Perioperative and Postoperative Care Flashcards
What are the 4 types of surgery?
Immediate
Urgent
Expedited
Elective
What are the aims of the pre-assessment clinic?
reduce cancellations reduce bad days addresses patient risks optimise patients prior to surgery helps prevent complications
What is involved when a patient attends pre-assessment clinic?
Hx: PMH in full drugs & allergies previous general anaesthetics exercise tolerance
examination: ABCDE
ASA Grade –> follow national guidelines - traffic light system to see what tests need to be run eg renal function
grade of surgery
-1 = minor whilst 4 = major +
Identify risks - P-POSSUM
Determine level of post-op care
Inform patient
What is the ASA grade?
ASA Grade - determine co-morbidities 1 = healthy patient 2 = mild systemic disease 3 = severe systemic disease 4 = severe systemic disease + threat to life 5 = moribund aka death within 24hrs 6 = brain dead --> organ donation suffix E = emergency
When is an echocardiogram performed at pre-assessment clinic?
if heart murmur + cardiac symptom
OR
signs of HF
When must a patient stop eating food prior to surgery?
6 hrs for food
4 hrs for breast milk
2hrs for clear fluids
How are incidents reported?
Datix
What is the WHO surgical sign-in?
Before the patient undergoes anaesthesia;
the patient must confirm his/her identity
the site of operation
what procedure is to be carried out and that he/she has consented for the procedure.
The site of operation must be marked if applicable.
Then the presence or absence of allergies must be checked
the amount of expected blood loss discussed
an anaesthetic safety check must be completed.
What is the WHO time-out?
Before the surgical procedure begins (i.e. before the first incision);
All the people in the room must introduce themselves by name and role.
The surgeon and anaesthetist must then confirm the name of the patient and the procedure taking place, and any anticipated critical events, and consent form
These clinicians also discuss the need for antibiotics and imaging
What is the WHO surgical sign-out?
Before the patient leaves the operating room;
The instrument, sponge and needle counts are checked
The equipment is checked
The specimens are checked and appropriately labelled. The surgeon, anaesthetist and nursing staff then must discuss any key concerns for recovery management of the patient.
What is NatSSIPs?
= National Safety Standards for Invasive Procedures
What is monitored post-op?
Vital signs
fluid balance
blood results
What medications are given post-op?
VTE prophylaxis
Prophylactic Abx
analgesia
Beyond medication and obvs, what else is involved in post-op care?
nutrition
wound cleaning
physiotherapy
What are some general surgical complications?
haemorrhage
VTE
wound complication
SIRS = systemic inflammatory response syndrome
can be immediate/early/late
