PRE AND POST OPERATIVE CARE OF CHILDREN UNDERGOING SURGERY

 

PRE AND POST OPERATIVE CARE OF CHILDREN UNDERGOING SURGERY

 

Pre and Post Operative Care of infants and children

 

1.Preoperative Care

Ø The preparation and management of a patient before surgery.

Ø The patient’s nothing by mouth (NPO) status, nutritional state, medical and surgical history, allergies, current medication, physical handicaps, signs of infection and elimination habits are recorded.

Ø The patients understanding of the operative pre-operative and post-operative procedure.

Ø The patients ability to verbalize anxieties, and the family’s knowledge of the planned surgery are ascertained and education provided.

Ø The accuracy of patients signed informed consent is verified, requests in the physicians pre-operative orders are fulfilled and the patients identification bands and blood type are checked.

Ø Vital signs are recorded, and any abnormalities of the electrocardiogram, chest x-ray or laboratory tests are reported to the surgeon and anesthesiologist.

Ø If needed, the number of matched blood units required to be held for a possible blood transfusion is determined.

Ø When ordered, an enema is given a bowel preparation is completed, a nasogastric tube or indwelling catheter is inserted and parenteral fluids are administered.

Ø If pre-operative sedation is administered, the side rails of the bed are raised.

Ø Before transfer to the operating room with the completed chart.  The patient voids, and any dentures, contact lenses, jewellery, and valuables are removed for safe keeping.

Ø Interventions the nurse performs and explains the pre-operative procedures.

Ø Reinforces the physicians explanation of the operation, provides instruction and emotional support.

Ø Answers the patients questions as honestly as possible, avoiding standard clichés in responding to any anxiety and reassures the patient that medication will be available to relive postoperative pain.

Ø Depending on the surgical procedure, the nurse shows the patient how to turn, cough, deep, breathe and support the incision during coughing.

Ø Instructions on leg exercises are also gives.

Ø The nurse informs the patient and the patients family about the post-operative period in the postanesthesia care unit or the intensive care unit, if indicated.

Ø Outcome criteria the patients who is carefully prepared for an operation.  Psychologically and physically.  Experiences less anxiety and is more likely to make an uneventful recovery.

 

POST OPERATIVE CARE

 

Preparation prior to admission to recovery area

At the beginning of each shift check that:-

Ø Re-intubation trolley is checked against the contents list and all items are present and emergency drugs are in date.

Ø Resuscitation trolley has received its daily check as per protocol.

Ø Defibrilator is in full working order and has passed the daily user test.

Ø Suction equipment is clean in rule working order and has passed safety tests.

Ø Oxygen supplies (high and low flow) are in full working order.

Ø Emergency alarm bells are working.

Ø Emergency breathing systems.

Ø Sharps containers are available

Ø A supply of clean gowns and warmed blankets are available.

Ø Quality control checks have been performed on near patient testing equipment.

Ø Children requiring isolation precautions have been identified and if necessary allocated a specific recovery bed space or practitioner to provide a recovery service within the theatre, as per guidelines, isolation precautions and infections cleans in theatres.

Ø Children with learning difficulties have been identified the allotted bedspace which is quiter with lower lighting.

 

INITIAL ASSESSMENT

               On arrival to the recovery unit, a through bead to toe assessment of the child’s physiological status must be conducted.

 

AIRWAY ASSESSMENT

Assess the airway

     Is the child self – ventilating / requiring assisted ventilation maintaining own airway / requiring airway support.  Observe for signs of partial or complete airway obstruction i.e., supracostal intercostals subcostal retraction, inspiratory stridor or crowing, nasal flaring tracheal tug or decreased / absent air entry

 

SUMMARY

          This article has reviewed the pre-operative assessment especially in shoulder surgery.  It draws attention to the main stays of this assessment, which are a detailed history and clinical examination must be conducted and additional tests and investigations be requested which are specific to the needs of the individual.

 

          The fundamentals behind routine post-operative care have also been discussed.  Post-operative care beings once the procedure has ended, with the patient being reviewed in the anaesthetic recovery room then have their vital signs monitored once they are deemed safe enough to be transferred from the recovery room the ward.