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Pre and Post-Operative Nursing Care
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Pre-Operative Nursing Care Aim
To provide information to members of the ophthalmic team Have a basic understanding of caring for the pre-operative patient Promote efficient and safe pre-operative patient care
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Pre-Operative Nursing Care
After Screening and Before Admission On Admission Handing Over to the Operating Room Team
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Pre-Operative Nursing Care After Screening and Before Admission
Consent signed and witnessed Patient is assessed to identify factors that might interfere with the safe performance and outcome of the surgery Necessary tests and investigations are done prior to surgery Essential 2-way process to obtain information from patient and their family Concerns and expectations are discussed Fasting Washing body, hair and face What to wear What to bring Cost Date and time to arrive
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Pre-Operative Nursing Care On Admission
Consent Assessment and history
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Pre-Operative Nursing Care On Admission
Vital Signs Surgical Site Preparation Eye preparation Dress for surgery Orientation Education Insert IV Tests needed
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Pre-Operative Nursing Care On Admission
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Pre-Operative Nursing Care Consent
Patient understands surgery Surgery confirmed Surgical site confirmed Correct patient is confirmed Patient signed the consent Surgeon signed the consent Correct patient,correct surgery, correct site- confirmed verbally/ documented/identity band
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Pre-Operative Nursing Care Assessment and History
Patient Address and telephone number Medical history and medication history Relevant blood relative medical history Allergies Tests needed like A scan, X-rays, MRI Check fasting time Social status – transport, living alone, someone to accompany them Psychosocial issues – anxiety, confusion, claustrophobia
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Pre-Operative Nursing Care Assessment and History
Respiratory distress/breathlessness/asthma Tremor/uncontrolled body movement Ability/concerns about being able to lie still and flat Wearing dentures Hearing problem and hearing aid during operation
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Pre-Operative Nursing Care Vital Signs
Temperature Pulse (heart rate) Respiration Blood Pressure Pain Other Oxygen Saturation ECG (adult or cardiac patients) Blood Sugar Level (for diabetic patients Weight (for General anesthetic patients and children)
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Pre-Operative Nursing Care Surgical Site/Eye Preparation
Wash the face and eye Confirm and mark the operative eye Check eye for the absence of acute inflammation Dilating or constricting drops Betadine wash (if Doctor prefers) Educate the patient Assist the doctor with Local block if necessary Pressure to reduce IOP Monitor Vital signs Check absence of movement (akinesia) and feeling (local)
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Pre-Operative Nursing Care Preparing the Patient
Dress for OR Full dress change/half-dress change No shoes (shoe covers) Hair cover Remove jewellery and watches Orientation to the environment Toilet-make sure bladder is empty prior to surgery Phone, bell etc
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Pre-Operative Nursing Care Education/IV/Tests
Insert IV Tests
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Pre-Operative Nursing Care Safe Site Surgery
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Pre-Operative Nursing Care Safe Site Surgery
Handover to the Operating Room Team
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Pre-Operative Nursing Care Summary of Pre-Operative Care
The key to the smooth and efficient preparation of patients for surgery. A tool for identifying patient abnormalities that might interfere with the safe performance and outcome of the operation. With appropriate information, it can reduce patient anxiety to a minimum. Increases patient satisfaction/understanding of the operation, effective communication, and prevents patient cancellation on the day of surgery
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Post-operative Nursing Care Outline
Transportation to Recovery Preparing to accept patient to recovery Initial post-operative care During the stay Discharge Criteria Discharge 18
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Post-operative Nursing Care Transportation to Recovery
Trolley vs. walk GA/Local. Adult/child. Able/not-able Assist the patient 19
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Post-operative Nursing Care Preparing to Accept Patients to Recovery
At the beginning of the day test and check Defibrillator, emergency trolley, oxygen, suction, stock levels Be ready for: Patient handed over from the operating room staff Bed area ready, oxygen, suction and monitors Wear gloves and eye shields Oxygen, monitor, vital signs Start keeping notes 20
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Post-operative Nursing Care Initial Post-Operative Care
Do not leave the patient unattended Ensure their safety, airway, breathing, temperature, pain management 21
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Post-operative Nursing Care During the Stay
Measuring levels of recovery Vital Signs Nausea and Vomiting Wound and dressing Pain, discomfort, pressure 22
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care During the Stay
Nausea and Vomiting Scoring AVPU Scoring None Alert A Nausea only 1 Responds to voice V Vomit x 1 2 Responds to pain P Vomit > 1 3 Unresponsive U Blood Loss Scoring Pain Scoring Chart None Minor – Small amount of blood on dressing only 1 Moderate – Dressing saturated / changed 2 Severe – active bleeding / patient swallowing blood (inform attending Dr) 3 25
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care Discharge Criteria
Did the patient recover to an acceptable level?Please refer to recovery monitoring / discharge criteria sheet
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Post-operative Nursing Care Discharge Criteria
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Post-operative Nursing Care Discharge
Confirm the patient is ready to go (signed out) Discharge ‘take home items’ given. E.g. eye drops Patient Education Eye care at home Don’t Does When to see the Dr next Emergency 29
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Post-operative Nursing Care Discharge
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Post-operative Nursing Care Summary of Post-Operative Care
Ophthalmic nurses can play valuable role in post-op care Informing patient to contact the hospital about any concerns or problems and ensuring patients have hospital contact number Ensures better follow-up and compliance Clear post-operative instructions and explanations given to patient and relatives will result in Reducing the patient’s anxiety The best possible outcome. Emphasis on follow up care Results in early identification of complications Early assessment of outcomes
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Thank You
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References ORBIS Recovery Room Care Recording and Discharge PD-605
Heather Machin-Associate director of Nursing Pam Bailey- ORBIS Staff Nurse 8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a &eid=4-u1.0-B s0015&isbn=
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