PERIOPERATIVE NURSING (PRE-OP)

hi everybody I am that nursing profit and welcome to my channel in today's video we're gonna be talking about perioperative nursing now this is a large topic and I don't want it to be like information overload so what I decided to do is actually break this up into three separate videos so we're going to do pre-op Interop and post-operative nursing otherwise it's gonna be really long and it's gonna be a lot of stuff for you to remember so this first video is going to focus on a preoperative nursing and what the nurse does preoperatively so let's get into it the first thing we're going to do is we're gonna make sure that the consent is signed now it is not our responsibility to talk to the patient about the benefits and the risks of the surgery they're having that is the surgeons job and actually they have to sign the consent but what we can do is we can witness the consent that is our legal role in getting a consent so we need to make sure that it is signed and that we have another chart and ready to go and then we can witness it because we were in the room when doctor explained everything review the patient's NPO status so if this was a scheduled surgery we planned this in advance hopefully they knew they are supposed to be NPO for at least eight hours prior to that surgery so we're gonna ask them when was the last time you had anything to eat or drink and hopefully they'll say nothing says yesterday asked about bowel prep when appropriate some surgeries require our procedures will require bowel prep prior and so that's something either they do at home or they come into the hospital and wait a couple hours and have that done not every surgery needs this done so if it's applicable ask about it get a baseline of their vitals next we're going to either review or draw their labs so if their labs are previously done this is a scheduled thing maybe they met the doctor in the office or the clinic beforehand and they drew the labs there we can review those results or we're gonna draw a brand new labs on this patient things we're gonna be looking for commonly will be like there HNH hemoglobin and hematocrit they're starting out platelet count their white blood cell count and depending on the type of surgery of their electrolytes like a CMP so those are things we're gonna check for preoperatively so those are the labs we should drop give any meds preoperatively so usually we're gonna pump them full of IV fluids if they come in scheduled for that procedure ideally it's two hours before the surgery and that's enough time for us to do all of these things and it's enough time for us to get a couple bags of fluid in them and then antibiotics those are also given pretty commonly like a prophylactic antibiotic prior to surgery sometimes we might even give certain medications like anti endemics or steroids or things like that whatever the doctor may have ordered sedatives that kind of thing those are pretty common meds given preoperatively we're gonna insert an IV and possibly insert a Foley catheter depending on what kind of surgery it is if they're going to be unconscious they're gonna have general anesthesia they're definitely going to need an IV and an indwelling Foley we're gonna make sure they remove all jewelry makeup nail polish if they have dentures or hearing aid glasses contact lenses we're gonna ask them to remove those things prior to surgery and then we're going to put family member or somebody in charge of these items so that they don't get lost while patient is in surgery and that will direct that family to the waiting area there's going to be a designated area for them to wait and throughout the procedure we're gonna come back and update the family members on what's going on of course just like everything we have to do a baseline head-to-toe assessment we need to know what they're starting out like skin prep may or may not be involved so skin prep can include washing certain areas of the body with antimicrobial soap or shaving certain areas of the body depending on where they're having the surgery of course the big one right reviewing allergies especially the things like latex allergies and then their current medication and I've made a list here of some medications that are considered high-risk for surgery so those include aspirin and insects sometimes people take those every single day so we need to know is this something you take every day so aspirin and sets antidepressants anticonvulsants blood thinners or anticoagulants steroids and then of course certain vitamins and herbal supplements so like ginkgo has a really bad reputation garlic has a really bad reputation when it comes to bleeding and that's a big risk factor to have during surgery right is the risk for bleeding or hemorrhaging bleeding too much so we need to know are those vitamins and herbal supplements that they're taking we may need to do a full admit on this patient depending on what's going on with them we're always going to do baseline vitals baseline head-to-toe because we've never seen this person before but if they're having like an outpatient surgery or like a scheduled a surgery where the nurse in the clinic or in the surgical center like calls them at home the week before and starts asking them all the questions about like their health history their surgical history their family history all of those things you ask in a proper admission then you don't need to do that as the pre-op nurse because it's already been done if it's not that kind of surgery and you don't have the luxury of all that stuff being done ahead of time you might need to do it now in the preoperative stage we need to review their health beliefs or religious beliefs prior to surgery because a common thing that can happen during surgery is blood loss and so we will give a blood transfusion during the operation or right after and if this is the type of person who doesn't believe in that and doesn't want to have a blood transfusion we need to know that ahead of time so that we don't just give it to them without their consent when maybe they're unconscious and can't tell us know so that's something really important that we want to review prior of course everybody who's going to have a procedure is going to be considered a fall risk so we're gonna have sidereel's up bed in the lowest position they're gonna have their fall wrist bracelet on everything is going to be considered a fall risk precaution so making sure they're safe and in the stop bank doing a stop bang I'll do that here when I'm done with this because I'll make up a chart and tell you exactly what a stop Banyas it's just says for people who are at risk for sleep apnea or a risk for complications during surgery because of it of course this is the time they're going to be conscious right they're going to be able to listen to us so we're going to do a lot of teaching during this time so what are we teaching them we're teaching them about what we're doing as we're doing it so I'm inserting this IV because we need to give you medication during the procedure right so explaining what you're doing while you're doing it what will happen during the surgery so if they're gonna be unconscious letting them know what's going to have them given a general idea if they're going to be awake during the surgery letting them know okay you might feel this you might hear this sound that kind of stuff assess the patient's level of understanding this happens a lot doctor will come in they'll get the consent they'll explain the risks and benefits and do everything and in the walk out of the room and the patient will look at the nurse and say I have no idea what they just said to me I don't know what I just agreed to have done and that's bad right that's dangerous so you always want to assess what do you understand what do you think is gonna happen involve the family right because of course they'll be family they're gonna want to know what's going on they're gonna have questions the patient might be like I get it I'm good I don't have any questions but the family will have 100 questions right so be prepared to answer any questions that are appropriate don't forget to address the emotional aspect of surgery as well most people are nervous about it right they're nervous going in they're afraid they might think like Oh what if I never wake up like scary stuff like that right so asking them how are they feeling and letting them go through those emotions ask they're coping strategies and then inquire about their own self-concept and body image especially during like certain surgeries so like if you're having something like a colostomy placed right obviously that's gonna alter the way you look right and that can alter your body image and how you feel about the way you look right so don't forget about stuff like that that's important too so what groups of people are at risk those with extremes in age so the very young and the very old so like little children babies and the elderly those who are obese the higher the BMI the higher the risk you have and then those who have a comorbidity or some other chronic disease like a diabetes diabetes is huge when it comes to surgery when you think diabetes and surgery think post-op infection they're at high high risk for that and I know I asked questions about that 80 I asked questions about that and I'm sure NCLEX will ask questions about that too so when you think diabetes and surgery think post-operative infections that is HUGE if this is a scheduled surgery something that's been planned far in advance and you are doing that admission stuff like over the phone some things you might want to do or bring up is asking them to stop certain medications like blood thinners asking them to stop smoking right alcohol use substance abuse that kind of stuff some surgeries they require the patient to lose weight to be eligible to get the surgery so it's not like everything's an emergency and we're doing it today right some of these surgeries are planned and we have time to ask the patient these sorts of questions when they're not planned who when there are emergencies right which in OB we're in emergencies all the time right when they're nothing you still got to do all this stuff and that is why teamwork is really really important so one nurse will come in and do the IV another nurse will come and do the consent somebody also put in the Foley catheter right and we all work together now let's talk about what a stop bang score really is now let's talk about how to do stop being assessment really it's just a couple of yes-or-no questions so the S stands for snoring do you snore yes there no and ladies they snore cuz a lot of people snore right when I say snore it's like do you snore loud enough that somebody can actually hear you in another room that kind of story it's higher do you feel tired or drowsy or sleep ease throughout the day always for observed so has another person your bed mate your spouse your partner whatever observed you stop breathing while you were sleeping P is for pressure so blood pressure so have you been treated or are you currently being treated for blood pressure problems right now are you currently on a blood pressure medication BMI greater than 35 H over 50 years old neck circumference greater than 40 centimeters and then gender males so men are at higher risk for developing complications during surgery simply by being men as are people who are older and who have a higher BMI so this is the staff they score it's pretty easy to figure out it's just a bunch of yes-or-no questions that we ask the patient prior to surgery now let's talk about the different types of surgery when we talk about the different types of surgeries we usually put them into three categories the reason they're having it done the risk involved in the sense of urgency so let's talk about them in more detail here so under our reason we have diagnostic so a diagnostic surgery is done to identify the presence of a disease a very common one is a biopsy an exploratory surgery is to check the extent of that disease and a common one of those is an exploratory laparotomy an ablative surgery is the removal of an organ so commonly could be like an appendix removal or a hysterectomy or something like that reconstructive surgery is the repair of an organ so there's some sort of damage to the organ constructive is a repair of a congenitally damaged organ so usually this is done in babies but sometimes later in life these things can be done so they were born with something wrong to one of their organs like maybe their kidneys or something like that and then they needed to have a surgery to repair that palliative surgery it's done to Aleve signs and symptoms okay palliative surgery is not curative surgery it's not gonna all of a sudden make them better but it's gonna make them feel better it's gonna help reduce their signs and symptoms and the things that they're I'm dealing with so it's a nice thing and an example of this is to maybe remove cancerous tissue it doesn't mean you're necessarily gonna be cancer free but whatever issues that tissue is causing in your body like certain like pains and things like that hopefully that will be aided in removing this tissue it's gonna help them feel better cosmetic surgery this is what we call like plastic surgery right so this is done to improve one's appearance so these are the reasons we can do surgery these are the type of surgeries it can also be risk related so a major surgery versus like a minor surgery so major surgery would be like a cabbage or like a heart transplant or something like that right that's a major surgery where they're gonna be in the room for a long time and it takes a lot of hands it's you know it takes several hours it's very dangerous we're touching your organs that kind of stuff major surgery a minor surgery is gonna be the opposite usually it's more superficial it's less invasive and it takes a shorter amount of time lower risk so major surgeries are much higher risk minor surgeries are much lower risk and then finally the urgency of the surgery that's our final category so if it's an emergent we needed surgery we need to do it right now and immediately because if we don't do it this person's either gonna die or they're gonna lose a limb so to save life for them that's what we say an urgent surgery needs to be done sooner rather than later and when I say sooner rather than later I say as soon as possible roughly within about 24 hours okay so it's not like I'm gonna die right now if you don't do this but I might or there might be severe complications if you don't do it soon maybe within the next couple of hours that kind of thing and then elective surgeries elective kind of throws people off because you hear elective and you automatically think cosmetic right you think all are the same right no no so elective is simply is something that can be scheduled so this might be a surgery that is necessary or not necessary so cosmetic surgery plastic surgery can be an elective surgery you don't need to have it but then getting your tonsils removed you may need to have that done right you just don't need to have it done within the next 24 hours or right now right so an elective surgery is one that you can schedule in advance okay so this is the first video in the series of three this was pre-op the next one is going to be in shock thank you so much for watching if you have any questions or comments please let me know and if not I'll see you on next one

Channel: That nursing prof

Views: 102,629

Keywords: nurse, RN, PN, LPN, LVN, CNA, Tech, Surgical, surgery, nursing, school, student, college, university, Pre op, operation, operative, STOP BANG, scrub, PACU, Peri, nclex pn, perioperative nursing, nclex rn, nclex exam, perioperative nurse, nursing school, head to toe assessment, perioperative nursing fundamentals, perioperative nursing med surg, perioperative nursing nclex, registered nurse, nclex test, nclex rn review videos

Id: 87FBupeZw3s

Length: 16min 28sec (988 seconds)

Published: Sat Apr 11 2020