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Professional Role of Nurse
- Assessment,
- Advocacy,
- Assure Safety,
- Assure Informed Consent, & Education
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Preoperative Care
- When?
- Where?
- What is the nurses role?
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Patient Interview
Patient Interview
- }Reason for surgery
- }Health History
- Cardiac
- Pulmonary
- Musculoskeletal
- Endocrine
- }Complications from anesthesia
- }Emotional state and readiness
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Patient Interview cont
- Family History
- Complications from anesthesia
- Undiagnosed problems
- (cardiac, diabetes, pulmonary)
- Medications
- Prescription
- Over the Counter (aspirin, ibuprofen)
- Vitamins
- Herbal
- Recreational drug use
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Patient Interview
- Allergies
- On chart and patient banded
- >Food, medications,chemicals, environmental, latex
- >Autogolous or directed blood
- >Cultural/Spiritual issues
- Jehovah Witness-blood transfusions
- Decision making
- Advanced Directives,DNR
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Physical Examination
- >The Joint Commission requires PE to be on chart
- >Complete Head to Toe assessment
- >Review pre-op labs and medication
- >Assess for problems that may increase risk for
- complications during and after surgery
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Lab/Diagnostic Tests
- >Standard panels covered by insurance
- >May be specific based on diagnosis
- >EKG
- >UA
- >CXR
- >Chemistry panel (electrolytes, renal function)
- >CBC
- >Clotting studies: PT/INR, aPTT
- >Type and Crossmatch for blood transfusion
- >Pregnancy
- >Sometimes: ABGs,
- pulmonary function tests, liver function tests
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Factors That Increase Surgical Risk
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- }Anemia
- }Fever, infection
- }Smoker, drug abuse
- }Emotional instability
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Focus on older Adult
- }More chronic diseases & allergies
- }Greater malnutrition
- }Decreased ability to handle stress & anesthesia
- }Decreased immune response
- }Increased risk heart complications
- }Increased risk of confusion
- }Increased fall risk
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Professional Role as Educator
Preoperative Preparation/Education
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Preoperative Preparation/Education
- }Provide pre-operative recommendations
- }Stop smoking 6 weeks before sx
- }Specifics given for medications
- }Stop aspirin 2 weeks before sx
}Stay healthy & report acute illness, fever
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What Can I Expect???
- }Preoperative Routine
- }When to arrive to hospital
- }How pain will be managed
- }Management of equipment
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Patient Education
- }NPO Status: The American Society of Anesthesiologist, 1999 task force recommendations
- }Clear liquids 2 hours
- }Breast milk 4 hours
- }Nonhuman milk and formula 6 hours
- }Light meal 6 hours
- }Regular or heavy meal 8 hours
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Education: Nursing Interventions to Prevent Life-Threatening Postop Complications
- Atelectasis,
- Pneumonia,
- DeepVein Thrombosis
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Respiratory & Vascular PostopComplications
- }Explanation and
- demonstration of postoperative procedures and exercises that will be used
- following surgery to prevent complications
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Expected Outcome of Preop Education
- }Reduced anxiety and fear
- }Increased cooperation/participation in care following sx
- }Decreased respiratory
- and vascular complications
- }Prevent atelectasis, pneumonia
- }No DVT
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Professional Role as Patient Advocate
Ensure A Culture Of Safety
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Advocacy
- }Informed Consent”
- }Invasive Procedure
- }Consent for blood transfusion
- }Confirm preoperative checklist is completed
- }Assess readiness for surgery
- }physical and emotional
- }Advanced Directives & DNR
- }orders are on the chart
- }acknowledged by all members of the healthcare surgical team
- Right to be informed and involved in health care
- decisions
- Informed Consent implies that patient has sufficient
- knowledge to understand:
- Nature of and reason for surgery
- Who will perform and if others are present
- Available options and risks
- Risks of surgery and anesthesia
- Possibility of blood transfusions
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}Surgeons vs. NursesRole in Informed Consent
- Surgeon
- }Detailed information regarding surgical procedure, blood use and risks
- Nurse
- }May clarify information
- }Verifies that consent form is signed before sedation
- occurs & signs as a witness
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Assure Safety
}Identify andreport “Key Abnormal Findings” to surgeon
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}Day of Surgery Preoperative Checklist
- }Skin prep (bath, scrub, shower)
- }Hospital Gown only
- (no underwear)
- }No jewelry
- }Tape ring
- }No nail polish
- }No make up
- }Identification and allergy band
- }Prosthesis removed
- }Glasses and hearing aid sent with patient sometimes
- }Antiembolism stockings applied/
- SCD sleeves
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}Day of Surgery Preoperative Checklist
- }Chart
- }Physical Examination
- }Consent
- }Laboratory/Diagnostic results
- }Old Chart sent sometimes
- }Medication Administration Record
- }Addressograph
- }Valuables secure
- }Preop Medications sent
- with patient
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}Day of Surgery Preoperative Checklist
- }When called:
- }Check vital signs and record
- }Check blood sugar if diabetic
- }Have pt void and record time
- }Preop medication given and record time
- }Or given in preoperative holding area
- }Sign preoperative checklist
- }Family may accompanyto OR, then sent to wait in OR waiting area}
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}Intraoperative Care Preoperative Holding
- }Preoperative Holding Area
- }Verify chart completeand consent form signed
- }Check identificationby two methods and verify surgery scheduled}Start IV line
- }Cover hair withhairnet
- }Patient Education
- }Steps of procedure (holding OR PACU)
- }Cold in OR
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}Intraoperative Care Preoperative Holding
- }Complementary/Alternative therapy
- }Administer Preoperative Medications
- }Antibiotics
- }Sedatives
- }Antiemetics/ H2 blockers/anticholinergics
- }Anxiolytics
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Intraoperative CarePreoperative Holding
- Ensure Safety
- Joint Commission National Patient Safety Goal
- }For Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery
- }For surgeries that are site specific have the patient mark the surgery site with a indelible marker
- }Nonoperative site NOT marked
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Surgical Team
- }Surgeon
- }Anesthesiologist}
- CRNA}
- Scrub nurse
- }Circulating nurse
- }OR Surgical Tech
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