Role of Perioperative Nurse
Perioperative nurses provide critical care for patients in high-dependency situations. This care involves collaboration with other healthcare professionals as well as safe and effective management of the problem. Besides, the perioperative nurse acts as a patient advocate during the perioperative experience and safeguards the patient's integrity. The nurse also identifies the patient's sociological, psychological, and physiological needs before, during, and after the operation (Nagle, 2006). Besides, a perioperative nurse implements an individualized nursing care program based on behavioral and natural sciences to ordinate nursing interventions. All these actions of the perioperative nurse are meant to maintain and restore the patient's welfare and health before, during, and after surgery.
Other roles of a perioperative nurse include taking care of a patient during interventional procedures and before, during, and after surgery. Before the operation, the nurse will ensure that the patient feels less anxious. During the process, the nurse provides all the necessary assistance to the surgical team. After surgery, the nurse provides the best care to the patient by ensuring that all patients' needs are met (Nagle, 2006). The perioperative nurse's roles are a wide range from the functions of an anesthetic nurse, instrument nurse, circulating nurse, post-anesthesia care unit nurse, nurse practitioners, perioperative nurse surgeon's assistant, and preoperative patient assessment and education nurse. These nurses also ensure proper communication between the ward staff and the theatre team.
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Principles of Aseptic Technique in the Operating Room
Aseptic techniques are meant to prevent surgical complications from taking place due to infections that may occur at any time during hospitalization or surgery. Sterile techniques and aseptic techniques may be used interchangeably. The techniques used to aid in the reduction and elimination of microorganisms in the hospital and the operating room include regular handwashing by the hospital staff through sanitization or soap. Other techniques involve using sterile gloves when handling high-risk patients like patients with wounds and known infections, and other likely sources of pathogens. This also applies when handling hospital surfaces and equipment, such as contaminated sponges. Besides, surgical team members are to remain within the sterile area to prevent cross-termination. Talking is also kept at a minimum and only when necessary since it increases moisture-laden chances with bacteria. Also, equipment used during surgery must be sterilized and cleaned or disposed of later to prevent cross-contamination. The surgery team should ensure they remain seated or standing throughout the operation, depending on how they had started.
Importance of Safety in the Operating Room
Safety in the operating room is to maximize patient safety. Patient safety emphasizes medical errors that often lead to adverse events in the operating room and their prevention. Safety in the operating room can be ensured through sterile and aseptic techniques in the surgical room, taking care of patient's psychological, physical, and sociological needs on time, and using appropriate and sterile equipment during surgical procedures. Safety in the OR refers to both the healthcare personnel and the patient (Sayed et al., 2013). Lack of safety in hospitals and OR can be catastrophic for the patient, surgical team, and institution. As a result, OR safety is essential in ensuring proper healthcare outcomes. It helps prevent nosocomial infections that could otherwise lead to adverse health effects for the patient, which may be fatal in extreme cases.
Common Types of, and Delivery Systems for Anesthesia
Four main types of anesthesia can be used during surgery, and they include general, regional, local, and monitored anesthesia care. The type of anesthesia administered generally depends on the patient's health condition, the type of surgery, the surgeon and anesthesia provider's preference, and the length of the procedure. General anesthesia is administered to the patient intravenously or through masks, and it will render the patient temporarily unconscious. It also paralyzes muscles and hence the need for ventilators to help in breathing. On the other hand, regional anesthesia is administered through a flexible catheter line and injections to specific sites with a numbing medication. Local anesthesia is administered locally, on the area where the procedure is to be performed. It is used for minor procedures such as for a skin biopsy or for filling a cavity. Numbing medication is either injected into the area, applied as a cream, or sprayed on the skin. Monitored anesthesia care, on the other hand, is used for outpatient procedures such as cataract surgery or colonoscopy is usually administered intravenously.
Nursing Responsibilities in Admitting Patients to the Post-Anesthesia Care Unit (PACU)
Post-anesthesia care may include resuscitation and airway management, postoperative nausea and vomiting, development of policies, discharge from PACU, and continuous quality improvement (Gilmour, 2005). The nurse ensures the provision of safe and consistent patient care following the patient's condition. This is also to ensure a safe patient transition to the post-anesthesia period. The PACU provides necessary resources that the nurse uses for regional anesthesia, sedation, or general anesthesia and is appropriate for the patient. PACU involves phase I, phase II, and extended care. The first phase involves patient care aimed at a patient return to baseline vital signs. The second phase is focused on the specific needs of the patient and the patient's continued recovery. The third phase is for patients who cannot go to another location even though they have met the criteria to leave phase I.
Nursing Responsibilities in the Prevention of Postoperative Complications of Patients in the PACU
To avoid postoperative patient complications, the nurse ensures postoperative multimodal pain management. The nurse is focused on analgesia that eliminates or limits the need for opioids to limit the opioid crisis. The nurse engages the patient in early mobilizing, eating, and drinking after the procedure to support the patient's more rapid recovery. The nurse also encourages the patient to resume their regular diet and normal activities of daily living. The nurse also reduces the incidences of postoperative nausea and vomiting by ensuring the patient is adequately hydrated, maintaining anesthesia, and administering regional anesthesia while minimizing the administration of opioids. For high-risk patients, prophylactic approaches are specifically effective in the management of postoperative nausea and vomiting.
Nursing Interventions to Manage Potential Problems During the Postoperative Period
Potential complications that might occur post-operation include hemorrhage that may occur due to ineffective alterations in coagulation and vascular closure. The nursing interventions that manage this include regularly monitoring vital signs to detect any signs of hypovolemia (Gilmour, 2005). The nurse may also conduct coagulation studies and monitor platelet levels to ensure no alterations that may lead to coagulopathies. Other complications that may occur post-operation include urinary retention, which may result from the surgical procedure, pain, fear, supine positioning, or analgesic and anesthetic medication. The nurse may intervene by placing the patient in a normal position as much as possible to allow voiding and notifying the physician if six hours after surgery, the patient does not urinate. This is to avoid urinary discomfort and distention.
Differentiate Discharge Criteria from Phase I and Phase II Post-Anesthesia
Phase I-Refer to care immediately after surgery. It includes more intense monitoring such as mechanical ventilation and arterial blood pressure monitoring and ECG use. This phase aims to facilitate the transfer of a patient to the inpatient unit r to phase II. Phase I is usually labor-intensive and costly. Discharge from phase I is generally based on a pre-determined physiological scoring system using a criteria-based system.
Phase II-the patient is transferred to phase II after phase I priorities have been met. It is based on the needs of the patients and facility policy and is focused on the continued recovery of the patient (AANA, 2019) . It is often applied in ambulatory admission and is aimed at preparing a patient for transfer to an extended care facility or discharge to home.
Data from the Initial Nursing Assessment to the Management of the Patient After the Transfer from the PACU to the General Care Unit
Patient identification and handover during admission to PACU should occur using the handover flow sheet. Communication of postoperative orders should be done both through EMR and verbally. This should be in addition to the operation report. Any issues throughout the intra-operative period should be highlighted during clinical handover to allow for clarifications about a patient before accepting care of a patient. The initial assessment to be done once care is accepted in the PACU include; assessment of circulation, breathing and oxygen levels. It also includes an assessment of dressings and wound sites, analgesia, any reportable blood loss and urine output (AANA, 2019) . The discharge criteria to be used in PACU; no active vomiting, the clinical observations are appropriate for the age of the patient, pain is managed, and there is a sedation score of 2 0r less.
References
AANA. (2019, August). Postanesthesia Care Practice Considerations. Retrieved from American Association of Nurse Anesthetists: https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/postanesthesia-care-practice-considerations.pdf?sfvrsn=677a6ac5_8.
Gilmour, D. (2005). Perioperative care. In Nursing, the surgical patient (pp. 17-33). Elsevier Science, London.
Nagle, G. M. (2006). Perioperative nursing. Nursing Clinics , 41 (2), xi-xv.
Sayed, H. A., Zayed, M., El Qareh, N. M., Khafagy, H., Helmy, A. H., & Soliman, M. (2013). Patient safety in the operating room at a governmental hospital. The Journal Of The Egyptian Public Health Association , 88 (2), 85-89.
