Perioperative Nursing: Objectives, Legal Aspects, and Patient Care, Exams of Nursing

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PERIOPERATIVE

NURSING

NOTES

OBJECTIVES

Review the history of surgery and antiseptics.

Discuss the legal aspects of theatre nursing.

Describe the layout of a typical modern operating theatre.

Describe perioperative nursing care.

Describe infection prevention in the operating room, asepsis and infection control in the operating theatre.

DEFINITION OF TERMS

 Informed consent – the patients autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved.  Perioperative phase- period of time that constitute the surgical experience, includes the preoperative phase, intraoperative phase and postoperative phase of nursing care  Preoperative phase- period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table.

 Intraoperative phase- period of time from when the patient is transferred to the operating room table to when he or she is admitted to the post anesthesia care unit (pacu).  Postoperative phase- period of time that begins with the admission of the patient to PACU and ends after a follow-up evaluation in the clinical setting or home.  Anesthesia - a state of narcosis, analgesia, relaxation and loss of reflexes.  Surgical asepsis- absence of microorganisms in the surgical environment to reduce the risk of infection.

 In order to control hemorrhage, the ancient Greeks and Romans, used strings as ligatures. Later on, during the Middle Ages, they came up with the use of hot iron. This idea has been developed into the use of cautery to control bleeding.  By the beginning of the 20th century, many types of ligatures were available, prepared from metal, nylon and cotton.  The control of infection dates back to the efforts of Louis Pasteur, who proved that bacteria caused infections. In 1865, Joseph Lister used carbonic acid to reduce the growth of bacteria in wounds. In 1886 Von Bergemen introduced sterilisation of dressings.

 Operating theatre nursing is a special branch of nursing. The theatre nurse has evolved together with the development of the theatre. They are a member of a bigger team, all of whom work together to provide a safe passage through the operating theatre for every patient.  However small or insignificant the task to be performed, the theatre nurse is responsible for the success of the procedure. They must, therefore, be highly skilled and trained, in order to be able to ensure a successful outcome for the patient.

3. The nurse ensures that the patient has signed an informed consent, after the surgeon has explained the advantages and outcomes of the operation.
4. Make sure that the patient observes a ‘Nil by oral’ rule. The fasting should usually start six hours before the operation.
5. Blood works: All should be within the acceptable ranges e.g. full Haemogram including HB, urea, electrolytes and creatinine.
6. The patient should be counseled and reassured especially those receiving operations such as amputation, or mastectomy.

7. The site to be operated on should be shaved of hair and cleaned with warm soapy water, to reduce the bacteria on the patient’s skin. The area shaved should be larger than the incision site.
8. Catheterisation and IV branula insertion may be necessary depending on the surgery.
9. Observations of vital signs, urine testing for sugars, proteins and acetone should be done.
10. The receiving area nurse should confirm that the above preoperative measures have been taken by the ward nurse in order to allow the patient in theatre.

6. The items to be used for the operation must be counted and recorded before and after operation to prevent loss of swabs, tubes, blades, forceps, abdominal packs and any instrument used.
7. Theatre nurses must know where the exits are, for use in case of an emergency.
8. Sockets in theatre should be covered during scrubbing to prevent risk of conducting currents. They should also be one meter or more above the floor level.
9. All electrical machines must be checked to ascertain optimum function before use on the patient.

CATEGORIES OF SURGERY BASED

ON URGENCY

I. Emergent— Patient requires immediate attention; disorder may be life- threatening. Done without delay. E.g. severe bleeding, bladder or intestinal obstruction, fracture skull, gunshot or stab wound, or extensive burns. II. Urgent - Patient requires prompt attention within 24-30 hours. E.g. in case of acute gallbladder infection, kidney or ureter stones.

SURGERY CATEGORIES BASED ON REASONS:



Diagnostic (e.g., biopsy, exploratory

laparotomy).



Curative (e.g., excision of a tumor or an

inflamed appendix).



Reparative (e.g., multiple wound repair).



Reconstructive or cosmetic (e.g.,

mammoplasty or a facelift)



Palliative (e.g., to relieve pain or correct a

problem e.g. a gastrostomy tube may be inserted

to compensate for the inability to swallow food)

SURGERY CATEGORY BASED ON RISK

Minor :- procedure without significant risk; often done with local anesthesia. E.g. incision and drainage (I&D); implantation of a venous access device; muscle biopsy.  Major:- procedure of greater risk usually longer and more extensive than a minor procedure. E.g. mitral valve replacement, pancreas transplant, lymph node dissection.

Reception  (^) Clean area.  (^) Handing over of patient’s documents.  Communication of pre operative instruction/ care.  Handing over area by operating theatre staff. Receiving area  (^) Semi-sterile.  (^) Patients reception area.  Waiting bay awaiting theatre procedure.  Some medications can be administered here.  Reassurance of patients continues.

Scrubbing area  (^) Surgical scrubbing is done here.  (^) Contains sinks with running water (hot and cold).  Antiseptic scrubbing solution.  Soft bristle scrubbing brush. Setting area  (^) Sterile area that connects to the operating room.  (^) Sterile instruments are arranged on a draped stainless steel trolley by the scrub nurse.  High standards of infection control are observed here to prevent contamination of instruments.