Preoperative Nursing Protocol and First Six Hours of Post-Operative Procedures - Essay Example

? Preoperative Nursing Protocol and First Six Hours of Post-Operative Procedures The events that surround Hospital Admission Process, and surgery related procedures can somewhat be confusing, as well as stressful. Arguably, one needs to understand the whole process for purposes of taking the appropriate steps towards easing the process. This paper sets out to highlight the preoperative Nursing Protocols, as well as the first six hours of the post-operative procedures a patient who goes through a surgery procedure needs to impress. With a view to stare clear the practical aspect of the surgical procedures, this discussion shall be based upon Ms Meredith Parker’s case employing the ABCDEF as proposed by Ian (2010). It is noted that Meredith Parker is a 36 year old woman who is a supervisor in a large department store. She works full time, leaving little time to spend with her two small children aged 4 and 2. Over the last two months, Meredith has lost 10kg and has now begun to experience episodes of right sided pain under her ribs, radiating through to her shoulder blade. These have become more frequent, lasting for several hours with episodes of nausea and vomiting. Following a GP referral and investigations she has been admitted to the ward for a laparoscopic cholecystectomy. She stopped taking the combined oral contraceptive pill one year ago and smokes 15 cigarettes per day. In pre-admission clinic her observations were: BP 140/84 mmHg; pulse rate 74 beats/min and regular; respiratory rate 17 breaths/min; temperature 36.8 o C, oxygen saturation 98%.Her waist circumference is 92cm. It is certain that with Meredith Parker’s case there are numerous foreseeable consequences that she is likely to encounter if appropriate professional procedure is not impressed. As clearly highlighted in the history of the patient, she is a smoker. Research indicate that smoking often rob the patient’s body of oxygen and significantly interferes with the body of the patient from recovering properly. As widely cited, there is need to impress exercise prior to any surgical procedure. Arguably, exercising increases the level of fitness of a patient and it also promotes quick recovery. However, this are limited to some period of time before hospital admission. Research suggests that before any surgery, a patient needs to be subjected to various diagnostic tests. These might include chest x-ray, CT Scan, biopsies, bone scan, ventilation studies, bronchoscopy, and perhaps blood work. These constitute the prospective assessment. However, one thing to content with is that these processes have to follow a particular protocol commonly referred to as ABCDEF. Certainly Meredith Parker has to adhere to the ABCDEF process. This way, she would be provided with A- Antibiotics shot/Anaesthetistconsulation, followed by B — Blood tests and Bowel for purposes of monitoring proper urinary output, then C — Consent from the patient in order to get be allowed to conduct a Chest X-ray (CXR). It is after this that Meridith Parker shall receive D — Drug chart, which would concern any previous medication/DVT prophylaxis treatment, she would then undergo E — Echocardiography (ECG) followed by F — Fluid monitoring and Food intake, in which she would be kept on nothing per oral (NPO) for at least 12 hours before surgery. In a rather practical approach to Meredith Parker, it is worth noting that there are various steps towards surgery that involve all these procedures in a very specific way and cover the details of management even in six hours post operatively. The first step is to take a detailed history about the symptoms. This includes presenting complaints, history of presenting complaints, social, family, personal and drug history. It is essential that all the associated symptoms should be checked. It is important to note if there has been any change in symptoms or if there is any doubt in diagnosis so that they can be checked again. After that, a detail examination is required. In our patient, we should especially focus on abdominal examination and compare our nursing notes with doctor’s notes. Systemic review of all other systems involved, can show either a complication of the disease or any other associated complaint. Detailed history of co-morbid is important as they can affect the surgical procedure. Ask possibly about hypertension, diabetes, and any family history of tuberculosis, asthma or any other infectious diseases (Bray A 2006, pp 135). Special notes should be made if any one of them is present so that care may be taken during the surgical procedure. It is important to ask about any previous drug reactions or documented history if patient is taking any drug on regular bases. Especial consideration should be paid if there is history of steroid intake because they can cause delayed wound healing and make a person prone to more infections (Frederick W. Clevenger 1997 pp: 583). After completion of the history, a nurse should check all the vitals of patient. According to the scenario, our patient had:BP 140/84 mmHg; pulse rate74 beats/min; regular respiratory rate 17 breaths/min; temperature 36.8 o C; oxygen saturation 98%.Her waist circumference is 92cm. It is important to conduct regular monitoring of all the vitals at least 24 hours before the surgery and proper charting should be done. Immediately consult a senior nurse if there is any change in these vitals. It is important that a patient is kept without any food intake at least 12 hours before the surgery because these food particles can cause aspiration during surgery. Patient should be given antibiotics shot before surgery so that there is protection against any possible infection (Webb AL 2006 pp 663). Details of blood tests, culture, ultrasound reports, liver and lung tests and ECG should be performed to check systemic review of patient so that these factors are kept in mind while performing the surgery and details of these is given with the “ABCDEF” mentioned above. Along with all these procedures, it is important to take a detailed consent from patient. Explain him about the surgical problem, procedure that is to be performed, prognosis in surgery and any post surgical complications. This is important and nurses need to play special consideration for it because informed consent is important for the patient himself and also prevents any legal problem that can occur later. Blanket consents should never be done and gravity of situation should be understood properly.This reduces patient’s anxiety (Mats Sjoling 2003, pp 169). After all these protocols patient is taken to operation theatre. Perioperative sterilization of surgical instruments and other surgical material are very important concerns and need to be monitored before any surgical intervention. The reason for doing this is themajor problems during surgeries and the fact that more than 14-16% percent of nosocomial infections are due to this reason (Cynthia Halvorson 2000). Proper sterilization is one procedure that is very important but neglected in most of the hospitals especially government run facilities because there is increase patient burden. Due to improper sterilization, there is a transmission of infectious diseases which would ultimately increase the burden on the health care system. Compromising this can put both the doctor and patient at risk. By acting upon basic guidelines of sterilization, we can make health care more cost effective and can also prevent high level of infections in post operative patients. It is the responsibility of a nurse working in Operation Theater to ensure that instruments are properly sterilized before they are used by the surgeons and comes under her jurisdiction (SherilynPramann 2010). Cleaning, inspection, packing and storage of sterile supplies are the responsibilities of perioperative. There is no single method of cleaning or packing that is appropriate for all the supplies and various methods are used. This inspection and screening would take high level of knowledge and skill on nursing part. Mostly instruments are sterilized in a separate department but perioperative nurse is responsible for final approval before that are used inside Operation Theater (Cynthia Spry 2009 p 71). The first job post operatively is to shift patient in a separate room where he can be monitored on regular basis. It is important to check vitals, IV fluids and urine output. Nurse should check if there are any surgical notes made by the doctor so that she can especially take care about those post surgical complications. For example, any patient operated for diabetic neuropathy and gangrene in foot should be monitored for fever or any other sign of infection for several days as diabetics are especially prone to infections. Complications can be divided on the basis of time. Immediate complications are those that occur in first 24 hours of surgery and delayed complications are those occurring after that. As part of the assignment, we would mainly focus on surgical complication that occurs in first six hours of the surgery. Hemorrhage is the most common complication that can occur and primary hemorrhage would be seen in first few hours of the surgery. This can be due to damage to any vessel or some other reason and it is important to manage that as soon as possible as to prevent blood loss. Consult surgeon if there is any massive bleed because this can put patient in risk state. Wound infection is seen because there patient is chronically ill, lacks immunity or there is improper surgical technique is used. Therefore, it is very important to make sure that all surgical instruments and environment is properly protected for signs of infection. Wound must be swabbed and antibiotic shot should be given to prevent this. Make sure that patient comes out of anesthesia properly depending on the duration of the drug given. If the patient has any history or co morbidity, he should be kept in special consideration post operatively. Post operative pyrexia can be because of numerous reason starting from chest infection, surgical wound infection or any other measure and therefore its cause should be identified. Don’t put patient on any medication without consulting the surgeon because it is the job of nurse to document and obey the guidelines set by the operating surgeon. Suggestions can always be given but it is never wise to take any action all by herself. Following all these protocols would increase the level of success in surgery and would decrease the level of chances for infection. They should be followed by the book in detail without rushing into any of these steps. References BRAY A. 2006. Preoperative nursing assessment of the surgical patient.Highlands Ranch, CO, USA.The Nursing Clinics of North America.41(2):135-50. DOI: 10.1016/j.cnur.2006.01.006 CYNTHIA SPRY (2009).Essentials of perioperative Nursing. Jones & Bartlett Learning, Page 71 CYNTHIA HALVORSON.2000.Microsurgery Team's Role in Surgical Site Infection Prevention.Team strategies for assessing and preparing the patient and the OR. Retrieved from http://www.infectioncontroltoday.com/articles/2000/12/nursing-role.aspx FREDERICK W. CLEVENGER, JOSEPH J. TEPAS. 1997. Preoperative Management of Patients with Major Trauma Injuries. AORN Journal, Volume 65, Issue 3. IAN NESBITT. 2010. SURGICAL TALK -2nd Edition Imperial College Press http://www.worldscibooks.com/medsci/p356.html MATS SJOLINGA, GUNNAR NORDAHLC, NICLAS OLOFSSOND, KENNETH ASPLUND. 2003. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Volume 51, Issue 2, Pages 169–176. SHERILYN PRAMANN. 2010. The Nurse’s Role in the Perioperative Experience with an Emphasis on Infection Control. JCCC Honors Journal, Volume 1, Issue 2, Article 3. WEBB AL, FLAGG RL, FINK AS. Reducing surgical site infections through a multidisciplinary computerized process for preoperative prophylactic antibiotic administration.American Journal of Surger.192(5):663-668. DOI: 10.1016/j.amjsurg.2006.08.014 Read More