Pre and Post-Operative Nursing Care

2 | ORBIS International

Pre-Operative Nursing CareAimTo provide information to members of the

ophthalmic team Have a basic understanding of caring for the

pre-operative patientPromote efficient and safe pre-operative

patient care


Pre-Operative Nursing Care

After Screening and Before Admission On Admission Handing Over to the Operating Room Team


Pre-Operative Nursing CareAfter Screening and Before AdmissionConsent signed and witnessedPatient is assessed to identify factors that might

interfere with the safe performance and outcome of the surgery

Necessary tests and investigations are done prior to surgery

Essential 2-way process to obtain information from patient and their family

Concerns and expectations are discussed•Fasting•Washing body, hair and face•What to wear•What to bring•Cost•Date and time to arrive


Pre-Operative Nursing CareOn Admission

Consent Assessment and history


Pre-Operative Nursing CareOn AdmissionVital Signs Surgical Site Preparation Eye preparation Dress for surgeryOrientationEducationInsert IV Tests needed


Pre-Operative Nursing CareOn Admission


Pre-Operative Nursing CareConsent

Patient understands surgerySurgery confirmedSurgical site confirmedCorrect patient is confirmedPatient signed the consentSurgeon signed the consentCorrect patient,correct surgery, correct site- confirmed verbally/documented/identity band


Pre-Operative Nursing CareAssessment and HistoryPatient Address and telephone numberMedical history and medication historyRelevant blood relative medical historyAllergiesTests needed like A scan, X-rays, MRICheck fasting timeSocial status – transport, living alone, someone to

accompany them Psychosocial issues – anxiety, confusion,

claustrophobia


Pre-Operative Nursing CareAssessment and HistoryRespiratory distress/breathlessness/asthmaTremor/uncontrolled body movementAbility/concerns about being able to lie still

and flatWearing denturesHearing problem and hearing aid during

operation


Pre-Operative Nursing CareVital SignsTemperaturePulse (heart rate)RespirationBlood PressurePain Other

•Oxygen Saturation•ECG (adult or cardiac patients)•Blood Sugar Level (for diabetic patients•Weight (for General anesthetic patients and children)


Pre-Operative Nursing CareSurgical Site/Eye PreparationWash the face and eyeConfirm and mark the operative eyeCheck eye for the absence of acute inflammation Dilating or constricting dropsBetadine wash (if Doctor prefers)Educate the patientAssist the doctor with Local block if necessaryPressure to reduce IOPMonitor Vital signsCheck absence of movement (akinesia) and feeling

(local)


Pre-Operative Nursing CarePreparing the Patient

Dress for OR• Full dress change/half-dress change

• No shoes (shoe covers)

• Hair cover

• Remove jewellery and watches

Orientation to the environment• Toilet-make sure bladder is empty prior to surgery

• Phone, bell etc


Pre-Operative Nursing Care Education/IV/TestsEducation

Insert IV

Tests


Pre-Operative Nursing CareSafe Site Surgery


Pre-Operative Nursing Care Safe Site Surgery

Handover to the Operating Room Team


Pre-Operative Nursing Care Summary of Pre-Operative CareSummary of Pre-Operative CareThe key to the smooth and efficient

preparation of patients for surgery.A tool for identifying patient abnormalities

that might interfere with the safe performance and outcome of the operation.

With appropriate information, it can reduce patient anxiety to a minimum.

Increases patient satisfaction/understanding of the operation, effective communication, and prevents patient cancellation on the day of surgery


Post-operative Nursing CareOutlineTransportation to Recovery

Preparing to accept patient to recovery

Initial post-operative care

During the stay

Discharge Criteria

Discharge


Post-operative Nursing Care Transportation to RecoveryTrolley vs. walk

• GA/Local. Adult/child. Able/not-able

Assist the patient


Post-operative Nursing Care Preparing to Accept Patients to RecoveryAt the beginning of the day test and check

• Defibrillator, emergency trolley, oxygen, suction, stock levels

Be ready for:• Patient handed over from the operating room staff

• Bed area ready, oxygen, suction and monitors

• Wear gloves and eye shields

• Oxygen, monitor, vital signs

• Start keeping notes


Post-operative Nursing Care Initial Post-Operative CareDo not leave the patient unattended

Ensure their safety, airway, breathing, temperature, pain management


Post-operative Nursing Care During the StayMeasuring levels of recovery

• Vital Signs

• Nausea and Vomiting

• Wound and dressing

• Pain, discomfort, pressure


Post-operative Nursing Care During the Stay



Nausea and Vomiting Scoring AVPU Scoring

None0

AlertA

Nausea only1

Responds to voiceV

Vomit x 12

Responds to painP

Vomit > 13

UnresponsiveU

Blood Loss Scoring Pain Scoring Chart

None 0

Minor – Small amount of blood on dressing only 1

Moderate – Dressing saturated / changed 2

Severe – active bleeding / patient

swallowing blood (inform attending Dr)

3


Post-operative Nursing Care Discharge CriteriaDid the patient recover to an acceptable level?

Please refer to recovery monitoring / discharge criteria sheet


Post-operative Nursing Care Discharge Criteria


Post-operative Nursing Care DischargeConfirm the patient is ready to go (signed out)

Discharge ‘take home items’ given. E.g. eye drops

Patient Education• Eye care at home

• Don’t

• Does

• When to see the Dr next

• Emergency


Post-operative Nursing Care Discharge


Post-operative Nursing Care Summary of Post-Operative CareOphthalmic nurses can play valuable role in post-op careInforming patient to contact the hospital about any concerns or

problems and ensuring patients have hospital contact number• Ensures better follow-up and compliance

Clear post-operative instructions and explanations given to patient and relatives will result in • Reducing the patient’s anxiety

• The best possible outcome.

Emphasis on follow up care • Results in early identification of complications

• Early assessment of outcomes

Thank You


References

ORBIS Recovery Room Care Recording and Discharge PD-605Heather Machin-Associate director of NursingPam Bailey- ORBIS Staff Nurse http://www.visitech.org/post-operative-care.htmlhttp://www.netdoctor.co.uk/health_advice/facts/surgeryinfo.htmhttp://www.google.co.za/search?q=preparing+patients+for+general+anesthetic&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-ahttp://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4160-3225-0..00018-0--s0015&isbn=978-1-4160-3225-0http://www.medindia.net/patients/patientinfo/

generalanesthesia_post.htm

http://www.visitech.org/post-operative-care.html

http://www.netdoctor.co.uk/health_advice/facts/surgeryinfo.htm

http://www.google.co.za/search?q=preparing+patients+for+general+anesthetic&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a



http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4160-3225-0..00018-0--s0015&isbn=978-1-4160-3225-0



Pre and Post-Operative Nursing Care

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