Operating room

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Operating room

  1. 1. ARE YOUREADY FOR YOUROPERATION?
  2. 2. Patient Safety:Provide safe patient careProvide a safe environment ERMTERUEL 2011
  3. 3. PROVIDE SAFE PATIENT CARE  Knowledge of procedure  Ensure the correct patient, correct site, and correct level.  Knowledge of positioning  Adhere to safe medication administration guidelinesERMTERUEL 2011  Surgical counts
  4. 4. WHO Safe Surgery Checklist JCAHO3 phases1.Sign in2. Time out3.Sign out
  5. 5. PROVIDE A SAFE ENVIRONMENT Adhere to asepsis Promote coordinated and effectiveERMTERUEL 2011 communication
  6. 6. ERMTERUEL 2011
  7. 7.  Advocate  Protector  Teacher  Change agent  Manager of patient careERMTERUEL 2011
  8. 8. Probability of morbidity or death from surgery
  9. 9. Severity:  benign or malignantLocation:  location of the disease and the organ requiring surgeryDuration:  length of the time the patient has been exposed to the illness dictates the degree of risk involved.
  10. 10. Operative risk is proportional with themagnitude ofthe operation
  11. 11. Based on health status and person’s mental attitude toward surgeryERMTERUEL 2011
  12. 12. a. Age  infants and elderly have the lowest tolerance to the stressful effects of surgery.b. Nutritional status  a well-nourished pre-op client is better prepared for surgical stress and return to optimal health after surgery. A. Obesity ERMTERUEL 2011 B. Malnutrition
  13. 13. c. Fluid and electrolyte problems  fluid volume deficit leads to possible intra and post-op complications.d. Presence of diseases  increases the operative risk
  14. 14. a. Pulmonary b. Cardiovascular
  15. 15. c.Hematologicd.Neurological
  16. 16. e. Liverf. Renal
  17. 17. h. Gastrointestinali. Integumentaryj. Disabilitiesk. endocrine
  18. 18. e. Use of medications 1. Tranquilizers 2. Insulin 3. Adrenal corticosteroids
  19. 19. e. Use of medications 4. Diuretics 5. Phenothiazines and antidepressants (MAO) 6. Antibiotics
  20. 20. FEAR1. Fear of the unknown2. Fear of anesthesia3. Fear of pain4. Fear of death5. Fear of disturbance of body image6. Worries
  21. 21. 1. Anxiousness2. Bewilderment3. Anger4. Tendency to exaggerate5. Sad, evasive, tearful, clingy ERMTERUEL 2011
  22. 22. 6. Inabilityto concentrate7. Short attention span8. Failure to carry out simple instructions9. Dazed ERMTERUEL 2011
  23. 23. 1. Regression  behaves in a childlike manner. 2. Denial  appears unalarmed 3. Intellectualization  would discuss operationERMTERUEL and illness rationally 2011 but without emotion
  24. 24. Caliber of theprofessional staff andhealth care facilities
  25. 25. 1. Surgeon2. Assistant to the surgeon3. Anesthesiologist4. Nurse anesthetist (CRNA)5. Circulating nurse6. Scrub nurse
  26. 26. works under the directsupervision of ananesthesiologist;most are nurses with required training
  27. 27. Organfunctions aredisturbed
  28. 28. Lifestyles may change
  29. 29. NursingResponsibility:Preoperative Phase
  30. 30. physiological andpsychological response
  31. 31. To stimulate blood circulation in the extremities to prevent thrombophlebitisLeg exercises To facilitate lung aeration and secretionDeep breathing and mobilization to prevent atelectasis andCoughing hypostatic pneumoniaExercises Done every two to four hours For circulation, stimulate respiration,Positioning and decrease stasis of gasAmbulation
  32. 32. Correct anydietarydeficiencies
  33. 33. ERMTERUEL 2011
  34. 34. Check forspecial orders Enema IV line
  35. 35. Check NPO
  36. 36. Check NPO
  37. 37. Have client void beforepre-op meds
  38. 38. Continue to supportemotionally
  39. 39. Accomplish “pre- op checklist.”
  40. 40.  Client has ID band and allergy bracelet Informed consent is signed and witnessed Diagnostic and laboratory test results Client voided Document height and weight Vital signs before exiting the ward
  41. 41. Purpose: allay anxiety produce amnesia reduce n&v dec resp secretions dec vagal nerve stimulations inc pain threshold inc effects of anesthetic agents
  42. 42. Peak effect is desired at thetime of inductionUsually given 45 min before induction
  43. 43. Pre-op Drugs Example PurposeAnti-anxiety Diazepam To decrease nervousness Promote relaxationAnti-cholinergic Atropine Decreases secretions Prevent bradycardiaMuscle relaxant Succinylcholine To promote muscle relaxationAnti-emetic Promethazine To prevent nausea and vomitingAntibiotic Cephalosporin To prevent infection
  44. 44. Pre-op Drugs Example PurposeAnalgesics Meperidine To decrease pain and decrease anesthetic doseAnti-histamine Diphenhydramine To decrease occurrence of allergyH-2 antagonist Cimetidine To decrease gastric fluid and acidity
  45. 45. Send entire medical recordor chart to the Operating roomwith patient
  46. 46.  Direct proper waiting room. Doctor informs family immediately after surgery. Explain reason for long interval of waiting. Explain what to expect.
  47. 47. LEGAL document required for certain diagnostic procedures or therapeutic measures including surgery
  48. 48. PURPOSE: ProtectionERMTERUEL 2011
  49. 49. 1. Given voluntarily 2. Given to individual who have the capacity to understand. 3. Given information toERMTERUEL be the ultimate decision maker. 2011
  50. 50.  Written consent made by the client. No signs of pressure No Sedation 24 hours before elective surgery emancipated minor Legal age and mentally capable 2 surgeon signed the consent in emergency. Authorized representative-minor, unconscious, psychologically ERMTERUEL 2011 incapacitated.
  51. 51. Exemptions:ERMTERUEL 2011
  52. 52.  No sedation The surgeon explains the consent The nurse: ADVOCATOR
  53. 53. Assisting the surgeonas scrub nurse and circulating nurse
  54. 54. METHOD by which contamination w/ microorganism is prevented to maintain sterility throughoutthe operative procedure.
  55. 55. SCRUBOUT !!!

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