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Proposal

Preparing Patients for Surgery and Procedures Instructions Created for WR 227 (Instructor G. Knox) by Anna Berka 12/3/2004. Proposal. Proposal continued. Proposal- last part. Obtaining approval.

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Proposal

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  1. Preparing Patients for Surgery and ProceduresInstructionsCreated for WR 227 (Instructor G. Knox) by Anna Berka 12/3/2004

  2. Proposal

  3. Proposal continued

  4. Proposal- last part

  5. Obtaining approval • Proposal was presented to both George Knox (WR 227 Instructor) and to Mary Kreger (4W Nursing Manager) • Approval was obtained, under condition that at this point instructions will be only student project

  6. Sample Instructions for RN

  7. Sample Instructions for RN cont’d • Check IV sites, page IV nurse for new access, if necessary. Patient needs one large-gauge site on each arm. Double-check when the sites were placed-they must be less than 72 hours old on the day of surgery. Often dressings over sites are dated with each dressing change-you need to check E-chart for actual date of site placement. • Patient is going to have two baths/ showers with Hibiclens. Try to do the first one ASAP. Linens need to be completely changed with each shower/ bath. Hair must be washed with Hibiclens as well (not with regular shampoo). • The goal is to have patient in bed by 2300-try to pack most of the preparations before this time. Explain to patient and family members that the following day is going to be long and busy. Make sure the family members understand they need to be present in the waiting area, or at least inside the hospital building. Ask them to plan accordingly, explain that they may be looking at 6-7 hours spent at the hospital. • Discuss with patient and family, which belongings they want to leave at the hospital. Explain to them our complicated policy regarding valuables. • In E-chart, select patient, go under "Assessment", select and click "Pre-op checklist". Fill out the areas you know.

  8. Patient Instructions For Patients Immediately After Open Heart Surgery • After surgery you will wake up in Intensive Care Unit (ICU). Your family members will be allowed to see you, but you may be unable to talk to them at first, due to all the equipment used to help with your recovery. • A nurse will be checking on you every ten-fifteen minutes. It is only done for about two days. Please, let the nurse know, when you have even the slightest discomfort. • DO NOT USE YOUR ARMS for reaching overhead, pushing yourself up in bed, resting on your elbow, holding on the bed rail, etc. It may upset healing of your sternum (breast bone).

  9. For six months after Open Heart Surgery, DO NOT EVER Carry heavy objects Push yourself up with your arms

  10. For six months after Open Heart Surgery, DO NOT EVER Lift your arms overhead Reach out/push with your arms

  11. Patient Instructions cont’d

  12. Consulting with Experts • I telephoned and asked for input Charge Nurse of OR at LGSH • I consulted with Charge Nurses for both shifts of 4W Cardiac care Unit • I circulated a note explaining the project and asking for suggestions to all full- and part-time nurses of Cardiac Care Unit • I reviewed LHS Policies and Procedures regarding interventions and open heart surgery (they are available on the Internet, but I used paper version available on 4W)

  13. References • Hacker, D. The Bedford Handbook, 6th Edition, Bedford/St. Martin’s 2002 • Woolever, K. Writing for the Technical Professions, Pearson Education Inc. 2005 • Removal of femoral venous and arterial sheaths, femostop and C-Clamp LHS 900.2381 Patient care • LPH Post-Arteriogram Orders #163282 (7/99) • LPH Admitting Orders for Adult Open Heart Surgery 124220 (6/01) • What to Expect With Your Open Heart Surgery LHS 900.3164 Patient Care • Getting Your Patient Ready for Open Heart Surgery (checklist)

  14. Acknowledgements • This project was prompted and guided by my PCC WR 227 instructor, George Knox. Thanks for all your input! • I owe it to the manager of 4W, Legacy Good Samaritan Hospital, Mary Kreger, for her patience, support and great suggestions. • All the nurses of 4 W, who responded to the survey, were incredibly helpful. Sue Weber and Brenda Wilson, Charge Nurses, added many insights and helped me search the policies.

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