Lecture 5: Admission, Pre-op Care & Education

Perioperative

All 3 phases of surgery

Preoperative

Before surgery

Intraoperative

During surgery

Postoperative

After surgery

NBM (nil by mouth)

Prevent aspiration during general anaesthesia

Skin cleansing

Reduce microorganisms

Baseline observations

Identify changes from normal

Empty bladder

Reduce risk of incontinence during surgery

nbm for how long

at least 6 hours before surgery

Atelectasis - when and what happens

24-48 hrs after surgery. Partial/complete collapse of alveoli

prevention of Atelectasis

deep breathing, effective pain relief, early mobilisation

DVT (deep vein thrombosis)

Blood clot in a deep vein, commonly the leg.

PE (pulmonary embolism):

Blood clot travels to the lungs.

FBC

Checks blood cells, haemoglobin and platelets

EUC

Electrolytes and kidney function

Blood group/crossmatch

Prepares for possible transfusion

Serum albumin

Nutritional/protein status

INR/APTT

Blood clotting

Urinalysis

Detects abnormalities in urine

Reagent strips: PH what is normal result and abnormal indication

4.6-8.0 - acid base changes

Reagent strips: Leukocytes, normal result and abnormal may indicate

0-4, UTI

Blood glucose level (BGL) purpose

idenitfy hypoglycaemia or hyperglycaemia

normal blood glucose level

4-7.8mmol/L

purpose of Anticoagulants

Prevent or treat blood clots (thromboembolism)

Coagulation process:

1. platelet plug

2. clotting cascade activities

3. fibrin forms stabilise blood clot

4. stops blood loss

Anticoagulants example

heparin and enoxaparin

action of warfarin

Blocks vitamin K activity

how to monitor warfin effect

INR - International Normalized Ratio

heparin action

inhibits clotting factors

Enoxaparin action

reduces clotting

warfarin action

blocks vitamin K

Dabigatran action

direct thrombin inhibitor

Rivaroxaban action

Factor Xa inhibitor

Apixaban action

Factor Xa inhibitor

Clopidogrel action

Prevents platelet aggregation

Clopidogrel cessation before surgery

5 days

Warfarin INR range

2-4

Smoking cessation advice before surgery

2 weeks

what are 4 things to do when admitting a patient

1. Explain your nursing role

2. guide the room, call bell, bathroom etc

3. Apply ID band

4. Assist with belongings