Operating Room Portfolio PDF

Page 1 of 42  TABLE OF CONTENTS Perioperative Care ……………………………………………………………………………………………………………………......... 3 The Patient: The Reason for the Existence of the Health Care Team …………………………………………………………… 9 The Surgical Team …………………………………………………………………………………………………………...

Page 1 of 42  TABLE OF CONTENTS Perioperative Care ……………………………………………………………………………………………………………………......... 3 The Patient: The Reason for the Existence of the Health Care Team …………………………………………………………… 9 The Surgical Team …………………………………………………………………………………………………………………………… 10 13 Principles of Sterile Technique ……………………………………………………………………………………………………….. 11 Western Visayas Medical Center (WVMC) Floor Plan with Photos of the Different Areas ………………………………….. 12 Handwashing Procedure and Surgical Hand Scrub Procedure …………………………………………………………………… 22 Gowning and Gloving ……………………………………………………………………………………………………………………….. 23 WHO Surgical Safety Checklist …………………………………………………………………………………………………………… 24 OS, Instruments, and Sharps ……………………………………………………………………………………………………………... 25 Prayer before Surgery ……………………………………………………………………………………………………………………… 41 Page 2 of 42  PERIOPERATIVE CARE PRE-OPERATIVE CARE Rationale: Surgery is emotionally stressful, causing degrees of fear and anxiety. Pre-operative care therefore includes adequate health teaching, physical preparation and psychologic support. This is the nurse’s primary responsibility. A. Pre-operative Interview PROCEDURES/STEPS RATIONALE 1. Verify the type of surgery, date and time schedule and name of surgeon. 2. Check the pre-orders. To determine your responsibilities toward preparing the client for surgery. 3. Consult the procedure book of your facility regarding the type of surgery, the preparation needed, the surgeon’s preferences. 4. Check client’s chart for the history and physical assessment with To protect the client, physician and staff. signed consent and also laboratories and other results like CBC and urinalysis. 5. Arrange to complete the forms and procedures if they are not on record. Also inform the laboratory about the missing data. 6. Plan sufficient uninterrupted time to carry out pre-op interview. 7. Using the appropriate form, perform the interview: a. Verification of client’s identity. To practice safety and ensure correct identification. b. General appearance and physical condition. This is an objective data which is sometimes used to complete the amount of anesthetic agent to be administered. c. Anxiety level The communication with client will usually tell you something about the client’s level of anxiety like restlessness. d. Knowledge level regarding the surgery. Remember that explicit details can raise the client anxiety level. e. Previous surgeries. They may have both physical and psychological consequences for the current surgery. Never assume that the client who has had multiple surgeries need less preparation. f. Smoking habits. Lung tissue of a client who smokes are more sensitive to anesthetic gases because of irritation. Page 3 of 42  g. List down drug alcohol intake. Because anesthetic agents and other medication ordered may interact with the medication the client is already taking. Heavy use of alcohol has multiple effects on the body that can change the client’s response to anesthesia, surgery and recovery. h. Support system data. Because the family and significant others are concerned about the client, may be involve in the health teaching and often care for the client after discharges. 8. Encourage client to ask question about the procedure, the policies of the hospital or aspect of care. 9. Provide emotional support. To add to the client’s confidence. 10. Evaluate the competence of your interview by reviewing the data for completeness. 11. Attach interview form to the client’s chart. B. Pre-operative Teaching Rationale: Well-planned, individualize pre-operative teaching prepares the client for intelligent participation in the activities surrounding the surgery and results in fewer post-op complication and a smoother post-op course. PROCEDURES/STEPS RATIONALE 1. Carefully review once again the pre-op orders. So that you can give appropriate information. 2. If you interviewed the client, you have some knowledge of his To go down on client’s level to get appropriate data. or her language, educational background and level of anxiety. 3. Plan to allow considerable uninterrupted time. So will not be hurried in your instructions and the client will feel more relaxed. 4. If family members or significant others are present, include them During the post-op period, these persons can often reinforce what if the client and they so wish and you think it is appropriate and has been taught. helpful to the client. 5. Provide quiet, non-stressful environment in which to teach. To make client more comfortable. 6. Design teaching plan in clinical teaching specific as: a. Pre-op routines b. Post-op routines i. Vital signs every 15 minutes. For early identification of any problem. ii. Dressing checks. These are made to observe the kind and amount of drainage. The surgical client can regain normal eating patterns sooner if this iii. Progressive surgical diet. progression is followed. Page 4 of 42  So the client will know what to expect. iv. Special procedure. You relieve the client’s fear that pain will not be controlled. c. Pain management So that the client will be actively participating in the use and d. Post-op appliances, tubes and equipment functions of appliance. The medication and the immobility of surgery will cause secretions e. Deep breathing and coughing to build up in the lungs. The purpose of teaching the client to move with as little discomfort f. Methods for moving as possible is to encourage the action, to prevent circulatory problems, stimulate the respiratory system and decrease discomfort from gas. Plan ample time to complete the task necessary before the client leaves the unit for surgery. 7. Record client’s vital signs. To establish a baseline data for future management and an elevated temperature can mean an infection, and the surgeon will have to decide whether to proceed with the surgery. 8. Administer/assist the client. It is necessary because mouth tends to dry during the unconscious period with the administration of anesthetic gases. 9. Assist in the insertion of NGT if ordered. 10. Have the client remove all items of clothing including underwear It can be changed or removed easily when the client is unconscious. and put on clean gown, untied. 11. Have the client void or insert a foley catheter if ordered. The bladder is emptied to avoid incontinence or injury during surgery. 12. Remove colored nail polish. So that the anesthesiologist can observe the nail beds during surgery for circulatory assessment. 13. Remove any make-up. So skin color can be assessed during surgery. 14. Remove hairpins and hair pieces. These can cause pressure on the client’s scalp during the unconscious period. 15. Remove all prostheses as eyeglasses, contact lenses, hearing Keep in place to provide a better seal around the endotracheal tube aids, partial or complete dentures and store them appropriately. that delivers the anesthetic agent loose teeth might be dislodged and aspirated during surgery. 16. Remove and store client’s jewelry. Guard against loss. 17. Put antiembolism stockings (T.E.D.) to the client if ordered. These stockings compress the peripheral leg tissue increasing venous return during the immobile period. 18. Leg exercises i. Calf surgery – alternately dorsiflex and plantarflex the foot Help calf muscles to contract and relax. ii. Quadriceps setting Alternately contract the interior thigh muscles and allow them to relax. Page 5 of 42  iii. Gluteal setting Alternately contract the posterior thigh and skeletal muscles and allow them to relax. N.B. Should be done ten times each hour post-op. In teaching steps: 1. Evaluate the effectiveness of your health teaching through client summarization. 2. Take note of the pre-operative teaching in your pre-op forms and in nurses notes. C. Assisting client for immediate pre-op care (the night before surgery) 1. Determine the precise time scheduled for surgery. 2. Check the chart for any changes or addition in orders. 3. Check the consent if duly signed. 4. Ascertain the location of the client’s family or friends during the surgical procedure. 5. Instruct (NPO) nothing by mouth after 12 midnight. 6. Check the chart for the pre-op medication order. 7. Prepare medications as ordered, administer and document. 8. Caution the client to remain quietly in bed once medication has been given. 9. Put the side rails up and place the call bell within reach. D. Routine before transferring client to the operating room 1. Follow the proper procedure for client identification as the client leaves the unit. 2. Send the client’s chart and x-rays with the client. 3. Check and record vital signs. 4. Evaluate using the following criteria: a. All actions/procedures ordered were completed on time. b. Client ready for surgery. 5. Records all pertinent data: a. pre-op checklist completed and signed b. document all nursing actions taken to prepare the client for surgery and the client’s response c. any articles sent with the client to surgery d. time and mode of transportation to operating room Page 6 of 42  POST-OPERATIVE CARE Immediate post-op care – where skilled care is provided by experienced nurses until the client has recovered from anesthesia or can respond to stimuli at the recovery room (RR) or post-anesthesia care unit (PACU). Rationale: Clients are not independent and depend on nurses for all aspects of care after major surgery. Provide for client comfort and safety. To prevent many potential problems. To act appropriately when problems are identified. A. Preparing Post-op Nursing Unit PROCEDURES/STEPS RATIONALE 1. Make post-operative bed a. extra protection at head b. extra protection and turn sheet in middle 2. Obtain necessary equipment: tissue, emesis basin, thermometer, BP apparatus, IV stand, pencil and paper B. Immediate Post-op Care of Clients PROCEDURES/STEPS RATIONALE 1. Move client carefully from stretcher to post-op bed. Rough or precipitous handling can contribute to sudden changes Leave in place blanket that covered the client. impulse and BP. To help prevent chills. 2. Receive report from recovery room nurse. To report will give information about the client’s stay in RR and serve as a baseline for your own assessment. 3. Make initial observations: a. time of arrival in unit b. responsiveness c. Vital signs: TPR, BP, pain d. Skin: color, condition (dry/moisture) e. Dressing: clean, dry, intact f. Presence of an IV infusion: type of solution, amount left in bottle, drip rate g. Catheter: unclamped, connected to drainage bag, freely draining, character and amount of urine Page 7 of 42  h. Other drainage tubes: unclamped, attached appropriately or suction, not kinked or under client, character and amount of drainage i. Safety and comfort: side rails up, bed in low positions, call bell within reach, appropriate position, pain, nausea, vomiting j. Check the chart for the following information: post-op diagnosis, operation performed, anesthetic agents used, estimated blood loss, blood/fluid replacement, types and locations of drain, vital signs when client left RR k. Medications administered in RR 4. Identify any problems present. 5. Plan actions to resolve/monitor problems identified. 6. Wash your hands. For infection control. 7. Determine equipment necessary. 8. Gather the appropriate equipment not already in the room. 9. Identify the client. To be sure that you are performing the procedure for the correct client. 10. Explain to the client what you plan to do. 11. Carry out procedures deemed necessary for assessment. Evaluate using appropriate criteria. Document. Page 8 of 42  THE PATIENT: The Reason for the Existence of the Health Care TeamPage 9 of 42  The Sterile Team Surgeon First Assistant Scrub Nurse The Non-Sterile Team Anesthesiologist Circulating Nurse Biomedical Technicians Nursing Auxiliaries Page 10 of 42  13 PRINCIPLES OF STERILE TECHNIQUE 1. The sterile team wears sterile attire. 2. When in doubt, discard! 3. Tables are sterile only at top level. 4. Sterile-to-sterile; unsterile-to-unsterile. 5. Once opened, use at once and do not reuse. 6. Below the top of a sterile table is unsterile. 7. A sterile field is created as close as possible to the scheduled time of use. 8. Sterile areas must be constantly kept in sight. 9. Sterile persons should maintain sterility. 10. Sterile persons limit contact with sterile areas. 11. Unsterile persons avoid sterile areas. 12. Once the sterile pack or drape is damaged, it becomes contaminated. 13. Microorganisms must be at a minimum level. Page 11 of 42 WESTERN VISAYAS MEDICAL CENTER – MANDURRIAO OPERATING ROOM FLOOR PLAN Page 12 of 42 Page 13 of 42 Page 14 of 42 Page 15 of 42 Page 16 of 42 Page 17 of 42 Page 18 of 42 Page 19 of 42 Page 20 of 42 Page 21 of 42 Page 22 of 42 Gowning and Gloving Page 23 of 42 Page 24 of 42 OS, Instruments, and Sharps Page 25 of 42 Page 26 of 42 Page 27 of 42 Page 28 of 42 Page 29 of 42 Page 30 of 42 Page 31 of 42 Page 32 of 42 Page 33 of 42 Page 34 of 42 Page 35 of 42 Page 36 of 42 Page 37 of 42 Page 38 of 42 Page 39 of 42 Page 40 of 42  PRAYER BEFORE SURGERY L ord Jesus, Divine Physician, Who in Your earthly life showed special concern for those who suffer and entrusted to Your disciples the ministry of healing, make us ever ready to alleviate the trials of our brethren. Make each one of us, aware of the great mission that is entrusted to us, strive always to be, in the performance of daily service, an instrument of Your merciful love. Enlighten our minds, guide our hands, make our hearts diligent and compassionate. Ensure that in every patient we know how to discern the features of Your Divine Face (Pope John Paul II). B less our patient __________, all the Operating Room staff and our profession, enlighten and guide us before, during and after this surgical procedure. May the Holy Spirit guide us in all our decisions. M ay Your Holy Angels protect us from all bodily and spiritual dangers. Keep us and all our patients safe and free from untoward complications. Lastly, grant to us, having constantly loved and served You in our suffering brethren, that at the end of our earthly pilgrimage we may contemplate your glorious FACE and experience the joy of the encounter with You in your Kingdom of joy and everlasting peace. We ask these through Your Most Holy Mother and All the Saints in Heaven. Amen. Page 41 of 42 This OR Portfolio is dedicated to the Almighty God for having blessed me with the necessary knowledge, skills, and attitude in the care of perioperative clients; … to my Augustinian brothers in the Community; … to my Nursing Family; … to the surgical and nursing team of Western Visayas Medical Center for helping me hone my knowledge, skills, and attitude in Perioperative Care; and most importantly, to my family, whose untiring love and support have helped me persevere in this holy sharing of life. Page 42 of 42