Week 9 Flashcards
When does preoperative care begin and end?
Begins when surgical intervention is first considered and ends when the patient is first admitted to the operating room.
This phase may be of short duration if the client is taken directly to the OR or soon after admission.
What is the aim of preoperative preparation?
To ensure the individual is in the best physical and psychological condition before undergoing surgery.
Is it essential to gather data about the clients health status through the taking of baseline observations and a detailed accurate nursing history.
The nursing assessment is based on data collected and includes the identification of actual and potential problems that may be faced by the individual throughout all phases of the operative period.
What are some of the actual and potential problems the patient may face and how can the nurse help?
Stressors including physical and psychological environment, issues at home, difficulty getting to shops, appointments
Referrals - physio, OT, dietician, psych/social worker
When giving preoperative education to the patient regarding pain management, what should the nurse discuss?
First ask the patient if they are experiencing any pain.
Instruct the patient they will be prescribed either oral or patient controlled analgesia postoperatively.
Explain importance of aperients as many analgesics may cause constipation. These are usually also prescribed.
Discuss preoperative education regarding VTE prophylaxis.
Explain use of intermittent pneumatic compression (IPC) pumps
Measure patient for
What are some of the physiological responses to the stress of surgery?
Increased peripheral vasoconstriction of blood coagulation
Increased rate and strength of heart beat
Increased reabsorption of sodium ions from kidneys, causing retention of sodium and water
Decreased peristalsis in GIT
Relaxation of smooth muscle that promoted dilation of the bronchioles
Increased breakdown of protein
Increased Basil Metabolic Rate
Increased circulation of glucose and mobilisation of stored fat
What are some therapeutic management approaches to stress?
Be friendly and relaxed, talk to your patient
Be flexible with treatment and care schedules
Involve your client and family in all care decisions
Calm and quiet environment
Adequate information
Effective ward orientation
Active participation of clients in care planning
Facilitate clients to express feelings and thoughts
Education
Medication
Immediately before the operation the patient must be prepared by the nurse. What preparations does the nurse conduct?
Weight (medication calculations and fluid status postoperative)
Vital signs (serve as baseline and guide for comparison postoperatively)
Void (to prevent bladder distention)
UA (kidneys excrete most drugs from body therefore any sign of kidney dysfunction is significant)
Anti-embolic stockings hygiene and comfort, appropriate clothing (usually a gown and paper cap)
Check ID bands against ID chart
Children must have EMLA applied to back of both hands 1 hour prior
Side rails must be up when transporting patient
Reassure family members
Explain how you would instruct a patient to use an incentive spirometer.
Hold incentive spirometer upright
Exhale normally and place lips tightly around the mouthpiece
Inhale at a sufficient rate to raise the ball in the first chamber, this will help you to achieve slow, sustained maximal inspiration
For a higher flow rate, inhale sufficient to raise two balls in the chambers
Remove your lips from mouthpiece and exhale normally
Rest in between each deep breath and repeat for a maximum of three
Perform this every hour
Prevents hospital acquired pneumonia
What equipment does the nurse need when preparing the preoperative patient?
Surgical pack - sheet, cap, gown, surgical wash (pt needs to shower using wash)
Clippers and shaving cream to remove hair from area to be operated
Equipment to take full set of vital signs
Measuring tape to measure for TED stockings
Incentive spirometry (Tri-flow meter)
Patient documentation - preoperative checklist, medication chart, FBC, Consent form, Braden scale, VTE assessment
