Patient Preparation

What should be involved in a preop assessment? (5)

• history taking

• client communication

• physical exam

• ASA score

• hydration status

5 vital signs

• temperature

• pulse rate

• respiration rate

• pain score

• nutrition

What information do you need updated on the day?

weight

What could be useful in larger hospitals during admits?

patient identification

Why should you reduce anxiety prior to surgery?

positive effects on healing and opiods

Ways to reduce anxiety (4)

• pet remedy

• trazadone

• plug in adapters

• cat hides

Negatives of bathing pateints before surgery (3)

• no tangible benefits

• rebound population on skin and excess shedding skin

• don’t want them wet/cold

Should you wash patients before surgery?

not recommended

How long should you withhold food?

roughly 12 hours

What sitauations affect withholding food? (2)

• flexability with each case

• pediatrice and neonatal might need a small portion of food in the morning

Why should patients be fasted? (2)

• prevents regurgitation

• reduces thoracic pressure

Negatives of fasting a patient too long?

could cause more acid reflux

Risks of IFVT (2)

• don’t want to overload

• excess fluid under GA = increase morbidity

Signs of fluid overload (5)

• occular swelling

• nasal discharge

• increased lung sounds

• dysnia

• increased RR

What can effect fluid retention?

medication or inhalation agents

Inhalation agents and IVFT (2)

• inhalational agents (e.g. iso and sevo) produce dose dependent hypotension

• due to peripheral vasodilation

Benefit of sevoflurane

shows the least cardiovascular effects of all the inhalational agents available

Flud rate under GA

3-5mls/kg/hr

Pre warming (2)

• expensive

• not always possible

Why should we preoxygenate patients? (2)

• reduces deoxygenation time

• goes from1/2 mins to 3/4

Best option for preoxygenation (2)

• mask better then flow by

• best to not stress and accept flow by

Benefits of using urinary catheters duing surgery (4)

• minimises spoiling risk – unhygienic and cools patient

• increase view for abdominal surgery

• monitor urine output

Benefits of using urinary catheters after surgery

Comfortable for patient when waking up

What to check when clipping patients? (3)

• clean? is the cleaning brush clean?

• sharp, no missing teeth

• are the blades too hot?

Notes for patient positioning (2)

• listen to surgeon

• think about positioning before placing IV to know you have access

Skin prep options (2)

• chlorhexidine (hibi)

• iodine

Con of hibi

irritant to mucous membranes

Benefit of hibi

not inactivated by bioorganic molecules

When to use iodine?

mouth and eyes

Skin prep notes (2)

• spirit after, not too much as cools

• check dilution rates