NURSING CARE PREPARATION



Operating roomYuliya WhiddenSouthwestern Oregon Community CollegeInstructor: Dustin Hawk, RN, BSNNovember 18, 2014 The patent’s readiness for surgery is critical to the outcome. Preoperative care focuses of preparing the patient for the surgery and patient safety. This care includes education and any intervention needed before surgery to reduce anxiety and complications and to promote patient cooperation in procedures after surgery (Ignatavicius, Workman, 2013). Preoperative care in my patient’s cases started the day before. In telephone interview a nurse obtained information about patient’s labs and other testing to make sure that all needed data is gathered and the patient’s condition allows her to go through surgery safe. If, for example, her labs were incomplete or she had significant deviations from the normal limits, the nurse would contact to a physician to clarify the possibility of the procedure. At the same time, during the telephone communication, the nurse educated the patient about schedule, preoperative, intraoperative, and postoperative interventions. Patient was instructed about diet, fluid intake, and medications to take before surgery. The day of surgery, the patient arrived at time, accompanied with her family member. Nurse anesthetist and nurse collected pertinent data about her health and previous surgery experience. Because of the patient had difficulty during previous anesthesia, she had an additional consultation with anesthesiologist. The nurse evaluated the patient’s knowledge about the procedure, gave her and her mother additional information, started an IV, gave prescribed medications, ensured informed consent, prepared skin on patient’s abdomen (washed with antibacterial solution), applied compression devices and thoroughly documented the information. One of the surgeon assistants assess the patient and wrote his initials on the potential incision site. A circulating nurse received the report from preoperative nurse, checked identification bracelet, ensure that the patient know what kind of surgery she was going to undergo, checked needed documentation and transferred the patient to the surgical suite. During the intraoperative period, the circulating nurse positioned the patient on the operating table, secure the positioning in the anatomical position, assisted anesthesia provider in intubation, ensured that all supplied needed for the surgery was present, ensured that all surgical team maintains sterile technique, and closely documented all interventions.The patient was administered general anesthesia. For this nurse anesthetist premedicated the patient, then intubated and gave IV agents to induce analgesia, hypnosis, and muscle relaxation. During the surgery, anesthetist monitored vital signs, ventilation parameters, and response of the patient on the surgical interventions, and, if needed, she corrected patient’s parameters by giving some medications or changing ventilation numbers.Before starting the surgery, the surgeon and his assistances made sure that this is the right patient and they are going to perform the right procedure in the right area (already noted by initials on the skin). After scrubbing, the surgery team started the surgery, communicated with each other to the point and helping each other. To reduce surgical site infections, the surgical team practiced strict aseptic technique. Before the incision, antibiotic was administered. After the incisions were closed, the surgeon injected an antibiotic into the wound. After the anesthetist woke up the patient and ensured that she could breath independently, the patient was carefully transferred to PACU. Nurse anesthetist and circulating nurse reported to the PACU nurse about the procedure, changing in vitals signs, medications, intake and output and what care this patient would need. The receiving nurse clarified some information and connected the patient to monitoring devices. The patient was assessed constantly, pain was assessed by nonverbal scale because the patient was not able to give the information on numerical scale (she is developmentally delayed) and pain medication was administered. The patient was needed constant reassurance and reorientation. As soon as patient’s vital signs were stable, pain was controlled and patient became more adequate, anesthesia provider assessed her and signed her off from PACU. The nurse gave telephone report to the assigned nurse in PSU and transferred the patient to the post surgical unit. The PSU nurse received the patient in the prepared room, where patient’s family was awaiting for her. It was an invaluable experience for me. First of all, I like the teamwork of all participants of the process. Second, the patient was the center the care, she was treated with respect, her dignity and privacy was protected as it was possible. The job of the surgeon team is amazing in terms of professionalism. I was proud to be a part of this team today. ReferencesIgnatavicius, D.D., & Workman, M.L. (2013). Medical - surgical nursing patient-centered collaborative care (7th ed.). St.Louis, MO: Saunders Elsevier. ................
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