Week 5 - Peri-Operative

Question 1

What are some Peri-Op considerations?

Answer 1

• Vital Signs
• Pre-op checklist
• NBM status
• Medications
• Consent
• Weight & height (if necessary) (Necessary for anaesthetic/medications)
• Specific physical assessments (Neurovascular, Neurological (GCS/PERRLA/limb strength), Respiratory/cardiovascular, Wound assessment)
• Pain (Acute, Chronic)

Question 2

What are some Peri-Op Assessments?

Answer 2

• Medical/surgical/family history
• Blood Tests/scans/X-rays
• Nutritional/fluid status
• Drugs (OTC/recreational)
• Alcohol use
• Respiratory status
• Cardiovascular status
• Hepatic/Renal Function
• Past and current medication use
• Endocrine function
• Allergies
• Psychosocial factors
• Cultural beliefs
• Spiritual beliefs

Question 3

What are some nursing priorities when some one returns from PACU?

Answer 3

• Airway – regular observations
• Vitals (EWS score)
• Pain
• AVPU
• Orientation to time person place (TPP)
• Nausea & Vomiting
• Wound check for strikethrough (through the dressing)

Question 4

What are some potential immediate complications from surgery?

Answer 4

Haemorrhage, atelectasis, shock, low urine output

Question 5

What are some potential early complications from surgery?

Answer 5

Pain, acute confusion syndrome, nausea & vomiting, fever, secondary haemorrhage. DVT, paralytic ileus, AKI

Question 6

What are some potential late complications from surgery?

Answer 6

Bowel obstruction due to adhesions, infection, incisional hernia, keloid scar formation

Question 7

How do you prevent perioperative complications Pre-Op?

Answer 7

• Pre-assessment clinic
• Fitness/Risk Assessment
• Addressing comorbidities
• Continue/stop relevant medications (Asprin for example)

Question 8

How do you prevent perioperative complications Intra-Op?

Answer 8

• Correct & timely antibiotics
• Cardiovascular optimisation
• Specific drugs (i.e. anti-emetics)

Question 9

How do you prevent perioperative complications Post-Op?

Answer 9

• ‘Enhanced recovery’ programmes
• Analgesia
• Early mobilisation
• Regular post op ward rounds

Question 10

How does being bariatric increase risk of infection?

Answer 10

• During surgery, fatty tissues are especially susceptible to infection
• Wound dehiscence, deep vein thrombosis and wound infections are more common
• Patient tends to have shallow breathing when supine, increasing the risk of hypoventilation and postoperative pulmonary complications
• Physical characteristics of short thick necks, large tongues, recessed chins associated with an increased oxygen demand and decreased pulmonary reserves – impedes intubation
• Difficulties associated with positioning, bariatric equipment required

Question 11

What are some considerations for surgery on the older population?

Answer 11

• The older patient has less physiological reserve than a younger person:
  1. Lower cardiac reserve
  2. Decreased renal/hepatic function
  3. Decreased gastrointestinal function
  4. Sensory limitations
  5. Dehydration, constipation, malnutrition may be evident