Goal of Preoperative Admission Clinic (PAC)?
gather data in order to identify risk factors and plan safe patient care by: -Physical Examination by Doctor -Preoperative checklist -Patient Interview -Lab results -Dissemination of Information regarding: preparation required knowledge required
Primary purposes of pt interview?
1.Obtain patient health information 2.Determine the patient’s expectations of surgery and anesthesia 3.Provide and clarify information about the surgical procedure 4.Assess the patient’s emotional state and readiness for surgery 5. Begin some postoperative teaching
Assessment & Intervention purpose?
Risk factors ↓ How requisites might be affected and therefore what to assess ↓ Total CareRequired – nursing interventions Ill Health usually changes the total care required and limits the SCA When “calculating” an individual’s total care required, one must consider his/her self-care requisites (USCRs, DSCRs and HDSCRs) as well as his/her BCFs. (collect data and look at risk factors)
All surgeries have an element of risk, related to: Type of surgery Who the individual is ↓ We assess the individual’s risk factors using the collected: BCF data and Self-Care Requisite data -Know risk factors for that specific pt
Age & Developmental Stage?
Examples: Very young Concern for heat loss → risk of hypothermia Very old Slower turnover rate in epidermal cells → affecting wound healing (cognitive,mobility)
** Health State**
-Feelings and Emotions Fears- #1 cause of anxiety Anxiety Hope- #1 positive outcome -Physical state Temperature – being cold will affect lung capacity, cardiac hx, pain -View of illness Outlook on outcome of surgery – how will it affect ADLs
Fears of surgery?
1. dying 2. complications 3. pain
Health Care System Factors?
Current Medical Diagnosis i.e. right hip arthroplasty related to hx. of osteoarthritis Summary of Current Medical Condition Review of systems Cardiovascular Respiratory Nervous Urinary etc. neuro assessment A,Ox3
Religion and Spirituality Language Culture important for pt to feel less anxiety
Family System Factors?
SIGNIFICANT OTHERS (support system) Key to reducing Anxiety Stress if no family present, get social worker
** Patterns of Living
Life Experiences Medical history Previous illnesses Hospitalizations -Allergies/Sensitivities Medications Foods Chemicals Tape Pollen Latex Medications (prescribed, OTC, herbal/vitamins or illicit drug use) Methods of Coping
**OTC medication that causes complications?
Echinacea: inflammation of liver Ginseng: increase bleeding St-Johns Wort: prolonged effects of anesthesia Vitamin E: increase bleeding time should be stopped 5 days before sx
Standard ACTION DEMAND for the patient in the perioperative period related to the USCRs?
Maintain sufficient intake of Air Maintain sufficient intake of Fluid Maintain sufficient Nutrition Maintain Elimination processes Maintain a balance between Activity and Rest Promoting Safety Promote a sense of Normalcy Maintain a balance between Solitude and Social Interaction Learning deep breathing and coughing exercises Learning to use the incentive inspirometer Learning to turn and position in bed Learning the importance of ambulation DB&C Removing make-up and nail polish preoperatively Removing dentures preoperatively Reducing weight if necessary Receiving anticholinergic drug 1 hour preop, if ordered (dries up secretions)
wound opens up
bowels/abdominal organs fall out of incision site
Maintain sufficient intake of FLUID? Reduce the risk of fluid and electrolyte imbalance postoperatively by:
Drinking adequate amounts of fluid per day (~2 L/day for an adult) Eating three balanced meals a day Reporting any fluid loss such as vomiting or diarrhea
Maintaining sufficient Food ? Prevent malnutrition due to the stress of surgery and the short term starvation that follows it by:
Eating a diet adequate in protein and calories Eating a well balanced diet, as per Canada’s Food Guide
Maintaining ELIMINATION processes?** Prevent urinary retention and possible atonic bladder in the post operative by: Prevent abdominal distention in the postoperative period by:
Voiding immediately before receiving preoperative med(s) to void atonic bladder Remaining NPO for the required period preoperatively Receiving an enema preoperatively, if ordered. auscultate bowel sound, passing gas? **no bowel sounds due to NPO,
Maintaining a balance between ACTIVITY and REST? Prevent thrombophlebitis and deep vein thrombosis(DVT) in the postoperative period by:
Learning the importance of leg exercises (ankle/calf pumps) Learning the importance of ambulation Learning the importance of changing positions in bed Requesting analgesics to maintain pain ≤ 5/10 Ted stockings-prevent clot formation, increase venous return
nerve endings don't send signal to void
Promoting SAFETY? Increase the ability of tissues to repair in the postoperative period by:
Eating a diet adequate in proteins Eating a diet rich in Vitamin C, A, K Verbalizing concerns to reduce stress and anxiety
Prevent injury from occurring during the preoperative and intraoperative period by:
Removing jewelry, hair pins, piercings preop Any exceptions? hearing aid Removing all prostheses Any exceptions? no Remaining in bed once any preop meds have been administered Stopping ingestion of all hazardous substances (tobacco, alcohol, illicit drugs)
Prevent the possibility of any incorrect procedure being performed by:
Wearing a patient ID bracelet Signing voluntarily, an informed consent for surgery surgeon signs consent form with pt
Promote a sense of NORMALCY Prevent the possibility of the loss of valuables by:
Locking valuables in safety box or sending them home with a family member
Decrease preoperative anxiety by:
Learning about and preparing for surgical interventions Receiving preoperative medications, as ordered Asking questions and discussing fears Receiving spiritual therapy Participating in recreational and diversional activities Using guided imagery Using distraction
How to do the WHO surgical checklist
-allergies -consent -name/DOB -warming blanket
Preparing the Return of the Patient to the Unit?
Arrange the room – place all clothes in locker Clear surfaces – put things in drawer or locker Prepare equipment needed IV pole and pump Suction Oxygen Emesis basin & tissues Preparation of Bed Clean linen, extra PK, top covers folded for easy access Extra pillows if needed Height of bed adjusted for stretcher Room furniture placed to allow stretcher to enter easily
Frequently Used Preoperative Medication