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Pre and Post Operative Assessment - Coggle Diagram
Pre and Post Operative Assessment
What is the purpose of a pre operative assessment?
Identify risks/potential complications
Anaesthetic
Surgical
Psychological/emotional
Social
Gather baseline data e.g. vital signs
Communication with the child and family
Referral to a more specialist centre
Pre op assessment clinics
People attending the hospital for elective surgery may attend a pre-op assessment clinic
Nurse-led pre-op assessment clinics reduce procedural cancellations, failure to attend, and patient anxiety (though the quality of evidence is low)
Nurse-led assessment clinics also improve patient preparation, recognition of postoperative needs, and patient/parent satisfaction with surgery (Hines et al., 2015)
Increased risk for anaesthetic complications
History of respiratory difficulties e.g. ex-premature babies with chronic lung disease
Children who currently have/have recently had upper respiratory tract infections
Smoking and other recreational drug use (Short and Malik, 2009)
History of anaesthetic complications
In emergency surgery – sometimes surgery needs to happen immediately, which may pose risks if the child has recently eaten or drunk
Pregnancy – pregnancy impacts respiratory, haematological, and immune system responses that may have anaesthetic implications. Many anaesthetic or perioperative drugs also undergo transplacental transfer (Bhatia and Chhabra, 2018)
Cardiac issues e.g. congenital health disease (White and Peyton, 2012)
Fasting Guidelines - - Royal College of Anaesthesia (2018)
Solid food, formula milk - 6 hours
Breast milk - 4 hours
Clear fluid - must be able to read a newspaper through it - 1 hour
Clear fluid is classed as water and squash, diluted with water or non-fizzy sports drinks. The recommendation is 3 ml/kg maximum volume.
Increased risk for surgical complcations - Different types of surgery carry different kinds and levels of risk. For example, some cardiac surgery can result in low cardiac output or problems feeding post-operatively (Brown et al., 2020). Bleeding and infection are common complications after many kinds of surgery.
Increased risk for pre assessment anxiety - Fronk and Billick (2020)
Shy children
Children whose parents have high levels of anxiety
Children with negative memories of previous hospital admissions/procedures.
Young people with pre-existing mental health problems e.g. depression and anxiety.
Children with no previous admissions to the hospital.
How should you explain the concept to different ages?
5-year-old - Distraction techniques, counting down when the aesthetic is being given, explaining the surgery like going to sleep and showing the child the processes on a teddy.
9-year-old - You can be more direct while still offering stickers or rewards after. Can ask them questions about their worries.
15-year-olds - The explanation can be more detailed so they can understand. They respect honesty more so may want a more direct answer.
What the purpose of post op assessment?
Pain assessment and management
Wound assessment and management
Identify any complications or side effects e.g. bleeding, infection, nausea and vomiting
Talk to child and family to see how they are doing generally and provide support
Neurovascular obs - They are done after any type of limb surgery and it is done to check the sensory and motor of the limb. They are also to check colour, perfusion, sensation, movement, pain, and pulse.
Nurse led discharge - (RCN, 2020)
Level of consciousness consistent with pre-operative state
Vital signs consistent with preoperative baseline
Any pain, nausea, and vomiting should be well-controlled and manageable by family at home – in terms of parent understanding as well as clinical status
Suitable written and verbal information has been provided to the family and you are satisfied that they understand it
Parents are aware of the expected recovery period.
Any necessary post-operative plans (e.g., follow-up appointment) are in place
This is not a comprehensive list – familiarise yourself with the policy in your local area