Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

Microbiology Quiz Series - 16

Where nurses are already leading on the green agenda

Many nurses up and down the country are making positive changes in the name of sustainability. Nursing Times has spoken to nurses implementing a range of initiatives to drive forward the green agenda.   How the idea of being ‘green’ boosted glove reduction The green…

The post Where nurses are already leading on the green agenda appeared first on Nursing Times.



Analysis: Tackling the issue of sustainability in healthcare settings

Making health and care settings more environmentally friendly brings with a unique set of challenges. But nurses have been making a difference and championing ways to improve sustainability, increasingly with the support of national policy. The emergence of Covid-19 has inevitably had an impact, however.…

The post Analysis: Tackling the issue of sustainability in healthcare settings appeared first on Nursing Times.



Anatomy and Physiology Quiz Series - 16

Nurses ‘need a voice’ in primary care redesign in wake of Covid-19

Any redesign of general practice services to meet the challenges of Covid-19 must be done with “nursing at its heart”, according to a primary care nurse leader, who is concerned that these conversations are being “medically dominated”. Julie Bolus, non-executive director and nurse lead at…

The post Nurses ‘need a voice’ in primary care redesign in wake of Covid-19 appeared first on Nursing Times.



Nursing Management Quiz Series - 18

Nurse hopes to encourage reading and raise funds for children’s services

A mental health nurse in the North East has started a fundraising campaign so patients in children and young people’s services have access to books and activities. Sinead McGowan, a psychiatric liaison nurse at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, is raising money…

The post Nurse hopes to encourage reading and raise funds for children’s services appeared first on Nursing Times.



Rise in childhood obesity ‘could lead to more MS cases’

Increasing levels of childhood obesity could potentially see more cases of multiple sclerosis (MS) as a knock-on effect, warn UK researchers. Childhood and adolescent obesity would contribute up to 14% of the overall risk of MS by 2035, according to observational research led by Queen…

The post Rise in childhood obesity ‘could lead to more MS cases’ appeared first on Nursing Times.



New RCN ‘Fair Pay for Nursing’ campaign seeks 12.5% rise

The Royal College of Nursing has today warned the government that it is “time to pay nursing staff fairly” as it seeks to secure a 12.5% wage increase for its members. The college has launched its Fair Pay for Nursing campaign, which is calling for…

The post New RCN ‘Fair Pay for Nursing’ campaign seeks 12.5% rise appeared first on Nursing Times.



Nursing Research Quiz Series - 21

‘Possible’ to adapt ventilators for two Covid-19 patients at once

Intensive care ventilators could potentially be adapted to support two Covid-19 patients at once as a “last resort”, should a spike in demand leave capacity struggling, according to UK researchers. They highlighted that when the first peak of the coronavirus pandemic approached, governments around the…

The post ‘Possible’ to adapt ventilators for two Covid-19 patients at once appeared first on Nursing Times.



Disqualified RCN election candidate considers legal challenge

One of the candidates controversially disqualified from the race to become the next Royal College of Nursing president has told Nursing Times he is considering legal action. Stuart McKenzie (pictured above) said he believed the reasons he was given by the college for his exclusion…

The post Disqualified RCN election candidate considers legal challenge appeared first on Nursing Times.



UK nursing informatics expert recognised by prestigious academy

A UK nursing academic has said he hopes nurses increasingly recognise the importance of informatics to improving care, having received a major international honour for his work. Professor Nick Hardiker has been selected as a fellow of the American Academy of Nursing (AAN) for his…

The post UK nursing informatics expert recognised by prestigious academy appeared first on Nursing Times.



Warning of possible surge in asthma attacks as schools reopen

School nurses and practice nurses could see asthma exacerbations surge massively when children return to school, a leading respiratory charity has warned. Asthma UK said attacks in children could “spike to unprecedented levels” when schools re-open, because of ongoing disruption to basic asthma care caused…

The post Warning of possible surge in asthma attacks as schools reopen appeared first on Nursing Times.



HEE announces extra funding to expand clinical placements

An additional 7,000 clinical placements for nursing and midwifery students will be available during the next academic year due to a new cash injection, according to Health Education England. The government arms’-length body said on Wednesday that £8.2m would go towards providing an additional 7,000…

The post HEE announces extra funding to expand clinical placements appeared first on Nursing Times.



Nurses keep pressure on with workplace pay demonstrations

Thousands of nurses and NHS colleagues across the country were due to be engaging in another round of demonstrations today as part of a grassroots pay campaign. The protests were expected to take place outside hospitals and other workplaces with one group set to march…

The post Nurses keep pressure on with workplace pay demonstrations appeared first on Nursing Times.



RCN election row escalates as name of second disqualified candidate revealed

Frustrated members are seeking to “force change” at the Royal College of Nursing via emergency measures, in the wake of the union’s botched presidential election. Meanwhile, Nursing Times can reveal that current RCN president, Professor Anne Marie Rafferty, is the other presidential candidate who was…

The post RCN election row escalates as name of second disqualified candidate revealed appeared first on Nursing Times.



‘Role model’ nurse shares ADHD story to inspire others

Having attention deficit hyperactivity disorder (ADHD) should not be seen as a barrier to pursuing a career in nursing, a newly qualified mental health nurse who was diagnosed with the condition during her studies has urged. Shezz Jordan, who studied at the University of Chester,…

The post ‘Role model’ nurse shares ADHD story to inspire others appeared first on Nursing Times.



Child Health Nursing Quiz Series - 17

Trusts offered extra funding for learning disability nurse apprentices

An extra cash bonus will be offered to employers in England for every learning disability nurse apprentice they take on, as part of efforts to bolster the fragile workforce, it has been revealed. Earlier this month the government pledged £172m to increase the number of…

The post Trusts offered extra funding for learning disability nurse apprentices appeared first on Nursing Times.



Warning of Covid-19 burnout risk among female health staff

The coronavirus pandemic is taking a “significant toll” on women working in health and social care in the UK, a new survey has revealed. It found that 72% of respondents believed their job was having a greater negative impact than usual on their mental wellbeing…

The post Warning of Covid-19 burnout risk among female health staff appeared first on Nursing Times.



Crisis deepens at RCN as council vice chair steps down

The Royal College of Nursing is in “uncharted waters” after a second high-profile resignation from its ruling council. The college has revealed that its vice chair of council, Richard Jones, has decided to step down “for health reasons”. “RCN Council is united in the aim…

The post Crisis deepens at RCN as council vice chair steps down appeared first on Nursing Times.



‘No safe caffeine level’ while pregnant or trying for a baby

Women who are pregnant or trying to conceive should be advised to avoid caffeine, according to researchers from Iceland, who have carried out a review of the available evidence. They warned that the evidence suggested that maternal caffeine consumption was associated with negative pregnancy outcomes…

The post ‘No safe caffeine level’ while pregnant or trying for a baby appeared first on Nursing Times.



Mental Health Nursing Quiz Series - 18

‘First’ resource developed to meet student nurse prescribing standard

Universities in North West England have developed what is believed to be the first online resource of its kind to help prepare student nurses for prescribing medications at an earlier point in their careers. It follows the introduction of the Nursing and Midwifery Council’s new…

The post ‘First’ resource developed to meet student nurse prescribing standard appeared first on Nursing Times.



Majority of care homes nurses felt mistreated during Covid-19 peak

Four-fifths of care home nurses would assess their experience of working during the coronavirus pandemic as "very negative", according to a new snapshot survey. During May and June 2020, the Queen's Nursing Institute polled members of its UK Care Home Nurses Network to find out…

The post Majority of care homes nurses felt mistreated during Covid-19 peak appeared first on Nursing Times.



RCN council chair resigns amid presidential election debacle

The chair of the Royal College of Nursing’s ruling council Dee Sissons has resigned, it has been announced. It follows unconfirmed reports that a vote of no confidence in Ms Sissons was due to be held in the near future over alleged mishandling of the…

The post RCN council chair resigns amid presidential election debacle appeared first on Nursing Times.



Community Health Nursing Quiz Series - 16

Obstetric and Gynecological Nursing Quiz Series - 16

Pharmacology Quiz Series - 18

‘Unique’ lockdown opportunity for nurses to test homeless people

Nurses on Merseyside have been involved in testing homeless people for infectious disease due to the “unique” opportunity afforded by the coronavirus pandemic. The HIV and hepatitis C testing initiative, which was rapidly introduced during lockdown, means that 67 homeless people in Liverpool are now…

The post ‘Unique’ lockdown opportunity for nurses to test homeless people appeared first on Nursing Times.



Multi-disciplinary care ‘vital’ for pregnant women with Covid-19

All pregnant women admitted to hospital with Covid-19 must have multi-disciplinary maternity care from the start, according to two royal colleges in response to the findings of a new report. They highlighted that clarity was key when providing specific advice to women with Covid-19 during…

The post Multi-disciplinary care ‘vital’ for pregnant women with Covid-19 appeared first on Nursing Times.



Single dose radiotherapy ‘effective alternative’ for early breast cancer

Single dose radiotherapy during surgery is as good as conventional radiotherapy for most women with early breast cancer, according to a study led by UK researchers. They found that, for most women, a single dose of targeted radiotherapy during surgery was just as effective as…

The post Single dose radiotherapy ‘effective alternative’ for early breast cancer appeared first on Nursing Times.



Medical-surgical Nursing Quiz Series - 21

Finalists revealed for the 2020 Nursing Times Awards

The nurses, teams and organisations that have made the final shortlist for the 2020 Nursing Times Awards have been announced. During a challenging year for the profession, we were honoured to hear your stories and read your entries to the 2020 Nursing Times Awards. Our…

The post Finalists revealed for the 2020 Nursing Times Awards appeared first on Nursing Times.



Nurses warn of worse staffing levels and rise in stress amid Covid-19

Worsened staffing levels, increased stress and growing concerns for the wellbeing of colleagues are just some of the issues reported by nurses working during the pandemic, a new survey has found. The latest Royal College of Nursing survey has explored the impact of the coronavirus…

The post Nurses warn of worse staffing levels and rise in stress amid Covid-19 appeared first on Nursing Times.



Machines help Kent dementia patients ‘to step back in time’

Patients living with dementia can now relive history thanks to the purchase of 10 new interactive devices for use in hospitals run by a trust in Kent. The RITAs (Reminiscent Interactive Therapeutic Activity) allow people to sing along to music from the 1940s and 50s,…

The post Machines help Kent dementia patients ‘to step back in time’ appeared first on Nursing Times.



Air pollution ‘linked’ to higher risk of children developing asthma

Fine air pollutants may contribute to the development of asthma and wheezing in children, according to a study by researchers in Denmark. They found children exposed to higher levels of fine particles in the air – known as PM2.5 – were more likely to develop…

The post Air pollution ‘linked’ to higher risk of children developing asthma appeared first on Nursing Times.



RCN reveals why candidates were disqualified from president election

Two candidates disqualified from the Royal College of Nursing’s presidential elections were found to have broken rules around the way in which they promoted their campaign, the union has confirmed. The RCN has revealed that the pair who were ousted from the election process were…

The post RCN reveals why candidates were disqualified from president election appeared first on Nursing Times.



NHS ‘clearing day’ advert angers nurses on social media

The nursing community has taken to social media to express their upset and concerns over a new advertisement for the profession, which they have branded “offensive” and “condescending”. Some nurses have said the advert, which was posted on social media by NHS England and Improvement…

The post NHS ‘clearing day’ advert angers nurses on social media appeared first on Nursing Times.



Fundamental of Nursing Quiz Series - 18

Tributes paid to ‘selfless and compassionate’ A&E nurse

Tributes have poured in for a “selfless” accident and emergency charge nurse who died “suddenly and tragically” at the weekend. Julian Lewis, who had worked in the emergency department at Wythenshawe Hospital for the past four years, died on Sunday 16 August, which was also…

The post Tributes paid to ‘selfless and compassionate’ A&E nurse appeared first on Nursing Times.



Midwives skipping meals and delaying toilet breaks, warns RCM

Midwives in England are “putting their own health and wellbeing on the line” to care for women and babies, with many missing meals and delaying going to the toilet because they do not have the time to take a break. These were the stark findings…

The post Midwives skipping meals and delaying toilet breaks, warns RCM appeared first on Nursing Times.



RCN council at centre of speculation over ‘no confidence vote’

The Royal College of Nursing has found itself the subject of further unwanted attention surrounding its now paused presidential election. Unconfirmed reports suggest that a request has been made for a vote of no confidence in the Royal College of Nursing’s council chair, Dee Sissons.…

The post RCN council at centre of speculation over ‘no confidence vote’ appeared first on Nursing Times.



Mental health facility named after ‘caring and dedicated’ support worker

A new private mental health hospital dedicated to children and adolescents will open in Coventry next month, bearing the name of a local support worker. Cygnet Joyce Parker Hospital, named after a former care worker, is described as state-of-the-art and will offer support to young…

The post Mental health facility named after ‘caring and dedicated’ support worker appeared first on Nursing Times.



Coronavirus pandemic gives nurses renewed focus on recycling

Nurses have ramped up their efforts to recycle waste at a hospital in Durham, following concerns over the volume of single-use personal protective equipment (PPE) that was being thrown away amid the coronavirus pandemic. Urgent care nurse practitioner Emma Francis told Nursing Times how the…

The post Coronavirus pandemic gives nurses renewed focus on recycling appeared first on Nursing Times.



Antibiotics may ‘lessen’ effectiveness of hormonal contraception

Antibacterial drugs may reduce the efficacy of hormonal contraceptives, meaning extra precautions may need to be taken to avoid unintended pregnancy, according to UK researchers. Their analysis, published in the journal BMJ Evidence Based Medicine, looked at the unwanted side effects associated with the combined…

The post Antibiotics may ‘lessen’ effectiveness of hormonal contraception appeared first on Nursing Times.



Northern care alliance and university appoint inaugural chair of nursing

A clinical academic nurse has been appointed as the Northern Care Alliance NHS Group and the University of Salford’s inaugural chair of nursing. Professor Heather Iles-Smith, from Leeds Teaching Hospitals NHS Trust, will take up the new role on 1 September. “I look forward to…

The post Northern care alliance and university appoint inaugural chair of nursing appeared first on Nursing Times.



Honey ‘better’ than usual care for easing respiratory symptoms

Honey is better than usual care for easing upper respiratory tract symptoms, especially cough, according to a review by UK researchers. The study authors from Oxford University found that honey was “superior” to usual care for the improvement of symptoms of upper respiratory tract infections…

The post Honey ‘better’ than usual care for easing respiratory symptoms appeared first on Nursing Times.



Psychology Quiz Series - 17

Concerns at dismantling of public health body in midst of Covid-19

The government has confirmed it is replacing Public Health England (PHE) with a new UK-wide body, sparking concerns about the timing of the move and the future of some of its functions. Health and care secretary Matt Hancock said today that a new organisation with…

The post Concerns at dismantling of public health body in midst of Covid-19 appeared first on Nursing Times.



Northern Ireland plans flu jab expansion but less than rest of UK

The flu vaccination programme in Northern Ireland is being expanded to help relieve winter pressures during the ongoing Covid-19 crisis but looks set to fall short of the rest of the UK. England, Scotland and Wales have previously announced that annual vaccination is be extended…

The post Northern Ireland plans flu jab expansion but less than rest of UK appeared first on Nursing Times.



Nurses feature in M&S campaign to raise funds for NHS charities

Four NHS nurses have been chosen to front a major campaign by Marks and Spencer to both thank its customers for supporting health service charities and help further boost donations. They will star in a new nationwide M&S campaign appearing in stores across the country…

The post Nurses feature in M&S campaign to raise funds for NHS charities appeared first on Nursing Times.



Vigilance ‘vital’ in immediate postnatal period for safe baby care

Effective clinical monitoring during skin-to-skin contact straight after birth is key to reducing the risk of sudden unexpected postnatal collapse (SUPC) in babies, according to a maternity safety report. The report, from the Healthcare Safety Investigation Branch (HSIB), focuses on the importance of monitoring to…

The post Vigilance ‘vital’ in immediate postnatal period for safe baby care appeared first on Nursing Times.



Nutrition and Biochemistry Quiz Series - 14

Nurses asked for views on prescribing practice in diabetes care

Nurses are being asked to take part in a new survey on prescribing practice within diabetes care, in a bid to help identify “where things might need to change or improve”. Trend Diabetes, an organisation that says it supports all nurses working in diabetes care,…

The post Nurses asked for views on prescribing practice in diabetes care appeared first on Nursing Times.



Transplant nurse becomes Bradford’s first living donor co-ordinator

A renal transplant nurse has become Bradford’s first ever living donor co-ordinator to help raise awareness of living kidney donation in the area. Michael Speight, who has been a senior renal transplant nurse at Bradford Teaching Hospitals NHS Foundation Trust for the past 10 years,…

The post Transplant nurse becomes Bradford’s first living donor co-ordinator appeared first on Nursing Times.



Any reform of public health bodies must ‘remove staff barriers’

Any reforms made to government public health agencies must “remove existing barriers” that prevented healthcare professionals responding to the coronavirus pandemic at the “scale required”, health leaders have warned. The comments come after it was reported on Sunday that the government arms'-length body Public Health…

The post Any reform of public health bodies must ‘remove staff barriers’ appeared first on Nursing Times.



Apply to be a Student Nursing Times Editor 2020-21!

Nursing Times has launched its search for the next group of Student Nursing Times Editors. Start your application today to be one of our editors for 2020-21. Starting during September 2020, the new editors will each represent their own area of healthcare: mental health, child,…

The post Apply to be a Student Nursing Times Editor 2020-21! appeared first on Nursing Times.



Nottingham nurses celebrate international award for excellence

A children’s hospital and sexual health service in the East Midlands have received international accreditation for their efforts to enable nursing excellence. Both Nottingham Children’s Hospital (NCH) and Nottingham Sexual Heath service have achieved the Pathway to Excellence accreditation from the American Nurses’ Credentialing Center…

The post Nottingham nurses celebrate international award for excellence appeared first on Nursing Times.



Campaign underway to attract ex London nurses back to profession

A new campaign to attract former nurses and midwives back onto wards across London has been launched. Health Education England (HEE) and NHS England and Improvement have teamed up to spearhead a new return to practice campaign, which is set to run until the end…

The post Campaign underway to attract ex London nurses back to profession appeared first on Nursing Times.



Microbiology Quiz Series - 15

Anatomy and Physiology Quiz Series - 15

Direct Laryngoscopy

Definition

Direct laryngoscopy allows visualization of the larynx by the use of a fiberoptic endoscope or laryngoscope passed through the mouth or nose and pharynx and larynx. It’s indicated for any condition requiring direct visualization or specimen samples for diagnosis, such as in patients with strong gag reflexes resulting from anatomic abnormalities and in those who have had no response to short-term therapy for symptoms of pharyngeal or laryngeal disease, such as chronic hoarseness, stridor, and hemoptysis.

Secretions or tissue may be removed during this procedure for further study. The test is usually contraindicated in patients with epiglottitis, but it may be performed on them in an operating room with resuscitative equipment.

Purpose
  • To detect lesions, strictures, or foreign bodies.
  • To remove benign lesions or foreign bodies from the larynx.
  • To help diagnose laryngeal or upper airway abnormalities.
  • To examine the larynx when indirect laryngoscopy is inadequate.
ProcedureDirect laryngoscopy
Preparation
  1. Make sure the patient has signed an appropriate consent form.
  2. Note and report all allergies.
  3. Check the patient’s history for hypersensitivity to the anesthetic.
  4. Instruct the patient to fast for 6 to 8 hours before the test.
  5. Give the patient a sedative to help him relax and a drug to reduce secretions.
  6. Give a general or local anesthetic to numb the gag reflex.
  7. Explain that the study takes about 30 minutes; it takes longer if minor surgery is performed as part of the procedure.
Implementation
  1. The patient is assisted into the supine position.
  2. A general anesthetic is given, or the mouth or nose and throat are sprayed with local anesthetic.
  3. The laryngoscope is inserted through the mouth.
  4. The larynx is examined for abnormalities.
  5. Specimens may be collected for further study.
  6. Minor surgery (polyp removal) may occur at this time.
Nursing Interventions
  1. Place the conscious patient in semi-Fowler’s position. Place the unconscious patient on his side with his head slightly elevated to prevent aspiration.
  2. Check the patient’s vital signs according to facility protocol, or every 15 minutes until the patient is stable and then every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours for 24 hours.
  3. Immediately report to the practitioner any adverse reaction to the anesthetic or sedative such as tachycardia, palpitations, hypertension, euphoria, excitation, and rapid, deep aspirations.
  4. Apply an ice collar per institution protocol to minimize laryngeal edema.
  5. Provide an emesis basin, and instruct the patient to spit out saliva rather than swallow it.
  6. Observe sputum for blood, and report excessive bleeding immediately.
  7. Instruct the patient to refrain from clearing his throat and coughing to prevent hemorrhaging at the biopsy site.
  8. Advise the patient to avoid smoking until his vital signs are stable and there’s no evidence of comlications.
  9. Immediately report subcutaneous crepitus around the patient’s face and neck, which may indicate tracheal perforation.
  10. Listen to the patient’s neck with a stethoscope for signs of stridor and airway obstruction.
Interpretation
Normal Results
  • No inflammation, lesions, strictures, or foreign bodies are found.
Abnormal Results
  • Combine with the results of a biopsy, abnormal lesions suggest possible laryngeal cancer or benign lesions.
  • Narrowing suggests stricture.
  • Inflammation suggests possible laryngeal edema secondary to radiation or tumor.
  • Asynchronous vocal cords suggest possible vocal cord dysfunction.
Complications
  • Subcutaneous crepitus around the patient’s face and neck – a sign of tracheal perforation.
  • Airway obstruction in the patient with epiglottiditis.
  • Adverse reaction to anesthetic.
  • Bleeding.

 

Nursing Management Quiz Series - 17

Electrocardiography (ECG)

Definition

Electrocardiography is the most commonly used test for evaluating cardiac status, graphically records the electrical current (electrical potential) generated by the heart. This current radiates from the heart in all directions and, on reaching the skin, is measured by electrodes connected to an amplier and strip chart recorder. The standard resting ECG uses five electrodes to measure the electrical potential from 12 different leads; the standard limb leads (I,II,III), the augmented limb leads (aVf, aVL, and aVr), and the precordial, or chest, leads (V1 through V6).Electrocardiography (ECG)

ECG tracings normally consist of three identifiable waveforms: the P wave, the QRS complex, and the T wave. The P wave depicts atrial depolarization; the QRS complex, ventricular depolarization; and the T wave, ventricular repolarization.

Computerized ECG machines use small electrode tabs that peel off a sheet and adhere to the patient’s skin. The entire ECG tracing is displayed on a screen so abnormalities can be corrected before printing; then it’s printed on one sheet of paper. Electrode tabs can remain on the patient’s chest, arms, and legs to provide continuous lead placement for serial ECG studies.

Purpose
  • To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac hypertrophy, pericarditis, electrolyte imbalances, myocardial ischemia, and the site and extent of myocardial infarction.
  • To monitor recovery from an MI.
  • To evaluate the effectiveness of cardiac medication.
  • To assess pacemaker performance
  • To determine effectiveness of thrombolytic therapy and the resolution of ST-segment depression or elevation and T-wave changes.
Procedure

ecg-lead-placement

Patient Preparation for Electrocardiography (ECG)
  1. Explain to the patient the need to lie still, relax, and breathe normally during the procedure.
  2. Note current cardiac drug therapy on the test request form as well as any other pertinent clinical information, such as chest pain or pacemaker.
  3. Explain that the test is painless and takes 5 to 10 minutes.
Implementation
  1. Place the patient in a supine or semi-Fowler’s position.
  2. Expose the chest, ankles, and wrists.
  3. Place electrodes on the inner aspect of the wrists, on the medical aspect of the lower legs, and on the chest.
  4. After all electrodes are in place, connect the lead wires.
  5. Press the START button and input any required information.
  6. Make sure that all leads are represented in the tracing. If not, determine which electrode has come loose, reattach it, and restart the tracing.
  7. All recording and other nearby electrical equipment should be properly grounded.
  8. Make sure that the electrodes are firmly attached.
Nursing Interventions
  1. Disconnect the equipment, remove the electrodes, and remove the gel with a moist cloth towel.
  2. If the patient is having recurrent chest pain or if serial ECG’s are ordered, leave the electrode patches in place.
Interpretations
Normal Results
  1. P wave that doesn’t exceed 2.5 mm (0.25 mV) in height or last longer than 0.12 second.
  2. PR interval (includes the P wave plus the PR segment) persisting for 0.12 to 0.2 second for heart rates above 60 beats/min.
  3. QT interval that varies with the heart rate and lasts 0.4 to 0.52 second for heart rates above 60 beats/min.
  4. Voltage of the R wave leads V1 through V6 that doesn’t exceed 27 mm.
  5. Total QRS complex lasting 0.06 to 0.1 second.
Abnormal Results
  1. Myocardial infarction (MI), right or left ventricular hypertrophy, arrhythmias, right or left bundle-branch block, ischemia, conduction defects or pericarditis, and electrolyte abnormalities.
  2. Abnormal wave forms during angina episodes or during exercise.
Precautions
  • The recording equipment and other nearby electrical equipment should be properly grounded to prevent electrical interference.
  • Double-check color codes and lead markings to be sure connectors march.
  • Make sure that the electrodes are firmly attached, and reattached them if loose skin contact is suspended. Don’t use cables that are broken, frayed, or bare.
Interfering Factors
  • Improper lead placement.
Complications
  • Skin sensitivity to the electrodes.

BAME students ‘must be supported’ over return to placements

Providers have been urged to ensure nursing students from black, Asian and minority ethnic (BAME) backgrounds are supported to raise concerns on their return to clinical placements amid Covid-19, under new guidance. It recognised that coronavirus had disproportionately affected people from BAME communities and highlighted…

The post BAME students ‘must be supported’ over return to placements appeared first on Nursing Times.



RCN presidential elections paused after ‘rule breach’ confirmed

The campaign for a new president and deputy president of the Royal College of Nursing has been officially paused, after it was confirmed that election rules had been “breached”. A postal ballot was set to open on 1 September and successful candidates were due to…

The post RCN presidential elections paused after ‘rule breach’ confirmed appeared first on Nursing Times.



Nursing Research Quiz Series - 20

Nurse shares experience of mortuary redeployment during Covid-19

A pre-assessment nurse who was redeployed to a mortuary during the Covid-19 peak has told of her experience and how she became the go-to for families who were unable to visit their deceased loved ones. Jo Groom, (pictured above), a pre-assessment nurse of 20 years…

The post Nurse shares experience of mortuary redeployment during Covid-19 appeared first on Nursing Times.



Health and care staff ‘most likely’ to have Covid-19 antibodies

Staff working in care homes and across healthcare settings are among those most likely to have already been infected with coronavirus, according to the findings of the world’s largest home antibody testing programme. More than 100,000 people across England tested themselves at home using a…

The post Health and care staff ‘most likely’ to have Covid-19 antibodies appeared first on Nursing Times.



Perioperative Nursing

 Overview

Perioperative nursing describes the wide variety of nursing functions associated with the patient’s surgical management. It has three phases of the surgical experience namely:

  1. Preoperative phase. This phase begins when the decision for surgical intervention is made and ends when the patient is transferred from the operating room.
  2. Intraoperative phase. This phase begins when the patient is admitted or transferred to the surgery department and ends when he or she is admitted to the recovery area.
  3. Postoperative phase. This phase begins with the admission of the patient to the recovery area and ends with a follow-up evaluation in the clinical setting or at home.
Preoperative Phase

The patient who consents to have surgery, particularly surgery that requires a general anesthetic, renders himself dependent on the knowledge, skill, and integrity of the health care team. In accepting this trust, the health care team members have an obligation to make the patient’s welfare their first consideration during the surgical experience.

The scope of activities during the preoperative phase includes the establishment of the patient’s baseline assessment in the clinical setting or at home, carrying out preoperative interview and preparing the patient for the anesthetic to be given and the surgery.

Goals during the Preoperative Phase

Although the physician is responsible for explaining the surgical procedure to the patient, the patient may ask the nurse questions about the surgery. There may be specific learning needs about the surgery that the patient and support persons should know. A nursing care plan and a teaching plan should be carried out. During this phase, emphasis is placed on:

  • Assessing and correcting physiological and psychological problems that may increase surgical risk.
  • Giving the patient and significant others complete learning and teaching guidelines regarding the surgery.
  • Instructing and demonstrating exercises that will benefit the patient postoperatively.
  • Planning for discharge and any projected changes in lifestyle due to the surgery.
Physiologic Assessment during the Preoperative Phase

Before any treatment is initiated, a health history is obtained and a physical examination is performed during which vital signs are noted and a data base is establish for future comparisons.

Diagnostic tests may be carried out during the preoperative phase such as:

  • Blood analyses such as complete blood count, sedimentation rate, c-reactive protein, serum protein electrophoresis with immunofixation, calcium, alkaline phosphatase, and chemistry profile
  • X-ray studies
  • MRI and CT scans (with or without myelography)
  • Electrodiagnostic studies
  • Bone scan
  • Endoscopies
  • Tissue biopsies
  • Stool studies
  • Urine studies

Significant physical findings are also noted to further describe the patient’s overall health condition. When the patient has been determined to be an appropriate candidate for surgery, and has elected to proceed with surgical intervention, the pre-operative assessment phase begins. The purpose of pre-operative evaluation is to reduce the morbidity of surgery, increase quality of intra-operative care, reduce costs associated with surgery, and return the patient to optimal functioning as soon as possible.

The following are the physiologic assessments necessary during the preoperative phase:

  • Age
  • Nutritional status and needs – determined by measuring the patient’s height and weight, triceps skin fold, upper arm circumference, serum protein levels and nitrogen balance. Obesity greatly increases the risk and severity of complications associated with surgery.
  • Fluid and Electrolyte Imbalance – Dehydration, hypovolemia and electrolyte imbalances should be carefully assessed and documented.
  • Infection
  • Drug and alcohol use – the acutely intoxicated person is susceptible to injury.
  • Respiratory status – patients with pre-existing pulmonary problems are evaluated by means pulmonary function studies and blood gas analysis to note the extent of respiratory insufficiency. The goal for potential surgical patient us to have an optimum respiratory function. Surgery is usually contraindicated for a patient who has a respiratory infection.
  • Cardiovascular status – cardiovascular diseases increases the risk of complications. Depending on the severity of symptoms, surgery may be deferred until medical treatment can be instituted to improve the patient’s condition.
  • Hepatic and renal function – surgery is contraindicated in patients with acute nephritis, acute renal insufficiency with oliguria or anuria, or other acute renal problems. Any disorder of the liver on the other hand, can have an effect on how an anesthetic is metabolized.
  • Endocrine function – diabetes, corticosteroid intake, amount of insulin administered
  • Immunologic function – existence of allergies, previous allergic reactions, sensitivities to certain medications, past adverse reactions to certain drugs, immunosuppression
  • Previous medication therapy – It is essential that the patient’s medication history be assessed by the nurse and anesthesiologist. The following are the medications that cause particular concern during the upcoming surgery:
    1. Adrenal corticosteroids – not to be discontinued abruptly before the surgery. Once discontinued suddenly, cardiovascular collapse may result for patients who are taking steroids for a long time. A bolus of steroid is then administered IV immediately before and after surgery.
    2. Diuretics – thiazide diuretics may cause excessive respiratory depression during the anesthesia administration.
    3. Phenothiazines – these medications may increase the hypotensive action of anesthetics.
    4. Antidepressants – MAOIs increase the hypotensive effects of anesthetics.
    5. Tranquilizers – medications such as barbiturates, diazepam and chlordiaxepoxide may cause an increase anxiety, tension and even seizures if withdrawn suddenly.
    6. Insulin – when a diabetic person is undergoing surgery, interaction between anesthetics and insulin must be considered.
    7. Antibiotics – “Mycin” drugs such as neomycin, kanamycin, and less frequently streptomycin may present problems when combined with curariform muscle relaxant. As a result nerve transmission is interrupted and apnea due to respiratory paralysis develops.
  • Presence of trauma
Psychological Nursing Assessment during the Preoperative Period
  • Fear of the unknown
  • Fear of death
  • Fear of anesthesia
  • Concerns about loss of work,  time, job and support from the family
  • Concerns on threat of permanent incapacity
  • Spiritual beliefs
  • Cultural values and beliefs
  • Fear of pain
Psychological Nursing Interventions:
  1. Explore the client’s fears, worries and concerns.
  2. Encourage patient verbalization of feelings.
  3. Provide information that helps to allay fears and concerns of the patient.
  4. Give empathetic support.
Informed consent

An informed consent is necessary to be signed by the patient before the surgery. The following are the purposes of an informed consent:

  • Protects the patient against unsanctioned surgery.
  • Protects the surgeon and hospital against legal action by a client who claims that an unauthorized procedure was performed.
  • To ensure that the client understands the nature of his or her treatment including the possible complications and disfigurement.
  • To indicate that the client’s decision was made without force or pressure.

Criteria for a Valid Informed Consent

  • Consent voluntarily given. Valid consent must be freely given without coercion.
  • For incompetent subjects, those who are NOT autonomous and cannot give or withhold consent, permission is required from a responsible family member who could either be apparent or a legal guardian. Minors (below 18 years of age), unconscious, mentally retarded, psychologically incapacitated fall under the incompetent subjects.
  • The consent should be in writing and should contain the following:
  1. Procedure explanation and the risks involved
  2. Description of benefits and alternatives
  3. An offer to answer questions about the procedure
  4. Statement that emphasizes that the client may withdraw the consent
  5. The information in the consent must be written and be delivered in language that a client can comprehend.
  6. Should be obtained before sedation.
Intraoperative Phase

The intraoperative phase extends from the time the client is admitted to the operating room, to the time of anesthesia administration, performance of the surgical procedure and until the client is transported to the recovery room or postanethesia care unit (PACU). Throughout the surgical experience the nurse functions as the patient’s chief advocate. The nurse’s care and concern extend from the time the patient is prepared for and instructed about the forthcoming surgical procedure to the immediate preoperative period and into the operative phase and recovery from anesthesia. The patient needs the security of knowing that someone is providing protection during the procedure and while he is anesthetized because surgery is usually a stressful experience.

Goals during the Intraoperative Phase
  1. Promote the principle of asepsis asepsis.
  2. Homeostasis
  3. Safe administration of anesthesia
  4. Hemostasis
The Surgical Team

The intraoperative phase begins when the patient is received in the surgical area and lasts until the patient is transferred to the recovery area. Although the surgeon has the most important role in this phase, there are key members of the surgical team.

  1. Surgeon – leader of the surgical team. He or she is ultimately responsible for performing the surgery effectively and safely; however, he is dependent upon other members of the team for the patient’s emotional well being and physiologic monitoring.
  2. Anesthesiologist or anesthetist – provides smooth induction of the patient’s anesthesia in order to prevent pain. This member is also responsible for maintaining satisfactory degrees of relaxation of the patient for the duration of the surgical procedure. Aside from that, the anesthesiologist continually monitors the physiologic status of the patient for the duration of the surgical procedure and the physiologic status of the patient to include oxygen exchange, systemic circulation, neurologic status, and vital signs. He or she then informs and advises the surgeon of impending complications.
  3. Scrub Nurse or Assistant – a nurse or surgical technician who prepares the surgical set-up, maintains surgical asepsis while draping and handling instruments, and assists the surgeon by passing instruments, sutures, and supplies.
  4. Circulating Nurse – respond to request from the surgeon, anesthesiologist or anesthetist, obtain supplies, deliver supplies to the sterile field, and carry out the nursing care plan.
Intraoperative Nursing Functions

Circulating Nurse

The circulating nurse manages the operating room and protects the safety and health needs of the patient by monitoring activities of members of the surgical team and checking the conditions in the operating room. Responsibilities of a circulation nurse are the following:

  1. Assures cleanliness in the OR.
  2. Guarantees the proper room temperature, humidity and lighting in OR.
  3. Make certain that equipments are safely functioning.
  4. Ensure that supplies and materials are available for use during surgical procedures.
  5. Monitors aseptic technique while coordinating the movement of related personnel.
  6. Monitors the patient throughout the operative procedure to ensure the person’s safety and well being.

Scrub Nurse

  1. Scrubbing for surgery.
  2. Setting up sterile tables.
  3. Preparing sutures and special equipments.
  4. Assists the surgeon and assistant during the surgical procedure by anticipating the required instruments, sponges, drains and other equipment.
  5. Keeps track of the time the patient is under anesthesia and the time the wound is open.
  6. Checks equipments and materials such as needles, sponges and instruments as the surgical incision is closed.
Classification of Physical status for Anesthesia before Surgery

The anesthesiologist should visit the patient before the surgery to provide information, answer questions and allay fears that may exist in the patient’s mind. The choice of anesthetic agent will be discussed and the patient has an opportunity to disclose and the patient has opportunity to disclose previous reactions and information about any medication currently being taken that may affect the choice of an agent. Aside from that, the patient’s general condition must also be assessed because it may affect the management of anesthesia. Thus, the anesthesiologist assesses the patient’s cardiovascular system and lungs. Inquiry about preexisting pulmonary infection sand the extent to which the patient smokes must also be determined. The classification of a client’s physical status for anesthesia before surgery is summarized below.

Classification of Physical Status for Anesthesia Before Surgery
ClassificationDescriptionExample
GoodNo organic disease; no systemic disturbanceUncomplicated hernias, fracture
FairMild to moderate systemic disturbanceMild cardiac (I and II) disease, mild diabetes
PoorSevere systemic disturbancePoorly controlled diabetes, pulmonary complications, moderate cardiac (III) disease
SeriousSystemic disease threatening lifeSevere renal disease, severe cardiac disease (IV), decompensation
MoribundLittle chance of survival but submitting to operation in desperationMassive pulmonary embolus, ruptured abdominal aneurysm with profound shock
EmergencyAny of the abive when surgery is performed in an emergency situationAn uncomplicated hernia that is now strangulated and associated with nausea and vomiting.

Source: Brunner and Suddarth’s Medical-Surgical Nursing by Smeltzer and Bare


Anesthesia

Anesthesia controls pain during surgery or other medical procedures. It includes using medicines, and sometimes close monitoring, to keep you comfortable. It can also help control breathing, blood pressure, blood flow, and heart rate and rhythm, when needed. Anesthetics are divided into two classes:

  1. Those that suspend sensation in the whole body – General anesthesia
  2. Those that suspend sensation in certain parts of the body – local, regional, epidural or spinal anesthesia

General Anesthesia

This type of anesthesia promotes total loss of consciousness and sensation. General anesthesia is commonly achieved when the anesthetic is inhaled or administered intravenously. It affects the brain as well as the entire body. Types of general anesthesia administration:

  • Volatile liquid anesthetics – this type of anesthetic produces anesthesia when their vapors are inhaled. Included in this group are the following:
    1. Halothane (Fluothane)
    2. Methoxyflurane (Penthrane)
    3. Enflurane (Ethrane)
    4. Isoflurane (Forane)
  • Gas Anesthetics – anesthetics administered by inhalation and are ALWAYS combined with oxygen. Included in this group are the following:
    1. Nitrous Oxide
    2. Cyclopropane

Stages of General Administration

Anesthesia consists of four stages, each of which presents a definite group of signs and symptoms.

Stage I: Onset or Induction or Beginning anesthesia. This stage extends from the administration of anesthesia to the time of loss of consciousness. The patient may have a ringing, roaring or buzzing in the ears and though still conscious, is aware of being unable to move the extremities easily. Low voices or minor sounds appear distressingly loud and unreal during this stage.

Stage II: Excitement or Delirium. Stage II extends from the time of loss of consciousness to the time of loss of lid reflex. This stage is characterized by struggling, shouting, talking, singing, laughing or even crying. However, these things may be avoided if the anesthetic is administered smoothly and quickly. The pupils become dilated but contract if exposed to light. Pulse rate is rapid and respirations are irregular.

Stage III: Surgical Anesthesia. This stage extends from the loss of lid reflex to the loss of most reflexes. It is reached by continued administration of the vapor or gas. The patient now is unconscious and is lying quietly on the table. Respirations are regular and the pulse rate is normal.

Stage IV: Overdosage or Medullary or Stage of Danger. This stage is reached when too much anesthesia has been administered. It is characterized by respiratory or cardiac depression or arrest. Respirations become shallow, the pulse is weak and thread and the pupils are widely dilated and no longer contract when exposed to light. Cyanosis develops afterwards and death follows rapidly unless prompt action is taken. To prevent death, immediate discontinuation of anesthetic should be done and respiratory and circulatory support is necessary.

Local Anesthesia

Local anesthetics can be topical, or isolated just to the surface. These are usually in the form of gels, creams or sprays. They may be applied to the skin before the injection of a local anesthetic that works to numb the area more deeply, in order to avoid the pain of the needle or the drug itself (penicillin, for example, causes pain upon injection).

Regional anesthesia

Regional anesthesia blocks pain to a larger part of the body. Anesthetic is injected around major nerves or the spinal cord. Medications may be administered to help the patient relax or sleep. Major types of regional anesthesia include:

  1. Peripheral nerve blocks. A nerve block is a shot of anesthetic near a specific nerve or group of nerves. It blocks pain in the part of the body supplied by the nerve. Nerve blocks are most often used for procedures on the hands, arms, feet, legs, or face.
  2. Epidural and spinal anesthesia. This is a shot of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly, hips, or legs.

With regional anesthesia, an anesthetic agent is injected around the nerved so that the area supplied by these nerves is anesthetized. The effect depends on the type of nerve involved. The patient under a spinal or local anesthesia is awake and aware of his or her surroundings.

Regional anesthesia carries more risks than local anesthesia, such as seizures and heart attacks, because of the increased involvement of the central nervous system. Sometimes regional anesthesia fails to provide enough pain relief or paralysis, and switching to general anesthesia is necessary.

Spinal Anesthesia

This is a type of conduction nerve block that occurs by introducing a local anesthetic into the subarachnoid space at the lumbar level which is usually between L4 and L5. Sterile technique is used as the spinal puncture is made and medication is injected through the needle. The spread of the anesthetic agent and the level of anesthesia depend on:

  1. the amount of fluid injected
  2. the speed with which it is injected
  3. positioning of the patient after injection
  4. specific gravity of the agent

Nursing Assessment after Spinal Anesthesia

  1. Monitoring vital signs.
  2. Observe patient and record the time when motion and sensation of the legs and the toes return.

Side Effects of Anesthesia

  1. Some numbness or reduced feeling in part of your body (local anesthesia)
  2. Nausea and vomiting.
  3. A mild drop in body temperature.

How do anesthesiologists determine the type of anesthesia to be used?

The type of anesthesia the anesthesiologist chooses depends on many factors. These include the procedure the client is having and his or her current health.

Position a Patient on the Operating Table

The nurse should have an idea which patient position is required for a certain surgical procedure to be performed. There are lots of factors to consider in positioning the patient which includes the following:

  1. Patient should be in a comfortable position as possible whether he or she is awake or asleep.
  2. The operative area must be adequately exposed.
  3. The vascular supply should not be obstructed by an awkward position or undue pressure on a part.
  4. There should be no interference with the patient’s respiration as a result of pressure of the arms on the chest or constriction of the neck or chest caused by a gown.
  5. The nerves of the client must be protected from undue pressure. Serious injury or paralysis may result from improper positioning of the arms, hands, legs or feet.
  6. Shoulder braces must be well padded to prevent irreparable nerve injury.
  7. Patient safety must be observed at all times.
  8. In case of excitement, the patient needs gentle restraint before induction.
Reason of Performing a Surgical Procedure
  1. To cure an illness or disease by removing the diseased tissue or organs.
  2. To visualize internal structures during diagnosis.
  3. To obtain tissue for examination.
  4. To prevent disease or injury.
  5. To improve appearance.
  6. To repair or remove traumatized tissue and structures.
  7. To relieve symptoms or pain.
Nursing Responsibility during the Intraoperative Phase
  1. Safety. Is the Highest Priority of nurses.
  2. Simultaneous placement of feet. This is to prevent dislocation of hip.
  3. Always apply knee strap.
  4. Arms should not be more than 90°
  5. Prepare and apply cautery pad. Cautery is used to stop bleeding.
Postoperative Phase

The postoperative period of the surgical experience extends from the time the client is transferred to the recovery room or past-anesthesia care unit (PACU) to the moment he or she is transported back to the surgical unit, discharged from the hospital until the follow-up care.

Goals during the Postoperative Period

During the postoperative period, reestablishing the patient’s physiologic balance, pain management and prevention of complications should be the focus of the nursing care. To do these it is crucial that the nurse perform careful assessment and immediate intervention in assisting the patient to optimal function quickly, safely and comfortably as possible.

  1. Maintaining adequate body system functions.
  2. Restoring body homeostasis.
  3. Pain and discomfort alleviation.
  4. Preventing postoperative complications.
  5. Promoting adequate discharge planning and health teaching.
Patient Care during Immediate Postoperative Phase: Transferring the Patient to RR or PACU

Patient Assessment

Special consideration to the patient’s incision site, vascular status and exposure should be implemented by the nurse when transferring the patient from the operating room to the postanethesia care unit (PACU) or postanesthesia recovery room (PARR). Every time the patient is moved, the nurse should first consider the location of the surgical incision to prevent further strain on the sutures. If the patient comes out of the operating room with drainage tubes, position should be adjusted in order to prevent obstruction on the drains.

  1. Assess air exchange status and note patient’s skin color
  2. Verify patient identity. The nurse must also know the type of operative procedure performed and the name of the surgeon responsible for the operation.
  3. Neurologic status assessment. Level of consciousness (LOC) assessment and Glasgow Coma Scale (GCS) are helpful in determining the neurologic status of the patient.
  4. Cardiovascular status assessment. This is done by determining the patient’s vital signs in the immediate postoperative period and skin temperature.
  5. Operative site examination. Dressings should be checked.

Positioning

Moving a patient from one position to another may result to serious arterial hypotension. This occurs when a patient is moved from a lithotomy to a horizontal position, from a lateral to a supine position, prone to supine position and even when a patient is transferred to the stretcher. Hence, it is very important that patients are moved slowly and carefully during the immediate postoperative phase.

Promoting Patient Safety

When transferred to the stretcher, the patient should be covered with blankets and secured with straps above the knees and elbows. These straps anchor the blankets at the same time restrain the patient should he or she pass through a stage of excitement while recovering from anesthesia. To protect the patient from falls, side rails should be raised.

Safety checks when transferring the patient from OR to RR:

S – Securing restraints for I.V. fluids and blood transfusion.

A – Assist the patient to a position appropriate for him on her based on the location of incision site and presence of drainage tubes.

F – Fall precaution implementation by making sure the side rails are raised and restraints are secured well.

E – Eliminating possible sources of injuries and accidents when moving the patient from the OR to RR or PACU.

Nursing Care for Patient in the PACU or RR

AIRWAY: Maintain a patent airway.

  1. Keep airway in place until the patient is fully awake and tries to eject it. The airway is allowed to remain in place while the client is unconscious to keep the passage open and prevents the tongue from falling back. When the tongue falls back, airway passage obstruction will result. Return of pharyngeal reflex, noted when the patient regains consciousness, may cause the patient to gag and vomit when the airway is not removed when the patient is awake.
  2. 2. Suction secretions as needed.

BREATHING: Maintaining adequate respiratory function.

B – Bilateral lung auscultation frequently.

R – Rest and place the patient in a lateral position with the neck extended, if not contraindicated, and the arm supported with a pillow. This position promotes chest expansion and facilitates breathing and ventilation.

E – Encourage the patient to take deep breaths. This aerates the lung fully and prevents hypostatic pneumonia.

A – Assess and periodically evaluate the patient’s orientation to name or command. Cerebral function alteration is highly suggestive of impaired oxygen delivery.

T – Turn the patient every 1 to 2 hours to facilitate breathing and ventilation.

H – Humidified oxygen administration. During exhalation, heat and moisture are normally lost, thus oxygen humidification is necessary. Aside from that, secretion removal is facilitated when kept moist through the moisture of the inhaled air. Also, dehydrated patients have irritated respiratory passages thus, it is very important make sure that the inhaled oxygen is humidified.

CIRCULATION: Assess status of circulatory system.

  1. Obtain patient’s vital signs as ordered and report any abnormalities.
  2. Monitor intake and output closely.
  3. Recognize early symptoms of shock or hemorrhage such as cold extremities, decreased urine output – less than 30 ml/hr, slow capillary refill – greater than 3 seconds, dropping blood pressure, narrowing pulse pressure, tachycardia – increased heart rate.

THERMOREGULATION: Assessing the patient’s thermoregulatory status.

  1. Hourly temperature assessment to detect hypothermia or hyperthermia.
  2. Report temperature abnormalities to the physician.
  3. Monitor the patient for postanethesia shivering or PAS. This is noted in hypothermic patients, about 30 to 45 minutes after admission to the PACU. PAS represents a heat-gain mechanism and relates to regaining the thermal balance.
  4. Provide a therapeutic environment with proper temperature and humidity. Warm blankets should be provided when the patient is cold.

FLUID VOLUME: Maintaining adequate fluid volume.

  1. Assess and evaluate patient’s skin color and turgor, mental status and body temperature.
  2. Monitor and recognize evidence of fluid and electrolyte imbalances such as nausea and vomiting and body weakness.
  3. Monitor intake and output closely.
  4. Recognize signs of fluid imbalances. HYPOVOLEMIA: decreased blood pressure, decreased urine output, increased pulse rate, increased respiration rate, and decreased central venous pressure (CVP). HYPERVOLEMIA: increased blood pressure and CVP, changes in lung sounds such as presence of crackles in the base of both lungs and changes in heart sounds such as the presence of S3 gallop.

SAFETY: Promoting patient safety.

  1. Avoid nerve damage and muscle strain by properly supporting and padding pressure areas.
  2. Frequent dressing examination for possible constriction.
  3. Raise the side rails to prevent the patient from falling.
  4. Protect the extremity where IV fluids are inserted to prevent possible needle dislodge.
  5. Make sure that bed wheels are locked.

COMFORT: Promoting patient comfort.

  1. Observe and assess behavioral and physiologic manifestations of pain.
  2. Administer medications for pain and document its efficacy.
  3. Assist the patient to a comfortable position.

SKIN INTEGRITY: Minimizing skin impairment.

  1. Record the amount and type of wound drainage.
  2. Regularly inspect dressings and reinforce them if necessary.
  3. Proper wound care as needed.
  4. Perform hand washing before and after contact with the patient.
  5. Turn the patient to sides every 1 to 2 hours.
  6. Maintain the patient’s good body alignment.
EVALUATION in PACU

Patients in PACU are evaluated to determine the client’s discharge from the unit. The following are the expected outcomes in PACU:

  1. Patient breathing easily.
  2. Clear lung sounds on auscultation.
  3. Stable vital signs.
  4. Stable body temperature with minimal chills or shivering.
  5. No signs of fluid volume imbalance as evidenced by an equal intake and output.
  6. Tolerable or minimized pain, as reported by the patient.
  7. Intact wound edges without drainage.
  8. Raised side rails.
  9. Appropriate patient position.
  10. Maintained quiet and therapeutic environment.
Patient Care during Immediate Postoperative Phase: Transferring the Patient from RR to the Surgical Unit

To determine the patient’s readiness for discharge from the PACU or RR certain criteria must be met. The parameters used for discharge from RR are the following:

  1. Uncompromised cardiopulmonary status
  2. Stable vital signs
  3. Adequate urine output – at least 30 ml/ hour
  4. Orientation to time, date and place
  5. Satisfactory response to commands
  6. Minimal pain
  7. Absence or controlled nausea and vomiting
  8. Pulse oximetry readings of adequate oxygen saturation
  9. Satisfactory response to commands
  10. Movement of extremities after regional anesthesia

Most hospitals use a scoring system to assess the general condition of patient in RR or PACU. Observation and evaluation of the patient’s physical signs is based on a set of objective criteria. The evaluation guide used is a modification of the APGAR scoring system used for newborns. Through this, a more objective assessment of the patient’s physical condition is guaranteed while recovering the RR or PACU. The perfect possible score in this modified APGAR scoring system is 10. To be discharge from RR or PACU the patient is required to have at least 7 to 8 points. Patients with score less than 7 must remain in RR or PACU until their condition improves. Areas of assessment in PACU or RR evaluation guide are:

  1. Respiration – ability to breathe deeply and cough.
  2. Circulation – systolic arterial pressure >80% of preanesthetic level
  3. Consciousness Level – verbally responds to questions or oriented to location
  4. Color – normal skin color and appearance: pinkish skin and mucus
  5. Muscle activity – moves spontaneously or on command
Nursing care during the intermediate postoperative period:

Assessment

  1. Respiratory status: airway patency, depth, rate and character of respirations, nature of breath sounds
  2. Circulatory Status: vital signs including blood pressure and skin condition
  3. Neurologic: level of responsiveness
  4. Drainage: presence of drainage, need to connect tubes to a specific drainage system, presence and condition of dressings
  5. Comfort: type of pain and location, nausea and vomiting, position change required
  6. Psychologic: nature of patient’s questions, need for rest and sleep, disturbance by noise, visitors, availability of call bell or call light
  7. Safety: need for side rails, drainage tubes unobstructed, IV fluid properly infusing and IV sites properly splinted
  8. Equipment: checked for proper functioning

Goals and Interventions

  • P – Preventing and/or relieving complications
  • O – Optimal respiratory function
  • S – Support: psychosocial well-being
  • T – Tissue perfusion and cardiovascular status maintenance
  • O – Observing and maintaining adequate fluid intake
  • P – Promoting adequate nutrition and elimination
  • A – Adequate fluid and electrolyte balance
  • R – Renal function maintenance
  • E – Encouraging activity and mobility within limits
  • T – Thorough wound care for adequate wound healing
  • I – Infection Control
  • V – Vigilant to manifestations of anxiety and promoting ways of relieving it
  • E – Eliminating environmental hazards and promoting client safety