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Preoperative Patient Care ST210 Concorde Career College, Portland Preoperative Patient Care Objectives: Identify reasons for surgical intervention List and describe the elements of the preoperative patient care routine and state the rationale that relates to each element State the purpose of proper patient identification and describe the identification process in the surgical setting Preoperative Patient Care Objectives: List the type of information that must be contained in the patient’s chart and describe the importance of each item Define the term informed consent, list the contents of the consent form, and describe guidelines that apply to obtaining informed consent Review basic handwashing and perform skills assessment There are many indications as to why thousands of people in the United States, as well as the world undergo surgery every year. Surgery and the way it is conducted today, takes an aim at faster recovery through the advancement of technology. Though this is true, surgery is only considered as a last resort when all conservative investigative measures or treatment of any disease process have failed. The goal of surgery is to assist the body with the healing process, either by removing something, repairing a defective structure within the body, or by cleaning out a wound. 4 Goals of Surgical Intervention Prophylactic (preventive) – To prevent the occurrence of a disease or illness. Restorative (curative) – To regain patient’s health and strength. Palliative – To relieve or alleviate symptoms, without curing the underlying cause or disease. Diagnostic – To investigate and identify the cause or nature of a condition, illness, or disease. 5 Reasons for Surgical Intervention 6 Indications for Surgery Diagnosis Trauma Metabolic Diseases Infection Congenital Defects Neoplasms Obstruction Reconstruction 7 Diagnosis – Direct visualization may be needed, within a body cavity, orifice, or joint (endoscopy). Pathological specimens may need to be taken either by endoscopy or an open incision. An example would be Exploratory Laparotomy (an opening into the abdomen to determine the cause of a problem not evident by other methods.) 8 Trauma – Also defined as injury, trauma can be caused by burns or accidents. Procedures may include repair of broken bones, removal of foreign bodies, debridement of burns, or reimplantation of limbs. 9 Metabolic Diseases – Removal of tissues or organs which are malfunctioning, are often a good indication for surgery. Some examples are splenectomy for thrombocytopenia, or a thyroid gland that is over producing. 10 Infection – Some infections, such as appendicitis, cholecystitis, or abscesses that do not respond to conventional therapy may require surgery. 11 Congenital Defects – Birth defects that require or are helped by surgery call for such procedures as herniorrhaphy, cleft lip repair, or a condition known as talipes equinovarus just to name a few. 12 Neoplasms – Surgical procedures may be performed for both benign and malignant neoplasms. Cancer may be treated by irradiation, chemotherapy, or en-bloc (as a whole) resection. 13 Obstruction – Tubes, vessels, ducts, or intestines can become obstructed by stones, growths, blood clots, twisting (volvulus), or intussusception (telescoping in on itself). 14 Reconstruction – Body parts may be reassembled to make them more functional or attractive. Degenerative disease of a joint may be corrected by arthroplasty, or breasts may be enlarged by augmentation mammoplasty. 15 Surgical Technologist Responsibilities Preoperative Intraoperative Postoperative Preoperative Case Management Prepare the OR Assemble necessary supplies Don PPE Prepare and maintain the sterile field Scrub, gown, and glove Organize supplies and equipment Count Drape Intraoperative Case Management Maintain the sterile field Anticipate Pass instruments, supplies as needed Prepare and handle medications Specimen care Dressings Postoperative Case Management Maintain sterile field until patient is transported Transport used instruments and equipment to decontamination area Prepare OR for next patient Dispose of sharps Five Steps to Critical Thinking Identifying the goal or problem Gathering and evaluating information Use A POSitive CARE Approach Generating one or more responses Implementing the best response Assessing the results A POSitive CARE Approach A POSitive Anatomy Pathology Operative procedure Specific variations CARE Caring attitude Application Role Environmental concern Preoperative Patient Care Routine Patient Preparation Psychological - usually occurs prior to admission to the health care facility Physiological - usually begins upon admission to the health care facility Preoperative Patient Care Routine Routine Procedures Diagnosis - often occurs prior to admission to the healthcare facility for surgical intervention Signs/symptoms H&P Diagnostic tests Preoperative Patient Care Routine If surgery is necessary… Informed consent must be obtained Patient is admitted for surgery (if not already admitted) and ID band is applied Patient information is obtained and chart assembled Patient changes to hospital attire and belongings are cared for Surgical Consent Informed Consent Pre-op Medication Who can sign? “Emancipated Minor” © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 25 Patient Possessions Patient should leave valuables at home What if they don’t/emergency? Prosthesis Wedding Ring Wigs Why/when must dentures be removed? Hearing aids © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 26 Common Admissions Process for the Surgical Patient Patient arrives at the hospital/OP surgery center (evening before or morning of procedure) ALL required paperwork is completed ID bracelet affixed Vital signs are taken Patient changes clothes IV is started Pre-op medication is given Time is allowed with the family/friends Patient is transported to the O.R. 27 © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. Preoperative Patient Care Routine If surgery is necessary (continued)… Patient is placed in a bed or on a gurney Patient’s vital signs are obtained Preoperative education occurs Physician’s orders are carried out (e.g., enema, shave) Patient is transported to the OR and transferred to the operating table Pre-operative Education What questions should be asked? Purpose of pre-op education? Facility pre-op? Can family/friend be present during a preop Need, type & extent of the procedure © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 29 Patient Identification Extremely important ID bracelet not removed until discharge Confirmed by all personnel “Time Out” Procedure © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 30 Patient Identification Methods of Patient Identification Verbal (patient or other individual) Visual (prior knowledge) Written Chart Surgery schedule Wrist band (all must match) Patient’s Chart Components of the Patient’s Chart Face sheet (billing information) H&P Results of diagnostic examinations Physician’s orders Progress notes Nursing notes Medication sheet Consents Reports of procedures performed What Happens Before Surgery?? Enemas Nail Polish (pulse oximeter) Sedation Pre-op Hygiene Pre-op Shave Diet (NPO) Make-up & Dress Call to the O.R. 33 Pre-op Assessment Vital Signs Voiding Catheter? Pt. ID © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. Patient Transport to the Operating Room Guardrails are up & secure Safety belt is secure Wheels are in correct position Transport the patient slowly with feet first Enter an elevator head first & exit feet first Be certain all parts of the patient are within the guardrails Use good body mechanics NEVER LEAVE THE PATIENT ALONE!!!!! © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 34 Patient Transfer to the Surgical Table The mobile patient may be able to transfer themselves What to do when the mobile patient can transfer themselves The immobile patient 35 How to transfer the immobile patient How would you help this patient move? © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. Patient Positioning Refer to pp 342354 ST for the ST Sorry dear, but I still couldn't understand what you're talking about. © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. 36 Important Concepts… Access must be provided to Surgical site Airway IVs Monitoring devices Compromise to body systems must be prevented 37 © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. Heat Loss During Surgery Effects up to 60% of all surgical patients Most of the patient’s heat loss occurs within the early stages of the procedure when the patient’s environment changes 38 © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. Intraoperative Heat Loss Occurs through: Radiation (from the pts. body to the environment) Convection (loss from the pts. body to a cooler surface) Evaporation (loss of heat via respiration or perspiration) • • • 39 © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. What does Hypothermia do? Vasoconstriction Which leads to: 40 Increased blood pressure Tissue hypoxia CNS Depression Slows metabolism of medication (anesthetic) © 2004 by Delmar Learning, a division of Thomson Learning, Inc. All Rights Reserved. How to Control Hypothermia Warmed blankets Warming blankets (water circulating) Forced-air Blankets Basic Handwash NOT the same as the surgical scrub Handwash lasts 30-60 seconds Used MANY times per day to: Mechanically remove transient bacteria Chemically reduce and prevent growth of resident bacteria
