Lecture notes Acute Care (SHN2004)

SHN2004 (Acute Care) – Pre, Intra and Post Operative Care


Pre-, intra- and post-operative care

Aims of the session
 Understand the role of the nurse in the operating theatre
 Gain awareness of perioperative patient care
 Discuss risks and complications associated with surgery
o Not that we will not be talking about emergency surgery here

Perioperative journey
 Pre-operative  Intraoperative (the operation itself)  Post-operative

Pre-operative nursing care
 Physical
o Full medical history
o Surgical and anaesthetic background (how have they responded to previous
surgeries etc. – any negative effectives?)
o Allergies
o Baseline vital signs (what is normal for that patient – without this we cannot
know for certain what is abnormal)
o Fasting
o Bowel clearance (for some surgeries)
 Psychological
o Address anxiety
 Prepared patients cope better and manage post-op pain more
effectively (Ying Jia Shermin Chieng, 2014, Perioperative anxiety and
postoperative pain in children and adolescents undergoing elective
surgical procedures: a quantitative systematic review)
 Administrative & safety
o Consent form, theatre checklist
 Anaesthetics
o Anaesthetic room care: monitoring vital signs, identifying the type of
anaesthetic required + any particular anaesthetic needs
o Anaesthetic drugs: induction agents, inhalation agents, muscle relaxants,
analgesics
 Induction agents – prevent the body from carrying out its normal
protective function (e.g. responding to pain)
 Inhalation agents – produce unconsciousness which have the
potential to produce dangerous side effects
o Stages of anaesthesia: analgesia, excitement, surgical anaesthesia, medullary
paralysis


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, SHN2004 (Acute Care) – Pre, Intra and Post Operative Care


 Essentially brings the patient as close to death as possible (though a
death as a result of anaesthesia is rare
o Induction, maintenance and extubation
o Equipment checks
o Monitoring:
 ECG
 Pulse oximeter
 Temperature probe
 Temperature of the patient can fall during surgery (anaesthetic
prevents the natural processes like shivering; also exposed
areas of the internal body see massive heat loss)
 Vapour analyser
 Capnography
 Non-invasive BP
 Anaesthesia
o Fluid Management
 Create a balance between too little fluid and fluid overload for best
perioperative outcome
 Fluid restriction: hypotension, inadequate perfusion, impaired
oxygenation, PONV
 Fluid overload: interstitial oedema, poor wound healing,
prolonged resumption of gastric function, heart failure
o Complications of General Anaesthetic
 During: respiratory depression, hypercarbia, cardiac arrhythmias,
asystole, hypotension, aspiration etc.
 After: nausea and vomiting, persistent sedation, pneumonia,
atelectasis, organ toxicity

Intraoperative (Surgery) Care
 Surgery
o Surgical instruments (cutting, dissecting, grasping, clamping, retracting,
suturing, suctioning etc).
 E.g. in terms of scissors there are several
o Surgical positioning
o Surgical scrubbing
 Much more in depth than standard medical hand washing
o Maintaining sterile field
o Swab and instrument counts
o Electrosurgery (burns, smoke)
o Tourniquet management (rise in circulating volume, SVR, CVP, paraesthesia,
ischaemia)

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