Preoperative Surgery - Essay Example

Introduction Preoperative surgery or before surgery, considerable time may be taken by patients to prepare for spine surgery. Learning about the spinal procedure and recovery, pre-operative testing and organizing the household for aftercare is all under preparation. Before surgery, a medical examination is given to the patient, Pre-operative tests, and its physical status is rated according to the ASA physical status classification system. The patient then signs a consent form if these results are satisfactory, later is given a surgical clearance. An autologous blood donation may be made some weeks prior to surgery if the procedure is expected to result in significant blood loss, Patients are also instructed to abstain from food or drink after midnight on the night before the procedure, to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure. A patient can be admitted to hospital either a day before the surgery, or on the day of the surgery. Admission may be earlier if the patient has additional medical problems. For bowel Preparation the patient takes some medications to help him clear his bowels. Smoking one week before surgery is strongly not allowed especially on the night before the surgery. Smoking makes it difficult to clear secretions after surgery, and may affect recovery. On exercise, a physiotherapist teaches the patient simple positioning and log rolling in bed preoperative. Breathing and limb exercises that may be required to be performed before and after surgery may also be taught. Food Consumption should be halted, not even water, after midnight. This is aimed at preventing any vomiting and subsequent breathing of the vomitus into the lung during surgery, which could be dangerous. During the day of surgery, before going for a surgery its advisable to take a shower, brush teeth and rinse mouth. Drinking anything on the morning of surgery should be refrained. Shortly before the estimated time of operation, following should be done: Empty the bladder, remove any dentures, spectacles and contact lenses, make-up, nail polish, hairpiece, jewellery and prosthesis ,Change into a gown. Medication in the form of tablets or an injection may be given to help someone to relax. This medication will make patient ``sleepy, and may cause dryness in mouth. Getting out of bed after taking the medication should not be attempted. A nurse or health attendant will transfer the patient to the operating theater on a trolley. After arriving in the Operating Theater the nurse will verify the patient identity and also the type of surgery scheduled for. He will be transferred to another trolley after verification, and wheeled into the induction room to meet the anesthetist and the surgeon. The anesthetist may give an injection to put the patient in a deep sleep, to avoid pain. Postoperative Nursing is all about patient management after surgery. It involves care given during immediate postoperative period, both in the post anesthesia care unit (PACU) and operating room. The patient should be discharged from the PACU after meeting established criteria for discharge, which is determined by a scale, e.g. Aldrete scale, and it scores the patient’s respiratory status, mobility, consciousness, circulation, and pulse oximetry. Basing on the surgery type and the condition of the patient, patient admission may be either in the intensive care unit or a general surgical floor. In the first 24 hours, the hospitalized patient transfers from the PACU, the patients gain should be assessed by the nurse taking over his or her care. The nurse anesthetist reports on the condition of patient, anesthesia type given, blood loss estimate, surgery type performed, and total fluids input and urine output during surgery. The PACU nurse should also be notified on any complications during surgery, including variations in hemodynamic (blood circulation) stability. Upon admission to the PACU. The first priorities are: patient's airway assessment patency (airway openness), consciousness level and vital signs. Post-operative recovery commences in the Post-Anesthesia Care Unit (PACU). This unit minimizes post-operative complications thus dedicated to meet patient’s needs. Surrendering to general anesthesia may take short time only, recovery from anesthesia takes time. The anesthesiologist maintains deep sleep throughout surgery. Muscle and fats absorbs some of the anesthesia during this time, this helps to maintain anesthesia Elimination of anesthesia take long time to be eliminated from the body tissues. The amount of time a patient takes in the PACU is affected by many factors which include: pre-operative medication, anesthetic used, and the time length of anesthetic administration during surgery. Hearing is the first sense to return after general anesthesia. Thus PACU staff speaks in a reassuring tone to let the patient know what they are doing. During Patient assessment Needs and Vital Signs in the PACU, certain devices may be worn by the patient to monitor automatically the vital signs. The usual devices used include: oximeter (records pulse) a blood pressure cuff and EKG leads (monitors the heart). Medication and fluids delivery intravenously is maintained by the IV remaining in place. The nurse monitors kidney function and hydration after many spine surgical procedures by the help of a urinary catheter which collects urine. The patient’s overall condition is assessed by a nurse in very few minutes. This helps to minimize post-operative complications. More so, the nurse will place warm blankets around the patient’s body to avoid coldness. The extended relief from pain is due to effects of anesthesia linger following surgery. Augment the diminished effects of anesthesia can be handled by other forms of pain management .To control pain of the patient post-operatively the Patient Controlled Analgesia (PCA) is used. The device work on the principle of self dosing thus allowing a patient to self-dose pain relieving medication at the push of a button. PCA is a computerized pump programmed that dispenses small doses of pain medication through the patient’s intravenous line (IV). The appropriate dose is got by a physician who sets the parameters. Sustained Pain relief i provides consistency and pleasing pain relief. Later, oral pain medications replace PCA. Nurse should be notified by the patients immediately if pain is not sufficiently relieved. Accumulation of fluids in the lungs that is life threatening is often caused by lying flat for long time. The patient is helped by the Nurse to sit upright so that he can breathe deeply and cough. This makes the secretions loose hence easily eliminated and there is low risk of being invaded by pneumonia. Deep breathing promotes elimination of anesthesia and increases circulation. Some patients are instructed to breath into a spirometer which is a device used to measure how deeply a patient is able to breath (e.g., lung capacity) and acts as an incentive so you will see just how deeply you are breathing. Respiratory status monitoring as well as, Vital signs, the incision, pain status and any drainage tubes is very vital and must be done every one to two hours for at least the first eight hours. Since patients are ever hypothermic after surgery, the temperature of the body monitoring is recommended, warmed IV fluids or a warm blanket may be needed to keep the required temperature at optimum. Frequent assessment of respiratory status should be done including assessment of lung sounds (auscultation) and chest excursion, as well as presence of an adequate cough. Also monitoring of fluid intake and urine output should be emphasized and is done every one to two hours. The assessment of the bladder is done to check for distension, if the patient lacks a urinary catheter, he may also be monitored for urination failure. The physician should be made aware on the patient urination status, e.g. if the patient never urinated six to eight hours after surgery. Neurological status is always assessed basing on surgeons instructions and is when the patient has had neurological or vascular procedure performed, and is usually done every one to two hours. Medication for nausea or vomiting may be required, as well as pain. Patients should be taught and always reminded on how to use a patient-controlled analgesia pump. The button is usually pushed by e.g. the nurse to deliver pain medication immediately after the surgery for the too sedated patient. Pain level should be rated on a pain scale in order to determine acceptable level of pain. It’s important to control pain because the patient may require performing coughing, deep breathing exercises, and may be able to turn in bed, sit up, and, eventually, walk. A positive effect on the first 24 hours after surgery is as a result of effective preoperative teaching. The Patients learning the idea of performing respiratory exercises to prevent pneumonia as well as movement is crucial for preventing blood clots, this encourages circulation to the extremities, and lungs is kept clear; they will definitely perform these tasks. Movement and respiratory exercises that needs to be understood also underscores the significance of keeping pain under control. Respiratory exercises that include coughing, deep breathing, and incentive spirometry must be done every two hours. Turning of the patient must be done every two hours at least when the patient is sitting on the edge of the bed for eight hours after surgery, unless contraindicated. The sequential compression devices are put on legs of those patients who fail to sit up in bed due to their surgery until they are able to move about. These devices are inflated air stockings which simulate the effect of walking on the calf muscles, and later returns blood to the heart. Nothing should be taken in the mouth if ordered by the surgeon, at least until when the cough and gag reflexes is back. Dry mouth of the patient is due to after surgery; to relieve this, oral sponges dipped in ice water or lemon ginger mouth swabs is used. In acute phase Problems that do occur are usually because of anesthesia, blood loss and operative trauma. Special attention and care should be critically observed on respiratory system, the cardio-vascular system and the microcirculation. The hemorrhage that is reactionary which normally occurs within 24 hours is a total sum of the loss in drainage tube and per-operative blood loss. Hence must be replaced 100% to achieve hemodynamic balance. Lying down posture can have negative impacts such as failure to pass urine may either be also because of the pain or worse, shutting down of kidney may still be because of hypovolumia. A catheter can rectify this and hypovolumia should be corrected. Complications of spinal surgery may arise during the early phase of post-operative, and may include, loss or lack of fluid volume, neurological injury, dural tear with cerebral, anemia, urinary retention, ileus, pneumonia, spinal fluid leakage, and venous thrombosis (1, 2, 3). The goal of postoperative care is to make sure that patients have good outcomes after surgical procedures. Lack of complications and adequate pain management during recovery is a good outcome following good preoperative care. To assist patients in taking control for regaining optimum health is one of the major objectives of preoperative care. Endoscopes use minimizes postoperative pain, reduces hospital time stay, facilitate recovery times, and decrease medical costs. This is so because surgical procedures are performed through small incisions, (1, 3, 4,). Postoperative care is indicated for all patients who have had an invasive procedure, regardless how minor. Thus, improper care can lead to complications. E.g. changing a surgical dressing without sterile technique leads to infection. Failure to monitor a patient closely, or failing to assist them with respiratory exercises and ambulation, leads to pneumonia or deep vein thrombosis, and potentially pulmonary embolus. Lack of thorough teaching to patients on what to expect may resist attempts to assist them, this may lead to complications and anger on the part of the patient or family. Conclusion Each health care team has a role in postoperative care. The surgeon performs surgery as well as managing the patient's postoperative care. Nurses are always at the bedside 24 hours a day, so their role is to monitor the patient for complications, assist the patient with respiratory exercises and regaining mobility, provide postoperative teaching, and generally care for the patient. Respiratory therapists provide instruction and assistance with respiratory exercises, and monitoring the patient's respiratory status. Radiology personnel take x-rays that are ordered by the physician, and laboratory personnel draw blood samples and perform blood tests. All team members must communication between all team members is highly recommended and with the patient to provide the best possible postoperative care. References 1 Feingold, D., Peck, S., Reinsma, E. & Ruda, S. Complications of lumbar spine surgery. Orthopedic Nursing, 10(4), 39-58, 1991 2 Kopp, M. Caring for the adult patient undergoing anterior/posterior spinal fusion. Orthopedic Nursing, 16(2), 55-61, 1997. 3 Whiffen, J. & Neuwirth, M. (1997). Spinal stenosis. In Bridwell, K. & DeWald, R. (Eds), The textbook of spinal surgery. (2nd Ed.) (pp 1561- 1580) Philadelphia: Lippincott-Raven Publishers. 4 Regan JJ, Yuan H, McAfee PC: Laparoscopic fusion of the lumbar Spine: minimally invasive spine surgery. A prospective multicentre study evaluating open and laparoscopic lumbar fusion. Spine 24:402-411, 1999. 5 Rosenthal D, Dickman CA: Thoracoscopic microsurgical excision of herniated thoracic discs J Neurosurg 89: 224-235, 2000. 6 Lischke V, Westphal K,Behne M,Wilke HJ, Rosenthal D,Marquardt Getal.Thoracoscopic microsurgical technique for vertebral surgery- anesthetic considerations.Acta Anaesthesiol Scand 42: 1119-1204, 1998. Read More