This essay is being submitted on May 28th, 2014, for (Instructor’s Name)’s (course title) course.
A surgery, be it major or minor, can become one of the stressful events of a person’s life. A patient who anticipates such complex treatment modality is likely to experience anxiety. Uncertainty lurks on mind as the time of the surgery approaches. Smeltzer et al (2010) state that “preoperative anxiety may be an anticipatory response to an experience viewed by the patient as a threat to his or her customary role in life, permanent incapacity, body integrity, increased responsibilities or burden on family members, or life itself”.
At this point of a patient’s life, a nurse has to give impeccable nursing care. The perioperative efforts carried out by the nurse make an essential contribution to patient outcomes. Preoperative anxiety can have an effect on the scheduled procedure, so proper nursing care has to be given.
Pre-operative Responsibilities of a Nurse
Pre-operative phase starts from the time the surgical intervention has been decided to the transfer of the patient to the operating room (Nettina, 2006). A surgery can be optional (e.g. cosmetic surgery), elective (the approximate time of surgery is at the convenience of a patient), required (the surgery has to be done within a few weeks), urgent (a surgical problem that requires attention, usually within 24-48 hours), or emergency (in which the condition of the patient requires immediate surgical intervention). Whatever the type of surgery that the patient has to go through, it is indeed imperative for the nurse to do initial assessment. Patient assessment includes the physical and psychological status. Aside from vital signs, height and weight, the nurse needs to find out the patient’s past medical history, present condition, medication history, allergies, limitations and other information that is relevant to the upcoming intervention.
Once the patient assessment has been done, the physician/surgeon obtains the informed consent. Informed consent—otherwise known as ‘operative permit’—is the process of informing the patient about the surgery including its nature, risks and possible outcomes. The duty of the nurse is to be present with the surgeon when the patient signs the hospital’s standard operative permit. After this, the nurse can now begin to perform preoperative teaching.
Preoperative education helps the patient and his or her significant others a lot of things. Health teachings can be offered through various media such as conversation, discussion, audiovisual aids, demonstrations and return demonstrations. The ultimate goal of preoperative education is to help the patient understand the surgical experience to minimize anxiety and promote full recovery from the surgery and anesthesia. The first thing the nurse should do is to determine what the patient already knows and ascertain his or her psychosocial status to the impending surgical intervention. After establishing the patient’s level of understanding, the nurse will now proceed with the health teaching using the most effective vehicle for information relay. Most importantly, the patient and his/her SO are also encouraged to ask questions and express concerns.
General preoperative instructions are aimed at bettering the outcome of the surgery. For instance, incentive spirometry, deep breathing exercises and coughing are encouraged for patients undergoing major surgeries that usually involve general anesthetics and abdominal incisions to prevent postoperative pulmonary complications (Thomas and McIntosh, 1994). Other instructions include turning and leg exercises.
During the final preparation, the nurse needs to implement the physician’s orders for preoperative care. This would depend on the type of surgery the patient has to undergo. In general, the following measures have to be carried out: 1) bowel preparation, 2) personal hygiene, 3) administration of pre-operative medications, 4) removal of jewellery, dentures, prostheses and clothing, and 4) sedation.
Post-operative Responsibilities of a Nurse
Nettina (2006) states that the post-operative phase starts when the patient has been admitted to the Post-Anesthesia Care Unit (PACU) to his or her follow-up evaluation. PACU—also known as the ‘recovery room’—accommodates a group of surgical patients who are continuously monitored by highly skilled medical practitioners, especially nurses. The majority of the recovery room nurse’s time is spent on bedside care. Basically, the goals of the nursing care are to detect and prevent surgical complications, relieve patient’s discomfort and ease the transitioning—from a state of dependence to independence.
Continuity of care has to be ensured through relaying the following information from the surgical team to the PACU nurse: 1) type of surgery, 2) intraoperative complications, 3) dressings and drains, 4) presence of oxygen administration devices (e.g. ET tube), 5) types of lines and locations (e.g. peripheral I.V. lines), 6) catheters inserted, 7) fluid and electrolyte administrations, 8) drug allergies, and 9) pre-existing medical conditions.
During this time, the patient is very vulnerable to a lot of complications such as airway obstruction, hemorrhages and hypothermia. This is why initial assessment before receiving the patient is important. There is a need for the PACU nurse to verify the patient’s stability with the anaesthesiologist in terms of respiratory status, circulatory status, hemodynamics, oxygen saturation and temperature. The patient’s level of consciousness, response to stimuli, pain score and reflexes are also assessed carefully. The lines, tubes, drains and dressings are constantly checked for fluid and blood losses and other abnormalities. The nurse is also required to perform safety checks through verifying the side rails and/or restraints are in place. Any inconsistencies observed are immediately relayed to the surgeon/medical team.
REFERENCES
- Nettina, S. M., & Lippincott Williams & Wilkins. (2010). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer Health.
- Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.
- Thomas, J.A., & McIntosh, J.M. (1994). Are incentive spirometry, intermittent positive pressure breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Physical Therapy, 74, 1 3-10. Retrieved from http://ptjournal.apta.org/content/74/1/3.short
