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
- 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.
- 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.
- airway breathing circulation,
- drains OK?
- bleeding too much
- Pain control
- Lines drains and Airway
- could take an hour or 2 in the PACU
- 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
- RCA – Root cause analysis