Perioperative nursing care

Nurses role in perioperatove nursing

1. PRE OPERATIVE AND POST OPERATIVE NURSING CARE

2. PERIOPERATIVE NURSING - Used to describe the nursing care provided in the total surgical experience of the patient.

3. 3 PHASES OF PERIOPERATIVE NURSING PREOPERATIVE PHASE INTRAOPERATIVE PHASE POST OPERATIVE PHASE

4. PREOPERATIVE PHASE It extends from the time the patient is admitted in the surgical unit, to the time he/she is prepared for the surgical procedure, until he/she is transported in the operating room.

5. INTRAOPERATIVE PHASE extends from the time the patient is admitted to the OR, to the time of administration of anesthesia, surgical procedure is done, until he/she is transported to the Recovery Room/PACU.

6. POST-OPERATIVE PHASE Extends from the time the patient is admitted to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow up care.

7. NURSES ROLE IN PER IOPERATIVE NURSING

8. PREOPERATIVE PHASE PREOPERATIVE ASSESSMENT OBTAINING INFORMED CONSENT PREOPERATIVE TEACHING PHYSICAL PREPARATION OF PATIENT PSYCHOLOGICAL PREPARATION OF PATIENT

9. PREOPERATIVE ASSESSMENT Review pre operative laboratory and diagnostic studies Review the client’s health history Asses physical needs Asses psychological needs Assess cultural needs

10. OBTAINING INFORMED CONSENT Before surgery the patient must sign a surgical consent form Patients must sign a consent form for any procedure that requires anesthesia and has risks of complications The nurse is responsible for ensuring that all necessary parties have signed the consent form, that it is in the chart prior transfer to OR.

11. PREOPERATIVE TEACHING Teaching patients about their surgical procedure and expectations before and after surgery is best done during preoperative period. Preoperative medication All preoperative medications will be ordered by the surgeon/ anesthesiologist. Preop meds for scheduled case is to be administered at least 30 minutes to 1 hour prior surgery as per P.O.

12. PREOPERATIVE TEACHING All medications and treatments except for the preop drugs ordered prior surgery are automatically cancelled at midnight on the day of surgery unless otherwise ordered by the surgeon EXCEPT: On call antibiotic will be given at the same time as the premeds or as ordered.

13. PREOPERATIVE TEACHING 2. The anesthesiologist/ internist will order any other P.O. medications Pre operative medications are documented in the MAR in STAT Pre-Operative columns. These forms are in the patients chart before the patients is endorsed to the OR.

14. PHYSICAL PREPARATION Nutrition and Fluids Elimination Hygiene Medications Sleep Care of Valuables Prostheses Special Orders Surgical Skin Preparation Safety Protocols Vital Signs

15. PSYCHOLOGICAL PREPARATION Careful preoperative teaching can reduce fear.

16. PREOPERATIVE CHECKLIST This shall be completed by the nurse assigned to the patient on any shift. The nurse checking any item on this list must mark it with a check and put her initials. The night shift charge is responsible for ensuring the chart is in order. Checklist final completion is the responsibility of the nurse giving pre meds and/or the staff sending the patient to OR.

17. TRANSFER RING PATIENT TO OR

18. Verify correct patient against OR call slip and patients ID Band and by asking patients full name and checking the patients medical record Assist patient on to stretcher ensuring privacy while transferring from bed Raise side rails and secure patient by use of stretcher straps Document patient status on transfer from unit to OR The nurse who had completed the OR checklist is responsible to accompany the patient to OR with the OR orderly during transportation of the patient

19. RESPONSIBILITIES

20. All nursing department are responsible for compliance with this procedure. The nurse administering pre-operative medication is responsible for ensuring that the consent and all other requirements have been met before the medication is given. Documentation of pre-medication administration will include time, date and RN signature. The nurse endorsing patient to OR is responsible for final check of the patient and chart.

21. POST OPERATIVE PHASE

22. RESPONSIBILITIES

23. Appraise the air exchange status of the patient and note his skin color Note swallowing/gag reflexes, LOC, including patient’s response to stimuli Monitor vital signs Determine and evaluate any lines, tubes, or drains, estimated blood loss, condition of the wound, medications used, infusions including transfusions, and output. Evaluate patients level of comfort and safety by indicators such as pain and protective reflexes Evaluate activity status; movement of extremities.

24. Position patient in bed as ordered or position of comfort. Administer analgesics and document efficacy. Encourage patient to take deep breath to aerate lungs fully and prevent hypostatic pneumonia. Use incentive spirometer as ordered. Re-orient patient once conscious to his/her room, call light, and therapeutic devices. Place call bell within patients reach. Leave all side rails in the up position and put the bed in low position, ensuring bed wheels are locked. Instruct patient not to ambulate without assistance and to use call bell when assistance is needed. Perform on going assessment and interventions.

25. Review po and administer prescribed medications. Monitor signs related to nature of surgery. Perform safety checks to verify that side rails are in place and restraints properly applied as indicated. Maintain accurate intake output record and replaced fluids as ordered. The cardiovascular, respiratory, skin, gastro intestinal and genitourinary system must be reassessed every 4 hours for the first 24 hours post operatively If patient’s status is stable after 24 hours, then reassess the required system each shift and review care plan initiated.

26. DOCUMENTATION

27. Any deviation from normal should be documented in the nurses notes. Document pain medication administered and note effectiveness. Record V/S, IV fluid, I&O etc. on appropriate forms Document nursing intervention and patient tolerance or response to intervention on nurses notes. Review care plan each shift and update as necessary.

28. QUESTIONS?