Acute Care
Content
TRI GGER1 :Pr e pa r i ngt hepa t i e ntf ort he at r e Nut r i t i ona ndhy dr a t i on Th eRo y a lCo l l e geo fNu r s i n g( 2 00 5)r e c omme nd sc l e arfl u i d su pt ot woh ou r sa ndf o odu pt os i x hour sbef or ei nduc t i oni nheal t h ypat i ent sofal lages .Manyc l i ni c alar eashav es etf as t i ngt i mesf or pat i ent s . F as t i n gc a nb ed i ffic u l tt o ma na ge wh en t h ea t r el i s t sc a nb ec h a ng ed a nd o pe r a t i o nsc a n c el l e d. Nu r s esne edt obeawa r eofpa t i e ntc omf or ta ndhy d r at i o n,an de na bl et h em t oac c es sf oo dan dd r i nk f orasl ongasi spos si bl e,i nl i newi t hl oc al pol i c y . Al ls t a ffs h o ul dk n o w wh en p at i e nt sa r en i lb ymo ut h( NBM) ,a nd t h i ss h o ul db ed oc u me me nt e di n pat i ent s ’r ec or ds . Onc epat i ent sar ef as t i ng ,mout hc ar es houl dbea v ai l abl eoradmi ni s t er edt ot hos eunabl et oper f or m i tt hems el v es . Wh eno pe r a t i o nsar ec a n c el l e d,p oo rc o mm mmu ni c a t i o nb et we eno pe r a t i n gd ep ar t me nt san dwa r d sma y me anp at i e nt s ’NBM s t a t u si spr o l o ng ed( NPSA,2 01 1) .Th i si s s u en ee dst ob ea dd r e s s edbys en i o r n ur s i ngan dme di c al s t a ff,a nddec i s i o nsp as s edt owa r dandop er at i ngde par t me nts t aff . Ot he ra c t i ons Pa t i e nt ss h o ul dwa s ho rs h o we ru s i n gs o a pa ndwa t e rt h ee v e n i n gb ef o r es u r g er y( NI CE, 2 0 0 8 ) ; Pr es c r i bedmedi c at i ons houl dber e vi ewedpr eop er at i v el yandonl yes s ent i al medi c i nesgi v en -t hos et ak enor al l ys houl dbes wal l owe dwi t ht hes mal ma l es ta mou mo ntofwat erpos s i bl e; Me di c i n est h atwi l lc a us ed r o ws i n es ss h ou l db ea dmi n i s t e r e do nc et h ep at i e nth asb ee n pr epar edf ort heat r eandt hepat i ents houl dbeadv i s edt os t a yont hebedwi t hac al l bel l ; Hai ra r o un dt h ei n ci s i ons i t es h ou l db er e mo mo v edo nt h ed ayofs ur g er yi fn ec e ss ar y ,us i n g el ec t r i cc l i pper swi t has i ngl eus edi s pos abl ehead; Pat i ent s ’c omf or ta nddi gni t yshoul dbemai nt ai nedwhent he yar ec hangi n gi nt ot hei rt heat r e go wn; De pe nd i n go nt h es u r g er y ,p at i e nt sma ma ywe arp an t s ,b utwo me me ns h o ul db ea s k e dt or e mo mo v e br asbef or es ur ger y ; An t i e mb mb ol i s ms t o c k i n gss h ou l db eme as u r e da ndfi t t e do na dmi s s i o no ri mme di a t e l ybe f o r e t r ans f ert ot hea t r e,depen di ngonVTEr i s k ; J e we l l e r ys h ou l db er e mo mo v edwh er ep os s i b l e ,a l t h ou gh l o c alp ol i c yma ya l l o wt a pet ob e appl i edar oundj ewel l er yt hati sdi ffic ul tt or emov e; Den t u r esan dh ea r i n ga i d ss ho ul dber e mo mo v ed,a ndpa t i e nt sma ma yp r ef e rt h i st ob ed on ei nt he anaes t he t i cr oom -t hes ei t emss houl dbet ak ent ot h er ec ov er yar ea,a ndst or eda ndl ab el l ed; L oo set e et h,c a pso rc r o wn ss h ou l db ei d en t i fi e da sas af e t yp r e c aut i o nt op r e v en tc ho ki n g dur i ngana es t hes i a; Wr i s t b an dd et ai l ss ho ul db ec h ec k e dwi t hp at i en t san dt oen s ur et h eyma mat c ht h os eo np at i e nt r ec or ds ,medi c i ner ec or ds ,Xr a ysandt es tr es ul t s ; Vi t al s i gn ss ho ul db er ec or de da ndab no r mal r e ad i n gsr e por t ed ; Al l e r g i e ss h ou l db ed oc u me me nt e d; Th es i t eo fs u r g er ys ho ul dbemar k e do nt h ewa r do rd a yun i tbe f o r ep at i e nt sgot ot h ea t r eor r e c ei v epr e me me ds( NPSA,2 00 5) ;t h i ss ho ul db ec h ec k e db yt h en ur s eo nt h ewa r do rd ayun i t whoi scompl et i ngt hepr eoper at i v ec hec kl i s t ; Co ns e nts h ou l dh av eb ee no bt a i n edi nl i n ewi t hDe pa r t me nto fHe al t h( 2 00 9)g ui d an c e,a nd c h ec k e di mme di a t e l yb ef o r es u r g er y .Th i si n v o l v e se ns u r i n gp at i e nt su nd er s t a nd t h e p r o c ed ur ea ndt h att h eyar eh ap pyt og oa he adwi t hi t .Ho wc o ns e nti sga i n eda ndc o nfi r me d •
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wi l l d ep en do na gean dmen t al c a pa ci t y .
Li ddl eC ( 2012)Pr ep ar i ngpat i ent st ounder g os ur ger y . Nur s i n gTi mes ;108:48 ,121 3.
TRI GGER 4:WHAT ARE THE PRI ORI TI ES OFBEN’ S CARE? ( 8br eat hspermi nut e,di ffic ul tt o r ous e,pi npoi ntpupi l s )
T r i adofOpi oi dI nt ox i c at i on 1 . Pi n po i n tp up i l s 2. Co ma 3 . Re s p i r a t o r yd ep r e s s i o n Nur s i ngI nt er v ent i ons : 1 . No t i f yph y s i c i a n. 2. I fh y po gl y c e mi c ,a dmi n i s t ero x y ge n,5 0% d ex t r o seaso r d er e db yt heph y s i c i an . 3. I fdec r e as edl e vel ofc ons c i ous nes s ,gi v ena l o x one( ant i d ot ef oropi at eo v er dos e)asor der ed . 4. Moni t orr es pi r at or y ,neur ov as cul arandc ar di ov as c ul ars t at usc l os el y . 5. * I fn al o x on ep r o du ce sn or e s po ns ea ta l l ,t h ep at i e ntma yr eq ui r ei n t u ba t i o na ndacomp ut e d t omo gr a ph ys c ano ft h ehe adt or u l eou tc er e br a lb l e ed i n go rh e adt r au ma .
REFERENCES: Wi l l i ams ,R. ,&Er i c ks on,T .( 2000) .Emer genc yDi agnos i sofOpi oi dI nt o xi c at i on.L ab or a t or yMe di c i n e, 31( 6) ,3343 42 .d oi : 10 . 1309/ qy 8t k gbnb va 6h706 Wo od ,P . ,Ma ho ne y ,P . ,& Co op er ,J .( 2 00 9) .T r auma a nd or t hopedi cs ur g er yi nc l i ni c alpr ac t i c e . L on do n:Sp r i n ge r .
TRI GGER 5:Wha ta r et heps y chos oc i a li mpa c t sofs ur ge r yf orBe na ndhi spa r e nt s ? Thes t r es sofs ur ger yc anpr oduc ei nc hi l dr en,‘ Phy s i ol ogi c al ,emot i onal ,c ogni t i v e,behav i our aland i nt er per s onalc ha ng es ” J ones ,B.( 2 015) .,t h es ec hangesc anper s i s tandof t enf al lunderc at egor i es s uc ha sgener ala nx i et yandr egr es s i on,s epar at i onanx i e t y ,anx i e t yabouts l eep,eat i ngdi s t ur banc e, aggr es s i o nt owar daut hor i t yan dapat h y/ wi t hdr a wal . Th e s ea r ej u s taf e wo fma n yr e a s o nsa st owh yc h i l d r e nwh oh a v eb e eno p er a t e do nma yh av e p s y c ho s oc i a li mp ac t sp os t s u r g er y .A s t u dywa sc o nd uc t e dt h ats h owe dt h atc h i l d r e n wh o we r e o pe r a t e d on wi t ho utp r e l i mi na r ye x pl an at i on so rso me t i mes d ec ei v i n gi n f o r mat i o nr e gar d i n gt h e s ur ger yof t enf el tbet r a y edb yt hos ewhot he ybel i e v edwoul dpr ot ec tt hem. Chi l dr ens omet i mesno tonl yf eel f r i ght enedb yt hei rdoc t or sbutma ybea l s owor r i edaboutda yt oda y
l i f epos t s ur ger y .Res pons esar ei nfl uenc edb yf ac t or ss uc hast hec hi l d’ sde v el opme nt all e vel ,pr i or e xper i e nc eswi t hi l l nes sa ndmedi c alc ar e,t heamounta ndqu al i t yofpr epar at i ont hati spr o vi dedan d t hes uppor t sav ai l abl et ot hec hi l dandf ami l y J on es ,B.( 2 01 5) . Negat i v eps y c hol ogi c alr es pons esi n c hi l d r e nt os ur g er yc a nb ei nt en s e,d ama gi n ga ndp r ol o ng eda ndt h eys ho ul db ea nt i c i p at e dp r i o rt o t hes ur gi c al e xper i enc e. Bencoul dbewor r i edabout : Thepos t oper at i v ec ompl i c at i onr e oc c ur r i ng Howl onghi sl egwi l l t ak et oheal I fhewi l l gett or i dehi squadbi k eagai n Whathi sf r i endswi l l t hi nkoft heac ci dent I fhi spar ent swi l l getr i dofhi squadbi k e Howl onghewi l l hav et os t a yi nhos pi t al f or Ev er y da yl i f ec hangesduet ohi si nj ur i es • • • • • • •
Be n’ sPa r e nt sc oul dbewor r i e da bout : • • • • •
Thepos t oper at i v ec ompl i c at i onr e oc c ur r i ng Wh att h eyar eg oi n gt od oa bo utt h eq ua db i k e Ben’ sov er al l heal t hands t at eofmi nd Get t i ngr i doft heQuadbi k eandBen ’ sr eac t i ont oi t Ev er y dayl i f ec hangesduet ot hei rs on’ si nj ur i es
Whatt henur secando I nor d ert oha v ebo t hBenan dhi spar ent sateas e,i twoul di mpor t antf ort henur s et oha v eat al k wi t ht h em a nda ns we ra n yqu es t i o nsei t h ero ft h em ma yh av ea bo utBe n’ sc on di t i o na ndh i sc ar e pos t s ur ger y . Thepar ent ss houl dbema dea war et h att her ei ss uppor ta v ai l a bl eno to nl yf r om t h ei r f ami l yandf r i endsbutf r om t hehos pi t al aswel l .
Re f e r e nc e s J ones ,B.( 20 15) .Pr e par i n gChi l d r e na ndF ami l i esf o rSur g er y :Ps y c h ol og i c a lRe sp ons e st oSu r g er y . [ o nl i ne]Meds c ape. c om.Av ai l abl eat :ht t p: / / www. meds c ape. c om/ v i ewar t i c l e/ 5 25 63 8_3[ Ac c es s ed 1 1Ma r .2 01 5] .
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wi l l d ep en do na gean dmen t al c a pa ci t y .
Li ddl eC ( 2012)Pr ep ar i ngpat i ent st ounder g os ur ger y . Nur s i n gTi mes ;108:48 ,121 3.
TRI GGER 4:WHAT ARE THE PRI ORI TI ES OFBEN’ S CARE? ( 8br eat hspermi nut e,di ffic ul tt o r ous e,pi npoi ntpupi l s )
T r i adofOpi oi dI nt ox i c at i on 1 . Pi n po i n tp up i l s 2. Co ma 3 . Re s p i r a t o r yd ep r e s s i o n Nur s i ngI nt er v ent i ons : 1 . No t i f yph y s i c i a n. 2. I fh y po gl y c e mi c ,a dmi n i s t ero x y ge n,5 0% d ex t r o seaso r d er e db yt heph y s i c i an . 3. I fdec r e as edl e vel ofc ons c i ous nes s ,gi v ena l o x one( ant i d ot ef oropi at eo v er dos e)asor der ed . 4. Moni t orr es pi r at or y ,neur ov as cul arandc ar di ov as c ul ars t at usc l os el y . 5. * I fn al o x on ep r o du ce sn or e s po ns ea ta l l ,t h ep at i e ntma yr eq ui r ei n t u ba t i o na ndacomp ut e d t omo gr a ph ys c ano ft h ehe adt or u l eou tc er e br a lb l e ed i n go rh e adt r au ma .
REFERENCES: Wi l l i ams ,R. ,&Er i c ks on,T .( 2000) .Emer genc yDi agnos i sofOpi oi dI nt o xi c at i on.L ab or a t or yMe di c i n e, 31( 6) ,3343 42 .d oi : 10 . 1309/ qy 8t k gbnb va 6h706 Wo od ,P . ,Ma ho ne y ,P . ,& Co op er ,J .( 2 00 9) .T r auma a nd or t hopedi cs ur g er yi nc l i ni c alpr ac t i c e . L on do n:Sp r i n ge r .
TRI GGER 5:Wha ta r et heps y chos oc i a li mpa c t sofs ur ge r yf orBe na ndhi spa r e nt s ? Thes t r es sofs ur ger yc anpr oduc ei nc hi l dr en,‘ Phy s i ol ogi c al ,emot i onal ,c ogni t i v e,behav i our aland i nt er per s onalc ha ng es ” J ones ,B.( 2 015) .,t h es ec hangesc anper s i s tandof t enf al lunderc at egor i es s uc ha sgener ala nx i et yandr egr es s i on,s epar at i onanx i e t y ,anx i e t yabouts l eep,eat i ngdi s t ur banc e, aggr es s i o nt owar daut hor i t yan dapat h y/ wi t hdr a wal . Th e s ea r ej u s taf e wo fma n yr e a s o nsa st owh yc h i l d r e nwh oh a v eb e eno p er a t e do nma yh av e p s y c ho s oc i a li mp ac t sp os t s u r g er y .A s t u dywa sc o nd uc t e dt h ats h owe dt h atc h i l d r e n wh o we r e o pe r a t e d on wi t ho utp r e l i mi na r ye x pl an at i on so rso me t i mes d ec ei v i n gi n f o r mat i o nr e gar d i n gt h e s ur ger yof t enf el tbet r a y edb yt hos ewhot he ybel i e v edwoul dpr ot ec tt hem. Chi l dr ens omet i mesno tonl yf eel f r i ght enedb yt hei rdoc t or sbutma ybea l s owor r i edaboutda yt oda y
l i f epos t s ur ger y .Res pons esar ei nfl uenc edb yf ac t or ss uc hast hec hi l d’ sde v el opme nt all e vel ,pr i or e xper i e nc eswi t hi l l nes sa ndmedi c alc ar e,t heamounta ndqu al i t yofpr epar at i ont hati spr o vi dedan d t hes uppor t sav ai l abl et ot hec hi l dandf ami l y J on es ,B.( 2 01 5) . Negat i v eps y c hol ogi c alr es pons esi n c hi l d r e nt os ur g er yc a nb ei nt en s e,d ama gi n ga ndp r ol o ng eda ndt h eys ho ul db ea nt i c i p at e dp r i o rt o t hes ur gi c al e xper i enc e. Bencoul dbewor r i edabout : Thepos t oper at i v ec ompl i c at i onr e oc c ur r i ng Howl onghi sl egwi l l t ak et oheal I fhewi l l gett or i dehi squadbi k eagai n Whathi sf r i endswi l l t hi nkoft heac ci dent I fhi spar ent swi l l getr i dofhi squadbi k e Howl onghewi l l hav et os t a yi nhos pi t al f or Ev er y da yl i f ec hangesduet ohi si nj ur i es • • • • • • •
Be n’ sPa r e nt sc oul dbewor r i e da bout : • • • • •
Thepos t oper at i v ec ompl i c at i onr e oc c ur r i ng Wh att h eyar eg oi n gt od oa bo utt h eq ua db i k e Ben’ sov er al l heal t hands t at eofmi nd Get t i ngr i doft heQuadbi k eandBen ’ sr eac t i ont oi t Ev er y dayl i f ec hangesduet ot hei rs on’ si nj ur i es
Whatt henur secando I nor d ert oha v ebo t hBenan dhi spar ent sateas e,i twoul di mpor t antf ort henur s et oha v eat al k wi t ht h em a nda ns we ra n yqu es t i o nsei t h ero ft h em ma yh av ea bo utBe n’ sc on di t i o na ndh i sc ar e pos t s ur ger y . Thepar ent ss houl dbema dea war et h att her ei ss uppor ta v ai l a bl eno to nl yf r om t h ei r f ami l yandf r i endsbutf r om t hehos pi t al aswel l .
Re f e r e nc e s J ones ,B.( 20 15) .Pr e par i n gChi l d r e na ndF ami l i esf o rSur g er y :Ps y c h ol og i c a lRe sp ons e st oSu r g er y . [ o nl i ne]Meds c ape. c om.Av ai l abl eat :ht t p: / / www. meds c ape. c om/ v i ewar t i c l e/ 5 25 63 8_3[ Ac c es s ed 1 1Ma r .2 01 5] .
