Preoperative preparation

Description:

Preoperative training of patients consists in a complex of actions. In some cases they come down to a minimum (at the immediate and urgent surgeries), and at planned operations have to be carried out more carefully.

At immediate surgeries concerning an acute appendicitis, the restrained hernia, not getting wounds of soft tissues there is enough injection of solution of morphine or Promedolum, shaving of a surgery field and release of a stomach from contents. At patients with severe injuries it is necessary to begin at once antishock actions (anesthesia, blockade, hemotransfusion and antishock liquids). Before operation for peritonitis, intestinal impassability it is necessary to carry out emergency measures on fight against dehydration, disintoxication therapy, correction of salt and electrolytic balance. These actions have to begin with the moment of arrival of the patient and not be the cause of a delay of operation.

By training the patient for planned operation the diagnosis has to be specified, the associated diseases able are revealed to complicate, and sometimes and to perform operation of impossible. It is necessary to establish the centers of an endogenous infection and whenever possible to sanify them. In the preoperative period inspect function of lungs and heart, especially at elderly patients. Preoperative transfusion of proteinaceous drugs and blood, and also fight against dehydration are necessary for the weakened patients. Much attention has to be paid to preparation of a nervous system of the patient before operation.

Nurse's duties. Medicamentous preparation for surgery is carried directly out by the nurse on doctor's orders. The nurse carries out also physical training of the patient directed to the prevention of postoperative complications, prepares integuments, an oral cavity, a zheludochnokishechny path of the patient for operation. The medic of surgical department has to remember that unfair performance even the most insignificant, at first sight, actions of care of the surgical patient, can lead to tragic effects.

Waiting for operation of people, naturally, worries, his concern is justified. Anticipation of pain, and in certain cases a presentiment of own helplessness in the postoperative period disturb and oppress the patient. The nurse, communicating with the patient, should not substitute the doctor at all and to try to explain him essence of the forthcoming operation. But it has to maintain in the patient confidence that thanks to high qualification of surgeons and anesthesiologists, by means of drugs and other special receptions operation and the postoperative period will be painless. It is important to convince the patient of success of treatment. It is the difficult task demanding in each case of individual approach to the sick person. Irrespective of own mood it is necessary to maintain constantly courage at the patient to whom operation is necessary.

It is very important to strengthen trust of the patient to those specialists who direct his treatment and will directly see off it. It concerns also those specialists who will treat the patient in the first days after operation in chamber of an intensive care.

Absolutely inadmissibly, that the nurse critically spoke in the presence of patients of work кого‑либо from medical personnel even if for similar criticism there are bases.

Important element of activity of the nurse is carrying out respiratory gymnastics, especially at a preparation for surgery of patients of advanced age. The nurse has to not only remind of need of carrying out respiratory gymnastics in strict accordance with appointment of the doctor, she is obliged to explain to patients that the postoperative period proceeds much easier at those who accurately carried out all appointments of the doctor before operation. The correct performance of the mode of breath (expectoration and removal separated respiratory tracts) plays a huge role in prevention of postoperative pulmonary complications.

The nurse has to control smokers. It is necessary to convince them of need to leave off smoking as smoking breaks a tussive reflex and promotes a phlegm delay in lungs that after operation involves pulmonary complications.

The oral cavity of the person contains a set of microorganisms among which there are also disease-producing. Especially there are a lot of them at caries of teeth, inflammations of gums and an adenoid disease (an inflammation of almonds). The healthy person has a natural cleaning of a mouth. After operation situation other. At patients salivation decreases, it is difficult for them, and often and it is impossible to brush teeth. Restriction or the termination of drink and meal through a mouth create additional conditions for development of an infection which can always sharply become more active and cause as a local inflammation of a cover of an oral cavity, pharynx, a parotid gland, and the general life-threatening complications (sepsis).

At patients with diseases of teeth and gums in the preoperative period it is necessary to make sanitation of an oral cavity. In the absence of explicit defeats of bodies of an oral cavity preoperative preparation comes down to observance of rules of hygiene: to toothbrushing by a brush 2 times a day (in the morning and before going to bed) and to obligatory rinsing of a mouth after each meal.

If the patient long time did not brush teeth, to it it is not necessary to recommend to begin in the preoperative period toothbrushing as it will cause irritation and an inflammation of gums that will force to postpone operation. Such patient can wipe teeth and language with the gauze sterile napkin moistened with solution of baking soda (1/2‑1 teaspoons on a glass of warm water). After that it is necessary to rinse a mouth warm water.

Preparation of a zheludochnokishechny path. Before any operation at the patient the zheludochnokishechny path has to be cleared. Gastric flatulence and intestines, filled with gases and contents, after operation worsens blood supply of these bodies that promotes development in infection intestines with its penetration out of limits of an intestinal wall, and owing to supertension can break seams on abdominal organs after operation. Besides, gastric flatulence and intestines sharply worsens function of serdechnososudisty and pulmonary systems that in turn worsens blood supply of abdominal organs. Contents of hollow bodies of a stomach at operations on these bodies can get into a free abdominal cavity, causing an inflammation of a peritoneum (peritonitis). Existence of contents in a stomach which surely meets at obstruction by a tumor of output department of a stomach or at ulcer narrowing is dangerous that during an introduction anesthesia it can get into the patient's mouth, and from there – in lungs and to cause suffocation.

At patients without disturbance of evacuation from a stomach preparation of upper parts of a digestive tract for operation is limited to a complete starvation in day of operation. At disturbances of evacuation from a stomach before operation pumping out of contents of a stomach is made. For this purpose use a thick gastric tube and an irrigation syringe of cavities.

At accumulation of the remains of food of a dense consistence and slime the gastric lavage is carried out, – instead of the syringe put on a big glass funnel the end of the probe.

A large number of gastric contents collects at patients with intestinal impassability.

The cleansing enema is, as a rule, applied to cleaning of lower parts of intestines. A single enema or even two enemas (for the night and in the morning) cannot effectively clear intestines at the patient with a chronic delay of a chair therefore one of the main tasks of the preoperative period – to achieve from a sick daily independent chair. It is especially necessary for patients with tendency to accumulation of gases (meteorism) and suffering from chronic locks. The correct diet can provide normalization of bowel emptying.

Preparation of integuments. In a time and folds of skin microorganisms which hit in a wound has to be excluded accumulate. It also makes sense of a preparation for surgery of integuments of the patient. Moreover, the contaminated skin after operation can become the place of development of gnoynovospalitelny diseases, i.e. an infection source for all organism.

On the eve of operation of the patient wash and change linen. Especially carefully it is necessary to wash out places of accumulation of sweat and dirt (axillary hollows, a crotch, a neck, feet, a navel and all skin folds, very deep at corpulent patients).

Hair on the head of the patient have to be accurately cut, men have a beard and moustaches – are shaved. Nails on hands and legs shall be close-cut. The varnish from nails should be washed away.

More effective cleansing of a body of the patient before operation, undoubtedly, is the shower which is easier transferred by many patients.

Bed patients at first rub off in a bed warm soap water, after that – alcohol, cologne, etc. On a bed the oilcloth has to be enclosed. At rubdown by water use a sponge. The nurse is obliged to examine all body of the patient and at detection of pustulous or other inflammatory damages of skin it is obligatory to report about it to the doctor.

Preparation of a surgery field. The surgery field is the area of skin which will be exposed to surgical intervention (section) during operation. The correct preparation operational weeding considerably reduces quantity of the microorganisms getting to an operational wound.

The nurse's duties in preparation of a surgery field come down to shaving of indumentum of this site in day of operation before reception by the patient of drugs and carrying out injections. (Shaving of hair of a surgery field is not made on the eve of operation in the evening because the small scratches which arose at the same time can inflame by the morning that will make impossible carrying out operation.)

Before a skin section in day of operation on the operating table the surgery field, at least, will be three times processed by 5‑10% spirit iodic tincture that considerably reduces probability of development of an infection not only after microtraumas of blankets of skin the razor, but also after its section all the way down.

Before the use the razor needs to be disinfected within 5‑10 min. in 3% solution of carbolic acid or 2% chloroamine solution.

It is necessary to shave, slightly pulling skin in the direction opposite to the razor course. Strictly at right angle to the direction of shaving it is reasonable to carry out direct movement of a cutting edge of the razor in relation to hair "against wool". However, at dense vegetation hair soap preferably dry shaving. The shaved surgery field is washed boiled water and wiped with alcohol. Borders of shaving have to exceed area of skin which will be bared after an obkladyvaniye of a surgery field by sterile sheets.

Before the majority of large operations all anatomic area of surgical intervention prepares: at head operation shave all head, at stomach operation – all stomach, including a pubis etc. It is necessary to know what sites of skin shave before typical operations. In certain cases it is necessary to learn from the surgeon the course of an estimated section of skin, and sometimes and an arrangement of a possible additional section in advance to prepare both surgery fields.

Transportation of the patient to the operating room. Has to spend days before operation of the patient in the conditions of absolute mental and physical rest. In the morning of the patient can get up, clean teeth, wash up a face and hands, to shave and visit a toilet. In the morning time hair of a surgery field shave. Having been returned to chamber of the patient has to go to bed and not show activity neither in a talk, nor in the movements. Later, about 8 h morning are spent usually by injections: to the patient enter the drugs training him for carrying out an anesthesia (calming, drugs etc.). This preparation is called premedication. After that the patient has to observe absolute rest and a bed rest. In chamber it has to be silent. If the patient does not sleep, it is necessary to remind of need to doze at least blindly.

Before transportation to the operational hall of the patient has to urinate. When training some patients for operation it is useful to develop at them skill to urinate lying in a bed that will facilitate then forced need to urinate lying after operation, and will save many from introduction of a rubber tube to a bladder – actions of unpleasant and serious possible infectious damages of an urinary system in sense. To teach the patient to urinate lying the nurse has to. The patient can sometimes urinate sitting on a bed, after that he lays down on a wheelchair.

Before transportation of the patient the nurse has to be convinced that he is correctly dressed. If breast operation, shirts at it does not be. At stomach operations on men there should not be underwear. Though underwear can be taken off also in preoperative.

Long hair at women have to be braided, accurately laid on the head and are tied by a gauze kerchief. Hours, rings and other jewelry have to be removed. Removable dentures leave in chamber.

It is inadmissible to transport the patient without pillow, with the head on weight. It is necessary to remember what before operation of the patient experiences strong emotional pressure therefore he has to feel constantly care and courtesy of medical personnel. Before transportation of the patient on operation it is necessary to be convinced of readiness of operational and anesthesiology personnel to accept it. All tools on tables have to be closed, traces of the previous operations are removed, wet cleaning of the operating room is made.

Deliver to operations of patients on a wheelchair in lying situation. Transportation of the patient lying is explained by need to save him from dangerous reactions of bodies of blood circulation to change of position of a body which are possible after premedication. Transport the patient smoothly, with a moderate speed, without blows by a wheelchair about objects in a corridor and a door.

Having brought the patient to the operating table, the nurse helps it to pass to it, and stacks on a table according to instructions of the anesthesiologist or surgeon, covers the patient with a sterile sheet. The seriously ill patient is transferred by anesthesiology crew and the scrub nurse.

Together with the patient the case history, a test tube with blood or serum (with a surname and the patient's initials) for definition of individual compatibility have to be delivered and transferred to the anesthesiologist to the operational hall at hemotransfusion, and in certain cases and necessary for the patient during operation of medicine which it used before.

If by the patient with the lowered hearing, it is necessary to transfer to anesthesiology crew the hearing aid as it will be necessary for contact with the patient.

Preparation for an immediate surgery. At states, life-threatening the patient (wound, a life-threatening loss of blood, etc.), preparation is not carried out, the patient is urgently brought to the operational hall, even without taking off from it clothes. In such cases operation begins along with carrying out an anesthesia and revival (resuscitation) without какой‑либо preparation.

Before other immediate surgeries preparation of a vsetaka for them is carried out, though in much the reduced volume. After making decision on need of operation preoperative preparation is carried out in parallel with continuation of inspection of the patient with the surgeon and the anesthesiologist. So, preparation of an oral cavity is limited to rinsing or wiping. Preparation of a zheludochnokishechny path can include pumping out of gastric contents and even leaving of the gastric nasal tube (for example, at intestinal impassability) for the period of operation. Give an enema seldom, only the siphon enema is allowed in attempts of conservative treatment of intestinal impassability. At all other acute surgical diseases of abdominal organs the enema is contraindicated.

The hygienic hydrotherapeutic procedure is carried out in a short form – a shower or washing of the patient. However preparation of a surgery field is carried out in full. If it is necessary to train the patients who arrived from production or about streets at which integuments are strongly contaminated preparation of skin of the patient is begun with mechanical cleaning of a surgery field which in these cases at least has to be twice more, than an estimated section. Skin is cleared the sterile gauze tampon moistened with one of the following liquids: ethyl ether, 0,5% liquid ammonia solution, pure alcohol. After cleaning of skin hair shave and make further preparation of a surgery field.

In all cases the nurse has to receive accurate instructions from the doctor on in what volume and to what term she has to execute the duties.