Preoperative Nursing Management Paper

S.P. should be up out of bed post-op day 1 and wearing TED hose continuously, as well as wearing SCDs overnight in bed. Constipation prevention should e achieved by administering scheduled doses of Colace. Proper nutrition should be encouraged to include plenty of protein to ensure proper wound healing and avoid development of pressure ulcers (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). S.P. should practice coughing and deep breathing throughout her hospital stay to avoid lung congestion and occurrence of pneumonia infection, educating the patient about smoking cessation assistance can be helpful as well.

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The patient’s vital signs have stabilized, with HR in the 70s, BP is in the 120s/60s, regular RR and 37.6o Celsius temperature. Graft site wound bed is pink with tissue granulation noted. The learner is expected to prepare the patient for discharge. This SCE prepares the learner for the following items of the NCLEX-RN test format:

What should the nurse suspect when hourly assessment of urine output on a postcraniotomy patient exhibits a urine output from a catheter of 1,500 mL for 2 consecutive hours?

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

Once the nurse and patient establish a rapport, and the patient is comfortable and willing to proceed with the intervention, preoperative care

Pre-op Nurse—is responsible for working closely with the attending surgeon. Her list of accountabilities include, talking with the patient or guardian forms and asking vital questions to allow for a safe operation. The pre-op nurse prepares all paperwork and makes sure all signatures have been obtained. This is done in the presence of a physician. She is responsible for taking the patients vital signs (blood pressure, temp, and heart-rate, start IV’s) to ensure that are not outside the lines of normalcy. In short the pre-op nurse will perform any duty to ensure that the patient is prepared for surgery this may include talking to family members. The nurse is also responsible

* Monitor fluid and electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with the use of an accurate intravenous infusion

The patient will require surgery to repair the hole in the intestines, and subsequently will have a drainage tube, NG tube, and feeding tube. All drains will need to monitored for placement/movement, and drainage. Input and output will be closely monitored and recorded. The patient will remain on NPO, or nothing by mouth, to rest the bowels along with frequent assessments to monitor for infection and bleeding. The nurse will need to monitor for bowel sounds, vital sign changes, temperature changes, pain, abdomen girth, and wound/incision inspections. The following labs will require monitoring: CBC, H&H, albumin, BUN & creatinine, glucose, and ABG’s and lactic acid if sepsis is suspected. Careful and frequent monitoring of labs will alert the nurse if the patient develops sepsis, or hypovolemia due to excessive bleeding (Belinhof, et al., 2012). In addition to vital signs and labs, the nurse will also include patient assessment into consideration before drawing conclusions by means of critical thinking. After the full assessment has been made, the nurse will report any findings to the health care provider that require further investigation or

She is with the patient throughout the full process. Before the operation, she will prepare the patient to receive the anesthesia and will perform a full patient assessment. This determines any patient allergies to certain chemicals or drugs; what medicine the patient can receive; how their bodies will react; and where the injection should be administered. Sometimes, the drug will be given in the form of an onsite injection, similar to an epidural. When the operation begins, Kelly will then assist the physician with monitoring and administering the anesthesia to ensure proper sedation. If the patient is not fully put to sleep, and a portion of his or her body is numbed instead, she monitors the input on the site of injection and ensures the patient cannot feel anything throughout their body. When the procedure is concluded, Mrs. Leonard’s duties will continue. She is in charge of overseeing that the patient recovers from the anesthesia smoothly and cares for the patient’s post-operative needs until they are

Jones arrived at the operating room at 0745 hrs. Patient was transferred to OR table with arm boards at a 90-degree angle and shoulder braces. Anesthesia administered general anesthesia at 0800 hrs. Anesthesia intubated patient at 0810 hrs. Hair was removed from perineum prior to skin prep. A catheter is inserted into the urinary bladder, the bladder is irrigated. Skin was prepped with Chloraprep from nipple to mid-thigh, and allowed to dry for 5 minutes. He was draped with cuffed towel and an impervious sheet under the scrotum, folded towels, sheet with an aperture, laparotomy sheet and an individual drape sheet. First count with surgical technologist and circulator is accurate.

In addition to the above, nurses should check the surgical site for redness, swelling, and purulent drainage to prevent infections. (Cincinnati children's hospital,2017).

Once the information is recorded a care plan based around the pre operative assessment can be created using the next step in the

The plan I would need in place would first to address her respiratory status and maintain a patent airway. I would also want to have the patient demonstrate how to splint while deep breathing or coughing. I would ask the Cna to help with position changes every 2 hours or more if needed for comfort for the patient. I would need to do a full assessment at this point if the patient is more stable. By having the patient deep breath will also help her return to consciousness, (Ahmed, Latif and Khan, 2013). I would want to keep her comfortable and in as little pain as possible. I would also want to try to educate her as to when to push for pain medications from her PCA pump. If there were any family I would want to try to get them involved with the education as well. The use of an incentive spirometer should be included in the teaching too. I would keep monitoring the incision site and watching for signs that the patient is in pain. While I was working on patient education with this patient, I would ask the CAN to do vitals on the 2 postop patients every 15 minutes for the first hour, reporting abnormal vital signs to myself or the other R.N. I would also ask the other R.N. if she/ he would do the discharge for that patient, while I remain with this patient and make sure she is going to stay stable.

A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional