Pre op Assessment/ERAS Flashcards
What is the purpose of a pre-op assessment?
To gather complete health history and physical exam in order to determine surgical risks
What are surgical risks determined by?
Patient baseline medical conditions
History of current diagnosis / condition
Anticipate changes to baseline status as a result of surgery
What is covered in patient history that uncover risk factors?
Medical conditions Medications Allergies Family history ex. Bleeding disorders Difficulties in previous surgeries
What are some patients rights during assessment?
Respect Information Autonomy Honouring wishes Privacy Confidentiality Medical records
What is some patient responsibilities during assessment?
Providing accurate info
Info about known medical conditions
Participating in decisions
Who has the speak up program to learn about patients rights?
The joint commission
Patients Bill of rights was founded by who?
American hospital Association
What are SDOH?
Social determinants of health
Environmental conditions that affect quality of life
How a place is experienced by population groups and impact on health
Ex. Where you’re born, live, work
Elements of social determinants of health?
Economic status Education Social/community context Health and health care Neighbourhood/built environment
Examples of economic SDOH?
Employment
Food insecurity
Housing insecurity
Poverty
Examples of health/health care SDOH?
Access to health care
Health literacy
Examples of neighborhood/built environment SDOH?
Access to healthy food
Crime/violence
Environmental conditions
Quality housing
Examples of education SDOH?
Early childhood
Enrolment in higher education
High school graduation
Language/literacy
Examples of social / community context SDOH?
Discrimination
Incarceration
Social cohesion
History and physical assessment is regulated by who?
Centers for Medicare and Medicaid (CMS)
The TJC provides accreditation requirements for facilities to follow
What is the nurses responsibility during medical and physical assessment?
To do assessment
To gather relevant info about care, treatment and services that address patient condition, plan of care and needs
Must be completed prior to procedures within scope
What is done in data collection?
Collecting pt data
Establishing nursing diagnosis
Identifying desired outcomes
Making data available to surgical team
Primary vs secondary data?
Primary data is most relatable
Comes from patient directly
Secondary data is from family, medical records, health care providers
What is ERAS?
Enhanced recovery after surgery
Goals of ERAS?
Decease patient stress response
Optimize patient physiological function
Facilitate recovery
Key components of ERAS?
Education Optimization of pt condition Minimal fasting pre op Multimodal pain relief Return to diet/activity the day of surgery DC home
Advantages to ERAS?
Fast recovery
Decrease hospital stays
Fewer post op complications
Pre hospital phase of ERAS?
Education
Pain plan
Pt optimization
Prehabilitation
Pre-op phase of ERAS?
Limit/fasting
Initial multimodal medication and/or regional block
When can you eat / drink with ERAS pre-op?
Light snack 6hrs pre-op
Carbohydrates drink 2hrs prior
Intra - op phase of ERAS?
Multimodal meds Normovolemia N/V prophylaxis Normothermia Normoglycemia Avoid tubes and drains
Post - op phase of ERAS?
Early nutrition Early mobility Multimodal pain relief N/V management No or very little IV fluid Education
Discharge of ERAS?
Monitor S&S and when to seek help
Follow up
Continuing planned therapy
ERAS challenges for patients?
Needs/experience
Health literacy/understanding
Attitude/beliefs
Health history
Staff challenges with ERAS?
Attitude/behaviour
Engagement
Communication
Skills/competency
Facility challenges with ERAS?
Leadership/support
Education
Availability of resources
When does skin decline in function?
Starts between 30-44yrs
Elasticity decreases
Skin thins
Sweat glands atrophy
- difficult temp regulation
