Introduction Perioperative Nursing .pptx

Perioperative Nursing

1. Preoperative Evaluation and Management By- M esale Solomon

2. OUTLINE INTRODUCTION GOAL GENERAL EVALUATION SPECIFIC (SYSTEMIC) EVALUATION PROPHYLAXIS PREOPERATIVE NOTE REFERENCES

3. INTRODUCTION DEFINITION: provides information on risk, defines & reduces the extent of known risks, & discover unknown risks prior to surgery Ranges from out patient evaluation to hospital inpatient management

4. GOAL I dentify the patient's problems D etermine if further information is needed Establish if patient is medically optimized Confirm appropriateness of planned procedure

5. General Evaluation History Past medical illness IHD,CHF, Renal insufficiency, prior CVA, bleeding tendency, DM, HTN Prior operations, operative complications Allergies Drug history Medications should be continued in the immediate preoperative period Hypoglycemic agent Anticoagulants, & Antipaltelets , INR<1.5 safe Discontinue Warfarin 4 days Preop and check PT Stop IV heparin 6 hours prior to surgery till 12hrs postop Individualize ACEI Social history

6. 2. Physical examination General- anemia, jaundice, cyanosis, nutritional status, CVS- heart sounds, peripheral pulses Resp - breath sounds, percussion note GI- abdominal masses, ascites CNS- conscious level,

7. 3. Investigations CBC BG & X-match Urinalysis RBS RFT LFT Serum electrolytes, Coagulation studies Pregnancy testing CXR, pulmonary function test EKG

8. Specific (systemic) Evaluation CVS Hypertension- defer elective surgery if SBP>=160 and DBP>=95 Newly diagnosed- further investigations Sympathetic activation during aneasthesia Most antihypertensive continued until time of surgery except ( β -blockers, clonidne , …) BP>160/95mmHg elective procedures should be deferred Optimize control Check potassium those on diuresis Recent MI- wait till 6mon Dysrhythmias CHF Anemia- preop transfusion if hgb<8, pt is symptomatic, active bleeding Prosthetic valve and valvular heart disease- prophylactic antibiotics

9. Respiratory system Infection- treat before elective surgery Asthma- continue puff COPD- regional anesthesia Smoking- stop before 4wk

10. GI system Nutrition Obesity Malnutrition Regurgitation risk Intestinal Obstruction GOO Jaundiced Prophylactic antibiotics Vit k Fluid

11. GI System cont …. Diet Colonic preparation Decrease risk of infection by 60% Mechanical Antibiotics

12. Renal Adequate hydration Avoid nephrotoxic drugs If on dialysis, do 24 hrs before & after surgery UTI

13. Endocrine DM Assess adequacy of glycemic control & presence of complications Tests – FBS, UA, Serum electrolyte, ECG Needs early preop admission Should be scheduled for early morning operation Perop – sliding scale Frequent postop glucose assessment (Q2-4hrs with sliding scale +/- BID intermediate insulin)

14. Thyroid- hyperthyroid Antithyroid drugs till euthyroid β- blockers till euthyroid Iodides till euthyroid (for 7-10 days before surgery) Adrenal- steroid use Perioperative stress-dose steroids – indicated pts undergoing major surgery who have received steroid therapy within the last year at least for >2wks Dose – Hydrocortisone, 100mg,IV the evening before surgery 100mg, IV stat at the beginning 100mg, Iv Q8hr at the day of surgery

15. Prophylaxis Antibiotics Assess risk (surgical & pt specific RF) Non-antimicrobial strategies Antimicrobial Coverage should be initiated not more than 2 hours (PO) or 30min (parenteral) before skin incision No gross contamination or overt infection, till 24 to 48 hours after surgery Repeat doses should be administered according to usual dosing Thrombophylaxis Pharmaceutical Mechanical Physical

16. Preoperative Note Preoperative Diagnosis Procedure Planned Type of Anesthesia Planned Laboratory Data Risk factor Consent form Allergies Major Medical Problems Medications Special Requirements

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