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IPH 2441

PRE & POST OPERATIVE CARE

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PRE-OPERATIVE CARE

• Aim:

To ensure the right patient has right operation and is as fit as possible for surgery.

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PRE-OPERATIVE CARE• SURGICAL LANGUAGE• Ostomy: - An artificial opening made to

create a new connection either between two conduits or between a conduit and the outside world. E.g. Colostomy-Stoma-Mouth

• Plasty:Plasty: -Refashioning of something to make it work.

• Ectomy: -Cutting something open . e.g .Appendicectomy

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PRE-OPERATIVE CARE

• Oscope: -An instrument for looking into the body. -Cystoscope.

• Lith: -Stone-Nephrolithotomy

• Chole: -To do with gall or bile

• Cyst: -A fluid filled sac

• Gram: -A radiological image, often using a radio-opaque contrast medium

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PRE-OPERATIVE CARE

• Docho: -To do with ducts

• Angio: -To do with tubes/blood vessels

• Per: -Going through a structure

• Trans: -Going across a structure

• A Sinus: - Blind ending tract which opens on the surface

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PRE-OPERATIVE CAREFistula-

• An abnormal communication between two epithelial surfaces commonly close spontaneously by chronic inflammation, distal obstruction, epithelialization of the tract, foreign bodies or the tract, foreign bodies or management tissue-will not close.

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PRE-OPERATIVE CARE

• External Intestinal Fistulae Management:

(1) Protection of Skin.

(2) Protection / Replacement of Fluid / Electrolytes.

(3) Parental Nutrition->if fails->Operation.

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Fear of Hospitalisation T:- The Unknown

I:- Incomplete Tasks M:- Mutilation P:- Pain O:- Other Symptoms S:- Self Blame S:- Seperation I:- Ignorance

B:- Being Alone L:- Loss E:- Expired Death/ Dying

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Anxiety is due to fear of

• T:- The unknown

• H:- Hospitalisation

• I:- In Dying

• N:- Nature of Surgery

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ANXIETY (1)

• G:- Give good and effective communication skills

• O:- Offer counselling facilities

• T:- Talk

• E:- Explain

• L:- Listen

• L:- Liase

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ANXIETY (2)• A:- An appointment with

surgeon / Dr. / Social Worker

• S:- Sit• L:- Listen• A:- Alone (time)• V:- Verbalise• E:- Empathise

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PRE-OPERATIVE CARE• History: - Past Medical & Nursing

History• Drugs: - (1)? Contraceptive Pill• (2)? Steroids

(3)? Anticoagulants (4)? Antihypertensive

• Allergies: - Antibiotics - Anaesthetic Agents - Antiseptics

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PRE-OPERATIVE CARE

Past Medical History• Diabetic, Jaundice, Rheumatic Fever

Epilepsy, Effects of Anaesthesia.

• ? Bleeding Disorder / Sickle Cell

• ? Smoker

• ? Physiotherapist

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PRE-OPERATIVE CARE

• Diabetic’s jaundice, Rheumatic fever, epilepsy, effects of anaesthesia.

• ? Bleeding disorder /

• Sickle cell

• ? Smoker

• ? Physiotherapist

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PRE-OPERATIVE CARE• Examination

• Tests

• History

• Examination of urine,

• HIV HbsAg, Sickle cell, U+E + FBC, Chest X-Ray/ECG. IF HB <HG/DL >Anaesthetist.

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PRE-OPERATIVE CARE• Specific Points: -

• Orchidopexy- Consent for orchidectom

• Cholecystectomy- Book per-operative and t-tube (for day 8) Cholangiogram

• Parotidectomy: - Warn risk to facial nerve

• Thyroidectomy: - If tracheal compression get thoracic inlet x-ray, ask for ENT opinion-check vocal cord

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PRE-OPERATIVE CARE

BLOOD TRANSFUSION

• 2 units:- Prostatectomy

• 4 units:- Colectomy

• 6 units:- Gastrectomy

• Abdominal

• Aortic Surgery

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• Cross-Matching• Consent under 16• Marking• Pre-medication/Prophylactic

Anti-biotics

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PRE-OPERATIVE CARE

• Cross-Matching

• Consent under 16

• Marking

• Pre-Medication

• Prophylactic Antibiotics

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PRE-OPERATIVE CARE

• Nursing Instructions

• Education

• DVT Prophylaxis

• Reassurance

• Chest X-ray

• Electrocardiogram

• Urea + Electrolytes

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PRE-OPERATIVE CARE

• A:- Admission

• E:- Explanations

• I:- Investigations

• O:- Observations

• U:- Urine Test

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Bio-Psycho- Social, Physical + Spiritual Needs

NURSING PROCESS

• Assessment

• P:- Planning

• I:- Implementation

• E:- Evaluation

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PRE-OPERATIVE CARE• P:- Physio, Pain• A:- Anaesthetist• T:- The Law (Consent)• I:- Infection (Antibiotics)• E:- Educate (Smoking, diet)• N:- Nil by Mouth• T:- T.E.D. Stockings & Heparin• S:- Shave / Sedation

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PRE-OPERATIVE CARE

• P:- Prosthesis

• R:- Rings to be taped

• I:- Identity Band

• C:- Check List

• E:- Evacuation of urine & faeces

• D:- Deliver Pre-Medication

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Post-Operative Care

• P:- Position

• O:- Observation

• S:-Skin Care

• I:- Investigations

• T:- Treatment

• I:- Intake/ Output

• O:- Other MDT

• N:- Note Morale

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Post Operative Complications• A:- Airway

• S:- Shock

• P:- Pain

• I:- Infection

• R:- Retention of Urine

• I:- Intake/ Output

• N:- Nausea/ Vomiting

• S:- Special Complications of Bed Rest

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12 Bed-Rest Complications (1)• M:- Muscular Atrophy

• O:- Osteoporosis

• T:- Thombosis

• H:- Hypotension

• E:- Embolism

• R:- Renal Stones / Calcali

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12 Bed-Rest Complications (2)

• I:- Interest (Boredom)

• S:- Special Complication: Foot Drop

• N:- Necrosis

• I:- Infection

• C:- Contractures

• E:- Excretion 1. Bowels 2. Bladder

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DISCHARGE PLANNING (1)

• D:- Drugs

• A:- Appointments

• M:- Moderations of Work

• A:- Alcohol

• G:- G.P. / G.P. Letter

• E:- Exercises (Sports)

• D:- Driving

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DISCHARGE PLANNING (2)

• A:- Anxiety

• R:- Reserved Sex

• S:- Sleep

• E:- Excessive 1) Caffein

2) Cholesterol

• S:- Smoking

• Special Organisations

• Special Professionals