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

Most Med cards?

Here are Zocor, and Synthroid. Zocor is a cholesterol lowering drug that is also used to prevent an MI in patients that have coronary heart disease. there is a chance for Rhabdomyolysis with this drug if the serum levels get too high so have the patient report any pain tenderness or weakness.  Synthroid is nice and easy because it is a synthetic – thyroid hormone. This will increase the person’s metabolism and the side effects are usually just too high metabolism related.

-Peter