Surgery
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Surgery is....
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Nurses role
The Nurses role during the peri-operative period of surgery depends on their position/department they work in. For this current article we will look at the medical-surgical nurses role in the pre-operative and the post-operative periods.
Pre-Operative Period
The role of the nurse in the pre-operative period is two fold. First, to make sure that the patient has not eaten for the pre-determined amount of time set by the Surgeon. Also, conduct any patient teaching about the surgery, the hold room, the OR itself, and the PACU. Instuct the family about the Surgeons preferences regarding family communication post-op as well. Second, all appropriate paperwork must be complete. This depends on your facility, but this mainly includes operative consent forms and pre-operative assessments and nurses notes. Depending on the time frame, on-call medicines (usually antibiotics) are given or sent with patient. Make sure your patients chart is in order, and that the current medication administration records are in the chart. Also, depending on your facility, make sure an adaquate amount of patient stickers are available for the surgery nurses, as well as any transfer forms that need to be filled out.
Intra-Operative Period
This refers to the period from when the patient enters the anaesthetic rooms in the operating suite, to the moment they are discharged from recovery. In nursing care terms, it therefore covers three different aspects of nursing; anaesthetic nursing, instrument and circulating nursing and recovery nursing. The role of the nurse in theatre tends to be a little different from those of the nurse on a ward. The primary focus of the theatre nurse is that of safety and sterility, and not of education and the patient relationship. The main principle of any operation is speed - the faster open and closed, the less chance of the patient becoming compromised post-surgically; the theatre nurse hastens this process. In addition, each of the three disciplines have their own remits: anaesthetic nurses are concerned with ensuring that drugs are drawn up and administered safely, that checking procedures are followed, that consent has been obtained, that the patient is readied appropriately (in terms of positioning) for their operation and the patient has emotional support; instrument and circulating nurses are concerned with keeping the sterile field sterile, keeping a tally of things that go in, and therefore out, of the body, and with assissting the surgeons as required; recovery nurses are concerned with ensuring that the patient returns to a "normal" post-operative state, that their pain is controlled, that they are not running fevers, and that there are no post-anaesthetic complications.
Post-Operative Period
Surgery is complete, PACU has called you report. Now it is time to get the patients room ready for their arrival. Depending on the surgery, make sure any equipment that is need is redily available to you. This could be graduated cylinders, tape, NG canisters, flushes, saftey pins, fresh linens or gowns, IVF and lines, etc. Once patient is in room and comfortable, explain the pain scale to the patient and make sure you have addressed their pain level before continuing any assessment. Once this is done, conduct your initial assessment as well as a wound assessment. Depending on the facility, get your hourly vitals as needed. Review post-op orders with the patient, as pain medicine and diet most likely has changed. Once you get back to the nursing station, make sure all orders are noted and correct. This is the time to make sure you have the orders you need. Most surgeries are very routine, and some doctors get too familiar with writing the post-op orders. Make sure you have all the orders you need, especially if this is a late case. Nothing is worse that the patient spiking a temp at 1 AM and not having a Tylenol Suppository order for an NPO patient. Continue to monitor this patient closely, as even the most routine of surgeries can go south on you in an instant.
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