Pre and Post op Care

Definitions. 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. Optional surgery Surgery is scheduled completely at the preference of the patient (e.g. Cosmetic surgery) Required The condition requires surgery within a few weeks (E.g. cataract surgery) Urgent This surgical problem requires attention within 24-48 hours (e.g. cancer) Emergency Situation requires immediate surgical attention without delay (intestinal obstruction) Elective The appropriate time for surgery is at the convenience of the patient, failure to have surgery is not catastrophic. (e.g. superficial cyst).

Criteria for day surgery selection. 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) Government targets 70% of all surgery should be Day Case All pts should be considered for Day Surgery unless health and fitness suggest otherwise Benefits pts in hospital shorter time Less time to contract infections etc. Relies on home social circumstances and primary care for ongoing treatment

Exercise 1. On admission for surgery patients undergo an assessment, what factors need to be considered Physical fitness psychological legal administrative

Answers. 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>>>> 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…. 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? 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?

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. 2hrs Preop for water (tap not fizzy)

Gastrointestinal preparation. Is this required for all types of surgery?

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.

Why is skin preparation necessary pre op?

It is necessary to remove dirt and transient micro organisms from the area. Local procedures should be followed.

Is this necessary pre op? Hair removal. Is this necessary pre op?

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. Clippers should be used to avoid damage to the skin if shaving is reqd

Pre op check list. Exercise Discuss each item on the checklist, and provide a rationale for its importance. Feedback to group.

Premedication. 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 Ensure checklist is with patients notes, along with consent form, x-rays, laboratory results, nurses records. Patient is transferred to theatre.

POST OPERATIVE CARE What factors should you consider when caring for a patient post operatively (this starts from accepting the patient from the recovery room) Information from recovery nurse Only accept pt when you have all the information regarding care required Observations

Post op care Answers 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 Respiratory complications Airway obstruction, chest infection Cardiovascular complications shock, haemorrhage, DVT, PE Gastrointestinal vomiting, constipation, paralytic ileus, retention of urine Wound infection

ANY QUESTIONS !