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samenvatting: keuzevak operatieverpleegkundige vives
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samenvatting: keuzevak januari operatieverpleegkundige. alles van in de pokerpoints + bijkomende leerdoelen. 4e jaar bachelor verpleegkundige. vives Brugge
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Keuzevak januari: operatieverpleegkundige,Bachelor verpleegkunde : januari
1
,Bachelor verpleegkunde : januari
Inhoudsopgave
Het denkproces van de operatieverpleegkundige .............................................................................................. 9
Inzoomen op taken van de anesthesieverpleegkundige .................................................................................... 9
Voorbereiding van de OP-zaal ................................................................................................................................................ 9
Onthaal en opvang in het operatiekwartier......................................................................................................................... 10
Installatie in de operatiezaal ............................................................................................................................ 11
Inzoomen op taken van de omloopverpleegkundige ...................................................................................... 11
Hulp aan de anesthesist en anesthesieverpleegkundige...................................................................................................... 11
Voorbereiden van de operatiezaal ............................................................................................................................... 11
Positioneren van de operatiept: specifieke houdingen ............................................................................................... 12
overlopen van safe surgery checklist ............................................................................................................................. 17
Hulp aan het operatieteam .............................................................................................................................................. 17
Installatie en connectie apparatuur en medisch materiaal ........................................................................................ 18
Inzoomen op taken van de intrumenterendevpk ............................................................................................. 18
Voorbereiden op een ingreep ................................................................................................................................................ 18
Zich steriel aankleden .............................................................................................................................................................. 18
opdekken van instrumententafels ........................................................................................................................................... 18
schikking chirurgische instrumentarium ............................................................................................................................ 18
Instrumentarium volgens chirurgische fasen ................................................................................................................... 19
Specifiek apparatuur preoperatief .................................................................................................................... 31
Diathermie ........................................................................................................................................................ 31
Ontwaakzaal ................................................................................................................................................... 33
Correcte overdracht ................................................................................................................................................................ 33
Vrije luchtweg ..................................................................................................................................................................... 33
Ademhaling ......................................................................................................................................................................... 33
Circulatie .............................................................................................................................................................................. 33
Pijn ......................................................................................................................................................................................... 33
Postoperatieve misselijkheid en dobbelstenen ............................................................................................................. 34
Mobilisatie – gevoeligheid ............................................................................................................................................... 34
Postoperatieve verwardheid ........................................................................................................................................... 34
Centrale sterilisatie afdeling (CSA) .................................................................................................................. 35
Ergnomische werken in het OK ........................................................................................................................ 35
Oorzaken van nek- en rugklachten ....................................................................................................................................... 35
Spieren ................................................................................................................................................................................. 35
Gewrichten .......................................................................................................................................................................... 35
Ligamenten .......................................................................................................................................................................... 35
Gebruik van loodschorten................................................................................................................................................. 35
Aandachtspunten om meer ergonomisch te werken............................................................................................................. 36
Aanpassen van de lichaamshouding ............................................................................................................................... 36
Schikking van instrumententafels ..................................................................................................................................... 36
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,Bachelor verpleegkunde : januari
Verplaatsen van patiënten ............................................................................................................................................... 36
Ortho/trauma ................................................................................................................................................... 37
bewegingsstelsel .............................................................................................................................................. 37
Anatomie bot ................................................................................................................................................... 37
Botombouw ............................................................................................................................................................................... 37
Fractuur ............................................................................................................................................................ 37
Fractuurtypen ............................................................................................................................................................................ 38
2 vormen van botgenezing ............................................................................................................................................... 38
directe botgenezing........................................................................................................................................................... 38
Indirecte botgenezing........................................................................................................................................................ 38
Principes van goede factuurbehandeling.............................................................................................................................. 39
Repositie ............................................................................................................................................................................... 39
Reductie ................................................................................................................................................................................ 39
fixatie ................................................................................................................................................................................... 39
Bloedvoorziening ................................................................................................................................................................ 39
Mobilisatie ........................................................................................................................................................................... 39
Osteosynthesemateriaal................................................................................................................................... 40
Kirschner .................................................................................................................................................................................... 40
Cerclagedraad ......................................................................................................................................................................... 40
externe fixatie .......................................................................................................................................................................... 40
Schroeven ......................................................................................................................................................... 41
Casus.......................................................................................................................................................................................... 41
Enkel en subtalaire gewricht ............................................................................................................................................ 41
Classificatie van fracturen ................................................................................................................................................ 41
Schroeven ............................................................................................................................................................................. 41
Functie schroeven ................................................................................................................................................................ 41
Trekschroef .......................................................................................................................................................................... 43
Instrumenten ......................................................................................................................................................................... 43
Voorbereiding .......................................................................................................................................................................... 43
Materiaal ............................................................................................................................................................................. 43
Zaal ....................................................................................................................................................................................... 44
Anesthesie ............................................................................................................................................................................ 44
De patient ............................................................................................................................................................................ 44
Aankomst in het OK................................................................................................................................................................. 44
Installatie in de zaal ................................................................................................................................................................ 45
Onder anesthesie brengen ...................................................................................................................................................... 45
Positioneren............................................................................................................................................................................... 45
Rugligging ............................................................................................................................................................................ 45
Tourniquet/garrot .............................................................................................................................................................. 45
Armen ................................................................................................................................................................................... 46
Tafel steriel opmaken .............................................................................................................................................................. 46
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,Bachelor verpleegkunde : januari
Ontsmetten en afdekken ......................................................................................................................................................... 46
Coagulatie ........................................................................................................................................................................... 46
Uitvoeren van de ingreep ....................................................................................................................................................... 46
Incisie en dissectie............................................................................................................................................................... 47
Fibula .................................................................................................................................................................................... 47
Reductie ................................................................................................................................................................................ 47
Fixatie ................................................................................................................................................................................... 47
Mediale fractuur................................................................................................................................................................. 47
Einde van de ingreep ............................................................................................................................................................... 47
Tijdens volledige verloop ingreep ......................................................................................................................................... 48
Naar recovery brengen........................................................................................................................................................... 48
Zaal opruimen .......................................................................................................................................................................... 48
Absolute stabiliteit.................................................................................................................................................................... 49
Relatieve stabiliteit ................................................................................................................................................................... 49
Intramedullaire nagel ....................................................................................................................................... 49
Casus.......................................................................................................................................................................................... 49
Intramedullaire nagel ........................................................................................................................................................ 50
Functionele repositie .......................................................................................................................................................... 50
Voorbereiding .......................................................................................................................................................................... 50
Materiaal ............................................................................................................................................................................. 50
Zaal ....................................................................................................................................................................................... 50
Anesthesie ............................................................................................................................................................................ 51
De patient ............................................................................................................................................................................ 51
Aankomst in het OK................................................................................................................................................................. 51
Installatie in de zaal ................................................................................................................................................................ 51
Onder anesthesie brengen ...................................................................................................................................................... 51
Intubatie ............................................................................................................................................................................... 52
Positioneren............................................................................................................................................................................... 52
Ontsmetten en afdekken ......................................................................................................................................................... 52
Tafels steriel opmaken ............................................................................................................................................................. 52
Uitvoeren van de ingreep ....................................................................................................................................................... 53
Einde van de ingreep ............................................................................................................................................................... 53
Hulp bij extubatie .............................................................................................................................................................. 53
Tijdens volledige verloop ingreep .................................................................................................................................. 53
Naar recovery brengen........................................................................................................................................................... 53
Zaal opruimen .......................................................................................................................................................................... 53
Platen ............................................................................................................................................................... 54
Casus.......................................................................................................................................................................................... 54
platen ......................................................................................................................................................................................... 54
Plaatfuncties.............................................................................................................................................................................. 55
DCP principe ( dynamic compression plate).................................................................................................................. 56
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,Bachelor verpleegkunde : januari
Hoekstabiliteit ..................................................................................................................................................................... 56
LCP plaats ............................................................................................................................................................................ 56
De instrumenten die eveneens zijn opgenomen in de syllabus benoemen en hun functie weergeven ........................... 57
De aandachtspunten bij het klaarzetten van een operatiezaal voor een enkelfractuur kunnen benoemen +
SCOMLADIT kunnen toelichten .............................................................................................................................................. 57
Checklist................................................................................................................................................................................ 57
Materiaal voor Rachi ......................................................................................................................................................... 57
Zaal ....................................................................................................................................................................................... 57
De patient: ongepland ingreep ....................................................................................................................................... 58
Anesthesie – SCOMLADIT (startklaar zaal) .................................................................................................................. 58
De aandachtspunten bij het gebruik van een tractietafel benoemen ................................................................................ 58
De aandachtspunten bij het ontvangen van een pt op het ok kunnen benoemen............................................................ 58
De aandachtspunten bij het gebruik van een neutrale plaat, bij diathermie, benoemen ............................................... 59
De aandachtspunten bij het opdekken van steriele sets benoemen ................................................................................... 59
Het verschil tussen rachi, epidurale en CSE uitleggen + enkele VPK aandachtspunten kunnen benoemen ................. 59
Spinale of epidurale anesthesie of combinatie ............................................................................................................ 59
Spinale ................................................................................................................................................................................. 59
Epidarale ............................................................................................................................................................................. 59
Combinatie .......................................................................................................................................................................... 60
Verdoving ............................................................................................................................................................................ 60
Verpleegkundige aandachtspunten bij plaatsen: ........................................................................................................ 60
Het nut en gebruik van de SSCL toelichten .......................................................................................................................... 61
Minimaal invasieve heelkunde ........................................................................................................................ 62
Kenmerken................................................................................................................................................................................. 62
Endoscopische chriurgie of sleutelgatchirurgie ............................................................................................................. 62
Instrumenten en apparatuur: .................................................................................................................................................. 62
Materiaal: ............................................................................................................................................................................ 62
Principe: aanleg van een pneumoperitoneum ................................................................................................. 63
Gevolgen: pneumoperitoneum ............................................................................................................................................... 63
Voordelen: ........................................................................................................................................................................... 63
Mogelijke complicaties ...................................................................................................................................................... 63
Bijkomende voordelen robotchirurgie ................................................................................................................................... 64
Nadelen ............................................................................................................................................................................... 64
Casus 1: prostaatkanker (zie ook PWP)............................................................................................................ 64
RLRP = robotgeassisteerde laparoscopische radicale prostatectomie ............................................................................. 64
Kenmerken ........................................................................................................................................................................... 64
Pre-operatieve voorbereiding ................................................................................................................................................ 65
Pre-operatief dag -1 (of dag 0) opname pt op verpleegafdeling ........................................................................ 65
Operatiedag (dag 0)........................................................................................................................................................ 65
Pre-anesthesiezaal ............................................................................................................................................................. 65
Voorbereiding operatiezaal ............................................................................................................................................ 66
Instrumenten ......................................................................................................................................................................... 66
Materiaal – afdekken en ontsmetten ............................................................................................................................. 66
Materiaal – overige .......................................................................................................................................................... 66
5
,Bachelor verpleegkunde : januari
Materiaal – clips/hemostase/hectingen/verband ...................................................................................................... 67
Ingreep ...................................................................................................................................................................................... 67
Omloopverpleegkundige .................................................................................................................................................. 67
Instrumenterende verpleegkundige ................................................................................................................................ 67
Ingreep ................................................................................................................................................................................. 67
Tijdens ingreep ................................................................................................................................................................... 68
Postoperatief ............................................................................................................................................................................ 68
Operatiezaal ...................................................................................................................................................................... 68
Recovery .............................................................................................................................................................................. 68
Afdeling ............................................................................................................................................................................... 68
Beschermingsmaatregelen ................................................................................................................................................ 69
Vroegtijdige detectie kan via 3 ‘basis’onderzoeken .................................................................................................. 70
Casus 2: appendectomie (zie ook pwp) ........................................................................................................................ 71
Pre-operatieve voorbereiding ................................................................................................................................................ 71
Voorbereiding kind ............................................................................................................................................................ 71
Operatiekwartier ............................................................................................................................................................... 71
Voorbereiding operatiezaal ............................................................................................................................................ 71
Materiaal – instrumenten .................................................................................................................................................. 71
Materiaal – overige: ......................................................................................................................................................... 71
Ingreep ...................................................................................................................................................................................... 72
Omloopverpleegkundige .................................................................................................................................................. 72
Instrumenterende verpleegkundige ................................................................................................................................ 72
Tijdens operatie .................................................................................................................................................................. 72
Postoperatief ............................................................................................................................................................................ 72
Operatiezaal ...................................................................................................................................................................... 73
Recovery .............................................................................................................................................................................. 73
Afdeling ............................................................................................................................................................................... 73
Nierstenen ................................................................................................................................................................................. 73
Incidentie .............................................................................................................................................................................. 73
Oorzaak ............................................................................................................................................................................... 73
Diagnose .............................................................................................................................................................................. 73
Preventie .............................................................................................................................................................................. 74
Mogelijke (chirurgische) interventies ............................................................................................................................... 74
Pre-operatieve voorbereiding ................................................................................................................................................ 74
Voorbereiding..................................................................................................................................................................... 74
Operatiekwartier ............................................................................................................................................................... 74
Voorbereiding operatiezaal ............................................................................................................................................ 74
Materiaal – instrumenten .................................................................................................................................................. 74
Materiaal – overige .......................................................................................................................................................... 75
Ingreep ...................................................................................................................................................................................... 75
Omloopverpleegkundige .................................................................................................................................................. 75
Instrumenterende verpleegkundige ................................................................................................................................ 75
Tijdens operatie .................................................................................................................................................................. 76
Postoperatief ............................................................................................................................................................................ 76
Operatiezaal ...................................................................................................................................................................... 76
Recovery .............................................................................................................................................................................. 76
Afdeling ............................................................................................................................................................................... 76
Casus 3: acute nierkoliek (zie ook pwp) .............................................................................................................................. 76
6
,Bachelor verpleegkunde : januari
Behandeling .............................................................................................................................................................................. 77
Rapid sequence induction ........................................................................................................................................................ 77
RSI toepassen ...................................................................................................................................................................... 77
Waarom keuze voor arteriele lijn ......................................................................................................................................... 77
Waarom keuze voor een 2de infuus ...................................................................................................................................... 77
Waarom combinatie van AA met CSE ................................................................................................................................. 77
AA (algehele anesthesie (narcose)) ................................................................................................................................ 78
CSE (gecombineerde spinale en epidurale anesthesie) .............................................................................................. 78
Wanneer rachi en wanneer epidurale ................................................................................................................................... 78
Waarom een patient bij een RLRP voorafgaand aan de operatie in extreme trendelbrug wordt geplaatst ............. 78
Aandachtspunten ................................................................................................................................................................ 78
Urlogische aandachtspunten postop na RLRP ...................................................................................................................... 79
Belang van normothermie en decubitus duiden.................................................................................................................... 79
Plastische heelkunde ........................................................................................................................................ 80
Maxillo-faciale heelkunde................................................................................................................................ 80
Reconstructieve driehoek ................................................................................................................................. 80
Primair sluiten ........................................................................................................................................................................... 80
Mutilerende heelkunde ..................................................................................................................................... 81
flappen ............................................................................................................................................................. 81
Vrije transplantaten (niet gevasculariseerd) ........................................................................................................................ 81
Huidgreffe (skin graft) EXAMEN! .................................................................................................................................... 81
Gesteelde flappen (lokale of regionale flappen)................................................................................................................ 82
Random huidflap ................................................................................................................................................................ 82
Axiale flap .......................................................................................................................................................................... 83
Gesteelde flappen (vascularisatie) ........................................................................................................................................ 84
Vascularisatie ...................................................................................................................................................................... 84
Andere soorten flappen .......................................................................................................................................................... 84
Bilobed flap ........................................................................................................................................................................ 84
Glabella – flap .................................................................................................................................................................. 85
Naso- labiale flap ............................................................................................................................................................. 85
Lattissimus dorsi flap myocutane flap ............................................................................................................................ 85
Vrije gevasculariseerde flap EXAMEN!!! .............................................................................................................................. 85
vrije flap of free flap .............................................................................................................................................................. 86
Radialis flap (radial forearm flapp rff) LEZEN................................................................................................................... 86
Nadelen ............................................................................................................................................................................... 86
Radialisflap ......................................................................................................................................................................... 86
Perforatorflap .......................................................................................................................................................................... 87
Vrije osteofasciocutane fibulaflap ......................................................................................................................................... 87
fibulaflap .................................................................................................................................................................................. 87
aandachtspunten ................................................................................................................................................................ 87
7
,Bachelor verpleegkunde : januari
Nadelen ............................................................................................................................................................................... 87
anesthesie ........................................................................................................................................................ 87
Micro vasculaire flap ........................................................................................................................................ 88
Micro-anastomose EXAMEN! ................................................................................................................................................. 88
Monitoring van de flap EXAMEN!! ................................................................................................................... 88
Borstreconstructieve technieken LEZEN ............................................................................................................ 89
Borstreconstructieve technieken kennen groeicurve ............................................................................................................. 89
begrippen ......................................................................................................................................................... 90
Flap: ........................................................................................................................................................................................... 90
Gesteelde flap: ......................................................................................................................................................................... 90
Vrije flap: .................................................................................................................................................................................. 90
Microvasculaire flap ................................................................................................................................................................ 90
SSG: ........................................................................................................................................................................................... 90
FTSG: ......................................................................................................................................................................................... 90
8
, Bachelor verpleegkunde : januari
Deel 1 : operatieverpleegkunde
Het denkproces van de operatieverpleegkundige
Tijdens het werken als vpk in het operatiekwartier wordt altijd éénzelfde denkproces doorlopen ongeacht het soort
ingreep dat plaatsvindt of het soort specialisme dat de ingreep uitvoert.
Stap 1 Patiëntenvoorstelling
Casus, diagnose, (on)geplande ingreep
Stap 2 Voorbereiding
Voorbereiden van operatiezaal, verzameling materiaal voor anesthesie, instrumentensets,
afdekpakketten
Voorbereiding van de operatiepatiënt
Stap 3 Installatie en opvang van de operatiëpatiënt in de operatiezaal
Stap 4 Onder anesthesie brengen (lokaal, locoregionaal, algemeen)
Stap 5 Positionering
Stap 6 Desinfecteren vh operatiegebied
Stap 7 Steriel afdekken vd operatiept
Steriel afdekken vh operatiegebied, de operatielampen, evt. bijkomend materiaal
Stap 8 Start ingreep
Stap 9 Einde ingreep
Stap 10 Transfer, installatie en overdracht van operatiepatiënt naar ontwaakzaal
Inzoomen op taken van de anesthesieverpleegkundige
Voorbereiding van de OP-zaal
- Anesthesie vpk assisteert de anesthesist bij het onder onesthesie brengen vd pt (locoregionaal of algemeen)
- Zorgt voor benodigde materiaal en de opvang en begeleiding van de PT: SCOMLADIT
S uction C ircuit O xygen M onitoring L argyngoscope A irway D rug I nfusion T emp
Is suctie O2 uitvaltest ? Lig alles Ligt alles klaar IV toegang ?
klaar voor extra tank O2 klaar ? voor
gebruik ? uit muur ? intubatie ?
Beademingsslangen in Tempsonde voorzien ?
orde ? Medicatie klaar ? Maatregelen genomen om
Is het beschikbaar ?
Alles vernieuwd voor Nieuw blad voorzien ? Noodmedicatie pre-op normothermie te
volgende pt ? Verschillende maten opgetrokken ? behouden ?
Anesthesietoestel de zelftest beschikbaar ? Tape voor fixatie van ETT in
uit? Lichtbron getest ? omgeving? 9
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