Ppt on prepost care aspects

PRE AND POST OPERATIVE CARE ASPECTS

1. PREOPERATIVE AND POST OPERATIVE CARE ASPECTS By Ms.Arushi Negi MSc. Nursing 1st year MODERATOR : Dr. Shilpi Sarkar, Tutor, RCON, JH

2. INTRODUCTION: Communication, teamwork, and patient assessment are crucial to ensuring good patient outcomes in the perioperative setting. Professional perioperative standards encompass the domains of behavioral response, physiologic response, and patient safety and are used as guides toward development of nursing diagnoses, interventions, and plans.

3. DEFINITION: Perioperative nursing, which spans the entire surgical experience, consists of three phases.

4. PREOPERATIVE PHASE

5. INTRAOPERATIVE PHASE: A.Maintenance of Safety Maintains aseptic, controlled environment Transfers patient to operating room bed or table Positions patient based on functional alignment and exposure of surgical site Ensures that the sponge, needle, and instrument counts are correct Completes intra-operative documentation

6. B.Physiologic Monitoring Distinguishes abnormal cardiopulmonary data Reports changes in patient's vital signs C.Psychological Support (Before Induction When Patient Is Conscious) Provides emotional support to patient Continues to assess patient's emotional status

7. POSTOPERATIVE PHASE A.Transfer of Patient to Postanesthesia Care Unit Communicates intraoperative information: a. Identifies patient by name b. States type of surgery performed c. Reports patient's vital signs and response to surgical procedure and anesthesia d. Describes intraoperative factors (e.g., insertion of drains or catheters, administration of blood, medications during surgery, or occurrence of unexpected events) e. Reports patient's preoperative level of consciousness f. Communicates presence of family or significant others

8. B.Postoperative Assessment Recovery Area Monitors patient's vital signs and physiologic status Assesses patient's pain level and administers appropriate pain-relief measures Maintains patient's safety (airway, circulation, prevention of injury) Administers medications

9. PREOPERATIVE CARE ASPECTS

10. 1.Informed Consent Informed consent is the patient's autonomous decision about whether to undergo a surgical procedure. Protect the patient from unsanctioned surgery and protect the surgeon from claims of an unauthorized operation or battery. Informed consent is necessary in the following circumstances: Invasive procedures Procedures requiring sedation and/or anesthesia or a nonsurgical procedure Procedures involving radiation

11. Informed consent should be in writing. It should contain the following:

12. 2. Preoperative Assessment Before any surgical treatment is initiated, a health history is obtained, a physical examination is performed during which vital signs are noted, and a database is established for future comparisons . Activity level should be determined. Known allergies to drugs, foods, and latex Blood tests, x-rays other diagnostic tests are prescribed

13. 2.1 Nutritional and Fluid Status Assessment of a patient's nutritional status identifies diseases that can affect the patient's surgical course, such as deficiencies in specific nutrients, metabolic abnormalities, and the effects of medications on nutrition. Dehydration, hypovolemia, and electrolyte imbalances can lead to significant problems in patients who are older.

14. 2.2 Dentition Dental caries, dentures are significant to the anesthesiologist because decayed teeth or dental prostheses may become dislodged during intubation and occlude the airway.

15. 2.3 Drug or Alcohol Use Ingesting even moderate amounts of alcohol prior to surgery can weaken a patient's immune system The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk.

16. 2.4 Respiratory Status

17. 2.5 Cardiovascular Status Ensuring that the cardiovascular system can support the oxygen, fluid, and nutritional needs of the perioperative period.

18. 2.6 Hepatic and Renal Function The presurgical goal is optimal function of the liver and urinary systems so that medications, anesthetic agents, body wastes, and toxins are adequately metabolized and removed from the body.

19. 2.7 Endocrine Function

20. 2.8 Immune Function To determine the presence of allergies. Identify and document any sensitivity to medications past adverse reactions . Look for previous allen reactions, including medications, blood transfusions, latex, and food products.

21. 2.9 Previous Medication Use A medication history is obtained because of the possible interactions with medications Any medications the patient is using or has used in the past is documented, including OTC preparations and herbal agents, as well as the frequency with which they are used.

22. 2.10 Psycho-social Factors The nurse anticipates that most patients have emotional reactions prior to surgery-obvious or veiled, normal or abnormal. Fear may be related to the unknown, lack of control, or of death and may be influenced by anesthesia, pain, complications, cancer, or prior surgical experience. Preoperative anxiety can be a preemptive response to a threat to the patient's role in life, a permanent incapacity or body integrity, increased responsibilities or burden on family members, or life itself.

23. 2.11 Spiritual and Cultural Beliefs Spiritual beliefs play an important role in how people cope with fear and anxiety. Regardless of the patient's religious affiliation, spiritual beliefs can be as therapeutic as medication. Every attempt must be made to help the patient obtain the spiritual support that he or she requests.

24. 3.Pre operative nursing interventions:

25. 4.Providing Psychosocial Interventions 4.1 Reducing Anxiety and Decreasing Fear Self introduction and explaining patient their role helps to calm anxiety.positive nurse patient relationship is maintained. 4.2 Respecting Cultural, Spiritual, and Religious Beliefs Identify and showing respect to patient’s cultural,spiritual and beliefs and if any needs should be communicated to the appropriate personnel.

26. 5.Maintaining Patient Safety Protecting patient from any injury. 6.Managing Nutrition and Fluids Major purpose of withholding fluids is to prevent aspiration . 7.Preparing the Bowel Enemas are not commonly prescribed preoperatively unless the patient is undergoing abdominal or pelvic surgery. 8.Preparing the Skin To decrease bacteria without injuring the skin.

27. PRE-OPERATIVE CHECKLIST

28. The completed medical record accompanies the patient to the OR with the surgical consent form attached, along with all laboratory reports and nurses records. Transporting the Patient to the Presurgical Area The patient is brought to the holding area or presurgical suite about 30 to 60 minutes before the anesthetic is to be given. The use of a standard process to verify patient identification, the surgical procedure, and the surgical site is imperative to maximize patient safety . Attending to Family Needs Most hospitals and ambulatory surgery centers have a waiting room

29. INTRAOPERATIVE CARE ASPECTS

30. INTRAOPERATIVE CARE ASPECTS:

31. 1.Surgical team Intraoperative surgical team includes patient, the circulating nurse, the scrub nurse, the surgeon, the registered nurse first assistant, the anesthesiologist.

32. 2.The surgical environment

33. 3.The surgical experience It includes type of anesthesia and sedation.

34. 4.Potential intraoperative complications

35. POST OPERATIVE CARE ASPECTS:

36. POST OPERATIVE CARE ASPECTS: The post anesthesia care unit (PACU), formerly referred to as the recovery room or postanesthesia recovery room, is located adjacent to the OR suite. Patients still under anesthesia or recovering from anesthesia are placed in this unit for easy access to experienced, highly skilled nurses, anesthesiologists or anesthetists, surgeons, advanced hemodynamic and pulmonary monitoring and support, special equipment, and medications.

37. 1.Admitting the Patient to the Postanesthesia Care Unit Transferring the postoperative patient from the OR to the PACU is the responsibility of the anesthesiologist or any other licensed member of the OR team. The nurse who admits the patient to the PACU reviews essential information with the anesthesiologist and the circulating nurse. Oxygen is applied, monitoring equipment is attached, and an immediate physiologic assessment is conducted.

38. 2.Nursing Management in the Postanesthesia Care Unit The nursing management objectives for the patient in the PACU are to provide care until the patient has recovered from the effects of anesthesia , is oriented, has stable vital signs, and shows no evidence of hemorrhage or other complications .

39. 2.1 Assessing the Patient Frequent, skilled assessments of the patient's airway, respiratory function, cardiovascular function, skin color, level of consciousness. The nurse performs and documents a base line assessment, then checks the surgical site for hemorrhage and makes sure that all drainage tubes & monitoring lines are connected and functioning. After the initial assessment, vital signs are monitored and the patient's general physical status is assessed and documented at least every 15 minutes

40. 2.2 Maintaining a Patent Airway

41. 2.3 Maintaining Cardiovascular Stability To monitor cardiovascular stability, the nurse assesses the patient's mental status; vital signs; cardiac rhythm; skin temperature, color, and moisture; and urine output. The primary cardiovascular complications seen in the PACU include hypotension and shock, hemorrhage, hypertension, and dysrhythmias.

42. 2.4 Relieving Pain and Anxiety The PACU nurse monitors the patient's physiologic status, manages pain, and provides psychological support in an effort to relieve the patient's fears and concerns.

43. 2.5 Controlling Nausea and Vomiting Nausea and vomiting are common issues in the PAC Many medications are available to control postoperative nausea and vomiting (PONV) without over sedating the patient; they are commonly administered during surgery as well as in the PACU.

44. 2.6 Gerontological Considerations

45. 2.7 Determining Readiness for Post anesthesia Care Discharge A patient remains in the PACU until fully the anesthetic agent. Indicators of recovery includes blood pressure, adequate respiratory function, and a oxygen saturation level compared with baseline.

46. 3.Preparing the Postoperative Patient for Direct Discharge Ambulatory surgical centers frequently only have a step down PACU similar to a phase II PACU. Patient seen in this type of unit are usually healthy, and the plan is to discharge them directly to home. Prior to discharge, the patient will require verbal and written instructions and information about follow-up care.

47. 3.1 Promoting Home and Community-Based Care To ensure patient safety and recovery, expert patient education and discharge planning are necessary when a patient undergoes same-day or ambulatory surgery

48. 3.2 Discharge Preparation

49. 3.3 Continuing Care Some patients require referral for home care. These may be older patients, those who live alone, and patients with health care problems or disabilities that might into self-care or resumption of usual activities.

50. 4. Care of the Hospitalized Postoperative Patient Surgical patients who require hospital such as trauma patients, acutely ill patients, patients under major surgery, patients who require emergency surgery and patients with a concurrent medical disorder may be admitted to specialized ICUs for close monitoring and advance ventilation and support.

51. 4.1.Receiving the Patient in the Clinical Unit The patient's room is readied by assembling the equipment and supplies: IV pole, drainage, oxygen, emesis basin, tissues, disposable pads, blankets, and postoperative documentation forms. The receiving nurse reviews the postoperative orders, admits the patient to the unit, performs an initial assessment, and attends to the patient's immediate needs .

52. 4.2 Nursing Management After Surgery

53. A) Preventing Respiratory Complications : ▪Respiratory depressive effects of opioid medications, lung expansion secondary to pain, and decreased combine to put the patient at risk for respiratory complications, particularly atelectasis , pneumonia, and hypoxemia ▪To clear secretions and prevent pneumonia, the nurse encourages the patient to turn frequently, take deep breaths, cough and spirometery at least every 2 hours. ▪Analgesic agents are administered to permit more effective coughing, and oxygen administered . ▪Chest physical therapy may be prescribed if indicated.

54. B) Relieving Pain Opioid analgesic agents are commonly prescribed for pain and immediate postoperative restlessness. C) Signs and symptoms of shock IV fluid replacement may be prescribed for up to 24 hours after surgery or until the patient is stable and tolerating oral fluids

55. D) Encouraging Activity

56. E) Caring for Wounds

57. F) Maintaining Normal Body Temperature The patient is still at risk for malignant hyperthermia and hypothermia in the postoperative period. Treatment includes oxygen administration,adequate hydration, and proper nutrition. The risk of hypothermia is greater in older adults and in patients who were in the cool OR environment for a prolonged period.

58. G)Managing Gastrointestinal Function and Resuming Nutrition

59. H) Promoting Bowel Function Constipation is common after surgery Decreased mobility, decreased oral intake, and opioid analgesic medications contribute to difficulty having a bowel movement.

60. I) Managing Voiding

61. J ) Maintaining a Safe Environment During the immediate postoperative period, the patient recovering from anesthesia should have three and rails up, and the bed should be in the low position. The nurse assesses the patient's level of consciousness and orientation and determines whether the patient can resume wearing assistive devices as needed (e.g.. eyeglasses or hearing aid). Impaired vision, inability to hear postoperative instructions, or inability to communicate verbally places the patient at risk for injury. All objects the patient may need should be within reach, especially the call light.

62. K ) Providing Emotional Support to the Patient and Family Many factors contribute to this stress and anxiety, including pain, being in an unfamiliar environment, inability to control one's circumstances or care for oneself, fear of the long-term effects of surgery, Fear of complications, fatigue, spiritual distress, altered role responsibilities, ineffective coping, and altered body image, and all are potential reactions to the surgical experience.

63. L ) Managing Potential Complications

64. M ) Promoting Home and Community-Based Care Patient Self-Care Patients have always required detailed discharge instructions to become proficient in special self-care need after surgery .

65. RESEARCH Associations between Pre-, Post-, and Peri-operative Variables and Health Resource Use Following Surgery for Head and Neck Cancer. By Badr Hoda , Sobrero Maximiliano, Chen Joshua , Kotz Tamar , Genden Eric ,Sikora Andrew G. , Miles Brett . Published on : 2019 Feb 11 Objective: To examine associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients. Methods: Patients (N=183) who were seen for a pre-surgical consult between January, 2012 and December, 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients’ medical records.

66. Results Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life Inventory and M.D. Anderson Dysphagia Inventory composite scores, documented surgical complications, and having a tracheostomy, were significant predictors of hospital length of stay . Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions . Pre-surgical MDADI composite scores also significantly predicted ED visits within 30 days of hospital discharge Conclusions: Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged Length of stay and increased health resource use after hospital discharge.

67. 2.The Effect of Implementation of Preoperative and Postoperative Care Elements of a Perioperative Surgical Home Model on Outcomes in Patients Undergoing Hip Arthroplasty or Knee Arthroplasty By : Vetter Thomas R  , Barman Joydip , Jr Hunter James M , Jones Keith A , Pittet Jean-Francois Published on :2017 May Aim: (1)clinical, quality, and patient safety outcomes (2) operational and financial outcomes, in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Methods:  A 2-group before-and-after study design, with a nonrandomized preintervention PSH (PRE-PSH group, N = 1225) and postintervention PSH (POST-PSH group, N = 1363) data-collection strategy, was applied in this retrospective observational study. The 2 study groups were derived from 2 sequential 24-month time periods. Conventional inferential statistical tests were applied to assess group differences and associations, including regression modeling.

68. Results:  Compared with the PRE-PSH group, there was a 7.2% increase in day of surgery on-time starts ; a 5.8% decrease in day of surgery anesthesia-related delays ; and a 2.2% decrease in ICU admission rate in the POST-PSH group. There was a 0.6 decrease in the number of ICU days in the POST-PSH group compared with the PRE-PSH group however, there was no significant difference in the total hospital length of stay between the 2 study groups There was also no significant difference in the all-cause readmission rate between the study groups . Compared with the PRE-PSH group, the entire POST-PSH group was associated with a $432 decrease in direct nonsurgery costs for the THA and a $601 decrease in direct nonsurgery costs for the TKA patients. Conclusions:  On the basis of our preliminary findings, it appears that a PSH model with its expanded role of the anesthesiologist as the "perioperativist" can be associated with improvements in the operational outcomes of increased on-time surgery starts and reduced anesthesia-related delays and day-of-surgery case cancellations, and decreased selected costs in patients undergoing THA and TKA.

69. SUMMARY Through this topic we came to know about perioperative nursing , its phases , preoperative care aspects , intraoperative care aspects and post operative care aspects.

70. CONCLUSION Professional perioperative and peri-anesthesia nursing standards encompass the domains of behavioral response, physiologic response, and patient safety and are used as guides toward development of nursing diagnoses, interventions, and plan

71. BIBLIOGRAPHY Hinkle Janice L., Cheever Kerry H. , Brunner and suddarth’s textbbok of medical surgical nursing, volume 1, 13th edition, 2014, Wolters Kluwer (India) pvt ltd, New Delhi, page no-402-447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410733/ https://pubmed.ncbi.nlm.nih.gov/27898510/