Transcript Pre and Post op Care

Pre and Post op Care
By
Elaine Jones + Anne Wright.
Definitions.
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Perioperative nursing is a term used to
describe the nursing functions in the total
surgical experience of the patient, pre
operative, intra operative, and post operative
(Lipincott Manual of Nursing Practice
6th edition)
Pre operative phase.
 This
is from the time the decision
is made for surgical intervention
to the transfer of the patient to the
operating room.
Intra operative phase.
 This
is from the time the patient is
received in the operating room
until transferred to the recovery
room.
Post operative phase.
 From
the time of transfer to the
recovery room to transfer back to
ward.
Types of surgery.
Criteria for day surgery
selection.
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Surgery for short duration ( up to 60 minutes).
Type of operation in which post operative complications
are predictably low.
Age (based on biological/physiological age rather than
chronological).
BMI.
Support at home for 24 hrs
within 1 hours journey from hospital
access to telephone
Adequate toilet facilities (inside)
Exercise 1.
 On
admission for surgery
patients undergo an
assessment, what factors
need to be considered
Answers.
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Reason for admission
Biographical information
Current health status/illness
Medications
Symptoms/complaints/disabilities
Previous medical problems
Chronic illness
Family medical history
Nutritional status
Integrated Care Pathway
Continued>>>>
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Baseline observations.
Specimen collection.
Mobility Assessment.
Nutritional assessment.
Cardiovascular assessment
Respiratory assessment.
Urinary assessment.
Social assessment
Risk assessment
Psychological Assessment.
Patient
may be anxious
for numerous
reasons……..
Suggestions….
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Fear of the unknown
Anaesthetic + side effects / not waking up
Unrelieved pain
Restricted in bed post op.
Use of bed pan
Body image /effect on relationship, family
Dependant relatives.
Financial problems if sole provider for family.
In what ways can the nurse alleviate anxiety in the
pre op patient?
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Pre operative education:Patient information leaflets, diagrams,
posters
Pre op visit from recovery nurses.
Specialist nurses- pain control team, surgical
nurse specialist.
Consent.
>Legal requirement.
>Informed consent
Written consent should be obtained identifying that the
subject has received and understood: The procedure offered
 Reasonable alternatives to the procedure
 Possible benefits of the procedure to the patient.
 Risks, inconveniences, and discomforts of the
procedure.
 Answers to all patient's questions.
(DOH 2001)
Immediate pre operative
preparation.
 What
are the fasting
requirements for a patient pre
operatively?
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It is routine to fast patients for a
minimum of four hours before a
general anaesthetic, to empty the
stomach and avoid peri-or post
operative vomiting, or regurgitation,
which increases the risk of aspiration.
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2hrs Preop for water (tap not fizzy)
Gastrointestinal preparation.
 Is
this required for all types of
surgery?
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Bowel evacuation is carried out :To prevent defaecation during surgery
To reduce the risks of accidental damage to
the colon during abdominal surgery.
It is not required for all types of surgery, and
should not be seen as routine.
Skin preparation.
 Why
is skin preparation
necessary pre op?
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It is necessary to remove dirt and transient
micro organisms from the area.
Local procedures should be followed.
Hair removal.
Is
this necessary pre op?
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Controversial area of discussion!!
Against
Pre operative shaving increases risk of post
operative wound infection.
In favour of shaving:Avoidance of hairs trapping in the incision
A clear field of vision.
Pre op check list.
Exercise
Discuss each item on the checklist,
and provide a rationale for its
importance.
 Feedback to group.
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Premedication.
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Prior to any pre medication being given, the nurse
must :Ensure identity bands are worn and labelled
correctly.
Consent form is signed by patient and doctor.
Patient has voided urine.
Check all other items on the checklist.
Premedication to be given as prescribed at
appropriate time, with explanation to the patient.
Final check
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Ensure checklist is with patients notes, along
with consent form, x-rays, laboratory results,
nurses records.
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Patient is transferred to theatre.
POST OPERATIVE CARE
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What factors should you consider when
caring for a patient post operatively
(this starts from accepting the patient from
the recovery room)
Post op care
Answers
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Handover from recovery nurse to determine
post op instruction from surgeon/anaesthetist
Observations ( Airway patency, level of
consciousness,BP, pulse, respirations)
Temperature
Wound check ( e.g per vagina, per rectum)
Fluid balance (catheter, IVI, naso gastric tube,
catheter, wound drain)
Pain (pain score, positioning, analgesia)
General appearance (colour, pallor, sweating,
shivering)
Common post operative complications
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Respiratory complications
Airway obstruction, chest infection
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Cardiovascular complications
shock, haemorrhage, DVT, PE
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Gastrointestinal
vomiting, constipation, paralytic ileus,
retention of urine
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Wound infection
ANY QUESTIONS !