Slide 1ObjectivesCase Study PresentationPerioperative NursingPreoperative PhaseIdentify the priority nursing care for Mr. Egan:Identify the priority nursing care for Mr. Egan:What preoperative testing is appropriate for Mr. Egan?Pre-surgical Screening TestsSlide 10Slide 12Slide 13Informed Consent for Surgery & Blood TransfusionInformed Consent InformationInformed Consent InformationInformed Consent for Surgery, Anesthesia & Blood TransfusionSlide 18Advance DirectivesSlide 20Slide 21Latex Allergy/SensitivityLatex Allergy/SensitivitySlide 24Preparing the Patient Through TeachingSlide 26Ensuring Patient SafetyEnsuring Patient SafetySlide 29Slide 30Psychological AssessmentSlide 32Nursing Responsibilities during immediate preoperative periodNursing Responsibilities during immediate pre-operative periodPre-operative ChecklistPre-operative ChecklistSlide 37Slide 38Dr. Damon meets with Mr. Egan in the OR Holding Room.Final Safety ChecksEnsuring Patient SafetySlide 42Intraoperative SafetyIntra-operative SafetySlide 45Slide 46Slide 47Situation Background Assessment RecommendationSlide 49Slide 50Slide 51Postoperative Assessments and InterventionsPostoperative Assessments and InterventionsSlide 54Common Postoperative ComplicationsSlide 56Preventing Respiratory ComplicationsInterventions to Prevent Respiratory ComplicationsInterventions to Prevent Respiratory ComplicationsSlide 60Slide 61Interventions to Prevent Deep Vein Thrombosis (DVT)Interventions to Prevent Deep Vein Thrombosis (DVT)Slide 64Handwashing: Clean Hands Save LivesSlide 66Slide 67Which of the following does the nurse identify as abnormal?Critical Lab ValuesSlide 71Slide 72Slide 73Slide 74Slide 75ConfidentialitySpecial Needs of Older AdultsReady to go homeDischarge TeachingReferencesCare of the Surgical ClientCarolyn McCormick, BSN, RN East Carolina University Graduate Student Spring 2012 NUS 326Objectives Apply concepts from reading during case study presentation Demonstrate understanding by active participation in class discussionExamine the role of the nurse in all phases of perioperative careRecognize safety concerns for the patient during all phases of perioperative careCase Study Presentation10 minutes to review the case studyLook over the questionsPrepare to discuss your answersCase Study adapted from Altmiller (2008)•Inpatient•Ambulatory Surgery•Same-day AdmissionPreoperative•Minor procedure•Lengthy procedureIntraoperative•2 hours •Extended stay•Inpatient hospitalizationPostoperativePerioperative NursingPreoperative PhaseIdentify the priority nursing care for Mr. Egan:Identify the priority nursing care for Mr. Egan:Complete pre-operative testing/Preparation Maintain normal glucose levelsEnsure informed consentEnsure correct surgical sitePrevent post-op infectionComplete pre-operative teaching Address psychological comfortWhat preoperative testing is appropriate for Mr. Egan?Pre-surgical Screening Tests Chest x-ray (CXR)Electrocardiography (ECG)Complete blood count (CBC)Electrolytes (CHEM Panel)Urinalysis (UA)X-ray left lower extremityWhen completing medication reconciliation for Mr. Egan the evening before surgery, which orders increase the nurse’s concern?Insulin 6 units Regular with 15 unit NPH sub-cutaneous q am.Aspirin 325mg PO q d.Plavix 75mg PO everydayAtivan 0.5mg IV Push on call to OR in AM.Insulin 6 units Regular with 15 units NPH sub-cutaneous q am. Aspirin 325mg PO q d. Plavix 75mg PO everydayDr. Damon is Mr. Egan’s surgeon and Dr. Riley is Mr. Egan’s anesthesiologist. Both come to see him and discuss the surgery the evening before.How does the nurse ensure informed consent? What must the patient consent to for the procedure to be done?Informed Consent for Surgery & Blood Transfusion 3 Requirements:Adequate disclosure Understanding & comprehension Consent given voluntarilyInformed Consent InformationDescription of procedure and alternative therapiesUnderlying disease process and its natural courseName and qualifications of person performing procedureExplanation of risks and how often they occurExplanation that patient has the right to refuse treatment or withdraw consentInformed Consent InformationPatient must be 18 years old or an emancipated minorParent signs for children Patient must be competent to sign own consentPatient must be alert & orientedNot necessary if threat to life and patient or legally authorized person unavailableInformed Consent for Surgery, Anesthesia & Blood TransfusionPart of legal preparation for surgeryActive, shared decision making process Protects patient, surgeon, hospital and its employeesNurses role: advocate and witness appropriate person signatureWhat does it mean that Mr. Egan has an advance directive? How will it apply to his surgical procedure?Living WillDurable Power of Attorney for HealthcareAdvance DirectivesDuring the admission assessment, the nurse questions Mr. Egan to determine if there is a latex allergy or sensitivity.What symptoms would the nurse question Mr. Egan about in order to determine this?Latex Allergy/SensitivityS & SUrticaria RhinitisBronchospasmCompromised respiratory statusCirculatory collapse & DeathManagementIdentify those at riskLatex free environmentLatex free equipmentLatex Allergy/SensitivityAt Risk:Genetic predispositionHay feverAsthmaFood AllergiesHealth care professionalsRubber industry workersPreventing complications of surgery is an important part of all surgical patient’s care. What pre-operative teaching does Mr. Egan require in order to prevent complications?Preparing the Patient Through TeachingSurgical events and sensationsSurgical site preparationPain managementPhysical activitiesDeep breathingCoughingIncentive SpirometryLeg exercisesTurning in bedWhat measures should be taken during this pre-operative phase to ensure the patient’s safety?Ensuring Patient SafetyLook-Alike, Sound-Alike Medication NamesPatient IdentificationCommunication During Patient Hand-OversEnsuring Patient SafetyControl of Concentrated Electrolyte SolutionsAssuring Medication Accuracy at Transitions in CareAvoiding Catheter and Tubing Mis-ConnectionsSingle Use of Injection DevicesImproved Hand Hygiene to Prevent Health Care-Associated InfectionMr. Egan is very restless the evening before. He