Nursing in the Theatre Recovery Room - Essay Example

Running head: NURSING IN THE THEATRE RECOVERY ROOM Nursing in the Theatre Recovery Room [The of the appears here] [The of the institution appears here] Introduction The first formal attempt to define operating department nursing in USA came from the AORN: Professional nursing in the operating room is the identification of the physiological, psychological and sociological needs of the patient and the development and implementation of an individualized programme of nursing actions, based on the knowledge of the natural and behavioural sciences, to restore or maintain the health and welfare of the patient before, during and after surgical intervention (AORN 1969. p. 44). In this research, nursing interventions for preventing or dealing with some common postoperative complications have been discussed--including how the latest research may affect standard techniques. Patient Safety It has been argued that the historical development and acceptance of monitoring standards in anaesthesia has been a model for the processes involved in improving patients' safety in other areas of medicine. Economic interest arose in 1984, when the medical malpractice insurer for Harvard Medical School became worried about the number of incidents and claims resulting from anaesthesia care. A risk management committee reviewed all the claims in the company's files. Many cases centred on a failure to adequately ventilate the patient. Relatively straightforward human errors, often technical or mechanical in nature, and failure to recognise them until a very late stage caused many of the problems. The committee concluded that monitoring could prevent catastrophes, and that mandatory monitoring was warranted. Among the goals set were a system of anonymous critical incident reporting and documentation of a collective experience of rare events. While improvements in the safety and conduct of anaesthesia and postoperative care are very gratifying for the profession, most patients seem to be unaware of or unwilling to enquire about matters that will affect their safety and comfort during and after their operation. An obvious starting point, which has its pros and cons, is to improve patient education about their procedure. Augmenting patient information preoperatively with leaflets, pamphlets, (Timmons & Bower 1993) or videotape (Knoert et al. 1999) has shown definite benefits in helping to achieve good results with patient-controlled analgesia systems. Maintaining normal Ventilation and Respiration Guarding against postoperative atelectasis and pneumonia is another key nursing responsibility. Common circumstances that give rise to these complications include thoracic or abdominal surgery, general anesthesia, intubation, and painful breathing. Smokers face a sixfold increase in risk of postoperative pulmonary complications, and decreasing cigarette consumption within 1 month before surgery doesn't significantly reduce that risk. (However, because nicotine use delays wound healing and increases the risk of surgical site infections, nurse should still encourage patients to quit or abstain perioperatively.) Advanced age also increases the risk of postoperative respiratory complications. The benefits of postoperative deep breathing are known--a technique the nurse can teach without the benefit of technology. Even if the hospital is cutting costs by providing incentive spirometers only for specific surgeries, nurse can still teach the patient to take 10 deep breaths once an hour. He can be shown how to splint the incision site first and encouraged to hold each breath for 3 to 5 seconds by counting, "one, one thousand; two, one thousand," and so forth to himself with each breath. The nurse should encourage the patient to try increasing his times each hour. Rewarming Strategies Postoperative rewarming is a challenge for the critical care nurse because hypothermia can cause coagulation changes, acid-base and electrolyte imbalance, cardiac disturbance and altered drug effects. General anesthesia contributes to intraoperative heat loss by depressing the thermoregulatory center and decreasing the body's temperature. (Urden et al. 2002) ( Environmental factors such as cool operating room temperatures combined with the exposed body surface area and surgically opened body cavity, the use of unwarmed intravenous fluids and blood, skin preparations, and time in surgery all impact the production of a hypothermic state. Stimuli that affect the postoperative critical care patient and may also predispose the patient to hypothermia include age, gender, weight, electrolyte status, oxygen saturation, and preexisting medical conditions such as hypothyroidism, hypoglycemia, or malnourished states. (Haskell et al. 1997) Weston compared the use of warm cotton blankets, water-filled electric blankets, and forced air convection blankets in 42 postoperative cardiovascular surgery patients in a cardiothoracic intensive care unit (CTICU). (Weston 1995) The urinary bladder temperature was the dependent variable measure. The study generated significant differences (p Read More