Perioperative Care for Inguinal Hernia - Case Study Example

Perioperative Nursing Care Name of Student Student Number Institution Course Code Name of Instructor Date of Submission Perioperative Care for Inguinal Hernia Introduction This essay evaluates the perioperative care process of Mark a 60 year old Caucasian male preparing for an inguinal hernia. The patient lives in an urban environment and his GP has referred him to the General Surgeon for the repair operation. Prior evaluation of mark indicates that he is a moderate drinker, little overweight but otherwise fit and healthy. The peri-operative care of this patient will be evaluated based on the six nursing roles necessary for the procedure at hand. The six nursing roles to be evaluated incorporate Pre-admission Nurse, Day Stay Unit Nurse (Pre- and Post-Operative Care), Anaesthetic Nurse, Circulating (Scout Nurse, Instrument (Scrub) Nurse, and Post Anaesthesia Recovery Unit (PARU) Nurse. The essay describes the care provided in the six nursing roles and what is actually done during the stages of the perioperative care. Inguinal hernia repair involves a procedure that is not very complicated and does not require hospitalisation, although a number of patients spend some time in the hospital due to postoperative complications. The following sections outline the six roles of different nurses in the perioperative care of the patient. Pre-admission Nurse Pre-admission is a critical stage in this procedure as it serves as the platform for orienting the patient to the entire procedure in detail before the appointed surgery time. A pre-admission nurse is very crucial for the inguinal hernia repair as it is a common surgical procedure which requires pre-admission preparation and orientation of the patient (ADSNA 2009). The nurse is responsible for taking the patient through the requirements of the procedure and any probable complications as per the specialists order. Further, the patient is made aware of the necessity of the procedure, exact time of the operation, any probable complication and the eventual duration for recovery process (Neumayer, et al., 2003). Then, the nurse will issue some instructions concerning preparations for the surgery by the patient. The patient will be advised not to eat any food, chew gum or suck sweets after midnight prior to the operation day (Neumayer, et al. 2013). Lot of fluids will be required and most preferably water the day prior to the operation to keep the body hydrated. This is crucial to ensure the body is capable to overcome the effect of the anaesthesia and recovery completely. In this case, Mark has no general conditions that may hamper the procedure, but he will be required to keep off any alcoholic drink in the pre and post-operation period. The ethical issue that arises with the pre-admission nurse is in respect to keeping confidential the personal information shared by the patient during pre-admission visit or assessment. The information is only recorded for purposes of medical provision and identifying any risks that may arise during the operation with respect to the general health of the patient (NATN 2004). Day Stay Unit Nurse (Pre- and Post-Operative Care) After checking with the reception on the day of the surgery, the patient will be received by the Day Stay Unit Nurse who will record the blood pressure, pulse and temperature (King Edward Memorial Hospital 2012). The patient will also be assessed through questions to establish their level of awareness on the procedure and their preparedness. The nurse then explains to the patient, his calendar of events; what will happen during the operation day (Callesen 2003). This keeps the patient aware of the occurrences on the appointed. The surgeon will later approach the patient and discuss briefly concerning the surgery, then answer any remaining question (AHWAC Report 2006). Finally, the surgeon will ask the patient to sign the consent form which contains clear explanation of the risks and benefits of the operation. The site of the operation is then marked and then shaved. The patient is then disinfected and waits for further instructions on when to put on a gown and possibly some support stockings used to help prevent blood clots (Filed 2011). Post-operative care by the nurse will involve taking care of the patient awaiting recovery from the anaesthesia effect (NATN 2004). The nurse will also take care of the wound by observing of any discharge to take precautions and interventions. The nurse is also responsible for removing the intubation once the patient gains consciousness. The legal issues pertaining to the Day Stay Unit Nurse entails the signing of the consent which is introduced by the surgeon. The patient has the right of disclosure to all the contents of the consent before signing. This raises the risks and benefits of the procedure. Anaesthetic Nurse Local or regional anaesthesia is utilised in this case and thus, preparation for the administration is carried out by the nurse responsible. The anaesthesia nurse is responsible for preparing the anaesthetic room and machine based upon the information relayed to them by the anaesthetist (Callesen 2003). Further, they are responsible for the maintaining a safe environment for administration and care during anaesthesia. Prior to being taken to the theatre, the anaesthesia nurse approaches the patient to talk about the administration of the anaesthesia and answer any questions from the patient. In case of any pre-medication prescription by the anaesthetist, the nurse administers it and then escorts the patient to the anaesthetic room (ADSNA 2009). The patient then is made to lie down on a trolley which is followed by a safety checklist evaluation. Sticky pads are then attached to the patient’s chest, and connected to the heart monitor, and then the blood pressure cuff will be placed on the patient’s arm (Callesen 2003). The anaesthetist put the needle into the vein at the back of the patients hand to administer the anaesthetic. Once the patient is asleep, a tube is placed into his windpipe to aid in breathing and the operation commences. The only arising ethical issue pertains to the fact that the nurse cannot administer anaesthesia but provides information. Their duties are confined in regard to explanations necessary concerning the anaesthetic procedure by the nurse as well as the anaesthetist (Bowler 2002). Full information concerning the procedure and effects of anaesthesia are outlined before the patient. The only problem with anaesthesia is the postoperative complications that may arise. Circulating (Scout Nurse Circulating nurses are very effective in the theatre for monitoring the progress of the procedure. As a surgical nurse, they ensure the patient remains sterile while in the operation room (ACORN 2008). They also set up the operating room, filling the paperwork regarding the inguinal hernia repair. Their duty in preparation and sterilising the operating room goes a long way in ensuring effective inguinal hernia repair. The scout/ circulating nurse is expected to be active and focused in ensuring full sterilisation of the operating field to ensure the patient is safe from any infections (Matthews, et al. 2007). They also help in the operating team to access materials that are in the non-sterile area, like opening an autoclaved package for a practitioner in the operating room to access a sterile stool inside. Ethical issues pertaining to the circulating nurses involve the fact that they act under the guide or directive of the specialists and cannot administer any procedure on their own accord (Bowler 2002). Surgical procedures and drug prescription are only carried out by the surgeons and medical specialists. Nevertheless, the scout nurse only aids in the carrying out of the surgical process. Instrument (Scrub) Nurse The scrub nurse acts as the assistant to the surgeons while also monitoring the safety of the patient. Prior to the surgery, the scrub nurse ensures full sterilisation of the operation area, as well as the equipment for use. The nurses ensure hygiene of the operating room prior to the procedure and prepare instruments and equipment ready for the inguinal hernia surgery (ADSNA 2009). The instrument nurse does not require sterilisation as they work in the non-sterile area but ensures safety of the sterile area. They work closely with the scout nurse in ensuring high standards of sterility in the operating table (Bowler 2002). The scrub nurse is also responsible for the instruments utilised in the operation procedure and thus, has a direct role in ensuring safe completion of the procedure. The nurse is well aware of the procedure and is expected to have the grasp of the required instruments at any given stage of the surgery (Filed 2011). The scrub nurse works in corroboration with the circulation nurse in ensuring the surgeon and his team accesses all required materials and equipment. The ethical issues surrounding this nurse are identical to the scout nurse. They cannot recommend any instrument or procedure during the surgical process; but, only aids in ensuring safety and availability of required instruments and equipment (Bowler 2002). There are no legal issues surrounding this step as it is only in aiding the specialists in the surgical procedure. Post Anaesthesia Recovery Unit (PARU) Nurse The PARU nurse is involved in the patient care in the recovery ward after leaving the operating room. This is the nurse responsible for checking on the patients’ progress immediately after surgery and consequently evaluates the gaining consciousness from anaesthesia effect (ADSNA 2009). The nurse observes the wound site for any probable bleeding, swelling and redness in the duration of four hours after leaving the theatre until the patient is stable and conscious (King Edward Memorial Hospital 2012). Then observation is continued in an interval of four hours. Pain scores are also monitored by the PARU nurse, and pain relievers administered in cases of excess pain scores (NATN 2004). The nurse offers ice chips to the patient and if tolerated, water is given. The IV line still should remain in place until the patient is in a position to take and tolerate clear liquids (Callesen 2003). Once, the patient has recovered fully from the anaesthesia, administration of liquid food are commenced to replenish the body with nutrients as well as hydrate it. The PARU nurse monitors the patient while checking the blood pressure and wound site regularly and once convinced the patient is comfortable and will stable blood pressure, the patient is taken to the ward awaiting discharge (Matthews, et al. 2007). The nurse’s main objective is to evaluate and stabilise the patient after surgery and prevent the occurrence of any complications. This is crucial in order to safeguard the patient’s wellbeing until their fully recover and are stable to manage on their own. This nurse is competent to monitor progress of the patient immediately after surgery and can detect when an inguinal hernia repair patient is not progressing properly towards recovery and health stabilisation (Callesen 2003). The main treatment interventions involve nausea control: this is caused by the effect of anaesthesia. Also, pain monitoring and control is conducted by the PARU nurse. Any arising ethical issues pertain to managing the wellbeing of the patient and making records of the progress. In case of complications, the PARU nurse would only make interventions to stabilise the patient awaiting arrival of the specialist for diagnosis and prescription. Reference List AHWAC Report 2006, The perioperative workforce in Australia. Australian Health Workforce Advisory Committee, AHWAC, Sydney. Australian College of Operating Room Nurses 2008. ACORN standards for perioperative nurses, ACORN. Viewed 1 June 2014, . Australian Day Surgery Nurses Association 2009, Best practice guidelines for ambulatory surgery and procedures, Cambridge Publishing, Perth. Bowler, G 2002, ‘The Role of the Scrub Nurse,’ Nurse2Nurse, Vol. 2, no. 12, pp. 44- 45. Callesen, T 2003, Inguinal hernia repair: anaesthesia, pain and convalescence, Dan Med Bull, Vol. 50, pp. 203-218. Filed, P (ed.) 2011, Victorian surgical consultative council triennial report 2008- 2010. State of Victoria, Department of Health, Melbourne. King Edward Memorial Hospital 2012, Pre and post-operative care of repair of inguinal hernia. NCCU Clinical Guidelines Section 13. Matthews, R, Anthony, T, Kim, L, Wang, J, et al. 2007, ‘Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA cooperative hernia group,’ The American Journal of Surgery, Vol. 194, pp. 611-617. NATN 2004, Standards and recommendations for safe perioperative practice. NATN, Harrogate. Neumayer, L, Jonasson, O, Fitzbbons, R et al. 2003, ‘Tension-free inguinal hernia repair: the design of a trial to compare open and laparoscopic surgical techniques,’ J Am Coll Surg, Vol. 196, pp. 743- 752. Read More