what is involved in a preoperative
- age
- allergies
- vital sign trend
- nutritional status
- habits affecting tolerance to anesthesia
- presence of infections
- use of drugs that are contraindicated prior to surgery
- physiological status
- psychological state of the patient
remember in surgerys that consent is very important!!!
what is general anaesthesia used for and
- Used for major surgery
- Loss of sensation and consciousness
- Hypnosis/ analgesia/ amnesia
- Suppression of reflexes: vomiting, coughing
- Unable to maintain airway
- Eg Propafol
what is regional anaesthesia used for
- Used for major surgery
- No loss of consciousness
- Less complications compared to GA
- More rapid postop recovery
- Blocks pain experience for a region of the body
- Includes spinal/epidural anaesthesia and peripheral nerve block
- Nurses must monitor for migration of effect (eg breathing)
- Eg Bupivicaine
what is local anaesthesia used for
- Used for minor surgery
- Loss of sensation without loss of consciousness
- Can be injected, applied topically, aerosolised,
- Eg Lignocaine
what are some things the circulating nurse does
- deal with the management of unsterile activities in the operating area
- document the nursing care of the patient
- assessments
- interventions
- movement of unsterile items out of the surgical suite
- labelling and transporting specimens
what are some things the scrub nurse does
- is gowned and gloved and able to handle and pass sterile items into the sterile surgical field
- ‘boss’ of the sterile field
- assists with the actual procedure to varying diseases
what happens in PACU
- Stage I recovery
- Patients may be unconscious
- Require 1 to 1 nursing care
- Monitoring of Airway – Breathing – Circulation – Temperature
- Vitals signs and assessments ongoing
- May require ongoing airway support
- Symptom management : pain, nausea/vomiting - Can transfer to Stage II recovery once they are
- Conscious
- Haemodynamically stable
- Tolerate oral intake*
discharge criteria: PACU to ward
- Aldrete Scoring System:
- Respiration
- Able to deep breath and cough ? - O2 Saturation
- Able to maintain SaO2 > 92% on room air (RA) ? - Consciousness
Fully awake ? - Circulation
BP ± 20 of preop baseline? - Activity
Able to move all extremities?
what to assess for on arrival to the surgical ward
- Airway-Breathing-Circulation-Level of Consciousness – ability to move
- Vital signs including SaO2
- Pain – last dose, analgesia options – current pain experience
- Wound and drainage tubes
- Skin: colour, appearance, moisture, temperature
- Urinary status: catheter present ? Bladder distension?
- Position in bed : promote patent airway, comfort and mobility
- IV infusions and IV site(s)
- Symptoms: nausea/vomiting
- Emotional status
- Family
- Call bell
how to prevent respiratory complications
Assess for:
- Work of breathing
- Restlessness, confusion
- Activity tolerance
Plan for:
- Deep breathing and coughing
- Incentive spirometry
- Early mobilisation
how to prevent cardiovascular complications
Assess for:
- Blood pressure, heart rate,
- Skin temperature and perfusion
- Fluid balance deficit/overload
- Drain output
- IV therapy
- Syncope
- Urine output (minimum: 0.5ml/kg/hr)
Plan for:
- Balanced fluid balance
- Mobilisation to prevent clot formation; to promote cardiac output
- Heparin therapy as prescribed (LMWH)
- Bladder scan if HNPU 6-8 hr post-op
how to prevent integumentary complications
Assess for:
- Operative site healing, inflammation, union
- Monitor for signs of infection
Plan for:
- Monitor dressing for drainage
- Change dressing according to protocol
- Daily hygiene: facilitate/assist as necessary
- Mobilisation to encourage perfusion
- Keeping patient warm at all times (temp may be raised during first 48hrs)
how to promote comfort and rehabilitation
- Assess pain regularly throughout shift and manage within tolerable limits for patient
- Advocate on behalf of patient when analgesia inadequate
- Encourage early mobilisation and progression towards independence
- Refer to discharge plan and partner with patient to progress towards realistic activities of daily living
- Refer to community support services as necessary (eg home help, bathroom assistance, district nurse)
things to consider when you discharge your surgical patient
- Psychological Support/Encouragement
- Management of symptoms at home (pain, nausea, dizziness)
- Self-administering medications
- Care of incision site
- Progressive mobilisation
- Dietary advice
- Follow-up appointments
- When things aren’t going as planned…
