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Surgery Process: Southern Cross (Postoperative process (Patients will…
Surgery Process: Southern Cross
Preoperative Process
the patient is tranfered from the ward to the pre op bay by the admitting rn on the ward handover is given by the rn to the pre op nurse
Pre-op nurse checks in the patient and confirms the patient ID and confirms the following:
pt id
pt signature
surgery performed
srugery
when the patient last had fluids and food
allergies
any patient concerns
all of these follow the preop check list and are documented on the checklist
Patient is seen by the anaesthetic tech or nurse and a IV line is put in patient is given medication eg midazolam to relax them
the anaethetist goes over the anaesthetic route and what will occur what the patient is intubated e.g they will be unconsious
Surgeon comes into sign the consent forms if it hasnt be done and goes over the possible risks of the surgery, reasures the patient and goes over any concerns the patient may have
patient is given a warm blanket and awaits transfer to theater.
the tech will also gonfirm the patients identity
consent forms are checked
Perioperative Process
Patient is transfered from the preop bay to theater
Handover begins the following is handed over
-patient identifcation
relevant medical history
drug allergies and adverse reactions
type of surgery and the site
anaesthetic route
Sugeon introduces himself again and goes over risks and concerns regarding the procedure
Anaethetist attaches patient to monitors and puts the patient on oxygen via a non rebreather mask
each member of the surgical team and other circulating staff introduce themselves to the patient
aneasthetic is givnen by the aneathetist and the patient is intubated with an LMA tube
Time out before surgery commences by the surgeon, again the following is confirmed
patient ID,
allergeries
surgical procedure being done
relevan history
expected theater time
possible complications and risks that can be encuntered
Procedure commences
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Baseline vital signs are esablished and documented
Postoperative process
Patients will arrive still intubated in some cases once in the bedspace the aneathetist will confirm and go over the following
Patient identity
Surgery Performed
Type of anaesthetic administered
Perioperative complications
Any medical devices institu e.g indwelling catheters and drains
Medications given during theather such as propofol, ketamine, midazolam, morphine and fentanyl
If antibiotics are given during theater this should also be handed over to the recovery nurse
Immediately attach telemetry monitors to patient
Airway: Patiency, respiration rate , respiratory effort and depth
Maintain oral / laryngeal mast airway insitu untill patient is awake / rousable
Doument respirations on PACU chart every five minutes until time of discharge
Note if there is any difficulty breathing i.e cyanosis, tracheal tug, indrawing of clavicals or intercostal spacises
Note the use of acessory muscles during insipration
If nessessary support breathing with an Ambu bag to maintatin adequate oxygen saturation
Maintain open airway through employing a head tilt/ jaw thrust
Administer supplementry oxygen therapy if SpO2 is less than 95 percent
Continue to administer O2 until SPo2 is > 95 percent on room air
Record the number of Litres administered through the mask
Pulse/heart rate: monitor, rate, volume and rhythm
If irregularities occur, check pt hx, monitor with continuous ECG, record 12 lead ECG if necessary
If outside normal parameters consider the cause and notify the aneathetist immediately
Record on vitals chart every five minutes
Blood pressure: Pt BP should sit between 90/50-160/90
If NPIBP recordings show on the monitor reposition the cuff on the arm or try another machine
Hypotension: check patients capillary refill/perfusion status, positioning of the patient, patient parameters and medication used in theater
Hypertension: again check the pt parameters, consider the causee.g patin, metabolic stress, positioning or rate of IV fluids. Check to see if patient is on regular Antihypertensive medication and if so check to see if they were withheld
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Temperature: normal beteen 36-37 degrees celcius
Hyothermia <35.5 re warm using bair hugger according to protocol
Hyperthermia >38 degrees
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Neurological status
Take note of restlessness, agitation, confusion or deterioration in state of consiousness
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Blood Loss: Monitor wound ooze/PV loss(record typle and amount,
Ensure that suction is maintatined on deains
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Monitor the following
Post operatively patients are tranferred to recovery to rouse from the aneasthetic, to ensure that vital signs are stable and pain is managed prior to discharge to the ward
As patients are deemed vulnerable after the course of anaesthetic, it is expectrd that all assessment of patients will conducted in a manner that maintains the patients privacy and dignity