surgical patient journey Flashcards
what does pre operative mean? what are the two types of pre operative period?
the time before surgery
distant pre operative- more than 24 hours before surgery
immediate pre operative surgery- less than 24 hours before surgery
tasks to carry out in the pre operative period
- educate patients on what is going to happen
- encourage concordance with surgery and treatment beyond
- pre-operative assessment clinics
- specific investigations
- risk reduction measures
important information to know about the patient
- past medical history
- smoking/ alcohol/ other addictions
- past anaesthetic history
- drug history
- social history- who do they live with
- past surgical history (nausea and vomiting history?)
important information to know about the surgery
- length of stay
- surgical technique
- specific surgical risk
- anaesthetic technique
- specific anaesthetic risk
- will pts be able to eat or drink after surgery (diabetics)
- they will be immobile- risk of clot developing
4 important pre-operatic considerations
- appropriate pre-operative investigations
- starvation
- thromboprophylaxis
- antibiotic prophylaxis
3 types of pre operative investigations
- blood tests- FBC, U&E, LFT
- imaging- X-rays, CT, MRI
- specialist- ECG, lung function test, CPET
what is the 2-6 rule and who does it apply to
adults- intake of water up to 2 hours before surgery (water encouraged 2 hours before). a minimum of pre-operative fasting time of 6 hours (inc milk, or milk containing products)
why is it important for a patient to have an empty stomach
if you undergo general anaesthetic and you bring food back up it could be aspirated into the lungs
what is the 2-4-6 rule and who does it apply to
children- intake of water and other clear fluids up to 2 hours before (again, encouraged). Breast milk up to 4 hours before. Formula milk, cows milk or solids up to 6 hours before
does the 2-4-6 and 2-6 rule apply to oral medications?
no- take as normal
what are the two types of thromboprophylaxis
pharmacological thromboprophylaxis usually low molecular weight heparins eg enoxaparin
Mechanical means- stocking applied to encourage venous return
measures used to reduce infection risk
procedural measures- eg hand hygiene, aseptic measures, pharmacological measures
ways in which infection could still occur after surgery
wrong antibiotics prophylaxis given, on antibiotic for too long or too short
what are some risks for people with a high BMI when undergoing surgery
- associated medical condition
- temperature regulation
- anaesthetic considerations
- surgcical considerations
why does smoking increase risks during surgery
wound healing, intra operative and post operative breathing problems, pneumonia, increased risk of small and large vessel disease, DVT, chest infection, cardiovascular problems
what are some risks associated with hypertension during surgery
drugs, co-morbidities, risk of complications
how could you overcome anxiety before surgery/ what do you need to consider
benzodiazepines, distraction
you may need to consider a different route of administration for the anaesthesia
what are some factors to consider when a diabetic patient undergoes surgery
what insulins is the patient on eg short or long acting. starvation (affects blood glucose). surgical stress response- push blood sugar levels high, other medication
what are some things to consider in a patient with renal impairment
changing drug doses, further renal insults (through surgery), high doses of antibiotics could cause further renal function
what is the sliding scale regimen
changing from oral diabetic drugs to IV cannula to go on soluble insulin
what values need to be looked at to assess renal impairment
urea, creatinine, eGFR, urine output
what’s RIFLE
R- risk I- Injury F- failure L- loss E- end stage
what does rifle use to assess function
GFR and urine output
what are the consequences of reduce renal function
antibiotics doses
benefits of regional anaesthetic
get patients out of hospital quicker, reduce risk of nausea and vomiting
what class of drug is associated with risk of regional anaesthetic
anticoagulants- interaction
vital that timing is considered with anticoagulants and anti platelets
causes of decrease in oxygen sats
related to BMI, new pathology, pneumothorax, hypotension, PE, equipment problems eg blockage/ oxygen failure
immediate post operative problems
- primary haemorrhage
- bottom of lungs get compressed and can’t inflate
- shock
- low urine output
- inadequate intraoperative fluid
- myocardial infarction, blood loss and septicaemia
Early post operative problems
- secondary haemorrhage- bleed 24 hours after operation
- pneumonia
- wound or anastomosis dehiscence
- DVT
- acute urinary retention
- paralytic ileus
- wound infection
- nausea and vomiting
late post operative complications
- bowel obstruction due to fibrous adhesions which stick in the bowels
- incisional hernia- this could cause bowel obstruction as its in a place it shouldn’t be
- persistent sinus- breach of the skin (small hole that takes a long time to heal)
- recurrence of reason for surgery
what factors increase the risk of nausea and vomiting
female, previous history, history of motion sickness, type of surgery eg craniotomy, type of anaesthetic (opioids, nitrous oxide and volatile agents)
how do you prevent and treat nausea and vomiting
no smoking, cyclizine, meetoclopramide
what is ERAS
Enhanced recovery after surgery
combination of evidence based elements that in combination lead to: better recovery after major surgery, decreased complications, faster time to discharge home
