Vital roles of nurses (pre-operatively)
1. Have knowledge of disorder requiring surgery and coexisting disease
process
2. Identify the pt response to stress of surgery
3. Undertake complete pre-operative assessment, conduct and review
pre-operative diagnostic tests
4. Identify potential risks...
Nursing for Acute and Chronic Illness 1 (Victoria University)
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WEEK 1
Vital roles of nurses (pre-operatively)
1. Have knowledge of disorder requiring surgery and coexisting disease
process
2. Identify the pt response to stress of surgery
3. Undertake complete pre-operative assessment, conduct and review
pre-operative diagnostic tests
4. Identify potential risks associated with the procedure and coexisting
medical problems.
Pre-operative patient assessment
In advance or day of surgery
All components can reduce risk
Preoperative assessment
- nursing assessment
- anaesthetist assessment
- diagnostic testing
- may see a pharmacist
Also includes:
- verify understanding of surgeon-specific preoperative orders
- discuss, review advanced- directive document
- begin discharge planning by assessing patient’s need for postoperative
transportation, care
- patient education
- informed consent
Pre-operative diagnostics
Urinalysis
ECG
CXR
Full blood count/examination (FBC or FBE)
- several tests
- Haemoglobin (a red protein responsible for transporting oxygen in the
blood of vertebrates), haematocrit (the ratio of the volume of red blood cells
to the total volume of blood.), white blood cell and differential, platelets
Cross match, group and hold
Pre-operative Assessment
Nursing health history includes:
Medical/surgical history
Physical examination of client
Allergy identification
Current and past medication
Lifestyle factirs (smoking, illegal substances use and abuse of alcohol)
Client and families understanding of surgery
Support mechanism
Spiritual/cultural beliefs
Discharge planning
Anaesthetist visit
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Identification of risk factors and analysis of diagnostic data
Nursing diagnosis (potential and actual)
Nurses Role (intra and post-operatively)
Continuously assess patient
Take into account
- pre-operative assessment
- identify risk factors
Consider/pre-empt potential complication
Peri-operative risk factors
Age
Advance Age
- increase the risk and severity of complications
- may already suffer from chronic illness
- affects physiological, cognitive and psychosocial responses to stress of
surgery
- decreased tolerance of general anaesthesia and postoperative medication
- decreased adipose tissue
>hypothermia
- delayed would healing
- poor reserve (all organs)
- prolonged recovery:
>Two fold increase to experiencing surgical complication
Nutritional status
Optimal nutrition
- promotes healing
- resist infection and surgical complications
Assessment
- Diet,
- obesity,
- under nutrition,
- malnutrition
- weight loss
- BMI
- Waist
- Circumference
Condition which increase surgical RISK:
- malnutrition
- Obesity
(OBESITY)
difficulties:
- access to surgical site
- anaesthetic
- positioning and mobilisation
- specialised equipment
- increase the risk and severity of complications
Obese people CAN suffers from:
- high cholesterol, HT
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- sleep apnoea (temporary cessaytion of breathing), decreased lung capacity
- diabetes mellitus (HIGH BSL for prolonged time)
- Gastro-oesophagel reflux disease (GORD)
Fluid and electrolyte balance
Restore Electrolyte and fluid imbalances pre and intra operatively
Risk assessment:
- vomiting
- diarrhoea
- renal function
- intake
- output
- serum electrolyte levels
- medications (diuretics=pee, latives= faeces)
- diet
Potential Complications
- electrolyte imbalances
- hypovolemia (a decreased volume of circulating blood in the body)
- hypervolemia (increased volume of circulating blood in the body)
- depending on the degree of dehydration an /or type of electrolyte
imbalance:
acute pulmonary oedema (APO)
cadiac arrhythmias
congestive cardiac failure (CCF)
General health
- Cardiovascular
Risk assessment
o Pre-exiting disease
o Baseline vitals
o Baseline bloods
o Current medications treatment compliance
Monitoring cardiac function during intra and post operative periods
Cardiovascular Disorders that can increase RISK:
o Hypertension
Increase intra/post bleeding
Increase haemorrhagic stroke
o heart disease (IHD, CCF, arrhythmias, angina)
o deep vein thrombosis (DVT)
high risk of PE (pulmonary embolism)
- Respiratory
Incomplete lung expansion
- Hypoventilation
- Pt position (supine, prone)
- Dependent ventilation
- Length of surgery
Respiratory disorders that can increase RISK:
o Bronchitis
o Asthma
o Atelectasis, Pneumonia
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