Med Surg Session 9: Peri-Operative Nursing

Perioperative nursing

 

Session 9

 

covers Pre, intra and postoperative care

 

There are a vast range in the types of surgeries, but there are consistencies throughout the nursing care.

  • ie. safety, advocacy, outcomes, and surgical scrubs

 

Pre-op

    • Call the patient: hold/take meds, history, questions that the patient may have
    • administer pre-op meds: ativan, antibiotics,maybe zofran, fluids, robinul (anticholinergic to dry up secretions)
    • Prepare meds to be administered.
    • be aware of cultural factors: will they accept blood, do they want to bury an amputated limbs.
    • showing competence to the patient, comfort, honesty, actively listening, promotes trust.

 

  • Double check the site of operation and ask them “where do you understand that we will be operating on?”.

 

  • Isolation precautions: if the person has an open MRSA would it will be scheduled as the last op of the day and “terminally cleaned” afterwards.
  • Preop anesthesia assessment at bedside: Mallampati score of mouth and throat opening, history of anesthesia, respiration.

 

intraoperative

  • starts in the transfer to OR and ends in the transfer to post-op.
  • Circulation nurse and scrub nurse in the OR
  • patient concerns: everyone’s face is covered, patient is exposed, left support system, a ton of question, and it can be noisy.
  • who is in the OR: Circulator RN, Scrub RN, Anesthesia, surgical team,
    • secondary: students, perfusion, neuromonitoring, radiology, orientees.
  • surgical team:
    • anesthesia provider: anesthetic plan, attending resident, CRNA, and/or Student CRNA, anesthesia tech.
    • this is interprofessional!
  • measure blood loss
  • count the tools before during and after, to protect from something being left behind.

 

PACU

  • airway breathing circulation,
  • drains OK?
  • bleeding too much
  • urinating?
  • Pain control
  • Lines drains and Airway
  • could take an hour or 2 in the PACU
  • assessments:
    • Airway management, circulation, pain level assessment and trend,
  • Alcohol pad under the nose to relieve nausea for a short time.

 

QSEN – (quality and safety education of nurses) teamwork and collaboration

  • it is a continuous plan of care and should be throughout
  • CAUTI
  • RCA – Root cause analysis
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