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    G. EMERGENCY PRE-OP CARE

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    makoniwishes47
    emergency pre op care

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    G. EMERGENCY PRE-OP CARE

    Uploaded by

    makoniwishes47
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    emergency pre op care

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    emergency pre op care

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2 views5 pages

    G. EMERGENCY PRE-OP CARE

    Uploaded by

    makoniwishes47
    emergency pre op care

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    GENERAL EMERGENCY

    PRE-OPERATIVE CARE
    By Mr. Nosiku

    Note this pre-op care covers all abdominal surgical conditions

    I will prepare the patient for emergency surgery because his condition
    is immediately life threatening .

     Note that in an emergency the preoperative preparation is limited to basic


    essentials.

    OBJECTIVES/AIMS
    1. To prepare the patient physiologically and psychologically for emergency
    surgery
    2. To resuscitate the patient before surgery
    3. To relieve pain
    4. To prevent complications such as intestinal necrosis
    PATIENT ASSESSMEMT AND RESUSCITATION

    I will do a quick assessment on the level of consciousness and Get ONLY relevant
    history for the patient’s present condition that is useful for resuscitation and approach
    for surgery. I will assess and intervene in the following to resuscitate the patient

    AIRWAY

    I will assess the airway for patency and ensure that it is patent by positioning the
    patient in a recumbent position with head turned to one side to promote drainage of
    the oral secretions
    BREATHING

    I will assess the breathing status by observing the rate and depth of respirations,
    checking oxygen saturation by doing pulse oximetry and checking for presence of
    cyanosis. I will commence supplemental oxygen therapy by nasal catheter or mask at 5
    Litres per minute to improve tissue oxygenation. I will Insert an NG tube to
    decompress the abdomen in cases of abdominal distension which may interfere with
    breathing. This promotes full lung expansion since distension tends to push abdominal
    organs to the thoracic cage

    CIRCULATION:

    I will check the pulse and blood pressure to rule out shock and assess the level of
    dehydration by checking for skin turgor and sunken eyes or dry lips.

    I will quickly cannulate the patient and commence fluids intravenous infusion to restore
    intravascular volume and correct shock

    I will elevate the foot end of the bed to promote blood flow to the vital organs of the
    body such as lungs, brain and the heart and I will cover the patient is with extra linen
    to keep him warm.

    PAIN RELIEF

    Most patients with acute abdomen or requiring emergency surgery are usually in
    severe pain. (Check stem of the question). I will nurse the patient in the most
    comfortable position to avoid pressure against the painful site and I give strong
    analgesic such as Pethidine 1mg/kg/bwt to block pain sensation and prevent neurogenic
    shock from severe pain.

    NB: For a patient who in not passing urine, catheterize the patient to empty the bladder
    and relieve pain arising from a full bladder.

    OBSERVATIONS:

    I will observe general condition of the patient to determine level of consciousness


    I will check vital signs: Temperature, Pulse, Respiration and Blood Pressure to monitor
    the conditions of the patient.

    I will monitor the flow rate the IV line to ensure that the fluid is flowing at the correct
    rate to improve the intravascular volume

    INVESTIGATIONS:

    Investigations are done at the same time with resuscitative measures and are limited to
    essentials. I will ensure that they are done quickly so that surgery is not delayed.

    I will quickly collect blood for :

    1. Haemoglobin estimation to rule out anaemia


    2. Grouping and cross matching to identify the patient’s blood group in case of the
    need for blood transfusion.
    3. Random blood sugar to rule out hypoglycaemia
    Other investigations that will/may be done include

    • Plain abdominal X-ray to Evaluate the state of the abdominal cavity

    • Abdominal ultra sounds- sound waves are used to show abdominal pictures

    PSYCHOLOGICAL CARE

    The patient who is conscious will be anxious because of severe abdominal pain and not
    knowing the outcome of the condition. I will explain the condition and disease process
    to the patient and relatives to increase awareness about the condition and allay anxiety.
    I will also explain the need for emergency surgery as the only alternative to correct the
    condition to gain the patient’s and family cooperation. I will also discuss the benefits
    and risks of surgery to help the patient and his family make an informed decision

    OBTAINING CONSENT:

    An informed consent is a legal document signed by the patient or his relative to signify
    that he/she has understood the process of the operation and is willing be operated on.
    Once the patient has agreed that surgery be performed on him, I will provide a consent
    form to either the patient or next of kin to sign to legalize the surgical operation or to
    allow the surgeon and his team perform surgery.
    PHYSICAL PREPARATION

    This involves the following areas of preparation for surgery

    GASTRIC PREPARATION

    I will immediately put the patient nil per oral and If the patient has eaten a meal within
    2hours I will pass a nasogastric tube to empty the stomach content to prevent
    aspiration of stomach contents during surgery when patient is under the effects of
    General anaesthesia. This may lead to aspirational pneumonia. The nasogastric tube is
    left in-situ for continuous drainage. Intravenous fluids are given as prescribed to
    maintain fluid and electrolyte balance and prevent shock (hypovolemic) as well as
    dehydration.

    BLADDER PREPARATION

    I will empty the urinary bladder by catheterizing the patient to prevent urinary retention
    during induction and operation. A full bladder may interfere with a surgical procedure
    by making the site less accessible and it may increase the risk of accidental injury to the
    bladder wall. This will also help in preventing urine incontinency and monitoring kidney
    function which may be affected by general anaesthesia.

    BOWEL PREPARATION

    If ordered and necessary I will administer an enema to cleanse the colon of fecal
    material.Bowel preparation helps to reduces the possibility of fecal incontinency during
    surgery as the muscles will be paralyzed by anesthesia and contaminate the surgical
    field.

    SKIN PREPARATION:

    Preoperative skin care is given in order to have the skin as free as possible of dirty
    particles, hair, cells, secretions and organisms .since this is an emergency I will quickly
    wipe the skin with antiseptic soap and shave or trim the hair of the skin from nipple line
    to mid-thigh to remove hairs that might harbor microbes.

    PREMEDICATION

    I will administer the following drugs;


    1. Atropine 0.6mg IM or IV to reduce over production body secertions
    2. Promethazine 12.5 mg to control nausea and vomiting induced by general
    anesthesia
    3. Diazepam 15mg IM/IV to relax muscles and calm the patient

    PATIENT IDENTIFICATION

    I will give an identity band containing the patient’s details:-


    name, age, diagnosis, type of operation, type of Anaesthesia
    This is done to prevent surgical errors.

    REMOVAL OF JEWELRY AND OTHER ITEMS

    I will remove the following

    Dentures to prevent choking, glasses or artificial lenses if any to prevent infection as


    they habour microbes, Jewelry to prevent electric shock where the diathermy machine
    is used and nail polish since it can mask cyanosis.

    GOWNING

    Before the patient goes to the theatre, I will provide clean gown as this will reduce
    chances of infection, will allow easy access to the operation site, keep the patient
    warm and maintain the patient’s privacy

    PATIENT TRANSFER

    I will do final observations, collect all patient’s records and do check listing to be sure
    that everything has been done. I will explain to the patient that he is being taken to
    theatre and while escorting him explain the expectation of the theatre department.

    POST OPERATIVE BED:

    Upon return from theatre I will make post-operative bed and tray in readiness for the
    patient after surgery. I will assemble all the emergency equipment and drugs on the
    acute bay

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