consent for themselves (ex: a patient with dementia). It must be proved legally that the person signing the informed consent is a proxy. The physician is responsible for the person who is performing the
procedure. The RN can witness and clarify information. If English is second language, must provide a hospital interpreter for the patient (not a family member).Pre-operative checklist: use this the day of surgery, goes through everything that you need to know and make sure of: dentures out, contacts off, nail polish removed, ID band and allergy band are on, client teaching has been completed, consent form signed, NPO, patient is in gown, no jewelry-bands taped, voiding prior to transfer, vitals within 4 hours of surgery of 30 minutes after pre-op, make sure preoperative lab work is on the chart, recognize abnormal lab values (notify physician right away), skin prep, history of aspirin, antidepressant, steroid or NSAID use, pre-op medications given, side rails up after pre-op. Common labs done- CBC, ELECTROLYTES, TYPE AND CROSS MATCH, BUN AND CREAT , PREGNANCY TEST (IF INDICATED), CLOTTING STUDIES – PTT, INR, - remember if they are on anticoagulants they will be discontinued pre-op for a period of time. During pre-op experience, we talk about identifying risk factors, and there are risk factors that patients are going to have questions about (ex: what about infection, anemia, loss of volume-hypovolemia, electrolyte imbalance, DVT), so do teaching involving those pieces. Teach them how to cough and deep breathe and how to use incentive spirometry. Also looking for risk factors that could cause surgical complications (Ex: if a person has chronic respiratory disease, that could potentially cause problems postoperatively, smoking patients, or even patients with heart failure (fluids are given during surgery, so may have to alter diuretics or monitor I&Os very carefully and auscultate breath sounds). Diabetes patients are definitely at risk. They have elevated blood sugars, so the stress of surgery will increase the blood sugar even more and they have increased risk of delayed healing. Obesity patients put more pressure on the incision and are at increased risk for wound evisceration or dehiscence. Older adults have potential for post-operative complications due to their age related changes. Patients should understand that when they are on scheduled medications, they should be aware of the medications that they should take and those that they should not. For example, the BLOOD THINNERS! Reinforce post op teaching- Turn Cough and Deep Breathe – incentive spirometry – post op diet – usual recovery plan- pain control – DVT prevention interventions- demonstrate splinting when coughing. If pre-op teaching occurs prior to surgery ( say a week or two before ) – make sure patient understands what medications they can take( e.g. holding aspirin for a week prior to surgery) , when they should be NPO, refrain from smoking. Intra-OP: SAFETY is the focus!!!!!!! Go through several safety checks to make sure that we have the right patient and the right procedure, etc. Safety includes transferring the patient, positioning on the table,
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- Fall '16
- Denise Cauble
- Nursing, Wound infection