Pre, Peri & Post op care Small group work

1. Pre, Peri & Post op care Small group work Mark Edwards

2. PREOPERATIVE CARE: FACTORS • The Assessment process should include: • a nursing history • physical assessment (physiological measurement) • identification of risk factors for the patient/client • identification of educational needs for patient/client AND their significant others. • Identification of psychological needs for the patient/client AND their significant others

3. Roles of the Perioperative Nurse. • RESPONSIBILITY INCULDED IN THIS ROLE, BUT NOT LIMITED TO ARE. • Education • Support and reassurance • Patient advocacy • Control of the environment • Maintaining of asepsis • Monitoring of the patient • Collaboration and consultation

4. POST OPERATIVE CARE: FACTORS • Immediate post-op phase nursing assessment must pay particular attention to: • respiratory status • cardiovascular status • central nervous system (effects of anaesthesia) • fluid balance • wound care • pain relief/comfort/general condition

5. POST OPERATIVE CARE: FACTORS • VITAL SIGNS • SKIN INTEGRITY/ CARE OF THE WOUND • LEVEL OF CONSCIOUSNESS • OXYGEN THERAPY • FLUID BALANCE/INTRAVENOUS THERAPY

6. POST OPERATIVE CARE: LONG TERM FACTORS • Long-term postoperative care is predominately concerned with preventing complications and returning the patient/client to a state whereby they can retake control over their own lives and lifestyle. The focus can be determined by using the identified factors to assess; plan; implement and evaluate the nursing care given

7. Case Scenario’s • Split into 3 groups

8. Group 1 Scenario • Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively • For one of the identified needs devise a plan of care, providing evidence based rationale for your actions.

9. Group 1 Scenario (1st page) • Annabel Richards is a 60 year lady who lives alone with close family living in the same street. Annabel is an emergency admission to your ward with a history of acute right upper quadrant abdominal pain, weight loss and jaundice. Following several investigations she is diagnosed as having acute cholecystitis and requires surgery.

10. Group 1 Scenario continued • During your assessment she tells you she has been drinking alcohol heavily since the death of her husband and her family are unaware of this. Her husband died whilst having an operation in the same hospital one year ago

11. Commonly asked questions • Fear of the unknown • Anaesthetic + side effects / not waking up • Unrelieved pain • Restricted in bed post op. • Use of bed pan • Body image /effect on relationship, family • Dependant relatives. • Financial problems if sole provider for family.

12. Scenario Group 2 • Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively • For one of the identified needs devise a plan of care, with evidence and a rationale for your action. • You will be presenting your assessments and care plan to your colleagues

13. Scenario Group 2 • Abdullah Patel is a 20 year old overseas student studying chemistry at the university. Abdullah is an emergency admission to your ward via A&E, who has fallen and has a fractured his right lateral malleolus . It is planned that surgery will be performed later in the afternoon. During your assessment you discover he has only arrived in the country a few days ago and does not have any friends in the halls of residence where he is living. He is anxious about his surgery and does not fully understand the procedure or know how he will cope when he goes home.

14. Nursing intervention • Nutritional status • Integrated Care Pathway • Baseline observations. • Specimen collection. • Mobility Assessment. • Nutritional assessment. • Cardiovascular assessment • Respiratory assessment. • Urinary assessment. • Social assessment • Risk assessment

15. Group 3 • Answer the following questions based on evidence based practice.

16. Group 3 Question 1Pre op check list exercise • Discuss each item on the checklist, and provide an evidence based rationale for its importance. • Feedback to group.

17. Consent answers • Legal requirement. • >Informed consent • Written consent should be obtained identifying that the subject has received and understood:- • The procedure offered • Reasonable alternatives to the procedure • Possible benefits of the procedure to the patient. • Risks, inconveniences, and discomforts of the procedure. • Answers to all patient's questions.

18. Question 2 • Discuss common post operative complications and how would you detect and prevent these complications? • Example:- • Respiratory • Cardiovascular • Gastrointestinal • Genitourinary • Wound

19. Group 3 Question 2 answer • Common post operative complications • Respiratory complications • Airway obstruction, chest infection • Cardiovascular complications • shock, haemorrhage, DVT, PE • Gastrointestinal • vomiting, constipation, paralytic ileus, retention of urine • Wound infection

20. Any Questions?