Pre, Peri & Post op care
Small group work
Mark Edwards
PREOPERATIVE CARE:
FACTORS
 The
Assessment process should
include:
a nursing history
physical assessment (physiological
measurement)
identification of risk factors for the patient/client
identification of educational needs for
patient/client AND their significant others.
Identification of psychological needs for the
patient/client AND their significant others
Roles of the Perioperative
Nurse.
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RESPONSIBILITY INCULDED IN THIS ROLE, BUT
NOT LIMITED TO ARE.
Education
Support and reassurance
Patient advocacy
Control of the environment
Maintaining of asepsis
Monitoring of the patient
Collaboration and consultation
POST OPERATIVE CARE:
FACTORS
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Immediate post-op phase nursing
assessment must pay particular
attention to:
respiratory status
 cardiovascular status
 central nervous system (effects of
anaesthesia)
 fluid balance
 wound care
 pain relief/comfort/general condition
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POST OPERATIVE CARE:
FACTORS
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VITAL SIGNS
SKIN INTEGRITY/ CARE OF THE
WOUND
LEVEL OF CONSCIOUSNESS
OXYGEN THERAPY
FLUID BALANCE/INTRAVENOUS
THERAPY
POST OPERATIVE CARE:
LONG TERM FACTORS
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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
Case Scenario’s
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Split into 3 groups
Group 1 Scenario
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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.
Group 1 Scenario (1
st
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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.
Group 1 Scenario
continued
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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
Commonly asked
questions
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Fear of the unknown
Anaesthetic + side effects / not waking up
Unrelieved pain
Restricted in bed post op.
Use of bed pan
Body image /effect on relationship, family
Dependant relatives.
Financial problems if sole provider for family.
Scenario Group 2
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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.
You will be presenting your assessments
and care plan to your colleagues
Scenario Group 2
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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.
Nursing intervention
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Nutritional status
Integrated Care Pathway
Baseline observations.
Specimen collection.
Mobility Assessment.
Nutritional assessment.
Cardiovascular assessment
Respiratory assessment.
Urinary assessment.
Social assessment
Risk assessment
Group 3
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Answer the following questions based
on evidence based practice.
Group 3 Question 1
Pre op check list exercise
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Discuss each item on the checklist,
and provide an evidence based
rationale for its importance.
Feedback to group.
Consent answers
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Legal requirement.
>Informed consent
Written consent should be obtained identifying that
the subject has received and understood:The procedure offered
Reasonable alternatives to the procedure
Possible benefits of the procedure to the patient.
Risks, inconveniences, and discomforts of the
procedure.
Answers to all patient's questions.
Question 2
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Discuss common post operative
complications and how would you detect
and prevent these complications?
Example:Respiratory
Cardiovascular
Gastrointestinal
Genitourinary
Wound
Group 3 Question 2
answer
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Common post operative complications
Respiratory complications
Airway obstruction, chest infection
Cardiovascular complications
shock, haemorrhage, DVT, PE
Gastrointestinal
vomiting, constipation, paralytic ileus,
retention of urine
Wound infection
Any Questions?