Pre and Post-Operative Nursing Care
Pre and Post-Operative Nursing Care
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Pre-Operative Nursing CareAimTo provide information to members of the
ophthalmic team Have a basic understanding of caring for the
pre-operative patientPromote efficient and safe pre-operative
patient care
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Pre-Operative Nursing Care
After Screening and Before Admission On Admission Handing Over to the Operating Room Team
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Pre-Operative Nursing CareAfter Screening and Before AdmissionConsent signed and witnessedPatient is assessed to identify factors that might
interfere with the safe performance and outcome of the surgery
Necessary tests and investigations are done prior to surgery
Essential 2-way process to obtain information from patient and their family
Concerns and expectations are discussed•Fasting•Washing body, hair and face•What to wear•What to bring•Cost•Date and time to arrive
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Pre-Operative Nursing CareOn Admission
Consent Assessment and history
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Pre-Operative Nursing CareOn AdmissionVital Signs Surgical Site Preparation Eye preparation Dress for surgeryOrientationEducationInsert IV Tests needed
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Pre-Operative Nursing CareOn Admission
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Pre-Operative Nursing CareConsent
Patient understands surgerySurgery confirmedSurgical site confirmedCorrect patient is confirmedPatient signed the consentSurgeon signed the consentCorrect patient,correct surgery, correct site- confirmed verbally/documented/identity band
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Pre-Operative Nursing CareAssessment and HistoryPatient Address and telephone numberMedical history and medication historyRelevant blood relative medical historyAllergiesTests needed like A scan, X-rays, MRICheck fasting timeSocial status – transport, living alone, someone to
accompany them Psychosocial issues – anxiety, confusion,
claustrophobia
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Pre-Operative Nursing CareAssessment and HistoryRespiratory distress/breathlessness/asthmaTremor/uncontrolled body movementAbility/concerns about being able to lie still
and flatWearing denturesHearing problem and hearing aid during
operation
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Pre-Operative Nursing CareVital SignsTemperaturePulse (heart rate)RespirationBlood PressurePain Other
•Oxygen Saturation•ECG (adult or cardiac patients)•Blood Sugar Level (for diabetic patients•Weight (for General anesthetic patients and children)
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Pre-Operative Nursing CareSurgical Site/Eye PreparationWash the face and eyeConfirm and mark the operative eyeCheck eye for the absence of acute inflammation Dilating or constricting dropsBetadine wash (if Doctor prefers)Educate the patientAssist the doctor with Local block if necessaryPressure to reduce IOPMonitor Vital signsCheck absence of movement (akinesia) and feeling
(local)
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Pre-Operative Nursing CarePreparing the Patient
Dress for OR• Full dress change/half-dress change
• No shoes (shoe covers)
• Hair cover
• Remove jewellery and watches
Orientation to the environment• Toilet-make sure bladder is empty prior to surgery
• Phone, bell etc
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Pre-Operative Nursing Care Education/IV/TestsEducation
Insert IV
Tests
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Pre-Operative Nursing CareSafe Site Surgery
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Pre-Operative Nursing Care Safe Site Surgery
Handover to the Operating Room Team
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Pre-Operative Nursing Care Summary of Pre-Operative CareSummary of Pre-Operative CareThe key to the smooth and efficient
preparation of patients for surgery.A tool for identifying patient abnormalities
that might interfere with the safe performance and outcome of the operation.
With appropriate information, it can reduce patient anxiety to a minimum.
Increases patient satisfaction/understanding of the operation, effective communication, and prevents patient cancellation on the day of surgery
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Post-operative Nursing CareOutlineTransportation to Recovery
Preparing to accept patient to recovery
Initial post-operative care
During the stay
Discharge Criteria
Discharge
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Post-operative Nursing Care Transportation to RecoveryTrolley vs. walk
• GA/Local. Adult/child. Able/not-able
Assist the patient
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Post-operative Nursing Care Preparing to Accept Patients to RecoveryAt the beginning of the day test and check
• Defibrillator, emergency trolley, oxygen, suction, stock levels
Be ready for:• Patient handed over from the operating room staff
• Bed area ready, oxygen, suction and monitors
• Wear gloves and eye shields
• Oxygen, monitor, vital signs
• Start keeping notes
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Post-operative Nursing Care Initial Post-Operative CareDo not leave the patient unattended
Ensure their safety, airway, breathing, temperature, pain management
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Post-operative Nursing Care During the StayMeasuring levels of recovery
• Vital Signs
• Nausea and Vomiting
• Wound and dressing
• Pain, discomfort, pressure
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care During the Stay
Nausea and Vomiting Scoring AVPU Scoring
None0
AlertA
Nausea only1
Responds to voiceV
Vomit x 12
Responds to painP
Vomit > 13
UnresponsiveU
Blood Loss Scoring Pain Scoring Chart
None 0
Minor – Small amount of blood on dressing only 1
Moderate – Dressing saturated / changed 2
Severe – active bleeding / patient
swallowing blood (inform attending Dr)
3
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Post-operative Nursing Care During the Stay
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Post-operative Nursing Care Discharge CriteriaDid the patient recover to an acceptable level?
Please refer to recovery monitoring / discharge criteria sheet
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Post-operative Nursing Care Discharge Criteria
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Post-operative Nursing Care DischargeConfirm the patient is ready to go (signed out)
Discharge ‘take home items’ given. E.g. eye drops
Patient Education• Eye care at home
• Don’t
• Does
• When to see the Dr next
• Emergency
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Post-operative Nursing Care Discharge
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Post-operative Nursing Care Summary of Post-Operative CareOphthalmic nurses can play valuable role in post-op careInforming patient to contact the hospital about any concerns or
problems and ensuring patients have hospital contact number• Ensures better follow-up and compliance
Clear post-operative instructions and explanations given to patient and relatives will result in • Reducing the patient’s anxiety
• The best possible outcome.
Emphasis on follow up care • Results in early identification of complications
• Early assessment of outcomes
Thank You
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References
ORBIS Recovery Room Care Recording and Discharge PD-605Heather Machin-Associate director of NursingPam Bailey- ORBIS Staff Nurse http://www.visitech.org/post-operative-care.htmlhttp://www.netdoctor.co.uk/health_advice/facts/surgeryinfo.htmhttp://www.google.co.za/search?q=preparing+patients+for+general+anesthetic&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-ahttp://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4160-3225-0..00018-0--s0015&isbn=978-1-4160-3225-0http://www.medindia.net/patients/patientinfo/
generalanesthesia_post.htm