the risk level presenting in the surgery. What are these risk levels?
1) Minor
2) Major
What are the routes of admission for elective patients?
- Day surgery patient: day-of-surgery admission (DOSA)
- Other elective patients: via Operating Room Direct
Admission service (ORDA) then transferred to the ward
post-operatively - Private patients reviewed in the surgeon’s room/clinic
What are the routes of admission for acute/emergency procedures?
- Acute admission to the ward
- Acute admission to the operating theatre
What assessments are done with the patient pre-operatively?
1) Past medical history and allergies
2) Physical examination: systemic review
3) Blood tests, blood grouping and antibody screen,
biochemical tests indicated, ECG, x-ray, etc.
4) Radiology
5) Medications
6) Psychosocial concerns
7) Language and cultural needs
8) Discharge planning
What are some factors that may affect the patient’s surgical experience?
- Elderly and young patients
- General health status: malnourished status,
obesity, hypoproteineamia, anaemia, diabetes,
fluid and electrolyte imbalance - Reason for admission: medical diagnosis of
malignancy may have great impacts on the patient
psychosocial aspect. - Habit/lifestyle: smoking, alcohol, OTC
medications, recreational drugs, herbal remedies
Why do we do pre-operative preperations?
- To ensure the patient participates in the
goal setting of treatment plan
(patient-centred care) - To establish trust and rapport
(therapeutic communication) - To ensure the process of signing the
informed consent is valid
(legal and ethical aspect) - To identify and manage any physiological and
psychosocial issues, eg. baseline data, lab results.
(physical and psychological preparation) - To take proactive steps in managing adverse
factors that may increase risk of post-op
complications : e.g. pre-op patient education for
pain management; medication and mechanical
prophylaxis for DVT; teaching post-op exercises - Most importantly…to determine if the patient is
safe enough for and understands the scheduled
surgery so as to achieve the best outcome of the
surgery.
What are some physiological effects to surgery?
- Respiratory
- Cardiovascular
- Urinary/hepatic
- Neurological / Musculoskeletal
- Endocrine system
- Immune system
- Gastrointestinal / Nutritional status
- Integumentary
What are some physical preparation for surgery?
- Bowel preparation
- Food and fluid restriction
- nil by mouth (NBM) – nil per ora (NPO)
-Preparation of the Skin - Dress the patient with the theatre gown (no undies)
- Deep venous thrombosis (DVT) prophylaxis :
compression stockings and low-molecular weight
heparin administration - Prostheses: hearing aid, dentures, etc
- Medications: pre-operative medications (pre-meds)
What are some examples of pre-operative patient education?
- Anti-embolism stockings (TED’s - AE)
- Anticoagulant agents administration
- Education of bed exercises and deep breathing &
coughing exercises - Pain management
- Information on the procedure and equipment
- Dietary restrictions
What does psychosocial nursing care help to determine?
- perception of the surgery
- expected outcome
- coping mechanisms
- knowledge level
What is a surgical informed consent?
Must Always include: - Consent for procedure - Consent for anaesthesia And - Consent for blood and blood products
What is a nurses’ role in the process of informed consent?
- A legal and ethical document
- A voluntary and written consent signed by the
individual patient (or other legal person) - Surgeon and anaesthetist’s responsibility
- Special considerations: e.g. under the age of 16;
mentally disabled
What to include in documentation?
- Pre-operative checklist
- Observation charts
- Medication charts: FBC, drug chart
- Nursing notes: initiating the care
plan and progress notes
What is a nurse responsible for pre-siurgery?
- Performs physical, psychological and social
assessment and preparation. - Communicates pre-operative concerns with
the multidisciplinary teams. - Ensure the patient’s consent is “informed”.
- Acts as an advocate for the patient.
- Completes relevant documentations
What are the three phases of surgery?
- Preoperative phase
- Intraoperative phase
- Postoperative phase
What is the preoperative phase?
Starts with the patients decision to have surgery and ends with her transferred to OR. Care focuses on preparing and teaching the patient
