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Questions and Answers
What are the key nursing assessments to perform at the insertion site of an intercostal catheter?
Inspect and palpate for signs of subcutaneous surgical emphysema, infection, swelling, and ensure the dressing is intact.
In the context of underwater seal drainage, what does the presence of bubbling in the water seal chamber indicate?
Bubbling indicates an air leak from the pleural space, suggesting that air is escaping into the drainage system.
What is the significance of recording drainage on the fluid balance chart for patients with an intercostal catheter?
Recording drainage accurately helps track fluid loss and assess the patient's condition, influencing further management.
Describe the important assessments to perform on a stoma to ensure its health and function.
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What nursing interventions should be considered for a patient with a nasogastric tube (NGT)?
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What are the key responsibilities of nursing during preoperative patient preparation?
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Explain the importance of gaining informed consent before surgery.
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What techniques can nurses teach patients to facilitate lung expansion after surgery?
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List three key assessments to perform on the day of surgery.
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What are signs and symptoms of a pulmonary embolism?
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What is the primary purpose of anti-embolic stockings in postoperative care?
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What initial assessment should a nurse perform for a deteriorating patient?
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How does pleural effusion manifest in patients?
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What is thoracentesis and when is it typically performed?
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Identify a common complication to monitor for in the postoperative patient.
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Study Notes
Preoperative Nursing Management
- Provide education on food and fluid restrictions prior to surgery.
- Prepare intravenous cannula for medication and fluid administration.
- Teach deep breathing, coughing techniques, and leg exercises to promote lung function and circulation.
- Conduct medical assessments and gain informed consent from the patient.
- Perform laboratory tests including blood type, full blood count (FBC), prothrombin time, liver function tests, and ECG.
Immediate Patient Preparation on Day of Surgery
- Complete a preoperative surgical checklist to ensure all steps are followed.
- Verify patient identity using two ID bands (one on wrist, one on ankle).
- Review and sign consent form for the procedure.
- Check vital signs and blood glucose levels.
- Administer preoperative and existing medications.
- Establish intravenous access if not already in place.
- Confirm allergy status and review pathology results.
- Secure valuables and ensure patient has fasted.
- Conduct skin preparation: removal of jewellery and hair, sanitize with surgical wash, and change into patient gown.
Immediate Postoperative Care
- Transition patient from post-anesthesia care unit (PACU) to the ward when stable.
- Manage pain control through prescribed medications.
- Document vital signs, bowel movements, fluid balance, and skin assessments.
- Monitor wound site for signs of complications including bleeding or infection.
- Perform neurological observations and pain assessments.
- Review details of the operation including anesthesia used and any complications encountered.
- Facilitate initial swallowing assessments and refer to speech pathologist if necessary.
- Complete risk assessments for mobility and plan for physiotherapy and occupational therapy referrals.
- Provide oral care and skin care as necessary.
- Plan for discharge including referrals to necessary services.
Anti-Embolic Stockings Management
- Indicated for prevention of DVT, pulmonary embolism, and improving circulation in trauma patients.
- Assess patient's surgical history, mobility, and previous DVT incidents.
- Inspect skin condition prior to applying stockings.
- Educate the patient on proper application techniques.
- Continuous monitoring and evaluation of efficacy post-application.
Deteriorating Patient Management
- Identify early signs of deterioration, including altered vital signs and mental status changes.
- Perform comprehensive initial assessments:
- Airway, Breathing, Circulation, Disability, Exposure (ABCDE).
- Activate emergency response (MetCall) as required.
- Administer oxygen therapy, IV fluids, and necessary medications.
- Keep family informed about patient status.
Respiratory System Conditions
- Pulmonary Embolism: Blockage of pulmonary artery; symptoms include shortness of breath (SOB), chest pain, cough, tachypnea, and tachycardia.
- Pleural Effusion: Fluid accumulation in pleural space; symptoms include SOB, chest pain, dry cough, hypoxia, and diminished breath sounds.
- Acute Pulmonary Edema: Excess fluid in lungs; symptoms include SOB, cough with crackles, and frothy sputum.
- Pneumothorax: Air in pleural space; symptoms include SOB, chest pain, and hypoxemia.
- Haemothorax: Blood accumulation in pleural space; similar symptoms to pneumothorax with hypotension.
- Hemopneumothorax: Combination of air and blood in pleural space; symptoms include SOB, chest pain, hypoxemia, hypotension, and tachycardia.
Thoracentesis and Under Water Seal Drainage (UWSD)
- Thoracentesis: Procedure to remove excess fluid or air from pleural space.
- UWSD Care: Regular inspection of insertion site for complications, ensure suction levels are as prescribed and monitor for air leaks or bubbling in the water seal chamber. Record drainage volumes accurately, check placement via chest X-ray, and maintain daily assessments while intercostal catheter is in situ.
Emergency Airway Management
- Use of artificial airways such as oropharyngeal, nasopharyngeal, and endotracheal tubes for airway maintenance.
- Suctioning performed with methods including Yankauer suction tips and various suction catheters as needed.
Gastrointestinal System Care
- Colostomy Care: Post-operative management includes checking stoma function (quantity, color, odor) and ensuring the stoma bag fits properly while monitoring for signs of infection or complications.
- NGT Indications: Used for gastric obstruction and enteral feeding needs; nursing care involves monitoring and maintaining the tube position as well as patient comfort.
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Description
This quiz focuses on the essential aspects of preoperative nursing management, including decision-making, consent for surgery, and patient education on food and fluid restrictions. It covers teaching techniques to improve respiratory function and circulation pre-surgery, as well as the roles of the anaesthetist and surgeon in the consent process.
