Post Operative Nursing

Upon observation of the circulating nurse, I noticed that she was very interactive and involved in the surgery. One of the responsibilities of the circulating nurse is to retrieve any surgical supplies that are not available in the operating room and to make or receive any calls for the surgeon. During the surgery, I noticed the nurse call for an x-ray for the surgeon, the laboratory for biopsy samples, and the operating room floor front desk to inform them that the surgery would be later than expected. This is her responsibility as the surgeon cannot break sterility by touching the phone and it is easier for him to communicate through her and not leave the surgical site. Also in the operating room, I observed the scrub nurses’ roles. Before the operation, the scrub nurse opened all of the sterile packages, arranged them on the sterile field, and took count of what was there along with the circulating nurse. The scrub nurse did this because she is sterile during the entire procedure, and once the sterile packs are opened, the contents can only be handled by sterile personnel. The scrub nurse also was ready and waiting at the sterile field at all times to get the surgeon any equipment needed from the sterile field. This is helpful to the surgeon because it enables the surgeon to stay at the surgical site and convenient for when

This essay discusses and reflects upon patient care in the post anaesthetic care unit (PACU) and is linked to my experiences on placement. It discusses how my approach to patient care has been challenged and analyses how evidence based practice can create a change in the way patients are cared for. It reviews the processes of managing the perioperative environment and evaluates the implications for practice when applying a change in healthcare. Wicker and O’Neill (2010) state that “The lack of immediate medical support in the recovery room means that practitioners work in a more autonomous role than any other area of the operating department” (p.379). By reflecting upon my experiences I am able to link practical and theoretical aspects of the operating department practitioner (ODP) job role. This will provide me with a greater understanding of professional practice and it will develop my personal knowledge and self-awareness (Forrest, 2008). Using a model of reflection is important as it provides a framework that can be systematically followed and acts as a guide through the process of reflection. For this essay I have chosen to use the Gibbs’ Reflective Cycle (1988) as it provides a methodical guide to reflection using a series of ordered questions that each lead to the next stage of the cycle (Forrest, 2008).

* Personnel Issues: One of the key barriers to effective interaction for the pre-op nurses is that they are not getting any information from the registrar or the surgeon related to the patients unique circumstances. There is not a communication process in place for the pre-op nurse to actively communicate with the surgeon or his office regarding a patient’s care during their day of surgery. An additional factor in this situation was the pre-op nurse documented the mother’s contact information in her notepad, but not on the

The purpose of this surgical follow through paper is to discuss Mrs. R’s experience as she moves through four different clinical experiences or phases that make up her surgical procedure. The phases Mrs. R will move through consist of her pre-operative clinical experience, her intra-operative clinical experience, her recovery room clinical experience, and finally her post-recovery room

Post-Operative Nausea and Vomiting (PONV) is defined as any nausea, retching or vomiting occurring during the first 24 hours after surgery (Oxford Journals). It is an uncomfortable and unpleasant experience for the patient and can adversely affect the post recovery outcome by causing dehydration, electrolyte imbalance, aspiration, wound dehiscence, increasing length of stay (LOS), unanticipated admission, and increased healthcare costs, not to mention a top concern and great dissatisfier for the patient (JPN, Hodgens). Since approximately 30% of all post-operative patients

She made sure that the patient’s belongings were gathered and placed in a bag for easy access when he was finished with his surgery. She confirmed that the patient had nothing to eat or drink that morning and showered twice with specific antibacterial soap. She signed as a witness on the consent form stating that the patient voluntarily signed the form. She completed an assessment for a baseline to compare when he would be in the recovery room. In addition, the nurse determined that the preoperative checklist was completed and all prescribed medication was given before the patient proceeded back for the operation. The nurses in the intraoperative phase were more concerned for the patient’s safety during surgery. They stressed the importance of me keeping a foot away from the sterile field at all times and ensured that the patient’s limbs were secured in place. An important patient care detail that occurred was the count of items utilized during the operation. The scrub and circulating nurse counted each piece that was used and made sure that everything was accounted for. In the postoperative phase, the nurses were primarily focused on the safety and orientation of the patient. The recovery nurses assessed if the patient was able to smile symmetrically, stick out his tongue, bilaterally squeeze with his hands, and perform plantar and dorsal flexion of his feet. They evaluated the pupils to ensure they reacted to light and assessed the vital signs closing to any

The preoperative stage is when the patient comes to the OR and is being prepped for the surgery. The patient is verified by the nurse, who needs to check patient identification, patient records and make sure is calm for the surgery. Before this particular surgery, the anesthesiologist came down before the surgery to administer a block to the patient. The block is to dull the nerve ending so when the patients comes out of surgery he will be in less pain. The consent form is signed by two people, the patient and the doctor performing the surgery. The consent form is the responsibility of the doctor, the nurse just verifies that both the doctor and the patient signed the form. It is very common for a patient to be anxious right before a major surgery. My patient didn’t seem anxious but just wanted it to be over and done with. One of the most important part of a nurse’s job is to keep the patient calm and relaxed. That can be accomplished just by talking to them and reassuring them. Keeping the patient company will also ease their nerves. The nurse makes sure the patient is calm and relaxed right before surgery. It is also important for the holding area nurse to make sure

The implications that can be applied to nursing and health care that I have discovered from Zhang’s study of the Impact Of Nurse-Initiated Preoperative Education on Postoperative Anxiety Symptoms and Complications After Coronary Artery Bypass Grafting are postoperative psychological assessments, professional psychological counseling, and the use of patient anxiety scales (2012). In my clinical placement, I have evaluated the postoperative assessments and education that takes place and it does not include psychological counselling or the use of anxiety of scales. By implementing and utilizing these three findings from the research study, it can inform a nurse’s empirical way of knowing. A nurse’s empirical way of knowing will be informed because based on the theories and results from the research study on reducing post-operative anxiety and complications, nurses can identify patients at risk for developing post-operative anxiety and implement care plans to help these patients. Furthermore, I also think that this evidence has informed a nurse’s personal way of knowing because once a nurse has the experience of providing thorough and effective preoperative education and counselling strategies, the nurse will be able to reflect on the experience and use a similar educational approach to other

In order for a effective and safe surgery, communication and collaboration must be sufficient. It was found that nurses are less likely to speak up or feel supported by other members of the health care team during surgery (Gawande et al., 2003). These communication problems can

Thinking ahead contingency planning and managing the unexpected are core skills for a perioperative nurse. Alfredsdottir and Bjornsdottir (2008) describe how prevention is a core component of the perioperative nurses work. Perioperative nurses consider how the background of their patient may contribute to their susceptibility and instability and how these may be risk factors during their patients surgery, this means trying to imagine everything that could go wrong and taking reasonable steps to manage these scenarios.

The article obviously illustrates a possible factor contributing to the occurrence of Mr. Lee’s re-operation. A research finding shows approximately 90 percent of nurses experienced an understaffing situation and the majority of them had an experience which they could not develop their nursing care plans (Ball et al. 2014, p. 116). However, a shortage of nursing staff in this case study can be solved because there were five times opportunities to receive support from the PACU. Staff shortage in this case study was clearly a solvable problem, and not only making time to provide nursing care, but also sharing or obtaining information about post-operative management with the PACU staff. It is a fact that there are many specialised nurses in a

I feel that with experience and practice that any medical-surgical nurse can tackle any situation whether stopping fluid from leak out of an abdominal incision site to suctioning a tracheostomy patient. A nurse should address situation under pressure but remain calm and to be able to think of the next step.

Postoperative pulmonary complications are common especially in elderly patients with comorbidities. Nearly 5% of all patients undergoing non-cardiac surgery experience significant pulmonary complications and are a common cause for postoperative morbidity and mortality. They account for up to 40% of all postoperative complications and 20% of potentially preventable deaths.29 The most common pulmonary complications to occur are lung collapse, hypoxemia, hypoventilation, acute respiratory distress syndrome, and pneumonia. Development of these complications can extend the intensive care unit stay and increase mortality. Patients of 70 years of age and above have a higher risk of respiratory complications including bacterial pneumonia, noncardiogenic pulmonary edema, and respiratory failure requiring intubation compared to younger paients.30 Age-related alterations in

In the pre-op I shadowed Hope, she has a very alert, attentive, focus and organized. Hope verified all the information she had received from Roxie, and went through again with the patient. Hope explained to the patient about drugs being administered before he will be wheeled into the operating room. Various drugs reduce vagal –induced bradycardia, inhibit oral and gastric secretions, and decreased the amount of anesthetic needed for the induction and maintenance of anesthesia (Ignatavicius & Workman, p 234). Before Hope administer all the ordered medications to the patient, the anesthesiologist came in and talked to patient, went through all the information about the past medical history, allergies, and if he had any reaction to any anesthetic agents that they use. The anesthesiologist also had a form explaining to the patient how the doctor preferred the patient to be anesthetized during the procedure which is general anesthesia commonly used in this kind of procedure. After all the anesthesia information was explain to the patient, the patient signed the form. Hope also waited for the surgeon to come and see the patient while the patient still awake before Hope can administer all the preoperative drugs and verify the operating room team that their patient is ready. When all of these are said and done Hope administer all the medications and

There is an ongoing shortage of qualified registered nurse (RNs) that it making it impossible to meet the demand for competent nurses. This forces less competent nurses to take on more responsibilities, thus inhibiting the ability to provide the safest possible care (Duffield et al. 2005). According to ACORN Standards (2014), in a theatre there should be a competent scrub nurse, scout nurse and an anaesthetic nurse. In the facility, there is no anaesthetic nurse, instead there is an anaesthetic technician. For the day the list was scheduled, the skill mix of the nursing staff was very poor, as the allocated staff in the theatre were a new graduate nurse and a novice nurse. Due to their inexperience, newly graduate and novice nurses may display insufficient levels of clinical performances (Hill 2010). Sternotomy for thyroidectomy and left upper lobectomy are complex procedures, thus it is much safer to have an experienced nurse for scrub and scout. Moreover, the VAT procedures have the potential to be life-threatening at any point due to the possibility of injuring the major pulmonary structure (Jancovici et. al 1996). Novice nurse may not know how to respond to certain situations or cues, which may endanger the life of the patient (Duffield et al. 2005). To manage this issue, on the day before surgery, the floor co-ordinator called casual experienced staff to