PRE OP CARE EMERGENCY

PRE-OP CARE EMERGENCY

ORIOPCPPBTP

1.    OBJECTIVES/GOALS

2.    RESUSCITATION

3.    INVESTIGATIONS

4.    OBSERVATIONS

5.    PSYCHOLOGICAL CARE

6.    CONSENT

7.    PHYSICAL PREPARATIONS

8.    PRE- MEDICATION

9.    BASELINE VITALS

10.TRANSPORTATION/HAND OVER

11.POST OP BED

 

 

 

  1. OBJECTIVES

-TO RELIEVE PAIN

-TO ALLAY ANXIETY

-TO PREPARE THE PATIENT FOR SURGERY.

 

2. RESUSCITATION      

·       Do quick assessment of level of consciousness and get brief history concerning pain; where, when, how and previous food eaten

·       Assess airway, breathing, circulation and hydration status.

·       Attend to these immediately to restore normal body functioning.

·       In most emergencies, investigations are done at the same time with resuscitative measures.

 

Airway

 Inspect for any blockage either by foreign body or secretions and make it patent by suctioning and repositioning.

·       Clean the vomitus with a clean cloth gently and avoid trauma.

Breathing

 Observe the raising and falling of chest wall and listen to breathing sounds

·       Count the respirations per minute for baseline data

·       Observe  for nasal flaring and cyanosis resulting from insufficient oxygen perfusion to the tissue due to obstructed airway

·       Check  blood oxygen saturation as baseline.

·       Commence  supplemental oxygen therapy by nasal catheter or mask at 5 Litres per minute.

·       Initiate breathing with ambu bag where chest movements are absent and

·        Do cardiac massage to stimulate cardiopulmonary activity.

·       Intubate  with  endotracheal tube where necessary and connect patient to the  mechanical ventilator for artificial respiration

·       Insert an NG tube to decompress the abdomen in cases of abdominal distension.

·       This promotes full lung expansion since distension tends to push abdominal organs to the thoracic cage.

 

 

Circulation

 

·       Check the pulse and blood pressure to rule out hypovolemic shock

·       Ascertain the level of dehydration by checking for skin turgor and sunken eyes or dry lips.

·       Access the IV line and commence fluids infusion to restore intravascular volume and correct shock- give plasma expanders

·       Intravenous fluids  also  correct fluid and electrolyte imbalance and  provide nutritional maintenance during periods of no oral intake

·       Continue monitoring the pulse and BP every 15 minutes

·       The foot end of the bed is elevated to promote blood flow to the vital organs of the body such as lungs, brain and the heart.

·       The patient is covered with extra linen to keep him or her warm.

 

INVESTIGATION

 All surgical patients undergo diagnostic tests for the circulatory, pulmonary and renal systems. The best laboratory tests include:

ü  Urinalysis

ü  Hemoglobin count

ü  Grouping and cross matching in anticipation of blood transfusion intraoperatively or postoperatively.

ü  Hematocrit

ü  Bleeding time and clotting time

ü  Electrocardiography

ü  Chest X ray

ü  Blood sugar test to rule out diabetes mellitus

ü  NB: other Laboratory investigations may be considered such as Liver Functions Tests depending on the condition of the patient.

 

OBSERVATIONS      

Vital signs such as Temperature, pulse, Respirations and Blood Pressure to be done on the patent to prevent shock.

PSYCHOLOGICAL CARE

·       Educate the patient on the surgery to be done on him or her. Reassure the patient about the outcome for the Surgery. The patient should know the importance of the Consent Form. Assess the patient’s concerns, his perception of surgery and usual patterns of dealing with stress identified. You can assess the level of the patients’ anxiety by observation of behaviors such as hypersensitivity, increased talking, and repetition of questions, crying, physical withdrawnness, decreased social interaction and insomnia. The signs of stress  in a preoperative care  include:

i.                 Increased heart and respiratory rate

ii.               Increased blood pressure

iii.             Moist palms

iv.             Restless movements

 

Encourage the patient to reveal his fears and concerns which you should know and show that they are real, acceptable, reasonable and expected. After recognizing the problems, you may initiate a discussion by saying, “I am sure you are aware about your impending operation. There may be something I may clarify for you if you would like to talk about it.” Unrealistic fears based on misinformation and misconception can be alleviated by providing factual information.

Any anticipated change in body appearance must be explained and advise the patient as to the available assistance and how he may manage his life. You may encourage the patient to see and talk with another patient who has had the same and successful operation.

CONSENT FORM

Quickly explain the importance of signing the consent to the patient if conscious.

Let the patient sign if conscious, above 18 years and in a sound state mentally.

Relative to sign the consent if the patient is unconscious

If no relative available the surgeon can sign on the patient’s behalf.

PHYSICAL PREPARATIONS

 Although the preparation details if sites differ according to the area being prepared, the basic principles governing are the same. Preoperative skin care is given in order to have the skin as free as possible of dirty particles, hair, cells, secretions and organisms. Shaving of the skin is done when ordered by the surgeon as other surgeons would rather have the patient go to the operating theatre unshaved. Operations on the skull or scalp require shaving of the whole head. If the operation is on the breast the shoulder or arm requires shaving from the elbow over the shoulder to the mid line of the back and the nipple line on the opposite side. The axillae must also be shaved completely. For abdominal operations the whole abdomen and lower thorax must be shaved in all cases. The pubis, groins and upper thigh must be included. For hernia operations the whole abdomen below the costal margin must be shaved. On the hip the appropriate side of the abdomen, pubis, perineum and the whole of the thigh must be shaved. Lower limb operations require preparation of the whole body. The patient has to have a bath, shower or bed bath the evening before or morning of surgery using an antibacterial solution or preparation. And before surgery he is given a clean hospital gown. Clean the mouth, teeth, night before and on the morning of operation to make sure that all food particles are removed. Remove the dentures because they may become displaced during operation and interfere with respiration. All jewllery is removed and kept in a safe place. The hair is combed and neatly arranged back from the face without hear pins, no coloured lips or nail polish for easy checking for cyanosis. An identification bracelet should be applied and checked with the correct name, sex, age, date, diagnosis and possible procedure. All the charts of the patient (laboratory results, X ray films, doctors’ and nurses’ notes etc) are put together so that they can be taken together with the patient to the operating theatre. Communication with family[M1] 

Tell the family where to wait from and expected time of surgery and who to contact for update during long operations.

 

PRE MEDICATION

 The main purpose of premedication is to reduce anxiety so that the maintenance of anesthesia will be smooth. A sedative is usually given a night before an operation to ensure a good night sleep. In Emergencies cases you can only give atropine, pethidine , and an antibiotics of choice.

 

BASE LINE VITALS

Temperature, pulse, Respirations and Blood pressure is done for a measure with the Vitals  Signs during Surgery to determine whether the condition is detoriating.

TRANSPOTATION/ HANDOVER

When all is done and the patient is ready inform the operating theatre and put him on the stretcher covered warmly. He is taken to the theatre at the arranged time. A nurse escorts the patient and on arrival to the operating theatre she introduces herself and her patient to theatre staff. Tell them the necessary information concerning his name, sex, age, diagnosis and possible operation. Show them the latest vital signs taken and the operation site.

 

POST OP BED

Soon after the patient has been taken to the operating theatre, make a Post Operative bed in anticipation of the patient’s return and organize all necessary resuscitation equipment and bed accessories e.g. suction machine, oxygen source, drip stand, TPR tray oral airways, needles, syringes of correct sizes, intravenous fluids, emergency drugs etc. The patient’s bed Post Operative bed should be near the nurse’s station for easy observations

 

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 [M1]Added subtitle