The Pre-operative nurse has many responsibilities to perform for their patients prior to surgery. Patients usually feel the Assessment Clinic prior to being transferred to the Outpatient facilities. However, if patients do not feel the Assessment Clinic, it's the pre-operative nurse's work to gather this information. The information to be compiled prior to surgery is really as follows; past health background, previous flu/pneumonia vaccination, previous surgeries, assessment of varied pre-existing disorders/diseases operations (such as hypertension, migraine headaches, diabetes, center trouble, etc. ), current medications (dose, frequency, last medication dosage used), name and phone number of a family member, pain evaluation, NPO status, assessment of any material in or on the patient's body (could it be removed), liquor/tobacco/drug use, if the individual has any dentures, glasses, or contacts that require to be removed prior to surgery, and what technique has been done and the location of your body the procedure is usually to be done on.
When all the Administration Evaluation is complete, the nurse then begins to "prep" the individual for surgery according to her responsibilities. The pre-operative nurses have many tasks. The nurse is to begin by checking out the physician's orders against the graph for the precise treatment being done. The nurse must ensure any laboratory work ordered has been in "normal" limitations with the patient. If there is previous history of heart and soul conditions, the patient must be cleared through radiology prior to surgery; the nurse is in charge of ensuring all appropriate varieties from radiology are present and signed consequently. Prior to being implemented any medications or having any invasive methods (IV), the nurse talks about the task to the patient and ensures they haven't any questions. The nurse then ensures that all surgery consent forms can be found and signed by the patient. For any female patients that aren't post-menopausal or hasn't got a hysterectomy, the nurse must get a urinalysis to rule out possible pregnancy prior to surgery. The nurse can be applied Sequential Compression Devices (SCD's) to the patient's calves to assist in preventing blood clots during surgery. The patient's respiratory status is validated through obtaining RR, HR and BP. The pre-operative nurse will not typically obtain these vitals as the OR products are in charge of this; however, the nurse is in charge of ensuring the vitals are within normal amounts for your patient and that the patient's vitals are charted.
The nurse then starts the patient's IV. Ahead of injecting the Jelco, the nurse administers 0. 1 ml of lidocaine, intro-dermally to numb the region. This helps calm the patient's anxieties due to the considered the "smaller" needle delivering a numbing agent before the "big" needle is placed. If the physician has ordered a catheter prior to surgery, the nurse is responsible for undertaking these orders. That is a sterile technique and can be performed by the pre-operative nurse.
After many of these responsibilities have been performed, the nurse does another pain assessment on the individual. If it is deemed necessary for pain medication supervision, the nurse will notify the physician by telephone and the nurse takes a mobile phone medication order. It is the nurse's responsibility to ensure the physician comes home and signs the telephone medication order that was given over the telephone as well as to carry out the orders when she can therefore the patient is not in any pain. Antibiotics are nearly always purchased prior to any surgery. If antibiotics are purchased, the nurse will administer through IV already established. All responsibilities performed must be charted prior to patient being used in the operating room. The nurse will continue to check in on the individual periodically until the patient is used back to surgery.
Duties of the Intra-operative Nurse
Once the individual is ready for surgery, they are really transferred to the intra-operative nurse. The intra-operative nurse will a "pre-op" interview asking the patient of any allergy symptoms, any metals in or on the body, of course, if these metals can be removed. When the material can be removed, it's the intra-operative nurse's responsibility to eliminate it and secure it to either a family member or where ever determined appropriate by said nurse. The intra-operative nurse is accountable for the individual during surgery and until they are really transferred to the Post-Anesthesia Care Device (PACU). The intra-operative nurse must maintain a log of times for stepping into the OR, intubation, anesthesia administration, Foley catheter insertion, when surgery starts off, and when surgery can stop. The intra-operative nurse is the only workers in the operating room that is not sterile and therefore can leave the operating room during surgery to obtain any materials needed such as extra sutures, emergency supplies in the event a patient codes, etc. Because of this the intra-operative nurse is named the "Circulator".
The intra-operative nurse helps the anesthesiologist with placements of the intubation pipe and the naso-gastric tube. Blood circulation pressure cuff, EKG (3 Business lead), and Pulse Ox are all attached to the individual by the intra-operative nurse. The nurse can be applied a sticky Bovie pad to the patient's outdoor, top thigh. The Bovie delivers probes of electricity through the patient's body during surgery which cauterizes the patient's veins and helps lessen bleeding. This is the reason for removing any metal prior to surgery.
Once the individual is under anesthesia, the nurse is in charge of correctly positioning the individual on the operating table in line with the process being performed and retaining the patient's security during surgery. Once setting is right, the nurse starts to "prep" the individual for surgery. This includes cleaning the medical area, as well as, any areas close by that could contaminate the surgical procedure or compromise the sterile field. The prep solution of preference for this center is Betadine. The nurse cleans the surgical site and encompassing areas three times with the prep solution, by using a fresh prep sponge every time and patted the region with sterile drape cloths among each cleansing. The intra-operative nurse also shacks up the suction canisters and preps a carrier of normal saline used for irrigation. The intra-operative nurse is also responsible for counting all instruments and sponges before surgery, before suturing, and after suturing. All of these obligations are performed prior to the attending physician enters the operating room.
Once the surgeon enters the area, the intra-operative nurse aids him/her with donning sterile gloves, wedding dress, and face mask and a "PERIODS" is performed. ENOUGH TIME out procedure contains specific verbal records between your intra-operative nurse, the anesthesiologist, and the medical expert. Patient ID is made through chart, arm band, and proclaiming aloud by the intra-operative nurse. The task is read out loud from the prepared consent. Any imaging required prior to surgery is established labeled and stated to be there. Pre-procedure antibiotics, medication dosage, and route are explained aloud by the intra-operative nurse. Any safe practices safeguards such as background of drug allergy symptoms, medication uses, etc. are explained aloud by the intra-operative nurse. Once all this information has been stated aloud, the intra-operative nurse says, "Does everyone agree?" at which time all staff must say aloud, "Agreed".
Once surgery has started, the nurse message or calls a friend or family member to see them surgery has started. The nurse is to call the family every hour that the individual is in the operating room. During surgery, the nurse is responsible for answering the phone, turning lights on / off, adjusting the heating system or air-con, placing any unsterile equipment, taking away and reapplying any sterile clothing, keeping trail and charting what items were used for the patient's technique, and any extra equipment needed by operative employees during surgery for billing purposes.
Also during surgery, the intra-operative nurse is to chart all times logged, any specimens (areas of the body) removed, sutures used, anyone within the operating room, amount of any liquids collected through suctioning, and who performed what strategies. If any specimens were removed, the intra-operative nurse is responsible for labeling and delivering to the lab. Once all materials are accounted for and the patient is released from the operating room, the individual is transferred to the PACU.
duties of the PACU nurse
I had not been able to monitor a nurse executing tasks in the PACU, however, one of the nurses was kind enough to be seated beside me and explain some of their tasks. Once a patient is transferred to the PACU, the PACU nurse applies a nose and mouth mask delivering air and vitals are obtained every ten minutes. The vitals obtained include blood pressure, pulse ox and EKG readings. The PACU nurse must keep an eye on the patient's temp, as well as patient's hemodynamics for just about any rhythm changes based on the patient's health background.
Patients are set up with a Patient controlled analgesic unit (PCA product) to deliver pain medication PRN as regarded by the individual at the drive of a button. The PCA unit is designed to only deliver a particular amount of pain medication it doesn't matter how often the patient "pushes the button" which means patient is not vulnerable to overdosing and does not have to wait on the nurse to manage pain medication.
If a Foley catheter was not placed yet, the PACU nurse will perform this obligation as the individual will not have bathroom privileges until they can be Post-op. PACU nurses cannot intubate, however, they can ex-tubate. The PACU nurse is also responsible for discontinuing arterial lines, inserting nerve blocks for pain management, and filling in all proper varieties and charting. PACU nurses can only care for no more than two patients at the same time. However, if the individual is less than eight years of age or a rigorous Care Unit patient, then that'll be the PACU nurse's only patient until they can be used in post-op. Once the patient is awake and established to be "stable", they are transferred back again to Outpatient where they were prepped Pre-op.
DUTIES OF THE PRE-OPERATIVE NURSE
Once patients are moved back again to Outpatient area, a Pre-operative nurse assumes responsibility for the patient until release, but functions post-op responsibilities. Vitals are obtained every thirty minutes by the outpatient helps, but are charted and supervised by the post-operative nurse. The nurse assesses the operative site for blood loss or excess bloating if the site is visible. The patient's pain is assessed and the PCA button is positioned well at your fingertips for the individual. The post-operative nurse investigations physician's orders for discharge pain medications and message or calls the order in to the patient's personal pharmacy of preference. The nurse discontinues the patient's IV, catheter, and SCD's. The family or whoever is providing transport home for the individual is notified and permitted to go back to the Outpatient prep area until patient is discharged. The post-operative nurse also gathers any release instructions as bought by the medical doctor and sets the post-op follow-up appointment prior to release. The doctor will designate the criteria where the patient must satisfy prior to the patient is discharged. For instance, if kidney stones were "zapped", the individual must void widely at least once before release. The post -operative nurse is accountable for making certain all required information when it comes to forms being signed and paperwork required in medical record is present, and everything charting required is complete for that patient.
ONE FACET OF PATIENT TEACHING
One facet of patient teaching i discovered was during post-op and prior to discharge. The example I witnessed was when the post-operative nurse specified to the patient what she should expect in the times to come, specifically how to "wipe" after heading to the toilet, as well as specific indicators of complications that could need immediate attention.
WHAT WERE MY STRENGTHS & WEAKNESSES
I believe that my advantages were first of all my previous, in-class education. I noticed very enlightened and realized what materials were needed and exactly how to begin an IV. Secondly, I really believe my determination to learn whatever the staff wanted to show me without reserve is another one of my talents.
My weakness was my not understanding the jargon employed by everyone. I had fashioned to consistently ask what all the acronyms used stood for. It looked like that they had an acronym for everything. I really believe the more scientific hours I am in a position to participate in, the greater jargon I am going to learn. I also believe going for a medical terminology school will be a tremendous property to my education investment.