Communication, documenting and reporting (Exam 1)

Gaps in client/family knowledge. They need to know (at the minimum):

-Type of surgery planned -Knowledge about and understanding of events during the perioperative period

Gaps in client/family knowledge

-Type of surgery planned -Knowledge about and understanding ofevents during the perioperative period

Preop Labs

-Urinalysis -Electrolytes -Hemoglobin and Hematocrit

Who is the patient advocate

the nurse

Labs to look at pre-op

•Urinalysis•Electrolytes•Hemoglobin and Hematocrit

Surgical safety checklist: What to do before skin incision

-Confirm all team members have introduced themselves by name and role. -Confirm the patient's name, procedure, and where the incision will be made. -Has antibiotic prophylaxis been given within the last 60 minutes? -Anticipated Critical Events To Surgeon: What are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss? -To Anaesthetist: Are there any patient-specific concerns? -To Nursing Team: Has sterility (including indicator results) been confirmed? Are there equipment issues or any concerns? -Is essential imaging displayed?

Your patient is scheduled for elective surgery and prior to going to OR expresses the following concern: "I am not supposed to receive any blood products due to my beliefs. I signed the form before saying it was ok becuase I felt pressure, I really need this surgery on my knee." What actions can the nurse take?

-Get more information. Have an open-ended conversation to understand their concerns -Make sure you fully understand their concerns before advocating for them -Talk with surgical team and its the surgeons decision to discuss other options

Surgical safety checklist. What to do before induction of anesthesia

-Has the patient confirmed his/her identity, site, procedure, and consent? - Is the site marked? -Is the anaesthesia machine and medication check complete? -Is the pulse oximeter on the patient and functioning? -Does the patient have a: Known allergy? -Difficult airway or aspiration risk? -Risk of >500ml blood loss (7ml/kg in children)?

What are key assessments to perform preoperatively?

-History -Physical assessment -Psychosocial -Labs -Diagnostics

Preop Diagnostics

-Imaging assessment -EKG (ECG)

INFORMED CONSENT: Consent involves understanding of:

-Nature/reason for surgery -Persons involved in the surgery -Benefits -Risks -Procedure

Consent involves understanding of:

-Nature/reason for surgery -Persons involved in the surgery -Benefits -Risks -Procedure

Your patient speaks a language different from the general language of the facility. The consent is signed by the surgeon. The patients name is missing. They are scheduled for surgery in the next hour. What is concerning? What can be done?

-Notify surgical team, specifically the surgeon. -Don't send them to the operating room until situated -Gain access to a translator

Pre-op Surgical assessment

-Prior experience with surgical procedures -Experience with pain control -Autologous or direct blood donations -Allergies, sensitivity to latex

Preop assessment

-Prior experience with surgical procedures -Experience with pain control -Autologous or direct blood donations -Allergies, sensitivity to latex

8 tips for high quality hand offs

1. Determine the critical information that needs to be communicated face to face and in writing. Cover everything needed to safely care for the patient in a timely fashion2. Standardize tools and methods used to communicate to receivers. These can be forms, templates, checklists, protocols, and mnemonics, such as I-PASS (stands for Illness severity, Patient summary, Action list, situation awareness, and contingency plans and synthesis by receiver.3. Don't rely solely on electronic or paper communications to hand-off the patient. if face-to-face communication is not possible, communicate by telephone or video conference. This allows the time and opportunity to ask questions4. If information is coming from many sources, combine and communicate it all at one time, rather than communicating the information separately5. Make sure the receiver gets the following minimum information: Sender contact information; Illness assessment, including severity; Patient summary, including events leading up to illness or admission, hospital course, ongoing assessment, and plan of care; To-do action list; Contingency plans; Allergy list; Code status; Medication list; Dated laboratory tests; Dated vital signs6. When conducting hand-offs or sign-outs, do them face to face in a designated location that is free from non-emergency interruptions, such as a "zone of silence"7. When conducting a hand-off, include all team members, and, if appropriate, the patient and family. This time can be used to consult, discuss, and ask and answer questions. Remember not to rely only on patients or family members to communicate vital information on their own to receivers.8. Use EHR's and other technologies to enhance hand-offs between senders and receivers- don't rely on them on their own

4.The nurse is interviewing and assessing a surgical client in the holding area. Which information should the nurse report to the anesthesiologist? Select all that apply (MultipleChoice)* 1. The client has loose, decayed teeth 2. The client report taking herbs and supplement 3. Clients has had a chest x-ray with no infiltrates and an ECG with normal sinus rhythm 4. Client reports smoking two packs of cigarettes a day

1. The client has loose, decayed teeth 2. The client report taking herbs and supplement 4. Client reports smoking two packs of cigarettes a day

1.The nurse is evaluating laboratory results prior to a client going to surgery. Which resultshould the nurse immediately report to the surgical team? (Single Choice)* 1. Potassium of 5 mEq/L 2. INR of 2.8 3. Hemoglobin 14 g/dL 4. Potassium of 3.6 mEq/L

2. INR of 2.8

2.The nurse assesses a client who says "I am really scared of having this surgery, what ifthey find something?" What is the most therapeutic response by the nurse (Single Choice)* 1. "It will be fine this surgeon has done thousands of these surgeries." 2. "I have had surgery too. I understand how you feel." 3. "Tell me about your fears of having this surgery." 4. "Tell me why you are worried about your surgery."

3. "Tell me about your fears of having this surgery."

Prior to surgery the nurse is completing a preoperative assessment. The client reports an allergy to morphine. What should the nurse do first? (Single Choice)* 1. Document the allergy on the EHR 2. Notify the surgeon 3. Ask the client the what happens when they take morphine 4. Apply an allergy bracelet to the client's wrist

3. Ask the client the what happens when they take morphine

Using medicines safely perioperative

Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. Take extra care with patients who take medicines to thin their blood. Record and pass along correct information about a patient's medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.

Postoperative

Begins with admittance to PACU—ends with complete recovery from surgery

Operative phase

Begins with the entrance to operating room and ends with transfer to post anesthesia care unit PACU/Recovery room

reasons for surgery

Curative Diagnostic Transplant Restorative Palliative Cosmetic Preventative

The client tells the preoperative nurse that she can't hear without her hearing aid and asks to wear it to surgery. What is the nurse's best response? A. Explain that it is policy not to take personal items to surgery because they may be lost B. Tell the client that the hearing aid can be brought to recovery room so it can be used upon waking C. Encourage the client to give the hearing aid to a family member for safe keeping D. Call the operating room to explain the concern and ask if the hearing aid can come with the client

D. Call the operating room to explain the concern and ask if the hearing aid can come with the client

Pre-op assessment, labs

History Physical assessment Psychosocial Labs Diagnostics

2023 Hospital National Patient Safety Goals

Identify patients correctly Improve staff communication Ue medicines safely Use alarms safely Prevent infection Identify patient safety risks Prevent mistakes in surgery

Ways to prevent mistakes in surgery

Make sure that the correct surgery is done on the correct patient and at the correct place on the patient's body. Mark the correct place on the patient's body where the surgery is to be done. Pause before the surgery to make sure that a mistake is not being made.

Surgical safety checklist. What to do before patient leaves operating room?

Nurse Verbally Confirms: The name of the procedure; Completion of instrument, sponge and needle counts; Specimen labelling (read specimen labels aloud, including patient name); Whether there are any equipment problems to be addressed To Surgeon, Anaesthetist and Nurse: What are the key concerns for recovery and management of this patient?

PERIOPERATIVE STAGES

Preoperative Intraoperative Postoperative

Preoperative phase

Stage from decision for surgery is made until transfer to the operating room

SURGICAL CATEGORIES

URGENCY OF SURGERY -elective -urgent -emergent SURGICAL APPROACH -simple -minimally invasive -radical