Analyze preoperative vital signs obtained and recognize client notations or issues that are to be communicated the primary nurse and the surgical team. 5. Provide care as appropriate to a stable client in the day surgery unit under direct supervision of an RAN. 6. Identify and prioritize teaching needs for the client preparing for surgery. 7. Discuss the role of the nurse in the preoperative phase. Interpolative Phase 1 . Discuss nursing interventions to reduce client and family anxiety. 2. Identify interventions to ensure client safety and dignity during an operative procedure. 3.
Compare and contrast the principles of surgical and medical sepsis. 4. Identify urging responsibilities for management of clients receiving anesthesia. 5. Identify and discuss the potential adverse reactions and complications of specific anesthetic agents. 6. Explain procedures to ensure the identity of the client and the accuracy of the planned surgical procedure. Postoperative Phase 1 . Discuss the nursing responsibilities when admitting a client to the PACIFIC. 2. Describe the ongoing head-to-toe assessment of the postoperative client. 3. Prioritize nursing care for the client who has respiratory depression after surgery. . Discuss the criteria for determining readiness of the client to be discharged from the cost-anesthesia care unit. 5. Assist in monitoring clients for complications. Medication Worksheet included 10 1. 3 medications used in the interpolative phase 2. 3 medications used in the post operative phase PAP Formatting & References 2. 12 point font, double spaced 3. Appropriate reference citations and reference list Grading Criteria included 5 Total Preoperative Report Pre-operative :Apt. Was found in bed with art. Jugular IV site 0730. She was a 37/F admitted with c/o of nausea and vomiting and abdominal pain
Amylase is normally secreted from pancreatic china cells into the pancreatic duct and then into the duodenum. Once in the intestine it aids diabolism of carbohydrates to their component simple sugars. Damage to pancreatic china cells (as in pancreatic) or obstruction of the pancreatic duct flow (as in pancreatic carcinoma or common bile duct gallstones) causes an outpouring of this enzyme into the interpenetrated lymph system and the free peritoneum. ” (Pagan, 2010, up. 60-61). “The most common cause of an elevated serum lipase is acute pancreatic.
Lipase is an enzyme secreted by the pancreas into the duodenum to break down triglycerides into fatty acids. As with amylase, lipase appears in the bloodstream following damage to or disease affecting incarnate china cells. Because lipase was thought to be produced only in the pancreas, elevated serum levels were considered to be specific to pathologic pancreatic conditions. Therefore elevated lipase levels are often found in patients with renal failure. ” (Pagan, 2010, up. 354-355). The role of the nurse in the informed consent form is to make sure that the person who signs the consent is the apt going to surgery.
Apt. Must be identified by two apt. Identifiers (First and last name and DOBB). “Informed consent includes the following information: Need for procedure in relation infinite and potential risk, likelihood of a successful outcome, alternative treatments or procedures available, anticipated risks should the procedure not be performed, physician’s advice as to what is needed, right to refuse treatment or withdrawal consent. ” (Lemon, 2011, p. 56) Apt. Has the risks reported of TN which can affect the anesthetic drugs in a positive way by keeping the BP from bottoming out or going to low.
The only teaching needs that this apt. Needed were deep breathing exercises and coughing after reorientation in PACIFIC and eventually hemophilia’s. Apt. Was 58 keg on hospital bed and severely malnourished. She hadn’t eaten in 2 days due to her nausea and vomiting and abdominal pain. Nutrition plays a big role in providing the body and wounds the unique ability of healing from surgery and trauma. Interpolative: Nursing interventions that were used to reduce client anxiety were proving warm blankets, and warm IV solutions.
Client dignity was upheld by draping the client appropriately and keeping the client covered. Each member of the team had responsibilities to provide care for the apt. There were two scrub nurses who prepared the surgical table with blades, gauze, and other instruments. There was an X-ray tech which helped surgeon with the placement of the reverse palindrome into the pots. Atrium for hemophilia’s. The anesthesiologist delivered the prescribed medication to allow the surgeon to perform the initiation of reverse tunneled palindrome and removal of peritoneal dialysis catheter.
The circulating nurse performed a time out where the apt. Was identified, procedure was called out, allergies were said and the time was stated. “The circulating nurse is a highly experienced registered nurse who coordinates and manages a wide range of activities before, during and after the surgical procedure. The circulating nurse observes the physical aspects of the operating room itself, the equipment, assists with transferring and positioning the patient, prepares the pots. Skin, ensures that no break in aseptic technique occurs, and counts all sponges and instruments. (Lemon, 2011, p. 67). The next few lines are what I saw during the intra-operative procedure: Procedure started at 0804 and ended at 0909 on 4/9/14. The apt. Was prepped for surgery and draped with the presenting part in a cut-out window of sterile drape. The surgeon stapled the drape to the apt. Chest 12 times to ensure the field maintained sterile and not compromised due to the curvatures of scoliosis. The IV site on the apt. Was used to initiate the intra-pop. Medications and was found not to be patent. The medications used were leaking out of the apt. Neck and apt. Was not absorbing fluids.
Two doctors on both sides of the apt. Tried to initiate an ‘V. One doctor was successful and the pre-pop. Medication was then administered. Apt. Became relaxed and fell to a deep sleep. Apt. BP 98/61 during procedure. The apt. Was placed in a supine lying position with safety belts attached, Allen stirrups, allows, and foam pads to provide comfort for the procedure. Apt. Was consistently being monitored for drops of VS., and the x-ray tech and surgeon ensured correct placement of catheter. The principles of surgical aseptic surround the amount of time spent scrubbing your hands. The surgical scrub is performed to render hands as clean as possible in preparation for a procedure. Skin cannot be rendered sterile but it can be considered “surgically clean” following the scrub. Following the 5- to II- minute surgical scrub, hands and arms are dried with sterile towels. ” (Lemon, 2011, and water. It keeps most germs off hands where as surgical cleansing keeps all off hands. Surgeon scrubs hands with hands up above waist so that the dirtiest part of arm is the elbows and the cleanest part is the hands.
Postoperative: The nursing responsibilities when admitting a client to the PACIFIC are immediate assessment of apt. Vitals and 02 stats. The apt. Was continuously monitored for pots. Ability to breathe and VS. were documented SQL inns and were monitored very closely. “Assessing mental status and level of consciousness is another ongoing nursing responsibility, and the apt. May require repeated orientation to time, place, ND person. Emotional support is also essential, because the apt. Is in a vulnerable and dependent position. Apt. Maintained stable VS. with Pull. Ox at 100% with non reverberate ox. Ask on. Apt. Complained of 12/10 pain in neck and upon further investigation her neck was 2 times the normal size on art. Side from bottom of ear down to base of neck due to swelling. Apt. Was given Morphine IV OMG. For pain. Apt. Reported pain decrease to 10 in 40 miss. Later. Apt. Was restless and uncomfortable until morphine kicked in. Apt. Was uneasy at start of PACIFIC and with longer time for medication to work she became more relaxed. Apt. Requested a neck massage which I gave her and she reported that it helped a little. Apt. Was in PACIFIC for 0910- 1015. Apt. As then transferred to the hemophilia’s dept. Where I watched hemophilia’s initiation for this apt. She would be there for 3 hours. “The ongoing head to toe assessment that was going on with this apt. Was: general appearance, vital signs, LOC, emotional status, quality of respirations, skin color and temperature, discomfort/pain, n/v, type of iv fluids and flow rate, dressing site. ” (Lemon, 2011, p. 75). Respiratory depression was the number one priority assessment. Client must be assessed for post-operative complications like DEW, shock, pulmonary embolism, pneumonia, tattletales, etc.
Priority nursing interventions for PACIFIC: #1 potential for alt. Rest. Function, #2 potential altered home dynamic status, #3 potential for anxiety RIOT surgery, #4 potential for post-pop pain, #5 potential for injury. Chest x-ray was performed to see the placement of palindrome and look for evidence of collectivists in IRIS. Collectivists is an inflammation of the gallbladder. Presenting symptoms are n/v, RI-SQ pain, pain after eating large or high fat meals. Respiratory depression is monitored frequently and RAN made sure that respirations stayed above 10.
The criteria for determining readiness of client to be discharged from PACIFIC involves looking at baseline, pre-operative VS. and comparing them with current vital signs for apt. Apt. Must also be stable. Nurse will also call support people and Med. Surgical floor to allow them to set room up and prepare for apt. To be taken to the hemophilia’s room for treatment. Overall, I thought the whole experience was a success. I really enjoyed the temperature of the OR room and felt each member of the team had an integral part in making sure the apt. Ad a great outcome.
As for learning opportunities, I felt each person had something to contribute and they did. The medical field is an inspiring amazing field to become a part of, I am truly honored to be in it. The surgeon was very skilled at his task at inserting the catheter and maintaining apt. Safety. I was initially alarmed at the number of staples inserted but after talking to you(Mrs.. Abundant), it became evident that there are medical reasons to insert the staples into the apt. I also read that it was at one time a common practice adhesive to better help it stay in place.
Stapling isn’t seen as much, but it is the erogenous preference to use the staples to make sure the area used stays sterile. Drapes are not moved once surgery has started. References Valerian, A. H. , & Isakson, C. A. (2013). Davit’s drug guide for nurses (Thirteenth De. ). Philadelphia: F. A. Davis Company. Garth, B. L. , & Nazarene, A. R. (2014). Intravenous medications: a handbook for nurses and health professionals (30th De. ). SST. Louis, Mo. : Mossy Elsevier. Lemon, P. , Burke, K. M. , & Falloff, G. (2011).