Emergency pre operative

 

Emergency pre operative 

 Aims 

-To promote normal respiration

-To promote normal nutritional status 

-to prevent complications 

RESUSCITATION 

I will do a quick history taking from the patient and family members and a quick assessment to know the level of consciousness.i will do vitals as baseline data.

I will do a the following resuscitative measures such Airway, Breathing and circulation to prevent shock and other complications

AIRWAY

-i will assess the patent of airways to know the state of respirations.

-i will remove all tight clothes to promote normal respirations.

-i will sunction the patient in case of secretions to prevent blockages in the airways.

-i will position the head of patient in lateral position to aid the drainage of secretions 

BREATHING PATTERNS

-I will check the respirations to check the patient has difficulties in breathing

-i will position the patient in prompt up position to promote lung/chest expansion 

-i will open nearby windows to promote air circulation in the room.

CIRCULATION 

-I will monitor for signs of dehydrations such as sunken eyes,low skin turgor to know if patient is dehydrated.

-i will monitor the blood pressure and pulse as the base line data.

-i will cannulate the patient on both arms using green cannula in readness for iV fluids.

PSYCHOLOGY CARE

-i will explain the procedure to be done to the patient to prevent anxiety.

-i will reassure the expected outcomes to promote cooperation 

-i will involve the family members in care decision to promote cooperation.

-i will encourage the patient and family members to ask questions to alley anxiety.

-when the patient and family member are clear about the procedure to be done I will let them sign the consent form.

CONSENT FORM SIGNING 

-i will give the patient to sign the consent form if is able a legal witness.

-if the patient is unable to write I will give the family member to sign on behalf and should be fully willing to sign as the witness.

-if both patient and family are not able to write I will let the surgeon sign on their behalf and in there presence.

INVESTIGATIONS

-i will do history taking to know the onset of the diagnosis and onsent of signs and symptoms 

-i will do physical examination to confirmation the signs and symptoms of intestinal obstruction such as severe abdominal pain, abdominal distension and tenderness.

-I will withdraw blood for FBC to rule out anaemia.

-i will take blood for blood grouping and x-matching in preparedness for blood transfusion 

-i will do abdominal ultra sound to confirm the diagnosis 

-i will do chest x-ray to rule out pneumonia

PHYSICAL PREPARING 

=Skin care

- I will shave the patient on area where incision is to be made to prevent infections

-i will remove all artificial nails for easy monitoring of signs of cyanosis 

-i will bath the patient to promote hygiene 

-i will remove all jewelries on hands and neck.

I will remove all dentures if the patient has.

=Bowel preparation 

-i will do gastric lavage if the patient ate anything in less than 8 hours 

-i will keep the patient nill per oral as I prepare the patient for surgery 

-i will encourage the family members not to give anything to the patient not untill the procedure is done.

=Elimination

- I will catheterize the patient for easy monitoring of fluid output 

-i will cannulate the patient in preparation for iV fluids.

PRE-MEDICATIONS

-I will give prescribed antibiotics to the patient to prevent infections 

-i will give prescribed analgesics such as pethidine to relieve pain.

-i will give drugs such as atropine to prevent secretions and dry them up.

OBSERVATIONS

-i will monitor the vital signs before taking the patient to OT for baseline data.

-i will observe the fluid input and output using the fluid balance chart to prevent dehydration and fluid overload.

-i will observe for signs of malnutrition

-i will observe for signs of dehydrations 

COLLECTIONS OF RESULTS 

-i will collect all the lab results in readness to take the patient to OT

-i will put all results and files together with the drug charts for the patient.

LABELLING PATIENT 

-i will label the patient using the hand /forehead band showing the name of patient,age,sex,ward, diagnosis procedure to be done.

GOWNING 

-i will gown the patient using the gown without any cloth inside not even a pant.

TRANSFER TO OT

-i will escort the patient to OT with an emergency tray of resuscitative instruments and drugs in case of shock on the way to OT.

-i will ask for assistant to escort me as I take the patient to OT.

HANDOVER

-i will give the handover to the theater/receiving nurse explaining the names of patient,age,sex, diagnosis procedure to be done,the vitals I got before transfer the patient,lab results and blood if any need to be collected from blood bank.

POST-OPERATIVE BED 

-i will prepare the post operative bed for the patient in preparedness for him after the procedure.

-i will put all resuscitative instruments in the ward such as drip stand,fluids, giving sets,BP machine,pulse oximeter,sunction machine,oxygen machine and other in preparedness for resuscitation after surgery.