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Lecture notes Acute Care (SHN2004)
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Pre, Intra and Post Op Care
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SHN2004 (Acute Care) – Pre, Intra and Post Operative CarePre-, intra- and post-operative care
Aims of the session
Understand the role of the nurse in the operating theatre
Gain awareness of perioperative patient care
Discuss risks and complications associated with surgery
o Not that we will not be talking about emergency surgery here
Perioperative journey
Pre-operative Intraoperative (the operation itself) Post-operative
Pre-operative nursing care
Physical
o Full medical history
o Surgical and anaesthetic background (how have they responded to previous
surgeries etc. – any negative effectives?)
o Allergies
o Baseline vital signs (what is normal for that patient – without this we cannot
know for certain what is abnormal)
o Fasting
o Bowel clearance (for some surgeries)
Psychological
o Address anxiety
Prepared patients cope better and manage post-op pain more
effectively (Ying Jia Shermin Chieng, 2014, Perioperative anxiety and
postoperative pain in children and adolescents undergoing elective
surgical procedures: a quantitative systematic review)
Administrative & safety
o Consent form, theatre checklist
Anaesthetics
o Anaesthetic room care: monitoring vital signs, identifying the type of
anaesthetic required + any particular anaesthetic needs
o Anaesthetic drugs: induction agents, inhalation agents, muscle relaxants,
analgesics
Induction agents – prevent the body from carrying out its normal
protective function (e.g. responding to pain)
Inhalation agents – produce unconsciousness which have the
potential to produce dangerous side effects
o Stages of anaesthesia: analgesia, excitement, surgical anaesthesia, medullary
paralysis
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, SHN2004 (Acute Care) – Pre, Intra and Post Operative Care
Essentially brings the patient as close to death as possible (though a
death as a result of anaesthesia is rare
o Induction, maintenance and extubation
o Equipment checks
o Monitoring:
ECG
Pulse oximeter
Temperature probe
Temperature of the patient can fall during surgery (anaesthetic
prevents the natural processes like shivering; also exposed
areas of the internal body see massive heat loss)
Vapour analyser
Capnography
Non-invasive BP
Anaesthesia
o Fluid Management
Create a balance between too little fluid and fluid overload for best
perioperative outcome
Fluid restriction: hypotension, inadequate perfusion, impaired
oxygenation, PONV
Fluid overload: interstitial oedema, poor wound healing,
prolonged resumption of gastric function, heart failure
o Complications of General Anaesthetic
During: respiratory depression, hypercarbia, cardiac arrhythmias,
asystole, hypotension, aspiration etc.
After: nausea and vomiting, persistent sedation, pneumonia,
atelectasis, organ toxicity
Intraoperative (Surgery) Care
Surgery
o Surgical instruments (cutting, dissecting, grasping, clamping, retracting,
suturing, suctioning etc).
E.g. in terms of scissors there are several
o Surgical positioning
o Surgical scrubbing
Much more in depth than standard medical hand washing
o Maintaining sterile field
o Swab and instrument counts
o Electrosurgery (burns, smoke)
o Tourniquet management (rise in circulating volume, SVR, CVP, paraesthesia,
ischaemia)
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