1. Pre, Peri & Post op care Small group work Mark Edwards

2. PREOPERATIVE CARE: FACTORS è The Assessment process should include: èa nursing history èphysical assessment (physiological measurement) èidentification of risk factors for the patient/client èidentification of educational needs for patient/client AND their significant others. èIdentification of psychological needs for the patient/client their significant others èIdentification of psychological needs for the patient/client AND their significant others

3. Roles of the Perioperative Nurse. RESPONSIBILITY INCULDED IN THIS ROLE, BUT NOT LIMITED TO ARE. RESPONSIBILITY INCULDED IN THIS ROLE, BUT NOT LIMITED TO ARE. Education Education Support and reassurance Support and reassurance Patient advocacy Patient advocacy Control of the environment Control of the environment Maintaining of asepsis Maintaining of asepsis Monitoring of the patient Monitoring of the patient Collaboration and consultation Collaboration and consultation

4. POST OPERATIVE CARE: FACTORS l Immediate post-op phase nursing assessment must pay particular attention to: l respiratory status l cardiovascular status l central nervous system (effects of anaesthesia) l fluid balance l wound care l pain relief/comfort/general condition

5. POST OPERATIVE CARE: FACTORS VITAL SIGNS VITAL SIGNS SKIN INTEGRITY/ CARE OF THE WOUND SKIN INTEGRITY/ CARE OF THE WOUND LEVEL OF CONSCIOUSNESS LEVEL OF CONSCIOUSNESS OXYGEN THERAPY OXYGEN THERAPY FLUID BALANCE/INTRAVENOUS THERAPY FLUID BALANCE/INTRAVENOUS THERAPY

6. POST OPERATIVE CARE: LONG TERM FACTORS Long-term postoperative care is predominately concerned with preventing complications and returning the patient/client to a state whereby they can retake control over their own lives and lifestyle. The focus can be determined by using the identified factors to assess; plan; implement and evaluate the nursing care given Long-term postoperative care is predominately concerned with preventing complications and returning the patient/client to a state whereby they can retake control over their own lives and lifestyle. The focus can be determined by using the identified factors to assess; plan; implement and evaluate the nursing care given

7. Case Scenario’s Split into 3 groups Split into 3 groups

8. Group 1 Scenario Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively For one of the identified needs devise a plan of care, providing evidence based rationale for your actions. For one of the identified needs devise a plan of care, providing evidence based rationale for your actions.

9. Group 1 Scenario (1 st page) Annabel Richards is a 60 year lady who lives alone with close family living in the same street. Annabel is an emergency admission to your ward with a history of acute right upper quadrant abdominal pain, weight loss and jaundice. Following several investigations she is diagnosed as having acute cholecystitis and requires surgery. Annabel Richards is a 60 year lady who lives alone with close family living in the same street. Annabel is an emergency admission to your ward with a history of acute right upper quadrant abdominal pain, weight loss and jaundice. Following several investigations she is diagnosed as having acute cholecystitis and requires surgery.

10. Group 1 Scenario continued During your assessment she tells you she has been drinking alcohol heavily since the death of her husband and her family are unaware of this. Her husband died whilst having an operation in the same hospital one year ago During your assessment she tells you she has been drinking alcohol heavily since the death of her husband and her family are unaware of this. Her husband died whilst having an operation in the same hospital one year ago

11. Commonly asked questions Fear of the unknown Fear of the unknown Anaesthetic + side effects / not waking up Anaesthetic + side effects / not waking up Unrelieved pain Unrelieved pain Restricted in bed post op. Restricted in bed post op. Use of bed pan Use of bed pan Body image /effect on relationship, family Body image /effect on relationship, family Dependant relatives. Dependant relatives. Financial problems if sole provider for family. Financial problems if sole provider for family.

12. Scenario Group 2 Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively Perform a holistic assessment on the patient using an appropriate model of care considering their needs pre and post operatively For one of the identified needs devise a plan of care, with evidence and a rationale for your action. For one of the identified needs devise a plan of care, with evidence and a rationale for your action. You will be presenting your assessments and care plan to your colleagues You will be presenting your assessments and care plan to your colleagues

13. Scenario Group 2 Abdullah Patel is a 20 year old overseas student studying chemistry at the university. Abdullah is an emergency admission to your ward via A&E, who has fallen and has a fractured his right lateral malleolus. It is planned that surgery will be performed later in the afternoon. During your assessment you discover he has only arrived in the country a few days ago and does not have any friends in the halls of residence where he is living. He is anxious about his surgery and does not fully understand the procedure or know how he will cope when he goes home. Abdullah Patel is a 20 year old overseas student studying chemistry at the university. Abdullah is an emergency admission to your ward via A&E, who has fallen and has a fractured his right lateral malleolus. It is planned that surgery will be performed later in the afternoon. During your assessment you discover he has only arrived in the country a few days ago and does not have any friends in the halls of residence where he is living. He is anxious about his surgery and does not fully understand the procedure or know how he will cope when he goes home.

14. Nursing intervention Nutritional status Nutritional status Integrated Care Pathway Integrated Care Pathway Baseline observations. Baseline observations. Specimen collection. Specimen collection. Mobility Assessment. Mobility Assessment. Nutritional assessment. Nutritional assessment. Cardiovascular assessment Cardiovascular assessment Respiratory assessment. Respiratory assessment. Urinary assessment. Urinary assessment. Social assessment Social assessment Risk assessment Risk assessment

15. Group 3 Answer the following questions based on evidence based practice. Answer the following questions based on evidence based practice.

16. Group 3 Question 1 Pre op check list exercise Discuss each item on the checklist, and provide an evidence based rationale for its importance. Discuss each item on the checklist, and provide an evidence based rationale for its importance. Feedback to group. Feedback to group.

17. Consent answers Legal requirement. Legal requirement. >Informed consent >Informed consent Written consent should be obtained identifying that the subject has received and understood:- Written consent should be obtained identifying that the subject has received and understood:- The procedure offered The procedure offered Reasonable alternatives to the procedure Reasonable alternatives to the procedure Possible benefits of the procedure to the patient. Possible benefits of the procedure to the patient. Risks, inconveniences, and discomforts of the procedure. Risks, inconveniences, and discomforts of the procedure. Answers to all patient's questions. Answers to all patient's questions.

18. Question 2 Discuss common post operative complications and how would you detect and prevent these complications? Discuss common post operative complications and how would you detect and prevent these complications? Example:- Example:- Respiratory Respiratory Cardiovascular Cardiovascular Gastrointestinal Gastrointestinal Genitourinary Genitourinary Wound Wound

19. Group 3 Question 2 answer Common post operative complications Common post operative complications Respiratory complications Respiratory complications Airway obstruction, chest infection Airway obstruction, chest infection Cardiovascular complications Cardiovascular complications shock, haemorrhage, DVT, PE shock, haemorrhage, DVT, PE Gastrointestinal Gastrointestinal vomiting, constipation, paralytic ileus, retention of urine vomiting, constipation, paralytic ileus, retention of urine Wound infection Wound infection

20. Any Questions?