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Study Unit 5.1

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12 views

Study Unit 5.1

Uploaded by

wilmimostert5
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Study Unit 5: Operation theatre

principles
Presented by: Ms. D Lesao
Overview of the Study Unit

• Study section 5.1 Introduces preoperative care


• Study section 5.2 Introduces intraoperative care
• Study section 5.3 Introduces postoperative care
Pre-operative care
Study Section 5.1
Learning outcomes
• Define the concepts related to perioperative
nursing.
• Discuss medico-legal risks related to preoperative
nursing care
• Discuss the legal and ethical issues related to
informed consent
• Discuss assessment of patient going for surgery
or therapeutic diagnostic procedure
• Plan, implement and evaluate preoperative nursing
care
• Discuss preoperative checklist
• Explain skin preparation for preoperative care
Concepts

• Informed consent: autonomous decision by the patient to


undergo a surgery after the surgeon has thoroughly explained the
nature, reasons and benefits of the procedure
• Perioperative nursing care: three phases to the care of the
patient undergoing surgery from admission to discharge, including pre-
intra-postoperative phases specific surgical interventions
• Premedication: prescribed to calm the patients and to pre-empt
anaesthesia
Classification & types of surgery

• The extend of the procedure , possible effects and


risks: minor or major surgery
• The objective and character of the procedure:
ablative, constructive, cosmetic, curative, palliative, diagnostic, exploratory,
prophylactic, reconstructive

• Urgency of the procedure: elective or emergency

Indications:
• Inappropriate or failed medical management
• Conditions that can be cured or corrected by surgery
• Diagnostic purposes
Preoperative phase

• Decision is made for surgery


• Patient is handed over to the operating room nurse
• Admission to the health facility
• Physical, psychological, emotional and spiritual
preparation:
• Safety and comfort
• Relay information related to the surgery
• Investigations to prevent complications, weigh risk
factors
Preoperative patient assessment

History of the patient (Identify high risk patients)


• Socio-economic: religion, cultural, education background
• Medical history: medical conditions, medications, previous
surgeries, sleep patterns
• Hospitalisations: Transfusions, response to previous
anaesthesia, allergies
• Lifestyle: exercise, smoking diet, alcohol
• Learning needs: information received from the doctor,
preconceived ideas, misconceptions
Preoperative patient assessment

Physical Examination
• Vital signs
• Weights and height
• Bruises or wounds
• All systems evaluation, note early abnormalities
and report to surgeon
• Nutritional status
• Ability to perform activities of daily living
• Anxiety levels
Preoperative patient assessment

Diagnostic tests
• Ensure all diagnostic tests results are included in
the patients file for instance: FBC,
electrocardiogram, x-rays etc.
• The results of the tests provide an objective
baseline regarding patient health status,
abnormalities to what needs to be verified by
diagnostic test or rectified by surgery
• Registered nurse must verify the test results and
report all abnormalities, the data must accompany
the patient to the operating theatre
Legal and ethical issues of the consent form

• Legal issues: agreement, information explained, NHA 61


of 2003 all procedures involving body invasion requires
consent of the patient
• Ethical issues: self-determination, autonomy, doctor’s
responsibility, advocacy role of the nurse, informed
consent-information to make decisions
• Medico-legal hazards: incomplete form, no procedure
indicated, signed by the wrong person, patient sedated, no
witness, multiple use, wrong procedure to obtain consent,
coercion
What are the legal How many types of
requirements of a consent did you witness
consent form? in hospital?
Informed patient consent
• Obtained on admission / when
surgery is confirmed by
surgeon as part of treatment
• In minors and mentally ill,
parents or guardians give
consent
• Ensure full completion of the
form
Is signed by all relevant parties
NB: Assist in preventing medical
legal risks such as :
1. Surgery on wrong patient
2. Incorrect procedure / wrong
limb operated
Preoperative check list
• Prior patient is transported to surgery ensure
Correct identification with an extra bracelet for the name
of the procedure
Informed consent
An intravenous line available
Nutrition
Nil-per-mouth
Skin preparation
Site-marking, bowel preparation
Correct identification of patient’s documents
Truthful vital signs obtained
Preoperative drugs administered if required
Preoperative patient assessment
Psychological assessment
• Identify any emotional tension and anxiety as it
may increase the great risk of complications
Contributing factors leading to anxiety
• Previous experience of surgery
• Lack of, or no knowledge of surgery
• Fear such as : Pain/anaesthetics/death or possible
complications, consequences of surgery
How can we assist with patient presenting with the
above concerns or fears ?
Preoperative skin preparation

• Hospital or ward protocol must be followed

• What is the current practices in skin preparation for


theatre?

• NB: No clipping or shaving is done in the ward as it


cause possible surgical site infections
Role of the nurse on day of surgery
Final preparation, usually 2 hours prior surgery
• Explain the preparations, clothes, transport, jewelry, dentures,
nail polish, prosthesis
• Personal hygiene, follow instructions, antiseptic, normal or
saline wash
• Remove prosthesis, jewelry, contact lenses, make-up, nail
polish
• Weigh and height, vial signs
• Correct identification, allergies
• Perform preoperative procedures such as catheter insertion, IVF
line, NGT, skin and bowel preparation
• Give premedication and ensure rest and safety of the patient
• Assemble patient records and necessary equipment, blood
products
Game time: Suffixes used in Surgery
1 2 3
A. -centesis
B. -ectomy 4
C. -ostomy
D. -otomy 5
E.
F.
-oorhaphy
-opexy
6 7
G.
H.
-oplasty
-otripsy
8
I. -scopy 9 10
J. -desis
Final thought

“I learned a long time ago that


minor surgery is when they do
the operation on someone else,
not you.”
Bill Walton

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