EMERGENCY PRE-OPERATIVE CARE OF A PATIENT UNDERGOING SURGERY

 EMERGENCY PRE-OPERATIVE CARE OF A PATIENT UNDERGOING SURGERY

AIMS: 1.TO RESUSCITATE THE PATIENT

            2.TO PREPARE THE PATIENT AS QUICKLY AS POSSIBLE FOR EMMEGENCY SURGERY

NB. This is an emergency therefore; the patient will be prepared for surgery as quickly as possible.

ASSESSMENT/ RESUSCITATION

Immediately the patient is received on the ward a quick history taking of the incidence is taken in order to ascertain the cause. The care taker is asked whether the patient has taken anything by mouth and instructions are given not to give anything per oral before surgery. If the client took something, an NGT is inserted in order to aspirate the gastric content thereby, preventing the patient from aspirating intra operatively.

 AIRWAY

The airway is assessed for patency, by noting if there are any secretions in the mouth and nose. If the airway is not patent, suctioning is done in order to clear the airway. The patient is positioned in latent position in order to prevent the tongue from falling back and blocking the airway and this position aids in postural drainage during the post-operative phase.

 BREATHING

The breathing pattern will be assessed by observing the chest raising and falling to monitor the respiratory function. The head will be tilted to the sides to prevent falling back of the tough which can broke the airway and impede breathing. Secretions are cleared to promote good ventilation, if the patient is still intubation will be done to keep the airway patent. Oxygen is administered in case of respiratory distress to improve breathing.

 CIRCULATION

The pulse rate will be monitored every after 15min in order to detect respiratory failure. The patient will be cannulated with two large bowl cannula in order to keep the veins open and for administration of fluids and medication. Peripheral refill and skin turgor will be assessed to rule out dehydration

INVESTIGATIONS/ OBSERVATIONS

Blood will be collected in order to ascertain the following, Bed side clotting time to rule out bleeding tendencies. Grouping and X match in case of blood transmission. FBC in order to ascertain the hemoglobin levels and other parameters.

I will do vital signs as follows:

Blood Pressure to detect shock. Respiration to rule out respiratory distress. Temperature to rule hypothermia/ hypothermia. Pulse to detect onset of shock. 

PSYCHOLOGICAL CARE

The nurse has to introduce him/ herself to the client and relatives. This is important even when the patient is unconscious because the sense of hearing is the last to be lost. The condition of the patient will be explained in simple terms to the relatives so that they are aware of what’s wrong with the patient. Also it is important that the relative ask questions in order to clear their misconceptions about surgery.

CONSENT FORM

After explaining a clear explanation on why the patient has to go under emergency surgery. A consent form is given to the patient if he/she is conscious and above 18 hrs to legalize the procedure. If the patient is unconscious or under 18 years, the relatives who is above 18 years of age will give consent. In cases where the patient has not relative and is unconscious the medical Superintendent can sign on behalf of the patient.

PHYSICAL PREPARATION

 BOWEL/ STOMACH PREPARATION

Patient has to be kept nil per oral in order to prevent gastric aspiration during surgery. If the patient had eaten something a nasal gastric tube will be inserted in order to aspirate gastric contents, also an enema can be passed to evacuate the bowels contents.

 URINARY PREPARATION

A full bladder can lead to obstruction which can lead to injury to other organs during surgery therefore a urinary catheter will be inserted to drain the bladder and also for assessing the kidney function through monitoring the urine output.

 SKIN PREPARATION

A quick bed bath will be done in order to promote comfort and reduce the number of microorganisms on the body.

The area where the surgery will be done will be shaved in order to reduce the number of microorganisms and infections intra operatively.

Make up will be removed as it can mask cynosis

 WHAT TO REMOVE

If the patient’s nails are painted it will be removed aid detection of cyanosis  

If the patient has any prosthesis or jewelries it will be removed to prevent electrocution in case the diathermy machine is used.

 PATIENT IDENTIFICATION

An identification bracelet having the patients name, age, sex, procedure to be done, site, and ward will be given to the patient for identification.

 GOWNING

The patient will be told to remove the clothes he/she is wearing and given a gown to wear when going for the surgery to prevent introducing of infections in theater.

 PATIENTS RECORDS

All patients record such as admission forms, client chart, x ray and other investigation records will be gathered for continuity of care

 ESCORTING PATIENT TO THEATRE

The patient will be escorted to theatre either on a wheelchair or stretcher 

When the patient reaches the operating theatre a proper handover will be given to the nurse on duty together with the patients file containing all the investigations done before surgery. 

POST OPERATIVE BED

After the handover is given the nurse returns to the ward and makes a post-operative bed having all the bed accessories such as bed cradle, bed elevator, cardiac table depending on the need in readiness to receive the patient after Surgery