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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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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