Fichas
Preoperative care across the lifespan
Fichas del conjunto (39)
- 1Referrals to preop assessment clinicDOSA and DSON pts - seen by
anesthetist, intern, RN, and pharmacist (DOSA only)
M60 - Anesthetic consult
DSU - not seen all in clinic, seen by anesthetist, with questionnaire - 2Preop assessment clinicanaesthestic assessment
surgical
nursing
pharmacist med history
other specialty health professionals - 3Preop assessment plan for each journeypreop - tests, pre meds, referrals
Intra op - type of anaesthesia, position in theatre, monitoring
Postop - immediate recovery care, ward care, discharge requirements - 4Individual patient plancomorbidities
complexity of surgery
type of anaesthetic planned
suitability and fitness for anaethesia
optimisation of patient
investigations
referrals to other specialists
discharge planning - 5benefits of preop assessmentcoordinated efficient, streamlined approach
individual for each patient
minimise delays and cancellations of surgery
improve admission process
maximise theatre time and beds
improve discharge process by addressing requirements
patient education with opportunity for questions and clarification
efficient use of humans and material resources
minimise preventable complications - 6Elective surgery admission category decisioncomplexity of surgery
post op requirements
individual patient risk for anaesthesia
complex patient medical probelms and social supports available
*Emergency patients are not seen in preop clinic, assessed by anaesthetist on ward or in emergency department - 7Admission categories for elective surgeryDay surgery unit (DSU) - admission and discharge on same day
Day surgery overnight (DSON) - 23 hour stay, discharge at 0800
Day of surgery admission (DOSA) - admitted morning of surgery, post operative admission to a pre arranged bed
Inpatient - very complex medical conditions requiring stabilisation pre operatively - 8peri-operative high risk clinicclinic for multiple patient comorbidities
Aim - optimise comorbidities in pre op
minimie post op risk factors
Determine risk of surgery vs conservative management
* risk benefit analysis - 9AIM of POHR clinic continuespatient ed
pre op planning
inpatient planning
post operative/discharge planing
long term follow up - 10Role of nurse in POHR clinicMedical history
Medication history
Social history
smoking history
risk assessments/test investigations - 11POHR clinic assessment examplesrisk assessments - Epworth sleepiness scale, mini mental state exam
Test and investigations - 6 min exercise test, spirometry, BSL
Patient education/referrals - quit line, DARU, diabetes centre, nutrition info sheets, community services referral
other referrals - chest clinic, sleep studies, radiology, blood tests, sometimes advanced care directives discussions - 12Assessment nurse divides patient into categoriesrequiring anaesthetic assessment
assessment nurse only led
phone assessment
post instructions to patient - 13assessment plan for dayfollowing review by surgeon
an experienced nurse carries out initial screening assessment
review anesthetic questionnaire and case notes
considers: surgery to be performed, type of anaesthesia planned, patients age and social factors - 14Day surgery ANZCA guidelinesminimise risk of post op haemorrhage, airway compromise, pose op pain control, no special post op nursing requirements other then H@H, RDNA, MRU etc
rapid return to normal food and fluid intake - 15patient suitability for day srugery*procedure should not be considered in isolation
individual patient assessment: medical, anaesthetic, nursing, social factors - 16patient suitability criteria for day surgerymedical stable ASA 1-111
motivated to have surgery on day basis- most of care will be continued at home
Compliant and able to follow instructions
responsible adult for escort home and supervision first night post op
proximity to a phone - 17American Society Anesthesiologists (ASA) Physical Status RatingASA 1- normal, healthy
ASA 2- mild systemic disease, well-controlled, HT, asthma, diabetes, smoker
ASA 3- severe systemic disease that limits activity but not incapacitating, poorly controlled HT, angina, obesity, resp disease
ASA 4- incapacitating systemic disease that is constant threat to life, unstable angina, CCF
ASA 5 - moribund patient who is not expected to survive without operation, ruptured abdominal aneurysm, massive trauma, intracanial bleed with mass effect, multiple organ dysfunction
ASA 6 - a declared brain dead patient whose organs are being removed for donor purposes - 18Day patient suitability (cont)travelling distance home less than 2 hours depending on nature of surgery
type of anaesthesia, age, medical conditions
proximity to emergency care if required
country patients may need accomodation - 19Day surgery patients important issues to consider before surgeryamount of care required post op
who will care for them
pain management strategies
*day surgery does not mean day recovery, care continues at home - 20identification risk factorsintering with positive outcome can be identified at preop evaluation
consideration is given to patient's age, comorbidities, medications, support systems, nature and extent of planned surgical procedure
type of anaesthesia - 21Pre anaesthetic patient questionairemedications - dose, time, prescribed, herbals, recreational
allergies - medications, anaesthetic drugs, latex, food, anaphylaxis
probelms with anaesthetics - difficult intubation, bronchospasm, arrhythmias, protracted PONV, prolonged recovery, family history
Cardio - angina, MI
Respiratory - asthma, COPD
Renal - ARF, CRF
Hepatic - hep B, C
Neuromuscular - epilepsy, MS, cerebral tumours
cerebrovascular - CVA, TIA, SAH, dizzy
Haematological - leukaemia, bleeding disorders, anaemia
Gastro - reflux, bowel obstruction, crohns
endocrine - diabetes, thyroid disease
musculoskeletal - arthirtis, amputation
neck/jaw stiffness - limited neck movement, linited mouth opening
Dentition - caps, crowns, bridework, dentures
psychiatric history - schizophrenia, alzhemiers
pregnancy/breast feeding
alcohol dependence, history
morbid obesity - 22anaesthetic assessmentidentify risk factors
assessment of suitability and fitness for anaesthesia
organisation for tests and investigations
referral for other speciality opinions
anaesthetic consent - 23Pre operative patient management planPatient anxiety management - pre medication, 1st on theatre list, LA cream
Reflux/nausea prophylaxis - oral ranitidine night prior and morning of surgery/metoclopromide
Respiratory management -pre operative nebulised normal saline - 24Patient management plan cont for pre opDVT prophylaxis - s/c clexane, anti embolic stockings
anticoag management - discuss with surgeon, may cease warfarin, heparin
diabetic management - 1st on list, education on insulin, hypoglycaemics, BGL in clinic and on arrival for surgery
Antibiotic management - prosthetic valves, valvular heart disease
smoking advice - cease smoking 48 hours prior, nebulised salbutamol on arrival
patients breast feeding - 1st on list, provided guidelines and drug info on anesthesia and analgesia while breast feeding
patient with drug/alcohol dependence - discussion with DARU, management plan
latex allergy - notify all peri op staff, 1st on list
prisoners - arrange post op admission for pain relief and observation
third party consent - surgery and anaesthesia, enduring guardian, loco parentis, relative - 25patient management plan contpatients with intellectual disability - ascertain gestures, sounds for pain management if non verbal
non - english speaking patients - assessment for interpreter, discuss discharge in case of emergency help - 26Nursing assessmentvital signs, height, weight, BMI
Health evaluation
nursing assessment
braden risk assessment
verbal and written instructions
pre op requirements
discharge planning
urinalysis/MRSA swabs
Bowel preps - 27Role of accredited RN conducting the NLC patient assessmentaccountable for development of periop plan of care
responsible for following up any results or investigations from specialists
responsible as signing fit to proceed - 28NLC RN responsibilitiesmedication advice, management of comorbitidies, smoking cessation, anti coag management, pre and post op education and pain management, discussion with anaesthetist or surgical reg re plan of care
investigations - ECG/BGL
discharge planning, escort arrangements, post op overnight supervision
work expectations/ restrictions
community services referrals - 29Pre op assessment nurse - pain managementprovides education and practical advice
pain management at home
home care instructions
discharge meds
consideration of additional post op care requirements -ICU bed, acute pain service, diet and fluid management - 30Assessment of an elderly personslowing of reflexes, pressure points and hypothermia, loss of tissue elasticity, less able to respond to stresses
- 31Age related factorsskin sensitive to injury
decreased wound healing
altered response to medication
toxicity and side effects more pronounced
polypharmacy
positioning important
poor dentition
cervical arthritis - difficult to extend neck
stiff joints, need extra supports
allow longer time for questions and explanations
*impact of anaesthesia and surgery must be considered along medical condition and surgical probelm - 32Investigations may be requiredECG, CXR, cervical spine x-ray for rheumatoid arthirtis, blood tests, special tests- PFT, ECHO, est
- 33Surgical admission - surgical unit internmedical history and examination - detailed history of presenting condition
additional tests required
surgical consent obtained by consultant or reg in surgical OPD - 34children having surgeryfamily, past medical history, compliane, diversional therapy, clinical indications, age, surgery to be performed
- 35Discharge planningaim to identify any issues relevant to each patient and initiate action
assess requirements pre op
community services required, short stay facility, respite arrangements - 36Benefits of pre op assessmentindividual for each patient
identify risk factors
optimisation of patient
minimise avoidable post op complications
patient is well informed and prepared for surgery
relevant documentation required and completed for medical and nursing staff
delay and cancellations are avoided on day of surgery - 37Admission processesLHN - maximise service efficiency, continued expansion of day surgery
DOSA - admitted on day of surgery - 38the day before surgerypatient phones in and gets admission time
fasting details
confirms
questioins
issues highlighted
attempt to resolve
further planning
finalisation of plan - 39The day of surgery/procedurepatient arrives in admission area
checked by admin team
clinical admission occurs - checklist
any issues raised
waiting occurs
seen by surgical team/anaesthetist/nursing team
issues resolved
Información
- Descripción
- El usuario ha eliminado su información de asignaturas Fichas sobre Preoperative care across the lifespan, creado por Usuario eliminado el 12/06/2018.
- Creado por
- Usuario eliminado · jun 2018
- Actualizado
- 12 jun 2018
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- 22
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- Creado por Elizabeth Then · 12 jun 2018
- Copiado por Elizabeth Then · 12 jun 2018
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