The most complete interpretation of sleep orange
Orange juice. The symbolic meaning of orange juice in dream books is pleasure and temptation. Quite often we...
Preoperative preparation of elderly and old people. Preparing a patient for elective surgery algorithm
State educational institution of secondary vocational education "Sakhalin Basic Medical College"
Department of Advanced Training
Test No. 1 on the topic:
“Preparing the patient for surgery. Management of patients in the postoperative period"
Klyuchagina Tatyana Vladimirovna
Surgical nurse
MBUZ "Uglegorsk Central District Hospital"
October 2012
Main goal: increasing the theoretical knowledge and practical skills of a nurse in preparing patients for emergency, urgent and elective surgery, the ability to care for patients in the postoperative period.
The nurse should know:
v Organization system inpatient care to the population in health care facilities v Regulatory documents defining the main tasks, functions, conditions and procedures for the operation of health care facilities v Organization of nursing in the structural units of health care facilities v Therapeutic and protective regime v System of hospital infection control and patient infection safety and medical personnel in health care facilities v Occupational health and safety in health care facilities v Organization of perioperative nursing care
v Organization of restorative treatment and rehabilitation of patients in health care facilities v Fundamentals of rational and balanced nutrition, basics of therapeutic and diagnostic nutrition in health care facilities v Basic accounting forms medical documentation in health care facilities. The nurse must be able to: Ø Implement and document the essential steps of the nursing process in caring for patients. Ø Comply with safety and labor protection requirements in the department. Ø Ensure infection safety of the patient and medical personnel when performing manipulations and caring for patients. Ø Carry out preventive, therapeutic, diagnostic measures prescribed by doctors. Ø Master the technique of preparing for diagnostic studies. Ø Know the technique of preparing a patient for emergency and planned operations. Ø Master the technique of nursing manipulations. Ø Conduct health education work among patients and their relatives. Ø Provide emergency first aid in case of emergency conditions. Ø Carry out sanitary treatment of patients entering the department. Ø Prepare disinfectant solutions of a given concentration. Ø Disinfect patient care items. Ø Carry out disinfection and pre-sterilization cleaning of medical products. Ø Place dressings and surgical linens in the bags. Ø Use a sterile container. Ø Disinfect your hands. Ø Organize and supervise disinfection measures if necessary. Ø In the event of an emergency (cut, puncture of the skin, etc.), during nursing procedures, take measures to prevent occupational infection. Ø Carry out quality control of disinfection, pre-sterilization cleaning and sterilization. Preparing the patient for planned surgery. Preoperative period The preoperative period is the period from the moment the patient enters the surgical department for the operation until the moment it is performed. The purpose of preoperative preparation of the patient is to reduce the risk of developing intra- and postoperative complications. The preoperative period is divided into two stages: diagnostic and preparatory. The final diagnosis is the task of the doctor. It is the diagnosis that decides the urgency of the operation. But nursing observations of the patient’s condition, its changes and deviations can correct the doctor’s decision. If it turns out that the patient needs emergency surgery, then preparatory stage begins immediately after diagnosis and lasts from a few minutes to 1-2 hours. The main indications for emergency surgical intervention are bleeding of any etiology and acute inflammatory diseases. If there is no need for emergency surgery, make an appropriate entry in the medical history and prescribe planned surgical treatment. The nurse must know the absolute and relative indications for surgical intervention, both in emergency and planned surgery. The absolute indications for surgery are diseases and conditions that pose a threat to the patient’s life and can only be eliminated by surgical methods. Absolute indications for which emergency operations are performed are otherwise called vital indications. This group of indications includes: asphyxia, bleeding of any etiology, acute diseases of the abdominal organs (acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric ulcer and duodenum, acute intestinal obstruction, strangulated hernia), acute purulent surgical diseases. The absolute indications for elective surgery are the following diseases: malignant neoplasms (lung cancer, stomach cancer, breast cancer, etc.), esophageal stenosis, obstructive jaundice, etc. Relative indications for surgery are two groups of diseases: Urgent surgeries are a type of planned surgery. They are distinguished by the fact that surgical intervention cannot be postponed for a significant period. Urgent operations are usually performed 1-7 days from the moment of admission or diagnosis. So, for example, a patient with stopped stomach bleeding may be operated on the next day after admission due to the risk of recurrent bleeding. Urgent operations include operations for malignant neoplasms (usually within 5-7 days from admission after the necessary examination). Long-term postponement of these operations can lead to the fact that it will be impossible to carry out a full-fledged operation due to the progression of the process (the appearance of metastases, tumor germination of vital important organs and etc.). After making the main diagnosis, an examination of all vital systems is carried out, which is carried out in three stages: preliminary assessment, carrying out the standard minimum, additional examination. A preliminary assessment is carried out by a doctor and an anesthesiologist based on the collection of complaints, a survey of organs and systems, and data from a physical examination of the patient. When collecting anamnesis, it is important to find out whether the patient is susceptible to allergies, what medications he took (especially corticosteroid hormones, antibiotics, anticoagulants, barbiturates). These points are sometimes more easily identified by the nurse in the process of observing the patient and contacting him than during direct questioning. Nursing interventions when preparing a patient for surgery The standard minimum examination includes: a clinical blood test, biochemical analysis blood (total protein, bilirubin, transaminases, creatinine, sugar), blood clotting time, blood group and Rh factor, general urine test, chest fluorography (not more than 1 year old), dentist’s report on oral sanitation, electrocardiography, examination therapist, for women - examination by a gynecologist. The nurse’s tasks include preparing the patient for one or another type of analysis and additional monitoring of his condition. If any concomitant disease is detected, additional examination is carried out in order to make an accurate diagnosis. The preparatory stage is carried out jointly by the doctor and the nurse. It is carried out taking into account the focus on individual organs and systems of the body. Nervous system. The nervous system of surgical patients is significantly traumatized by pain and sleep disturbances, the fight against which with the help of various medications is very important in the preoperative period. It is important to remember that “psychological premedication,” along with pharmacological agents that help stabilize the patient’s mental state, help reduce the number of postoperative complications and facilitate anesthesia during surgery. The cardiovascular and hematopoietic systems require increased attention. If the activity of the cardiovascular system is impaired, measures to improve it are prescribed. Patients with acute anemia receive blood transfusions before, during and after surgery. To prevent complications from the respiratory system, it is necessary to teach the patient in advance proper breathing (deep inhalation and long exhalation through the mouth) and coughing in order to prevent retention of secretions and stagnation in the respiratory tract. For the same purpose, jars are sometimes placed on the eve of the operation. Gastrointestinal tract. When the stomach is full, after administration of anesthesia, the contents from it can begin to passively flow into the esophagus, pharynx, or oral cavity (regurgitation), and from there, with breathing, enter the larynx, trachea and bronchial tree (aspiration). Aspiration can lead to asphyxia - blockage of the airways, which can lead to the death of the patient or a serious complication - aspiration pneumonia. To prevent aspiration, the nurse should explain to the patient that on the day of the planned operation he should not eat or drink anything in the morning, and the day before he should eat a not very heavy dinner at 5-6 pm. Before a planned operation, the nurse gives the patient a cleansing enema. This is done so that when the muscles relax on the operating table, voluntary bowel movements do not occur. Immediately before the operation, care must be taken to empty the patient's bladder. To do this, in the vast majority of cases, you need to let the patient urinate. The need for bladder catheterization is rare. It may be necessary if the patient’s condition is severe, he is unconscious, or when performing special types operative Skin. On the eve of the operation, it is necessary to provide preliminary preparation surgical field. This event is carried out as one of the methods of prevention contact infection. The evening before the operation, the patient must take a shower or wash in the bathroom, put on clean linen, and also change the bed linen. On the morning of the operation, the nurse dry-shaves the hair in the area of the upcoming operation. This measure is necessary, since the presence of hair makes it difficult to treat the skin with antiseptics and can contribute to the development of postoperative infectious complications. You should shave on the day of surgery, and not earlier, as an infection may develop in the area of minor skin damage caused by shaving. When preparing for emergency surgery, they usually limit themselves to shaving. hairline only in the operation area. Psychological preparation of the patient for surgery With proper psychological preparation, the level of anxiety decreases, postoperative pain and the incidence of postoperative complications. The nurse checks whether the patient has signed consent for the operation. In case of emergency surgery, relatives can give consent. The patient's painful feelings about the upcoming operation have a severe traumatic effect. The patient may be afraid of a lot: the operation itself and the suffering and pain associated with it. He may fear for the outcome of the operation and its consequences. In any case, it is the sister, due to the fact that she is constantly with the patient, who must be able to find out the specifics of the fear of a particular patient, determine what exactly the patient is afraid of and how great and deep his fear is. The sister reports all her observations to the attending physician; she must become an attentive mediator and, on both sides, prepare a conversation between the patient and the attending physician about the upcoming operation, which should help dispel fears. Both the doctor and the nurse must “infect” the patient with their optimism, making him their ally in the fight against the disease and the difficulties of the postoperative period. Preoperative preparation of elderly and old people Older people have a more difficult time undergoing surgery, exhibit increased sensitivity to certain medications, and are prone to various complications due to age-related changes and concomitant diseases. Depression, isolation, and resentment reflect the vulnerability of the psyche of this category of patients. Attention to complaints, kindness and patience, punctuality in fulfilling appointments contribute to peace of mind and faith in a good outcome. Of particular importance is breathing exercises. Intestinal atony and accompanying constipation require an appropriate diet and laxatives. Elderly men often experience hypertrophy (adenoma) of the prostate gland with difficulty urinating, and therefore urine is removed with a catheter according to indications. Due to weak thermoregulation, a warm shower should be prescribed, and the temperature of the water in the bath should only be adjusted to 37*C. After the bath, the patient is thoroughly dried and dressed warmly. At night, as prescribed by the doctor, they give sleeping pills. Preoperative preparation of children As in adult patients, the essence of preoperative preparation for children is to create the best conditions for surgical intervention, however, the specific tasks that arise and methods for solving them have certain features, which are more pronounced the smaller the child. The nature of the preparation and its duration depend on a number of factors: the age of the child, the date of admission from the moment of illness (birth), the presence of concomitant diseases and complications, etc. The type of pathology and the urgency of the operation (planned, emergency) are also taken into account. Moreover, some of the measures are common to all diseases, while the other part is applicable only in preparation for certain operations and in certain situations. The nurse must be well versed in the age-related characteristics of training and competently carry out the doctor’s prescriptions. Newborns and infants are most often operated on for emergency and urgent indications caused by malformations of internal organs. The main tasks of preoperative preparation are the prevention of respiratory failure, hypothermia, blood clotting disorders and water-salt metabolism, as well as the fight against these conditions. Older children undergo surgery both routinely and for emergency reasons. In the first case, a thorough clinical examination. Much attention should be given to sparing the psyche small child. Children often show signs of anxiety, ask when the operation will take place, and experience fear of the intervention. Neuropsychic breakdowns are sometimes associated with manipulation carried out unexpectedly, so it is always necessary to briefly explain to the child the nature of the upcoming procedure. It is absolutely necessary to avoid intimidating words and expressions, to act no longer with a shout, but with gentle and even treatment. Otherwise, the nurse can nullify all the efforts of the doctor trying to achieve trust and peace of mind of the child who is scheduled for surgery. Mental preparation is of great importance for a favorable outcome of surgery and normal course postoperative period. Setting up a cleansing enema Cleansing enemas are used for mechanical emptying of the colon for: Contraindications: bleeding from the digestive tract; acute inflammatory diseases of the colon and rectum; malignant neoplasms of the rectum; the first days after surgery; cracks in the anus; rectal prolapse; acute appendicitis, peritonitis; massive swelling. Equipment: system consisting of an Esmarch mug, a 1.5 m long connecting tube with a valve or clamp; tripod; sterile rectal tip, wipes; water at a temperature of 20°C, in an amount of 1.5-2 l; water thermometer; petrolatum; spatula for lubricating the tip with Vaseline; oilcloth and diaper; vessel with oilcloth; pelvis; overalls: disposable gloves, medical gown, oilcloth apron, replacement shoes. Preparing for the procedure. Place an oilcloth under the patient’s buttocks, hanging into the basin and covered with a diaper. Execution of the procedure. Completion of the procedure. 1.Escort the patient to the toilet or provide a bedpan when the urge to defecate appears. Provide toilet paper. If the patient is lying on a bedpan, then, if possible, raise the head of the bed by 45°-60°. 2.Make sure the procedure was effective. If the patient is lying on a bedpan, place the bedpan on a chair (bench) and cover it with oilcloth. Inspect the feces. 3.Disassemble the systems. Place in a container with a disinfectant solution. Wash the patient. .Change robe, gloves, apron. Place gloves and an apron in containers with a disinfectant solution. 5.Disinfect used items. Sanitary and hygienic treatment of the patient. Preparation of the surgical field On the eve of the operation, the patient should take a bath or shower, and the area adjacent to the surgical field and the surgical field itself should be thoroughly shaved on the morning of the operation. When a seriously ill patient is admitted, the surgical field is shaved by the operating room nurse. The preparation of the surgical field is carried out in the preoperative room under the guidance of an operating nurse who is not involved in the operation. Considering that it is often necessary to widen the incision during surgery, hair is shaved far beyond the intended surgical field. During operations on the scalp, as a rule, all hair is shaved off. The exceptions are small soft tissue wounds and benign skin tumors, especially in women. Before surgery on the abdominal organs, the hair on the entire front surface of the abdomen, including the pubis, is shaved. During operations on the stomach, liver, and spleen in men, the hair on the chest is shaved down to the level of the nipples. When this incision is located below the navel, the hair on the pubic area and upper thighs is shaved. In patients with inguinal hernias and other diseases of this area, shave hair in the genital area and perineum. During operations of the anus, hair in the perineum and genitals, on the inner thighs and buttocks is shaved. In operations on the extremities, the entire affected segment of the extremity is included in the surgical field. Before knee surgery, hair is shaved, starting from the upper third of the thigh to the middle of the lower leg. In patients with varicose veins, the hair in the corresponding groin area, pubic area, and entire leg is shaved. During breast surgery, the hair in the armpit is shaved. If the operation is to be completed with a skin graft, the hair in the areas where the flap will be harvested should be shaved carefully and carefully so as not to scratch the skin. Premedication Premedication is the use of medications to prepare a patient for general or local anesthesia, to relieve psycho-emotional stress, as well as reduce the secretion of saliva and mucus in the respiratory tract, suppress unwanted autonomic reflexes(tachycardia, arrhythmias), enhancing analgesia and deepening sleep at the stage of induction of anesthesia, reducing discomfort during injection of local anesthetic, reducing the risk of nausea and vomiting in the postoperative period, preventing aspiration of gastric contents during induction of anesthesia. When preparing for local anesthesia, attention should be paid to the patient. Explain to him the advantages of local anesthesia. In a conversation with the patient, it is necessary to convince him that the operation will be performed painlessly if the patient reports in time the appearance of pain, which can be stopped by adding an anesthetic. The patient must be carefully examined, especially the skin where local anesthesia will be administered, since this type of anesthesia cannot be performed for pustular diseases and skin irritations. It is necessary to find out allergic diseases in the patient, especially allergies to anesthetics. Before anesthesia, measure blood pressure, body temperature, and count pulse. Before premedication, ask the patient to empty the bladder. 20-30 minutes before surgery, premedicate: administer 0.1% atropine solution, 1% promedol solution and 1% diphenhydramine solution, 1 ml intramuscularly in one syringe. After premedication, the patient should be conscious, sleepy, calm and cooperative. Detailed conversation, suggestion and emotional support are integral components of preparation for surgery. Drug doses depend on age, weight, physical and mental status. Seriously ill and weakened people, as well as infants and the elderly, need smaller doses of sedatives and tranquilizers. With psychomotor agitation, on the contrary, higher doses may be required. After premedication, you must strictly adhere to bed rest until the end of local anesthesia. Rules for bringing a patient into the operating room After preparing the surgical field, the operating room nurse removes the surgical linen from the patient and helps him change into the operating room linen. The department staff, wearing shoe covers and gauze masks, wheel the gurney with the patient into the operating room. If the patient is conscious and active, then he independently moves to the operating table from the gurney; if he is in serious condition, he is helped by a nurse and a nurse. The patient must be placed in the desired position. The location or position of the patient on the operating table may be different, depending on the area in which the surgical wound will be located, the nature of the operation, its stage, as well as the condition of the patient. Patient position on the operating table · On the back horizontally - during operations on the face, chest, abdominal organs, bladder, external male genitalia, limbs. · Position on the back with the head tilted back - during operations on the thyroid gland and larynx. · Position on the back, a cushion on the table is placed under the lower ribs for better access and examination of the organs of the upper abdomen - during operations on gallbladder, spleen. · Position on the side (right or left) - during kidney operations. · Position on the back with the lower limbs bent at the hip and knee joints - when carrying out gynecological operations and during operations in the rectal area. · Trendelenburg position with the head end of the table lowered - during operations on the pelvic organs. · Position with the lower end of the table lowered - during brain surgery. · Lying position on the stomach - during operations on occipital region head, on the spine, sacral region. X-ray research methods R-study of the stomach and duodenum. Purpose: diagnosis of diseases of the stomach and duodenum Contraindications: ulcer bleeding Execution algorithm: . .Explain that no preparation is required .Warn the patient to come to the X-ray room at the time indicated by the doctor. .In the X-ray room, the patient ingests a suspension of barium sulfate in the amount of 150-200 ml. 5.The doctor takes pictures Irrigoscopy (examination of the colon) Purpose of the study: diagnosis of diseases of the large intestine. Equipment: 1.5 liters of barium sulfate suspension (36-37*), a system consisting of an Esmarch mug, a 1.5 m long connecting tube with a valve or clamp; tripod; sterile rectal tip, wipes; water at a temperature of 20°C, in an amount of 1.5-2 l; water thermometer; petrolatum; spatula for lubricating the tip with Vaseline; oilcloth and diaper; vessel with oilcloth; pelvis; overalls: disposable gloves, medical gown, oilcloth apron, replacement shoes. Execution algorithm: .Explain to the patient the process and necessity of this procedure. .Explain the meaning of the upcoming preparation for the study: · exclude gas-forming foods from the diet (vegetables, fruits, dairy, yeast products, brown bread); · give the patient 30-60 ml of castor oil at 12-13 o'clock on the day before the study; · give 2 cleansing enemas the evening before the examination and in the morning 2 hours before the procedure; · On the morning of the test, give the patient a light protein breakfast. 3.Conduct the patient to the X-ray room at the appointed time. .Using an enema, administer a suspension of barium sulfate up to 1.5 liters prepared in the X-ray room. .A series of photographs are taken. Intravenous excretory urography operation patient preparation nursing Purpose: diagnosis of kidney and urinary tract diseases. Equipment: 20 ml disposable syringes, 305 sodium thiosulfate solution, everything necessary for a cleansing enema, contrast agent (urografin or verografin, as prescribed by a doctor). Execution algorithm: .Train the patient and his family members in preparation for the study .Indicate the consequences of violating the nurse’s recommendations .Avoid gas-forming foods from your diet for 3 days before the test. .Avoid eating 18-20 hours before the test. .Ensure that you take a laxative as prescribed by your doctor the day before lunch; limit fluid intake from the second half of the day before the test. .Give a cleansing enema the day before the examination and 2 hours before the examination in the morning. .Do not eat, take medications, smoke, do injections or other procedures before the study. .Empty your bladder immediately before the procedure. 10.Take the patient to the X-ray room. 11.Take an overview photo. .Inject slowly 20-40-60 ml of contrast agent intravenously as prescribed by the doctor. .Take a series of photographs. Preparing the patient for endoscopy Currently, endoscopic research methods are used both for diagnosis and treatment of various diseases. Modern endoscopy plays a special role in recognizing the early stages of many diseases, especially oncological diseases (cancer) of various organs (stomach, bladder, lungs). Most often, endoscopy is combined with targeted (under visual control) biopsy, therapeutic measures(administration of drugs), probing. Endoscopy is a method of visual examination of hollow organs using optical-mechanical lighting devices. Endoscopic methods include: Bronchoscopy<#"16" src="/wimg/11/doc_zip2.jpg" />Gastroscopy<#"16" src="/wimg/11/doc_zip3.jpg" />Hysteroscopy<#"16" src="/wimg/11/doc_zip4.jpg" />Colonoscopy - colon mucosa. Colposcopy - vaginal opening and vaginal walls. Laparoscopy<#"16" src="/wimg/11/doc_zip7.jpg" />Otoscopy - external ear canal and eardrum. Sigmoidoscopy - rectum and distal part sigmoid colon. Ureteroscopy<#"16" src="/wimg/11/doc_zip10.jpg" />Cholangioscopy<#"16" src="/wimg/11/doc_zip11.jpg" />Cystoscopy<#"16" src="/wimg/11/doc_zip12.jpg" />Esophagogastroduodenoscopy - examination of the esophagus, stomach cavity and duodenum. Fistuloscopy - examination of internal and external fistulas. Thoracoscopy<#"16" src="/wimg/11/doc_zip15.jpg" />Cardioscopy<#"16" src="/wimg/11/doc_zip16.jpg" />Angioscopy<#"16" src="/wimg/11/doc_zip17.jpg" />Arthroscopy<#"16" src="/wimg/11/doc_zip18.jpg" />Ventriculoscopy<#"justify">Preparing the patient for fibrogastroduodenoscopy (FGDS) FGDS - endoscopic examination of the esophagus, stomach, duodenum, using a gastroscope. At this study The gastroscope is inserted through the mouth. Purpose: therapeutic, diagnostic (detection of the condition of the mucous membrane of the organs being studied - inflammation, ulcers, polyps, tumors; performing a biopsy, administering medications). Indications: diseases of the esophagus, stomach, duodenum. Sequencing: )Inform the patient about the purpose and progress of the procedure, obtain his consent. )On the eve of the study, the last meal is no later than 21:00 (light dinner). )The study is carried out on an empty stomach (do not drink, do not smoke, do not take medications). )Warn the patient that during the study he will be unable to speak or swallow saliva. )Bring a towel with you to the examination (for spitting saliva). )If there are removable dentures, warn the patient that they need to be removed. )Explain to the patient that immediately before the examination the pharynx and pharynx are anesthetized (with Lidocaine or Dicaine solution) by irrigation from an inhaler. )The patient's position is lying on the left side. )After the examination, do not eat for 2 hours. Preparing the patient for sigmoidoscopy (RRS) RRS - endoscopic examination of the rectum and sigmoid colon using a rigid endoscope (rectoscope). In this study, the rectoscope is inserted through the anus 25-30 cm. Purpose: therapeutic, diagnostic (detection of the condition of the mucous membrane - inflammation, erosion, hemorrhage, tumors, internal hemorrhoids, smears are obtained, a biopsy is performed). Indications: diseases of the rectum and sigmoid colon. Sequencing: )Inform the patient about the purpose and progress of the study, obtain his consent. )Three days before the test, exclude foods that cause gas from your diet. )In the evening and morning before the study - a cleansing enema until the effect of “clean waters” is performed. )On the eve of the study, at 12 noon, the patient drinks 60 ml of a 25% barium sulfate solution. )The study is carried out in the morning on an empty stomach. )The patient's position during the examination is lying on his left side with his legs raised to his stomach. )Before the examination, the anal area is anesthetized with 3% dicaine ointment. Preparing the patient for cystoscopy Cystoscopy is an endoscopic examination of the bladder with a cystoscope. In this type of examination, the cystoscope is inserted through the urethra. Purpose: therapeutic, diagnostic (detection of the condition of the mucous membrane - ulceration, papillomas, tumors, the presence of stones, determine the excretory ability of the kidneys). Indications: diseases of the urinary system. Sequencing: )Inform the patient about the purpose and progress of the upcoming study, obtain his consent. )Empty your bladder before the test. )Carry out hygienic toileting of the genitals. )The position of the patient during the examination is on the back, with legs apart, knees bent, on the urological chair. )The external opening of the urethra is treated with a sterile solution of Furacillin or Rivanol. )When inserting a cystoscope, the external opening urethra, treated with anesthetics. )After the study, stay in bed for at least two hours. Preparing the patient for bronchoscopy Bronchoscopy is an endoscopic examination of the bronchial tree using a bronchoscope. In this study, the bronchoscope is inserted through the mouth. Purpose: therapeutic, diagnostic (diagnosis of erosions and ulcers of the bronchial mucosa, removal of foreign bodies, removal of polyps, treatment of bronchiectasis, lung abscesses, administering medications, extracting sputum, performing a biopsy). Sequencing: )Inform the patient about the purpose and progress of the upcoming study and obtain his consent. )The study is carried out on an empty stomach. No smoking. In the evening, as prescribed by the doctor, administer tranquilizers. )Immediately before the examination, empty the bladder. )Immediately before the study, as prescribed by the doctor, inject subcutaneously a 0.1% solution of Atropine 1.0 ml, a 1% solution of Diphenhydramine 1.0 ml. )The patient's position during the examination is sitting or lying down with his head thrown back. )Before inserting the bronchoscope, anesthetize the upper respiratory tract. )After the examination, do not eat or smoke for 2 hours. Ensuring patient infection safety After each patient is discharged, the bed, bedside table, and bedpan stand are wiped with a rag generously moistened with a disinfectant solution. The bed is covered with bedding that has undergone chamber treatment according to the regime for vegetative forms of microbes. If possible, cyclical filling of wards is observed. The patient is given individual care items: a spittoon, bedpan, etc., which after use are immediately removed from the room and washed thoroughly. After the patient is discharged, items individual care subjected to disinfection. It is strictly prohibited to accept soft toys and other items that cannot withstand disinfection into surgical departments. At the end of work, gowns, masks, and slippers are changed. Unauthorized movement of patients from ward to ward and exit to other departments is strictly prohibited. Underwear and bed linen are changed at least once every 7 days (after hygienic washing). In addition, linen must be changed if soiled. When changing underwear and bed linen, it is carefully collected in cotton bags or containers with a lid. It is strictly forbidden to throw used linen on the floor or into open receptacles. Sorting and dismantling of dirty linen is carried out in a specially designated room outside the department. After changing linen, all items in the room and the floor are wiped with a disinfectant solution. Patients are discharged in a separate room (discharge room). After discharge or death of the patient, slippers and other shoes are wiped with a swab moistened with a 25% formaldehyde solution or a 40% acetic acid solution until the inner surface is completely moistened. Then the shoes are placed in a plastic bag for 3 hours, after which they are removed and aired for 10-12 hours until the smell of the drug disappears. The department is kept orderly and clean. Cleaning is carried out at least 2 times a day using a wet method, soap and soda solution. Disinfectants use after changing linen and in case of nosocomial infections. In wards for patients with purulent-septic diseases and postoperative purulent complications, daily cleaning is carried out with the mandatory use of disinfectants. Features of preparing a patient for emergency surgery Emergency operations are necessary for injuries (soft tissue damage, bone fractures) and acute surgical pathology (appendicitis, cholecystitis, complicated ulcers, strangulated hernias, intestinal obstruction, peritonitis). Emergency operations force us to reduce preparation as much as possible, carrying out only the necessary sanitization, disinfecting and shaving the surgical field. It is necessary to have time to determine the blood type, Rh factor, and measure the temperature. The contents are removed from an overfilled stomach, and the stomach is probed in cases where the patient ate food after 5-6 o'clock in the evening the day before. There is no need to do enemas before emergency operations, since there is usually no time for this, in addition, for patients in critical condition, this procedure can be very difficult. During emergency operations for acute diseases of the abdominal organs, administering an enema is generally contraindicated. If indicated, an intravenous infusion is urgently established and the patient with the operating system is taken to the operating room, where the necessary measures are continued during anesthesia and surgery. Postoperative management of patients A postoperative complication is a new pathological condition that is not typical for the normal course of the postoperative period and is not a consequence of the progression of the underlying disease. It is important to distinguish complications from surgical reactions, which are a natural reaction of the patient’s body to illness and surgical aggression. Postoperative complications, in contrast to postoperative reactions, sharply reduce the quality of treatment, delay recovery, and endanger the patient's life. There are early (from 6-10% and up to 30% during long and extensive operations) and late complications. Each of six components is important in the occurrence of postoperative complications: the patient, the disease, the operator, the method, the environment, and chance. Complications may be: · development of disorders caused by the underlying disease; · dysfunctions of vital systems (respiratory, cardiovascular, liver, kidneys) caused by concomitant diseases; · consequences of defects in the execution of the operation The characteristics of hospital infections and the patient care system in the hospital are important. this hospital, schemes for the prevention of certain conditions, diet therapy, selection of medical and nursing personnel. Postoperative complications are prone to progression and recurrence and often lead to other complications. There are no minor postoperative complications. In most cases, repeated interventions are required. The frequency of postoperative complications is about 10%, with the share of infectious ones being 80%. The risk increases during emergency as well as long-term operations. The duration of the operation is one of the leading factors in the development of purulent complications. Technical errors: inadequate access, unreliable hemostasis, traumatic procedure, accidental (undetected) damage to other organs, inability to delimit the field when opening a hollow organ, leaving foreign bodies, inadequate interventions, suture defects, inadequate drainage, defects in postoperative management. Prevention of complications in the early and late postoperative period The main objectives of the postoperative period are: prevention and treatment of postoperative complications, acceleration of regeneration processes, restoration of the patient’s ability to work. The postoperative period is divided into three phases: early - the first 3-5 days after surgery, late - 2-3 weeks, long-term (or rehabilitation period) - usually from 3 weeks to 2 - 3 months. The postoperative period begins immediately after the end of the operation. At the end of the operation, when spontaneous breathing is restored, the endotracheal tube is removed and the patient, accompanied by an anesthesiologist and nurse, is transferred to the ward. The nurse must prepare a functional bed for the patient’s return, installing it so that it can be approached from all sides and rationally arrange the necessary equipment. Bed linen needs to be straightened, warmed, the room ventilated, bright lights dimmed. Depending on the condition and the nature of the operation undergone, a certain position of the patient in bed is ensured. After abdominal surgery, under local anesthesia, a position with the head end elevated and knees slightly bent is advisable. This position helps relax the abdominal muscles. If there are no contraindications, after 2-3 hours you can bend your legs and roll over on your side. Most often, after anesthesia, the patient is placed horizontally on his back without a pillow with his head turned to one side. This position serves as a prevention of cerebral anemia and prevents mucus and vomit from entering the respiratory tract. After spinal surgery, the patient should be placed on his stomach, having previously placed a shield on the bed. Patients who were operated on under general anesthesia need constant monitoring until they awaken and restore spontaneous breathing and reflexes. The nurse, observing the patient, monitors general condition, appearance, skin color, frequency, rhythm, pulse filling, frequency and depth of breathing, diuresis, discharge of gases and stool, body temperature. To combat pain, morphine, omnopon, and promedol are administered subcutaneously. During the first day, this is done every 4-5 hours. To prevent thromboembolic complications, it is necessary to combat dehydration, activate the patient in bed, physiotherapy from the first day, under the guidance of a sister, for varicose veins, according to indications - bandaging the legs with an elastic bandage, administering anticoagulants. A change in position in bed, cupping, mustard plasters, and breathing exercises under the guidance of a nurse are also necessary: inflating rubber bags and balloons. When coughing, special manipulations are indicated: you should place your palm on the wound and lightly press it while coughing. They improve blood circulation and ventilation of the lungs. If the patient is prohibited from drinking and eating, parenteral administration of solutions of proteins, electrolytes, glucose, and fat emulsions is prescribed. To compensate for blood loss and for the purpose of stimulation, blood, plasma, and blood substitutes are transfused. Several times a day, the nurse should clean the patient’s mouth: wipe with a ball moistened with hydrogen peroxide, a weak solution of sodium bicarbonate, boric acid or a solution of potassium permanganate on the mucous membrane, gums, teeth; remove plaque from the tongue with a lemon peel or swab dipped in a solution consisting of a teaspoon of sodium bicarbonate and a tablespoon of glycerin per glass of water; Lubricate your lips with Vaseline. If the patient's condition allows, he should be offered to rinse his mouth. During prolonged fasting, to prevent inflammation of the parotid gland, it is recommended to chew (do not swallow) black crackers, orange slices, and lemon to stimulate salivation. After transection (laparotomy), hiccups, regurgitation, vomiting, bloating, stool and gas retention may occur. Help for the patient consists of emptying the stomach with a probe (after gastric surgery, the probe is inserted by a doctor) inserted through the nose or mouth. To eliminate persistent hiccups, atropine (0.1% solution 1 ml), aminazine (2.5% solution 2 ml) is injected subcutaneously, and a cervical vagosympathetic blockade is performed. To remove gases, a gas outlet tube is inserted and prescribed drug treatment. After operations on the upper gastrointestinal tract, a hypertensive enema is given 2 days later. After surgery, patients sometimes cannot urinate on their own due to an unusual position or sphincter spasm. To combat this complication, a heating pad is placed on the bladder area, if there are no contraindications. Pouring water, a warm bed, intravenous administration of a solution of methenamine, magnesium sulfate, injections of atropine, and morphine are also induced to urinate. If all these measures are ineffective, resort to catheterization (morning and evening), keeping track of the amount of urine. Decreased urine output may be a symptom of a severe complication of postoperative renal failure. Due to impaired microcirculation in tissues, bedsores may develop due to prolonged compression. To prevent this complication, a set of targeted measures is required. First of all, you need careful skin care. When washing your skin, it is better to use mild and liquid soap. After washing, the skin should be thoroughly dried and, if necessary, moisturized with cream. Vulnerable places (sacrum, shoulder blade area, back of head, back surface elbow joint, heel) should be lubricated with camphor alcohol. To change the nature of the pressure on the tissue, rubber circles are placed under these places. You should also ensure that the bed linen is clean and dry, and carefully straighten the folds in the sheets. Massage and the use of a special anti-decubitus mattress (a mattress with constantly changing pressure in individual sections) have a positive effect. Great importance Early patient activation is essential for preventing bedsores. If possible, patients should be positioned, seated, or at least turned from side to side. The patient should also be taught to regularly change body position, pull themselves up, lift themselves, and examine vulnerable areas of the skin. If a person is confined to a chair or wheelchair, you should advise him to relieve pressure on the buttocks approximately every 15 minutes - lean forward and rise, leaning on the arms of the chair. Care for postoperative complications Bleeding may complicate any intervention. In addition to external bleeding, one should keep in mind the effusion of blood into the cavities or the lumen of hollow organs. The reasons are insufficient hemostasis during surgery, slipping of the ligature from a ligated vessel, prolapse of a blood clot, and blood clotting disorders. Help consists of eliminating the source of bleeding (often surgically, sometimes with conservative measures - cold, tamponade, pressure bandage), local use of hemostatic agents (thrombin, hemostatic sponge, factory film), replenishment of blood loss, increasing blood coagulation properties (plasma, calcium chloride, vikasol, aminocaproic acid). Pulmonary complications are caused by impaired circulation and ventilation of the lungs due to shallow breathing due to pain in the wound, accumulation of mucus in the bronchi (poor coughing and expectoration), blood stasis in the posterior parts of the lungs (long stay on the back), decreased lung excursions due to bloating of the stomach and intestines. Prevention of pulmonary complications consists of preliminary training in breathing exercises and coughing, frequent changes of position in bed with the chest raised, and pain control. Paresis of the stomach and intestines is observed after abdominal surgery, caused by atony of the muscles of the digestive tract and is accompanied by hiccups, belching, vomiting and retention of stool and gases. In the absence of complications from the operated organs, paresis can be managed through nasogastric suction, hypertonic enemas and gas tubes, intravenous administration of hypertonic solutions, agents that enhance peristalsis (prozerin), and relieve spasms (atropine). Peritonitis is inflammation of the peritoneum, a severe complication of intraperitoneal operations, most often caused by divergence (insufficiency) of sutures placed on the stomach or intestines. With an acute onset, pain suddenly occurs, the initial localization of which often corresponds to the affected organ. Then the pain becomes widespread. At the same time, intoxication quickly increases: temperature rises, pulse quickens, facial features become sharper, dry mouth, nausea, vomiting, muscle tension in the anterior abdominal wall. Against the background of massive antibiotic therapy, as well as in weakened elderly patients, the picture of peritonitis is not so pronounced. If peritoneal symptoms appear, prohibit the patient from drinking and eating, put cold on the stomach, do not administer painkillers, and invite a doctor. Psychosis after surgery occurs in weakened, excitable patients. They are manifested by motor agitation with disorientation, hallucinations, and delusions. In this state, the patient can jump out of bed, tear off the bandage, and injure others around him. Persuasion, attempts to calm the patient down, and put him to bed are ineffective. As prescribed by the doctor, 2.5% chlorpromazine solution is administered subcutaneously. Thromboembolic complications. Persons with varicose veins, blood clotting disorders, slow blood flow, vascular injury during surgery, obese people, as well as weakened (especially cancer) patients and women who have given birth a lot are predisposed to the development of thrombosis. When a blood clot forms and a vein becomes inflamed, thrombophlebitis occurs. First aid consists of prescribing strict bed rest to avoid blood clot rupture deep vein and embolism by its blood flow into the overlying parts of the circulatory system, even up to the pulmonary artery with all the ensuing complications, up to lightning death from blockage of the main trunk of the pulmonary artery. To prevent thrombosis, the patient’s activity in the postoperative period (reducing stagnation), combating dehydration, and wearing elastic bandages (stockings) in the presence of varicose veins is of great importance. Local treatment of thrombophlebitis is reduced to the application of oil-balsamic dressings (heparin ointment), giving the limb an elevated position (Behler splint, roller). As prescribed by the doctor, take anticoagulants, under the control of blood coagulation parameters. Postoperative care for children Anatomical and physiological features child's body determine the need for special postoperative care. The nurse must know the age standards for basic physiological indicators, the nature of the nutrition of children, various age groups, and also have a clear understanding of the pathology and the principle of surgical intervention. Among the factors influencing the course of the postoperative period in children and determining the need for special care for them, the most important is mental immaturity the patient and the body’s peculiar reaction to surgical trauma. General principles post-operative care for children After the child is delivered from the operating room to the ward, he is placed in a clean bed. The most comfortable position at first is on your back without a pillow. Small children, not understanding the seriousness of the condition, are overly active and often change position in bed, so they have to resort to fixing the patient by tying the limbs to the bed with cuffs. In very restless children, the torso is additionally fixed. Fixation should not be rough. Pulling the limbs too tightly with cuffs causes pain and venous congestion and can cause malnutrition of the foot or hand, including necrosis. Fingers should fit freely into the space between the cuff and the skin. The duration of fixation depends on the age of the child and the type of anesthesia. During the period of awakening from anesthesia, vomiting often occurs, so it is important to prevent aspiration of vomit to avoid aspiration pneumonia and asphyxia. As soon as the nurse notices the urge to vomit, she immediately turns the child’s head to the side, and after vomiting, carefully wipes the child’s mouth with a clean diaper. During the period of awakening and the following hours, the child experiences extreme thirst and persistently asks for a drink. In this case, the nurse strictly follows the doctor’s instructions and does not allow excess water intake, which can cause repeated vomiting. In the immediate postoperative period in children, pain control is of great importance. If the child is restless and complains of pain in the area of the postoperative wound or other place, the nurse immediately informs the doctor about this. Usually in such cases, sedative painkillers are prescribed. Only a doctor can dose medications. Postoperative sutures are usually closed with aseptic tape. While caring for the patient, the nurse ensures that the dressing around the stitches is clean. In the postoperative period, the following complications are most often observed: § Hyperthermia develops mainly in infants and is expressed in an increase in body temperature to 39°C and above, often accompanied by a convulsive syndrome. Apply ice packs to the area great vessels(femoral arteries), the child is exposed, the skin is wiped with alcohol. As prescribed by the doctor, antipyretic drugs are administered orally or parenterally § Respiratory failure is expressed in shortness of breath, bluish coloration of the lips or general cyanosis, shallow breathing. Sudden cessation of breathing may occur. The complication develops suddenly and gradually. The role of the nurse is especially important in the prevention of respiratory failure (prevention of aspiration of vomit, regular suction of mucus from the nasopharynx). In life-threatening conditions, the nurse provides first aid, providing the child with oxygen (oxygen therapy, mechanical ventilation). § Bleeding can be external or internal and is manifested by direct or indirect signs. Direct signs are bleeding from a postoperative wound, vomiting blood, and blood in the urine or feces. Indirect signs include pallor of the skin and visible mucous membranes, cold sweat, tachycardia, and decreased blood pressure. In any case, the nurse reports all signs of bleeding that she notices. § Oliguria, anuria - reduction or cessation of urine output. A sharp decrease in the amount of urine indicates either a pronounced decrease in blood volume or kidney damage. In any case, the nurse should inform the doctor about changes in the patient’s diuresis that she notices. Nutritional Features For the first days after surgery on the stomach and intestines, diet No. 0 is prescribed. The food consists of liquid and jelly-like dishes. Allowed: tea with sugar, fruit and berry jellies, jelly, rosehip decoction with sugar, diluted juices of fresh berries and fruits sweet water, weak broth, rice water. Food is given in small, frequent doses throughout the day. The diet is prescribed for no more than 2-3 days. Features of nutrition after appendectomy · 1st day - hunger · 2nd day - mineral water without gases, rosehip decoction, dried fruit compote Over the next three days: · All dishes are liquid and puree · Frequent fractional meals in small portions · Tea with sugar, rosehip infusion, compote · Low-fat chicken broth · Jelly, fruit and berry jelly · A glass of warm boiled water 20-30 minutes before meals, and 1 glass 1.5 hours after The postoperative diet involves avoiding: fatty, floury, salty foods and smoked foods. Features of nutrition after cholecystectomy Approximate daily diet First breakfast A glass of rosehip broth, low-fat cottage cheese with a small amount of sour cream, carrot puree. Lunch A glass of tea with blackcurrant jam or lemon with white crackers. Potato soup with carrot roots; boiled lean fish, boiled chicken or steamed beef cutlet; a glass of dried fruit compote. Steamed egg white omelet, mashed potatoes, semolina, rice, or well-mashed buckwheat porridge with milk. Before bedtime A glass of warm jelly with white day-old bread or crackers. A glass of warm dried fruit compote. Steam omelette or soft-boiled egg, steam cutlet, with carrot, potato or beetroot puree. A glass of tea. Lunch Compote, milk, or one-day yogurt, white bread, a slice of boiled fish. A plate of vegetable soup, mashed potatoes with meat pate or fish, tea with milk. Tea with lemon and cookies. Boiled beets, with a small amount of low-fat sour cream, a slice of bread, jelly. Before bedtime Steamed egg white omelet. At night when waking up A glass of fruit juice diluted with water. Thus, fractional rational nutrition, therapeutic exercises as prescribed by the doctor, regular walks on fresh air, and good mood and an optimistic attitude are the key to successfully preventing unwanted complications after surgery Features of nutrition after hemorrhoidectomy After hemorrhoidectomy, as well as after any other operation on the digestive organs, a diet is prescribed. In the postoperative period, days 1-2 are fasting. On the 2-3rd day - liquid and jelly-like dishes; 200 ml of low-fat meat or chicken broth, weak sweetened tea, rosehip infusion, fruit jelly. On the 3-4th day - add a soft-boiled egg, a steamed protein omelette, and low-fat cream. On the 5-6th day, the diet includes pureed milk porridge, mashed potatoes, and cream of vegetable soup. Meals should be divided up to 5-6 times a day, in small portions. Boiled and mashed food. Recommended vegetables: beets, carrots, zucchini, pumpkin, cauliflower. All vegetables should be consumed boiled. From fruits: bananas, peeled apples (preferably baked), plums, apricots (can be replaced with prunes and dried apricots). Exclude: · Acute · Alcohol Prevention of complications of postoperative wounds The wound after surgery is almost sterile. Caring for such a wound comes down to keeping the dressing clean and creating peace. Several times a day you need to monitor its condition, ensuring the comfort, safety of the dressing, its cleanliness and getting wet. If the wound is sutured tightly, the bandage should be dry. If the wound gets slightly wet, the top layers of the dressing should be changed using sterile material, without exposing the wound in any way. There should be no redness, swelling, infiltration, or any discharge in the area of the postoperative wound. The nurse must inform the doctor about the appearance of signs of inflammation. Features of caring for patients with drainages, graduates All drains must be sterile and used only once. They are stored on a sterile table or in a sterile antiseptic solution. Before use, wash with sterile 0.9% sodium chloride solution. Tubular drainages are inserted into the wound or cavity by a doctor. Drains can be removed through the wound, but more often they are removed through separate additional punctures next to the postoperative wound and are fixed with sutures to the skin. The skin around the drainage is treated daily with a 1% solution of brilliant green and the gauze napkins “pants” are changed. The nurse observes the amount and nature of discharge through the drain. If there is hemorrhagic content, a doctor must be called, blood pressure is measured and the pulse is calculated. The drainage tube from the patient can be extended using glass and rubber tubes. The vessel into which it is lowered must be sterile and filled 1/4 with an antiseptic solution. To prevent infection from entering through the drainage tube, the vessel is changed daily. The patient is placed on a functional bed so that the drainage is visible and care for him is not difficult, and he is placed in a position that facilitates the free outflow of discharge. When using active drainage using an electric suction, it is necessary to monitor its operation, maintaining the pressure in the system within 20-40 mm Hg, and monitoring the filling of the vessel. If there is any doubt about the patency of the drainage, a doctor is urgently called. Rinsing a wound or cavity through the drainage is carried out as prescribed by a doctor using a syringe, which must be tightly connected to the drainage tube. If prescribed by a doctor, the discharged exudate can be sent for testing to a bacteriological laboratory in a special test tube. The removal of tubular drainages is carried out by a doctor. If the drainage falls out of the wound or cavity during manipulation, the nurse urgently informs the doctor about this. The drainage used is not reinserted. Dressing the patient with drains in pleural cavity
Indications: care for drainage in a postoperative wound. Equipment: 4 tweezers, Cooper scissors, dressing material (balls, napkins), 0.9% sodium chloride solution, 70% alcohol, 1% iodonate solution, 1% brilliant green solution, bandage, cleol, replaceable drains, rubber gloves, container with dis. solution. Sequencing: .Reassure the patient and explain the upcoming procedure. .Wear rubber gloves. .Remove the old bandage securing the dressing (make sure that the drainage from the wound is not removed along with the dressing). .Change tweezers. .Treat the skin around the drainage with a gauze ball soaked in 0.9% sodium chloride solution. .Dry the skin around the drainage and treat with 70% alcohol. .Lubricate the edges of the wound with a 1% iodonate solution using blotting movements. If you are intolerant to iodonate, use a 1% solution of brilliant green. .Change tweezers. .Place sterile wipes on the wound surface around the drainage.
LESSON PLAN #15
date according to the calendar and thematic plan
Groups: General Medicine
Number of hours: 2
Topic of the training session:
Preoperative period
Type of training session:
lesson on learning new educational materialType of training session:
lectureGoals of training, development and education: To develop knowledge about the tasks of the preoperative period, about the preoperative preparation of patients before planned and emergency operations, the features of the preparation of children and the elderly .
Formation: knowledge on issues:
Development: independent thinking, imagination, memory, attention,student speech (enrichment of vocabulary words and professional terms)
Upbringing: feelings and personality qualities (worldview, moral, aesthetic, labor).
SOFTWARE REQUIREMENTS:
As a result of mastering the educational material, students should know: the main types of surgical interventions, tasks of the preoperative period, rules for preparing patients for planned and emergency operations, features of the preparation of children and the elderly.
Logistics support for the training session: presentation, situational tasks, tests
PROGRESS OF THE CLASS
1. Organizational and educational moment: checking attendance for classes, appearance, protective equipment, clothing, familiarization with the lesson plan - 5 minutes .
2. Familiarization with the topic, questions (see the text of the lecture below), setting educational goals and objectives - 5 minutes:
4. Presentation of new material (conversation) - 50 minutes
5. Fixing the material - 8 minutes:
6. Reflection: Control questions according to the material presented, difficulties in understanding it - 10 minutes .
2. Survey of students on the previous topic - 10 minutes .
7. Homework - 2 minutes . Total: 90 minutes.
Homework: pp. 67-72 pp. 232-241
Literature:
1. Kolb L.I., Leonovich S.I., Yaromich I.V. general surgery.- Minsk: Higher school, 2008.
2. Gritsuk I.R. Surgery.- Minsk: LLC " New knowledge», 2004
3. Dmitrieva Z.V., Koshelev A.A., Teplova A.I. Surgery with the basics of resuscitation. - St. Petersburg: Parity, 20024. L.I.Kolb, S.I.Leonovich, E.L.Kolb Nursing in surgery, Minsk, Higher School, 2007
5. Order of the Ministry of Health of the Republic of Belarus No. 109 " Hygienic requirements to the design, equipment and maintenance of healthcare organizations and to the implementation of sanitary-hygienic and anti-epidemic measures for the prevention of infectious diseases in healthcare organizations.
6. Order of the Ministry of Health of the Republic of Belarus No. 165 “On disinfection and sterilization by healthcare institutions
Teacher: L.G.Lagodich
TEXT OF LECTURE
Subject: Preoperative period
Questions:
1. Concept of operation. Types of surgical interventions.
2. The concept of the preoperative period, its tasks. Psychological and medicinal preparation for surgery.
3. Preoperative preparation of patients for planned surgical interventions. Features of preparation for emergency operations. Features of training children and elderly people.
1. Concept of operation. Types of surgical interventions.
Operation- mechanical impact on the patient’s tissues and organs using special tools and equipment. Preparing the patient for such an important event is necessary and depends primarily on the nature of the surgical intervention.
Types of surgical interventions
The system of measures aimed at preventing complications during and after surgery will be called preoperative preparation. Even a brilliantly performed operation cannot be successful if the patient is poorly prepared for it or if the care he receives after the operation is insufficient. (see textbook General Surgery, p. 232. Knowledge of topics in pre- and postoperative period will be required when answering almost every question on the exam papers)
Types of surgical interventions.
According to the purpose of execution:
There are diagnostic and therapeutic operations.
Diagnostic - these are operations performed to clarify the nature of the pathological process and determine the possibility of treating the patient. This type of operation should be regarded as the last stage of diagnosis, when no other non-invasive methods can solve diagnostic tasks. Diagnostic operations include punctures of pathological and natural cavities, various types of biopsies, laparocentesis, laparoscopy, thoracoscopy, arthroscopy, diagnostic laparotomy and thoracotomy, arteriography, phlebography, etc. etc. It should be noted that with the development of endoscopic technology, many diagnostic operations went down in history, as the opportunity arose to produce diagnostic examination with minimal trauma. However, these methods also have limits. Sometimes you have to do it with diagnostic purpose big operation. So, in the case of malignant tumors, only after opening the cavity and visual examination is it possible to finally establish a diagnosis and determine the possibility and feasibility of performing medical operation. Diagnostic laparotomy is most often used. For the sake of fairness, it should be said that in most cases such operations are planned as therapeutic ones, and only newly identified data on the nature of the pathological process (inremovability of the tumor, metastases) transfers it to the category of diagnostic.
Many diagnostic operations can also be therapeutic. For example, puncture of the pleural cavity, puncture of the joint cavity. As a result of their implementation, the diagnosis is clarified based on the nature of the contents, and the removal of blood or exudate, of course, has a therapeutic effect.
Medical operations - These are surgical interventions performed with the aim of curing a patient or improving his condition. Their nature depends on the characteristics of the pathological process, the patient’s condition and the tasks facing the surgeon.
According to the planned result.
Depending on the goal of the surgeon, to cure the patient or alleviate his condition, operations are divided into radical and palliative.
Radical- These are operations that result in the cure of a patient from a specific disease.
Palliative- these are operations as a result of which the main pathological process cannot be eliminated; only its complication is eliminated directly or in the near future, life-threatening, and also capable of sharply worsening the patient’s condition.
Palliative operations can be a stage of surgical treatment. Under certain circumstances radical surgery is currently impossible or impractical to perform. In such cases, palliative surgery is performed, and if the patient's condition or local conditions improve, radical surgery is performed.
According to the urgency of implementation.
There are emergency, urgent and planned operations.
Emergency- these are operations performed for life-saving reasons (diseases and injuries that directly threaten life) in the first minutes or hours of a patient’s admission to the hospital. If, even at first glance, the disease does not pose a threat to life in the coming hours, one should remember about the possibility of developing serious complications that sharply aggravate the patient’s condition.
Emergency operations are performed at any time of the day. The peculiarity of these operations is that the existing threat to life does not provide the opportunity to fully prepare the patient for surgical intervention. Considering that the task of emergency operations is to save lives, in most cases they are reduced to a minimum volume and may not be radical. The operational risk of this type of surgery is always higher than that of planned ones, so increasing the duration and morbidity due to the desire to radically cure the patient is absolutely not justified. Emergency operations are indicated for acute surgical diseases of the abdominal organs, acute injuries, acute diseases.
Urgent operations – these are operations performed in the coming days from the moment the patient is admitted to the hospital and the diagnosis is established. The duration of this period is determined by the time needed to prepare the patient for surgical treatment. Urgent operations are performed for diseases and injuries that do not directly pose a threat to life, but a delay in surgical intervention can lead to the development serious complications or the disease will reach a stage where radical treatment becomes impossible. This type of surgery is performed on patients with malignant neoplasms, diseases leading to severe impairment of various body functions (obstructive jaundice, stenosis of the gastric outlet, etc.). This also includes acute surgical diseases of the abdominal organs, in cases where conservative treatment led to an improvement in the patient’s condition and a slowdown in the development of the pathological process, which made it possible not to perform an emergency operation, but to carry out longer preparation. Such operations are called deferred. In such situations, in most cases, it is not advisable to delay the timing of surgical intervention, since the emergency situation may recur.
The obvious advantage of urgent operations over emergency ones is the opportunity to conduct a more in-depth examination of the patient and effective preoperative preparation. Therefore, the risk of urgent operations is significantly lower than emergency ones.
Planned- these are surgical interventions performed for chronic, slowly progressing surgical diseases. Considering the slow development of the pathological process, the operation can be postponed for a long time without harming the patient’s health and performed at a time convenient for him, in the most favorable situation, after an in-depth examination and full preoperative preparation.
By the number of stages.
Operations can besingle-moment and multi-moment .
In modern surgery, there is a tendency to perform surgical interventions simultaneously, that is, in one step. However, there are situations when it is technically impossible or impractical to perform the operation immediately. If the risk of surgical intervention is high, then it is possible to divide it into several less traumatic stages. Moreover, the second stage is most often performed under more favorable conditions.
Also distinguished repeated operations . These are operations performed on the same organ if the first operation did not achieve the desired effect or a complication developed, the cause of which was a previously performed operation.
According to the number of organs, on which surgery is performed.
There are combined and combined operations. The capabilities of modern anesthesiology make it possible to perform extensive surgical interventions on different organs simultaneously.
Combined – these are operations performed simultaneously for various pathological processes localized in different organs. These operations are also called simultaneous. The advantage of such operations is that in the patient’s understanding, during one surgical intervention he is cured of several diseases.
Combined – these are operations performed for the same disease, but on different organs. Most often, such interventions are performed in the treatment malignant diseases, in cases where a tumor of one organ affects neighboring ones.
According to the degree of infection.
Based on the degree of infection, surgical interventions are divided into clean, conditionally clean, conditionally infected, and infected.
This classification has great practical significance, since, firstly, before the operation, the possibility of developing an infectious process is assumed, secondly, it directs surgeons to carry out appropriate treatment, and thirdly, it determines the need for organizational measures to prevent the transmission of infection from one patient to another. to another.
Clean - these are operations for chronic, non-communicable diseases, during which the possibility of intraoperative infection is excluded (it is not planned to open a hollow organ, etc.). In this type of operation, the development of a purulent-inflammatory process is regarded as a complication.
Conditionally clean- these are operations performed for chronic diseases, which are not based on an infectious process, but during surgery it is planned to open a hollow organ (the likelihood of intraoperative infection). During such operations, the development of purulent-inflammatory complications is possible, but they are a complication, since the surgeon had to prevent their occurrence using special surgical techniques and methods of conservative treatment.
Conditionally infected - these are operations performed for acute surgical diseases, which are based on an inflammatory process, but a purulent complication has not yet developed. This also includes operations on the colon due to the high degree of possible infection. pathogenic microflora intestines. During these operations, the risk of infection is very high and even preventive actions do not guarantee that purulent complications will be avoided.
Infected- these are operations performed for purulent-inflammatory diseases. During these operations, there is already an infection in the tissues and it is necessary to carry out antibacterial therapy along with surgical treatment.
In terms of volume and trauma.
Based on the degree of trauma, operations are divided into four types.
Low-traumatic - these are small-scale operations on superficial tissues (removal of superficial benign formations, etc.). They do not cause dysfunction of the patient’s organs and systems.
Slightly traumatic - these are operations accompanied by an opening internal cavities and removing small anatomical formations(appendectomy, hernia repair, etc.). They cause transient dysfunctions of various organs and systems of the patient, which independently normalize without special treatment.
Moderately traumatic - these are operations accompanied by the removal or resection of an organ (gastric resection, operations on the biliary tract, etc.). During such operations, there are pronounced dysfunctions of various organs and systems that require intensive correction.
Traumatic- these are operations accompanied by the removal of one or more organs, resection of several organs, reconstruction of anatomical formations. Severe functional disorders are observed, which without special treatment can lead to death.
The division of operations according to traumaticity plays a role in determining the degree of risk of surgical intervention. However, it should be remembered that the degree of injury depends not only on the expected volume, but also on the technique of execution. Thus, a moderately traumatic operation can turn into a traumatic one if intraoperative complications occur. At the same time, the use of modern technologies for endoscopic and endovascular operations makes it possible to reduce the traumatic nature of the operation.
Also distinguished typical and atypical operations.
Typical operations are performed according to generally accepted schemes, using proven techniques and methods. Atypical operations are performed if the surgeon is faced with an atypical variant anatomical structure or the pathological process has acquired an unusual character. Performing atypical operations requires highly qualified an operating surgeon who, based on standard methods and techniques, will quickly find the most optimal option for the operation and technically be able to perform it.
2. The concept of the preoperative period, its tasks. Psychological and medicinal preparation for surgery.
Preoperative period – this is the time from the moment the patient is admitted to the surgical hospital until the start of surgical treatment. It is divided into 2 sections: diagnostic And preoperative preparation period
The duration of the preoperative period depends on:
Urgency of the operation;
The severity of the disease and the patient’s condition;
Presence of complications of the underlying disease;
Presence of concomitant pathology;
Severity of surgery;
Availability of diagnostic equipment, medications;
Finally, from the skill and coordination of the medical staff.
There is the followingstandard of general preparation of a patient for elective surgery
When the preoperative examination has been completed and all abnormalities identified in the patient have been eliminated or corrected, the immediate preoperative preparation begins on the evening before the upcoming operation.
It provides for the following activities:
The evening before surgery and the morning before surgery, you should wash thoroughly. After all, cleanliness of the skin plays a decisive role in preventing suppuration of the surgical wound.
Before surgery under general anesthesia or anesthesia, it is necessary to cleanse the intestines. If a relatively minor operation is to be performed, it is enough to do a cleansing enema the evening before the operation and the morning before, or take a laxative the evening before the operation (2 - 4 tablets of Dulcolax or Bisacodyl before bed).
If a large abdominal operation or an operation with perineal access is planned, a particularly thorough bowel cleansing is required using a special drug (for example, Fortrans). The powder of the drug is diluted in 3 liters of pure drinking water. At about 5 - 6 pm on the day before the operation, you should stop eating and start drinking this solution (it should be drunk completely within about 3 - 4 hours). The intestines are thus washed to clean water.
After midnight on the eve of the operation and before it begins, you cannot eat or drink;
30-40 minutes before surgery - premedication as prescribed by the anesthesiologist.
The task of the preoperative period: maximum reduction of the risk of surgery, prevention of complications.
Psychological and medicinal preparation for surgery.
Trauma to the psyche of surgical patients begins in the clinic, when the doctor recommends surgical treatment, and continues in the hospital during the immediate appointment of the operation, preparation for it, etc. Therefore, a sensitive, attentive attitude towards the patient on the part of the attending physician and staff is very important. The authority of the doctor contributes to the establishment of close contact with the patient.
It is important to ensure that during the conversation with the patient and in the documents available for examination of the patient (referrals, tests, etc.), there are no words that frighten him such as cancer, sarcoma, malignant tumor, etc.
It is unacceptable, as already noted, in the presence of the patient to make comments to the staff about incorrect execution of prescriptions.
When deciding on an operation, the doctor must convincingly explain to the patient the advisability of performing it. With skillful conversation, the doctor strengthens his authority and the patient trusts him with his health.
The choice of pain relief method depends on the competence of the doctor. In an intelligible form, the doctor convinces the patient of the need for the type of pain relief that should be used.
On the day of the operation, the surgeon should pay maximum attention to the patient, encourage him, ask about his health, examine how the surgical field is prepared, listen to the heart and lungs, examine the pharynx, and reassure him.
If the patient is taken to the operating room ahead of time, order and silence should be established in the operating room.
Surgeon in full readiness waits for the patient, and not vice versa. During an operation under local anesthesia, the conversation should be between the surgeon and the patient. With his calmness and encouraging words, the surgeon has a beneficial effect on the patient’s psyche. Harsh remarks addressed to the patient are unacceptable.
In a difficult situation, when local anesthesia is insufficient, it is necessary to switch to general anesthesia in a timely manner so as not to cause suffering to the person being operated on and he does not witness the difficulties experienced by the surgeon.
After the operation is completed, the surgeon should examine the patient, feel the pulse and reassure him. The patient will see this as caring for him.
Everything in the room should be ready to receive the patient. The main thing is to eliminate pain with the use of painkillers, implement measures aimed at improving breathing and cardiovascular activity, which prevents a number of complications. The surgeon must repeatedly visit the patient he operated on.
In conclusion, it should be emphasized that the surgeon must be able to understand the patient’s personality and gain authority and trust. All surgical department personnel are obliged to spare the patient’s psyche. The surgical department itself, with its appearance and operating mode, should have a beneficial effect on the patient.
Sick people are always depressed, afraid of surgery and physical pain. The surgeon is obliged to dispel these doubts. However, the doctor should not say that the operation will not cause any problems. Any operation is associated with risks and complications.
A doctor, in a conversation with a patient, must explain to him the essence of the disease. If a patient with a malignant tumor continues to doubt and stubbornly refuses surgical treatment, then it is permissible to say that his disease may turn into cancer after some time. Finally, in case of a categorical refusal, it is advisable to tell the patient that he has initial stage tumors and delay in surgery will lead to neglect of the disease and an unfavorable outcome. The patient must understand that in this situation surgery is the only type of treatment. In some cases, the surgeon must explain to the patient the true essence of the operation, its consequences and prognosis.
The main role in normalizing the patient’s psyche is played by the patient’s trust in the department’s doctor and all the treating staff, the authority and competence of the surgeon.
Drug preparation for surgery consists of: premedications: 30 minutes before surgery the patient is given narcotic(promedol, omnopon, etc.), but not morphine, which depresses the respiratory center, and atropine 0.1% - 1.0 - to reduce the secretion of the glands of the oral cavity and bronchi.
Rules of surgical deontology:
Possibility of calm communication with relatives and accompanying persons during and after the patient’s admission to the surgical department;
The diagnosis of the disease should only be reported by the attending physician;
The attitude of the medical staff towards the patient is as attentive, polite, and helpful as possible;
No familiarity in relations between staff in the presence of the patient;
Medical documentation is stored in a place inaccessible to the patient;
Maximum organization and efficiency in the work of medical staff. Strict adherence to regimes;
The appearance of an employee directly affects his authority and is a mirror of his professional training;
3. Preoperative preparation of patients for planned surgical interventions. Features of preparation for emergency operations. Features of training children and elderly people.
Preoperative preparation is carried out for all patients. It is performed to a minimum extent only for patients undergoing surgery for emergency and emergency indications.
On the eve of a planned surgical operation, general preoperative preparation. Her goal:
1. Eliminate contraindications to surgery by examining the patient’s vital organs and systems.
2. Preparation of the patient psychologically.
3. To prepare as much as possible the patient’s body systems, on which the intervention will have the greatest load during the operation and in the postoperative period.
4. Prepare the surgical field.
Preparation procedure:
1.1. General inspection
Every patient admitted to a surgical hospital for surgical treatment must be undressed and the skin of all parts of the body examined. In the presence of weeping eczema, pustular rashes, boils or fresh traces of these diseases, the operation is temporarily postponed and the patient is sent for outpatient follow-up treatment. The operation on such a patient is performed a month after complete recovery, because infection can manifest itself at the site of surgery in a patient weakened by surgical trauma.
1.2. History taking
Taking an anamnesis makes it possible to find out and clarify previous diseases, to determine whether the patient suffers from hemophilia, syphilis, etc. In women, it is necessary to clarify the date of the last menstruation, since it has a great impact on the vital functions of the body.
1.3. Laboratory research
Planned patients are admitted to a surgical hospital after a laboratory examination in a clinic at their place of residence. They carry out a general blood and urine test, a urine test for sugar, the biochemical composition of the blood and the necessary x-ray examinations of the chest and abdominal organs.
1.4. Clinical observation
It is important for the patient to get to know the attending physician and to establish relationships between them. To completely eliminate contraindications to surgery, choose a method of pain relief and take measures to prevent subsequent complications, it is necessary that the patient fully opens up to the doctor. If special preparation of the patient for the operation is not required, then the preoperative period of the patient in the hospital is usually 1-2 days.
1.5. Psychological preparation of the patient (see above)
1.6. Special Events:
Respiratory preparation
Respiratory organs account for up to 10% of postoperative complications. Therefore, the surgeon should pay special attention to the patient’s respiratory system.
In the presence of bronchitis and emphysema, the risk of complications increases several times. Acute bronchitis is a contraindication to elective surgery. Patients with chronic bronchitis are subject to preoperative sanitation: they are prescribed expectorants and physiotherapeutic procedures.
Cardiovascular preparation
An ECG is performed on all patients over the age of 40, as well as in cases of heart complaints. An examination by a therapist is mandatory for older people. If the heart sounds are normal and there are no changes in the electrocardiogram, no special preparation is required.
Oral preparation
In all cases, before surgery, patients require sanitation of the oral cavity with the assistance of a dentist. Removal of removable dentures immediately before surgery
Preparing the gastrointestinal tract
Before a planned operation on the abdominal organs, the patient is given a cleansing enema the evening before the operation. When preparing patients for surgery on the large intestine, it must be cleaned. In these cases, 2 days before the operation, a laxative is given 1-2 times, the day before the operation the patient takes liquid food and is prescribed 2 enemas, in addition, another enema is given on the morning of the operation.
Liver preparation
Before the operation, liver functions such as protein synthetic, bilirubin-excretory, urea-forming, enzymatic, etc. are examined.
Determination of kidney function
During the preparation of patients for surgery and in the postoperative period, the condition of the kidneys is usually assessed by urine tests, functional tests, isotope renography, etc.
Preparation of the surgical field:
A hygienic bath or shower the day before;
In the morning - shaving the surgical field followed by treating the skin with ethyl alcohol;
Increasing the general resistance of the patient's body before surgery.
Increased body resistance contributes to better tissue regeneration and other reparative processes. Drip administration of glucose before surgery must be supplemented with the introduction of nicotinic and ascorbic acids, vitamins B1, B6. For the most severe patients, it is advisable to prescribe anabolic hormones, gamma globulin, plasma, albumin, and blood transfusions.
Each type of pathology requires certain features in preoperative preparation. We will talk about this when studying the corresponding pathology
Preparing patients for gastric surgery
In patients with advanced gastric diseases, there is often a deficiency in circulating blood volume, a decrease in blood proteins and a violation metabolic processes in organism.
To replenish proteins, blood, plasma, and albumin transfusions are necessary. Intravenous infusions of 5% glucose solution, sodium and potassium salts, fat emulsion preparations are performed (2-3 liters per day). On the eve of the operation, patients with pyloric stenosis wash their stomach daily with a 0.25% solution of hydrochloric acid before going to bed. Depending on the patient’s condition, preparation lasts 6-14 days. The day before surgery, patients are switched to liquid food (broth, tea). A cleansing enema is given at night, and in the morning on the day of surgery, the liquid is removed from the stomach with a probe.
Preparing patients for operations on the large intestine and rectum.
Except general training weakened patients, which includes blood transfusions, glucose solutions, sodium chloride, vitamins and cardiac medications, it is necessary to cleanse the intestines. The patient is allowed liquid food for two days before surgery. On the first day of preparation, a laxative is given in the morning and an enema is given in the evening. On the second day, a cleansing enema is done in the morning and evening. On the morning of the operation, enemas are not given. 5-6 days before surgery, the patient is prescribed chloramphenicol or kanamycin.
A patient with hemorrhoids is given a laxative a day before, and in the evening the rectum is washed with several cleansing enemas until clean water is obtained.
Preparation for surgery of patients with intestinal obstruction.
Patients with intestinal obstruction most often undergo surgery for life-saving reasons. It should last no more than 3 hours from the moment the patient enters the surgical department. During this time, it is necessary to administer antispasmodics (atropine, papaverine, no-shpu), rinse the stomach, conduct a bilateral perinephric blockade with a 0.25% novocaine solution (60-80 ml), and perform a siphon enema. This allows us to exclude dynamic intestinal obstruction, which will be resolved by the specified measures.
Preoperative preparation includes blood transfusion, polyglucin, sodium chloride, potassium, vitamins C and B1, cardiac medications.
Direct preparation of patients for surgery and rules for its implementation.
On the eve of the operation, the patient takes a bath. Before washing, the doctor pays attention to the skin to see if there are any pustules, rashes, or diaper rash. If detected, the planned operation is cancelled. The surgical site is shaved on the day of surgery to avoid cuts and scrapes that are prone to infection.
Features of the preparation of elderly and senile patients
An ECG and examination by a therapist and other related specialists for concomitant diseases are required;
Treatment of concomitant diseases and compensation of the functions of internal organs and systems;
The following should be considered body features of old people:
Weakened body defenses;
Tendency to develop hypostatic pneumonia;
Tendency to thrombosis and thromboembolism;
Difficulties in contact (hard of hearing, poor vision, memory, etc.;
Usually, overweight bodies;
Features of preparing children
Mandatory weighing of the child (emergency room), and adults too (dosage of anesthetics per kg of weight);
Stop feeding 4-5 hours before surgery. Starving a child is contraindicated;
Colon cleansing with enemas;
During gastric surgery - gastric lavage;
Children do not tolerate cooling well;
Specificity in drug dosage;
Difficult contact with the child;
Nutritional features;
Close contact between the surgeon and the pediatrician;
The surgical field is not torn;
The mother's presence at the child's bedside is very important;
Features of preparing patients for emergency operations
The shortest time for preparation;
Minimal additional examinations;
Partial sanitary treatment of the patient, washing or wiping contaminated areas of the body;
Gastric lavage - as directed by a doctor;
Dry shaving of the surgical field.
Degrees of operational risk -a set of factors influencing the outcome of surgery.
I degree - patients with no concomitant diseases or these diseases are localized or in remission;
II degree -
patients with mild and moderate disorders that do not interfere with normal life activities;
III degree -patients with severe systemic disorders;
IV degree -patients with extremely severe systemic disorders;
V degree -individual patients whose preoperative condition is so severe that their death can be expected within 24 hours even without surgery;
The favorable or unsatisfactory outcome of the operation, as well as the subsequent postoperative period, depends on the preoperative preparation of the patient, including the above observations and studies.
Maximum preparation eliminates the possibility of complications, prepares the patient’s vital organs for surgical intervention, creates a favorable psychological background, elevates the system, and all these factors contribute to the patient’s speedy recovery.
Preoperative preparation patients consists of a set of measures. In some cases, they are reduced to a minimum (for emergency and urgent operations), and for planned operations they must be carried out more carefully.
During emergency operations for acute appendicitis, strangulated hernia For non-penetrating soft tissue wounds, it is enough to inject a solution of morphine or promedol, shave the surgical field and empty the stomach of the contents. In patients with severe injuries, it is necessary to immediately begin anti-shock measures (pain relief, blockades, blood transfusions and anti-shock fluids). Before surgery for peritonitis or intestinal obstruction, emergency measures should be taken to combat dehydration, detoxification therapy, and correction of salt and electrolyte balance. These measures should begin from the moment the patient is admitted and should not cause a delay in the operation.
When preparing a patient for a planned operation, the diagnosis must be clarified and concomitant diseases identified that can complicate and sometimes make the operation impossible. Need to install hotspots endogenous infection and, if possible, sanitize them. In the preoperative period, the function of the lungs and heart is examined, especially in elderly patients. Weakened patients require preoperative transfusions of protein drugs and blood, as well as combating dehydration. Great attention should be paid to preparation nervous system patient before surgery.
Responsibilities of a nurse. Medication preparation for surgery is directly carried out by a nurse as prescribed by a doctor. The nurse also carries out physical training of the patient, aimed at preventing postoperative complications, prepares the skin, oral cavity, and gastrointestinal tract of the patient for surgery. A medical worker in a surgical department must remember that unscrupulous implementation of even the most insignificant, at first glance, measures of care for a surgical patient can lead to tragic consequences.
While waiting for an operation, a person is naturally worried, and his anxiety is justified. The expectation of pain, and in some cases the premonition of one’s own helplessness in the postoperative period, disturbs and depresses the patient. A nurse, when communicating with a patient, should under no circumstances replace the doctor and try to explain to him the essence of the upcoming operation. But it must support the patient’s confidence that, thanks to the highly qualified surgeons and anesthesiologists, with the help of medications and other special techniques, the operation and postoperative period will be painless. It is important to convince the patient of the success of treatment. This is a difficult task, requiring an individual approach to the sick person in each case. Regardless of your own mood, it is necessary to constantly maintain good spirits in a patient who is about to undergo surgery.
It is very important to strengthen the patient’s trust in those specialists who manage his treatment and directly carry out it. This also applies to those specialists who will treat the patient in the first days after surgery in the intensive care unit.
It is absolutely unacceptable for a nurse to speak critically in the presence of patients about the work of any of the medical staff, even if there are grounds for such criticism.
An important element of a nurse’s activity is performing breathing exercises, especially when preparing elderly patients for surgery. The nurse should not only remind of the need to carry out breathing exercises in strict accordance with the doctor’s prescription, she must explain to patients that the postoperative period is much easier for those who strictly followed all the doctor’s instructions before the operation. Proper breathing (coughing and removing secretions from the respiratory tract) plays a huge role in the prevention of postoperative pulmonary complications.
The nurse should monitor smokers. It is necessary to convince them of the need to quit smoking, since smoking disrupts the cough reflex and contributes to the retention of phlegm in the lungs, which after surgery leads to pulmonary complications.
The human oral cavity contains many microorganisms, some of which are pathogenic. There are especially many of them in cases of dental caries, gum inflammation and chronic tonsillitis (inflammation of the tonsils). A healthy person naturally cleanses their mouth. After the operation the situation is different. In patients, saliva production decreases; it is difficult, and often impossible, for them to brush their teeth. Limiting or stopping drinking and eating by mouth creates additional conditions for the development of infection, which can always sharply intensify and cause both local inflammation of the lining of the oral cavity, pharynx, parotid gland, and general life-threatening complications (sepsis).
In patients with diseases of the teeth and gums, it is necessary to sanitize the oral cavity in the preoperative period. In the absence of obvious lesions of the oral cavity, preoperative preparation boils down to observing the rules of hygiene: brushing your teeth 2 times a day (in the morning and before bed) and mandatory rinsing of the mouth after each meal.
If a patient has not brushed his teeth for a long time, he should not be advised to start brushing his teeth in the preoperative period, as this will cause irritation and inflammation of the gums, which will force the operation to be postponed. Such a patient can wipe his teeth and tongue with a sterile gauze cloth moistened with a solution baking soda(1/2-1 teaspoon per glass warm water). After this, you should rinse your mouth with warm water.
Preparing the gastrointestinal tract. Before any operation, the patient's gastrointestinal tract must be cleansed. Bloating of the stomach and intestines, filled with gases and contents, after surgery impairs the blood supply to these organs, which contributes to the development of infection in the intestines with penetration beyond the intestinal wall, and due to increased pressure, it can disrupt the sutures on the abdominal organs after surgery. In addition, bloating of the stomach and intestines sharply worsens the function of the cardiovascular and pulmonary systems, which in turn impairs the blood supply to the abdominal organs. During operations on these organs, the contents of the hollow organs of the abdomen can enter the free abdominal cavity, causing inflammation of the peritoneum (peritonitis). The presence of contents in the stomach, which necessarily occurs when the outlet of the stomach is blocked by a tumor or with ulcerative narrowing, is dangerous because during induction of anesthesia it can enter the patient’s mouth, and from there into the lungs and cause suffocation.
In patients without impaired gastric emptying, preparation of the upper digestive tract for surgery is limited to complete fasting on the day of surgery. If gastric emptying is impaired, the stomach contents are pumped out before surgery. To do this, use a thick gastric tube and a syringe to rinse the cavities.
If there is an accumulation of food debris of a thick consistency and mucus, the stomach is washed; instead of a syringe, a large glass funnel is placed on the end of the probe.
A large amount of gastric content accumulates in patients with intestinal obstruction.
To cleanse the lower intestines, a cleansing enema is usually used. A single enema or even two enemas (at night and in the morning) cannot effectively cleanse the intestines in a patient with chronic stool retention, therefore one of the main tasks of the preoperative period is to ensure that the patient has daily independent bowel movements. This is especially necessary for patients with a tendency to accumulate gases (flatulence) and those suffering from chronic constipation. A proper diet can help normalize bowel movements.
Skin preparation. Microorganisms accumulate in the pores and folds of the skin, and their entry into the wound must be prevented. This is the meaning of preparing the patient’s skin for surgery. Moreover, contaminated skin after surgery can become a site for the development of purulent-inflammatory diseases, i.e., a source of infection for the entire body.
On the eve of the operation, the patient is washed and his linen is changed. Particular care should be taken to rinse areas where sweat and dirt accumulate (armpits, perineum, neck, feet, navel and all skin folds, which are very deep in obese patients).
The hair on the patient's head should be neatly trimmed; in men, the beard and mustache should be shaved. Fingernails and toenails must be cut short. Nail polish must be washed off.
A more effective sanitary treatment of the patient’s body before surgery is undoubtedly a shower, which is easier for many patients to tolerate.
Bedridden patients are first wiped in bed with warm soapy water, then with alcohol, cologne, etc. An oilcloth should be placed on the bed. When wiping with water, use a sponge. The nurse is obliged to examine the patient’s entire body and, if pustular or other inflammatory skin lesions are detected, be sure to inform the doctor about it.
Preparation of the surgical field. The surgical field is the area of skin that will be subjected to surgical intervention(dissection) during surgery. Proper preparation of the surgical field significantly reduces the number of microorganisms entering the surgical wound.
The responsibilities of the nurse in preparing the surgical field are limited to shaving the hair of this area on the day of the operation before the patient takes medications and injections. (Shaving the hair of the surgical field is not done the evening before the operation, because the small scratches that arise during this may become inflamed by the morning, which will make it impossible to perform the operation.)
Before making a skin incision on the day of surgery on the operating table, the operating field will be treated at least three times with 5-10% alcoholic iodine tincture, which significantly reduces the likelihood of infection not only after microtrauma of the surface layers of the skin with a razor, but also after its dissection to its full depth .
Before use, the razor must be disinfected for 5-10 minutes in a 3% carbolic acid solution or a 2% chloramine solution.
You need to shave by slightly pulling the skin in the opposite direction to the direction of the razor. It is advisable to move the cutting edge of the razor directly at a right angle to the direction of shaving in relation to the hair “against the grain”. Dry shaving is preferable, however, with thick hair, lather the hair. The shaved surgical field is washed with boiled water and wiped with alcohol. The shaving margins should exceed the area of skin that will be exposed after covering the surgical field with sterile drapes.
Before most major operations, all preparations are made anatomical region surgical intervention: during head surgery, the entire head is shaved, during abdominal surgery, the entire abdomen, including the pubis, etc. You need to know which areas of the skin are shaved before typical operations. In some cases, you should ask the surgeon about the course of the proposed skin incision, and sometimes the location of a possible additional incision, in order to prepare both surgical fields in advance.
Transporting the patient to the operating room. The patient should spend the day before the operation in an atmosphere of complete mental and physical rest. In the morning, the patient can get out of bed, brush his teeth, wash his face and hands, shave and go to the toilet. In the morning, the hair of the surgical field is shaved. Returning to the ward, the patient should lie down in bed and not be active either in talking or in movements. Later, around 8 a.m., injections are usually performed: the patient is given medications that prepare him for anesthesia (sedatives, narcotics, etc.). This preparation is called premedication. After this, the patient must observe absolute rest and bed rest. The room should be quiet. If the patient does not sleep, you should remind him to at least take a nap with his eyes closed.
Before being transported to the operating room, the patient must urinate. When preparing some patients for surgery, it is useful to develop the skill of urinating while lying in bed, which will then alleviate the forced need to urinate while lying down after surgery, and many will be spared the insertion of a rubber tube into the bladder - an unpleasant and serious event in terms of possible infectious lesions urinary system. The nurse should teach the patient to urinate while lying down. Sometimes the patient may urinate while sitting on the bed, after which he lies down on the gurney.
Before transporting the patient, the nurse should ensure that the patient is properly dressed. If the operation is on the chest, he should not have a shirt. Men should not wear underwear during abdominal surgery. Although underwear can be removed in the preoperative room.
Women's long hair should be braided, neatly laid on the head and tied with a gauze scarf. Watches, rings and other jewelry should be removed. Removable dentures are left in the room.
It is unacceptable to transport a patient without a pillow, with his head suspended. It must be remembered that before the operation the patient experiences strong emotional stress, so he must constantly feel the care and attentiveness of the medical staff. Before transporting a patient to surgery, you should ensure that the operating room and anesthesiology staff are ready to receive him. All instruments on the tables must be closed, traces of previous operations must be removed, and the operating room must be wet cleaned.
For surgery, patients are transported on a gurney in a supine position. Transporting a patient lying down is explained by the need to protect him from dangerous reactions of the circulatory system to changes in body position, which are possible after premedication. The patient is transported smoothly, at a moderate speed, without hitting the gurney against objects in the corridor or doors.
Having delivered the patient to the operating table, the nurse helps him move onto it, places him on the table in accordance with the instructions of the anesthesiologist or surgeon, and covers the patient with a sterile sheet. A seriously ill patient is carried by the anesthesiology team and the operating room nurse.
Together with the patient, a medical history, a test tube with blood or serum (with the patient’s surname and initials) to determine individual compatibility for blood transfusion, and in some cases, the medications needed by the patient during the operation that he used must be delivered to the operating room and handed over to the anesthesiologist. before.
If the patient has reduced hearing, it must be transferred to the anesthesiology team hearing aid, since it will be needed for contact with the patient.
Preparing for emergency surgery. In conditions that threaten the patient’s life (wound, life-threatening loss of blood, etc.), no preparation is carried out; the patient is urgently taken to the operating room without even removing his clothes. In such cases, the operation begins simultaneously with anesthesia and revival (resuscitation) without any preparation.
Before other emergency operations, preparations for them are still carried out, although to a significantly reduced extent. After a decision is made about the need for surgery, preoperative preparation is carried out in parallel with the continued examination of the patient by the surgeon and anesthesiologist. Thus, preparation of the oral cavity is limited to rinsing or wiping. Gastrointestinal preparation may include draining gastric contents and even leaving a gastric nasal tube in place (eg, for intestinal obstruction) during surgery. An enema is rarely given; only a siphon enema is allowed when attempting conservative treatment of intestinal obstruction. For all other acute surgical diseases of the abdominal organs, an enema is contraindicated.
The hygienic water procedure is carried out in a shortened form - a shower or washing the patient. However, preparation of the surgical field is carried out in full. If it is necessary to prepare patients who have come from production or from the street and whose skin is heavily contaminated, the preparation of the patient’s skin begins with mechanical cleaning of the surgical field, which in these cases should be at least 2 times larger than the intended incision. The skin is cleaned with a sterile gauze swab moistened with one of the following liquids: ethyl ether, 0.5% solution ammonia, pure ethyl alcohol. After cleaning the skin, the hair is shaved and the surgical field is further prepared.
In all cases, the nurse must receive clear instructions from the doctor about to what extent and by what time she must fulfill her duties.
Practical lesson No. 5
Preoperative period- this is the time the patient stays in the hospital from the moment when the diagnostic examination is completed, the clinical diagnosis of the disease is established and the decision is made to operate on the patient, until the start of the operation.
The purpose of this period is to minimize possible complications and reduce the danger to the patient’s life both during and after the operation.
The main tasks of the preoperative period are: accurate diagnosis of the disease; determination of indications for surgery; choice of intervention method and pain relief method; identifying existing concomitant diseases of organs and systems of the body and carrying out a set of measures to improve the impaired functions of the patient’s organs and systems; carrying out measures to reduce the risk of endogenous infection; psychological preparation of the patient for the upcoming surgical intervention.
The preoperative period is divided into two stages - diagnostic and preoperative preparation.
Preparing the patient for surgery consists of normalizing the function of vital organs: cardiovascular and respiratory systems, gastrointestinal tract, liver and kidneys.
Study of the functions of organs and systems.
Functional study circulatory organs.
Functional study of the respiratory system.
Before the operation, the patient must be taught to breathe and cough correctly, which should be facilitated by breathing exercises daily for 10-15 minutes. The patient should quit smoking as soon as possible.
Blood test.
Liver function test.
Special studies blood (thymol, sublimate tests) allow you to assess the state of the detoxification capacity of the liver.
Renal function test. The kidneys remove excess products and harmful substances from the body and retain substances necessary for the functioning of the body. Normally, the kidneys secrete 1-2 liters of urine daily, which has a constant composition and specific gravity.
Preparing the patient for instrumental examination methods. In a modern surgical clinic, for examination purposes, they use various methods, many of which require special preparation of the patient.
There are several groups of examination methods: endoscopic, x-ray, ultrasound.
Endoscopic methods. Endoscopy is a method of examining internal organs using special instruments (endoscopes) equipped with optical and lighting systems.
Bronchoscopy is a visual (instrumental) examination of the bronchopulmonary system using bronchoscopes inserted into the patient’s respiratory tract. Indications for bronchoscopy are all types of bronchopulmonary pathology. Before bronchoscopy, the patient is prepared psychologically and medicinally, and they talk with him about the upcoming study. For premedication, drugs from the group of tranquilizers are prescribed. Research is carried out with an empty stomach, empty bladder and, if possible, intestines.
Fibroesophagogastroduodenoscopy - examination of the esophagus, stomach, duodenum. Indications are the diagnosis and treatment of acute and chronic diseases of the esophagus, stomach, duodenum, diseases of the duodenopancreatobiliary zone.
45 - 60 minutes before the study, premedication is carried out and 1 - 2 ml of a 0.1% solution of atropine and 2 ml of a 0.5% solution of seduxen (Relanium) are injected subcutaneously. To relieve emotional stress, tranquilizers (meprotan, seduxen, tazepam) are prescribed the night before and before the study. For anesthesia of the oropharynx, various drugs are used: dicaine, trimecaine, lidocaine. Up to 3 ml of a 0.25 - 3.0% solution of these anesthetics is applied by spraying, lubricating and rinsing. The anesthetic effect is enhanced and prolonged by adding a 0.1% adrenaline solution.
Cystoscopy is a method of examining the inner surface of the bladder.
Pleuroscopy is an examination of the pleural cavity using an endoscope inserted into it through a puncture or incision in the chest wall. On the eve of the study, patients are prescribed sedatives, 30 - 40 minutes before thoracoscopy, 1 ml of a 2% solution of promedol and 0.5 ml of a 0.1% solution of atropine are injected subcutaneously. The patient is prepared for thoracoscopy as for a routine surgical operation. Thoracoscopy is performed in the operating room or dressing room.
Laparoscopy is an endoscopic examination of the abdominal organs. Indications for laparoscopy are symptoms of damage to the abdominal organs with an unclear diagnosis for the purpose of biopsy of its pathological formations.
Preparation and premedication are carried out as for surgery on the abdominal organs. Planned laparoscopy is performed on an empty stomach after cleansing the intestines with an enema the evening before and in the morning on the day of the study. Hair on the front abdominal wall shaved immediately before the study. Typically, laparoscopy is performed under local anesthesia with a 0.25% novocaine solution. Anesthesia is indicated for mental patients, patients in shock and agitation.
Sigmoidoscopy is a method of visual examination of the rectal mucosa.
Fibercolonoscopy is an examination of the colon, as well as the terminal ileum. Indications are clinical and radiological signs of diseases of the colon. 3 days before the study, the patient is prescribed a slag-free diet. The day before the test, the patient takes 50 ml of castor oil. When preparing patients for colonoscopy the day before, enemas with a volume of 1.0-1.5 liters of water at room temperature are used with an interval of 1-2 hours, and in the morning before the study two more enemas are given. Colonoscopy is performed 2-3 hours after the last enema. Recently, preparations such as Fortrans have been successfully used to prepare for research, which allow you to quickly and efficiently prepare the colon.
Due to the presence of unpleasant and even painful sensations It is advisable to perform a colonoscopy after preliminary administration of painkillers, the type and dose of which are individual. In patients with mental disorders, severe pain syndrome Colonoscopy is performed under general anesthesia.
X-ray methods. Survey radiography of the abdominal organs. As a rule, the study is performed on an emergency basis without prior preparation of the patient if acute surgical pathology of the abdominal organs is suspected.
To diagnose disturbances in the passage of contents through the intestines, the Napalkov test is used - the patient is given 50 ml of barium sulfate suspension to drink and survey photographs of the abdominal cavity are taken after 4, 12 and 24 hours.
X-ray of the stomach and duodenum. When preparing the stomach and duodenum for x-ray examination, it is necessary to free them from food masses and gases. Before the study, it is not allowed to eat rough foods that contribute to the formation of gases. You can have dinner no later than 20.00. In the morning, the patient should not eat, drink water, or smoke. In the evening and morning, 2 hours before the test, the intestines are cleansed with an enema (1 liter of warm water).
The use of laxatives to cleanse the intestines is not recommended, as they promote gas formation. If the patient suffers from obstruction of the gastric outlet (tumor or ulcerative stenosis), then the gastric contents must be evacuated using a thick probe, followed by rinsing with clean water.
X-ray of the colon (irrigoscopy). The study is carried out after filling the lumen of the large intestine with a barium suspension through an enema. Sometimes, after taking barium or an X-ray examination of the stomach, the passage of barium suspension through the intestines is examined. In the morning, 2 hours before the study, two more cleansing enemas are given isotonic solution. Currently, preparations such as Fortrans are successfully used.
Examination of the chest and spine. X-ray examination of the cervical and thoracic spine, as well as the chest, does not require special preparation of the patient. The patient must be prepared for an x-ray examination of the lumbar spine, since the presence of a large accumulation of gas in the intestines interferes with obtaining high-quality x-rays. Preparation is carried out in the same way as for a kidney examination.
Ultrasound methods. Ultrasound examination is prescribed to patients to identify pathology of the hepatobiliary system, exclude infiltrates, pre- and postoperative abscesses, dynamics of the postoperative period, exclude metastasis or primary tumors; in urology - to exclude urolithiasis, kidney cysts, impaired urine outflow, inflammatory and purulent processes. Due to its sufficient information content and non-invasiveness, ultrasound is widely used in clinics and hospitals, and is also a relatively inexpensive and highly effective diagnostic method.
Ultrasound examination of the abdominal organs and retroperitoneal space. Before the examination, it is necessary to limit the consumption of vegetables, fruits, mineral water, legumes, cereal porridge. For full preparation, patients should additionally take modern medications that reduce gas formation in the intestines: espumizan the day before the study, two capsules 3 times, and on the day of the study in the morning - two capsules or pepfiz, one tablet 3 times a day on the eve of the study and one tablet in the morning on research day. The examination is carried out on an empty stomach. If the inspection is carried out after 12.00, a light breakfast is allowed in the morning no later than 8.00.
Ultrasound examination of the pelvic organs (gynecological, genitourinary system). The examination is carried out when the bladder is well filled. To do this, you should drink at least 1 liter of non-carbonated liquid 1 hour before the examination.
Ultrasound examination of blood vessels and the thyroid gland. The study does not require preparation.
Ultrasound examination of the mammary glands. The study is carried out on the 5-10th day of the ovarian-menstrual cycle.
Preparing for emergency surgery. Preparation for emergency surgery is kept to a minimum and limited to the most necessary research. Sometimes the patient is immediately taken from the emergency room to the emergency operating room. If possible, a general blood and urine test is performed, the blood group and Rh factor, blood glucose are determined, and other laboratory and additional examination methods are performed according to indications (ultrasound, radiography, fibrogastroduodenoscopy). Before an emergency operation, sanitization does not need to be carried out; if necessary, wipe dirty areas with a damp cloth. However, if possible, hair should be removed from the intended surgical site.
If the patient took food or liquid before surgery, then it is necessary to insert a gastric tube and evacuate the gastric contents. Cleansing enemas are contraindicated for most acute surgical diseases. Before surgery, the patient must empty the bladder or, if indicated, bladder catheterization is performed with a soft catheter. Premedication is usually performed 30 - 40 minutes before surgery or on the operating table, depending on its urgency.
Preparation for planned surgery. Planned patients are admitted to the hospital partially or fully examined, with an established or presumptive diagnosis. A full examination in the clinic significantly shortens the diagnostic stage in the hospital and reduces the preoperative period and the total length of the patient’s stay in the hospital, and also reduces the incidence of hospital infections.
For hospitalization, the patient must perform a standard minimum examination, which includes a general blood test, a general urine test, determination of blood clotting time, blood test for bilirubin, urea, glucose, determination of blood group and Rh factor, for antibodies to HIV infection, HBs- antigen, large-frame fluorography, ECG with interpretation, consultation with a therapist (if necessary, also with other specialists) and for women - a gynecologist, as well as data from special examination methods - ultrasonodopplerography, fibrogastroduodenoscopy, etc.
After making a diagnosis, assessing the operational risk, completing all the necessary examinations and making sure that the patient needs to be hospitalized, the clinic surgeon writes a referral for hospitalization, which must indicate the name of the insurance company and all the necessary details.
When patients with cancer are admitted to the clinic, preoperative preparation is carried out in parallel with the examination, which significantly shortens the patient’s hospital stay. It is impossible to delay the examination of cancer patients in a hospital for more than 10-12 days.
In the preoperative period, it is important not only to determine functional state organs and systems of the patient, but also to reduce the patient’s feeling of fear before the operation, eliminating everything that irritates him, worries him, and use sedatives and hypnotics.
On the eve of the operation, it is necessary to weigh the patient on a medical scale to calculate the dose of medications, measure body temperature, pulse rate, respiration rate, and blood pressure. Any deviations must be noted in the medical history and reported to the attending physician for timely treatment.
Great importance in preoperative preparation is attached to the sanitation of the patient's skin. Purity skin and the absence of inflammatory processes on it is an important measure to prevent the development purulent inflammation in a postoperative wound. Bowel preparation is carried out: in the evening before the operation and in the morning 3 hours before the operation, cleansing enemas are performed. On the eve of the operation, a light dinner is allowed at 17.00-18.00. On the day of surgery, it is strictly forbidden to drink or eat, as there is a risk of aspiration during anesthesia and the development of serious pulmonary complications.
1 hour before the operation, the patient is given a hygienic bath, hair is shaved off in those areas of the skin where tissue incisions are supposed to be made for surgical access (since over a longer period of time, cuts and scratches that may occur during shaving can become infected), underwear and bed linen are changed. Immediately before the operation, the patient must carry out all hygiene measures: rinse the mouth and brush the teeth, remove removable dentures and contact lenses, nail polish and jewelry, empty your bladder.
It should be noted that not only surgeons should take part in the preoperative preparation of the patient. The patient is examined by a therapist and an anesthesiologist, who, depending on the need, prescribe additional research methods and give recommendations on symptomatic treatment sick. The anesthesiologist prescribes premedication. As a rule, on the eve of surgery, evening and morning premedication is carried out 30 minutes before surgery (2% promedol solution - 1 ml, atropine sulfate - 0.01 mg/kg body weight, diphenhydramine - 0.3 mg/kg body weight).
Special measures carried out in the preoperative period and depending on the characteristics of the function and pathological changes organ on which the main stage of the operation is to be performed are discussed in the course “Private Surgery”.
Transporting the patient to the operating room
A medical history, x-rays, and a test tube of blood should be brought to the operating room along with the patient to perform a compatibility test for possible blood transfusion.
Patients are moved carefully, avoiding sudden movements and jolts. They are taken to the operating room in wheelchairs or stretchers. For each patient, the gurney is covered with oilcloth and filled with a clean sheet and blanket. The patient is placed on such a gurney, with a cap or scarf on his head and socks or shoe covers on his feet.
The patient is transported to the operating room head first on a surgical department gurney, and in the preoperative room he is transferred to an operating room gurney and taken to the operating room. Before bringing a patient to the operating room, the paramedic must make sure that bloody linen, dressings, and instruments from the previous operation are removed. The patient is transferred to the operating table in the position necessary for this operation, taking into account its nature and the patient’s condition. The upper and, if necessary, lower limbs should be properly secured.
The duty nurse is responsible for transporting patients.
Transportation and repositioning of a patient with external drainages, infusion systems, and endotracheal tubes is carried out with extreme caution.
- This is a strong stress for the whole body. And therefore this event is preceded by careful preparation of the patient, including both drug treatment and psychological influence on the patient.
Often surgery is the only chance for life
Operation, surgical intervention, surgical intervention is one of two treatment methods (along with medication) that traditional medicine has. This treatment method involves mechanical action on organs or individual tissues of a living organism - be it a person or an animal. According to the purpose of action, surgical intervention can be:
- therapeutic - that is, the purpose of the operation is to heal the organ, or the whole system body;
- diagnostic - during which organ tissue or its contents are taken for analysis. This type of operation includes a biopsy.
Therapeutic drugs, in turn, are divided according to the method of impact on organs:
- bloody - involve tissue dissection, suturing to stop bleeding, and other manipulations,
- bloodless - this is the reduction of dislocations, the application of plaster for fractures.
Any operation takes more than one day. It is preceded by careful preparation, then monitoring the patient in order to prevent undesirable consequences. Therefore, the entire period while the patient is in direct contact with medical staff is divided into periods:
- the preoperative period begins from the moment the patient arrives at the surgical department of the hospital;
- intraoperative period - the immediate time of the operation;
- The postoperative period includes postoperative rehabilitation.
According to the timing of execution, operations are classified as:
- emergency - when surgery is performed immediately as soon as the patient is taken to the hospital and a diagnosis is made;
- urgent operations are performed within 24-48 hours. These watches are used for additional diagnostics, or there is hope that the organ can be healed without surgery;
- planned operations are prescribed after a complete diagnosis of the organs, when it becomes clear that surgery is needed, and the optimal time for medical reasons for the patient and for the medical institution is selected.
Preparation for a planned operation depends on the nature of the disease, and can take 3 days or more. During this period, additional diagnostic procedures and special training are carried out.
Activities included in preparation for elective surgery
Before admission to the hospital, the patient should be examined as much as possible
During the period of preparation for a planned operation, a complete examination is carried out in order to identify concomitant diseases that may become a contraindication to surgical intervention. It is also important during this period to determine the patient’s tolerance to antibiotics and anesthetics.
The more complete the examination carried out in the clinic before the patient’s admission to the hospital, the less time the preoperative diagnosis will take. The minimum examination standard requires:
- general blood analysis,
- determination of blood clotting,
- determination of blood group and Rh factor
- general urine analysis,
- analysis for HIV and HBs antigen,
- fluorography,
- electrocardiogram with interpretation,
- consultation with a therapist and other specialists, for women – a gynecologist.
For patients, preparation for surgery is carried out simultaneously with examinations. This allows us to shorten the preoperative stage. The operation may be delayed if:
- which may indicate an infection. During the preoperative period, the patient's temperature is measured 2 times a day.
- Menstruation begins. It is also not recommended to plan surgery 2-3 days before the start of your period. During this period, blood clotting decreases, which can cause serious complications.
- There are boils, pustular rashes, and eczema on the body. This circumstance can delay the surgical intervention for a month until complete recovery, because inflammatory processes on the skin in an organism weakened by the operation can manifest itself in the internal organs.
Special measures in preparation for planned surgery
You need to properly prepare for the operation
Respiratory preparation
Up to 10 percent of complications in the postoperative period occur in the respiratory system. The risk of such complications increases especially if the patient has bronchitis or emphysema. Worsened bronchitis may be a contraindication for surgery. Such patients are treated, physiotherapeutic procedures and expectorant medications are prescribed.
Cardiovascular preparation
Patients over 40 years of age and those who have heart complaints are required to undergo an electrocardiogram. If there are no changes on the cardiogram and heart sounds are normal, then no additional preparation is required.
Preparing the mouth and throat
Preparatory procedures include mandatory improvement of the oral cavity with the participation of a dentist. Before surgery, it is necessary to cure all inflamed teeth and gums and improve the health of the oral cavity. Before the operation, removable dentures are removed. Chronic tonsillitis is also a contraindication to intracavitary operations. Therefore, it is necessary to first remove the tonsils, and then only proceed to the main operation.
Psychological preparation
Preoperative preparation should also include psychological work with the patient. The patient’s attitude towards his condition and the upcoming surgical procedure depends on the type of nervous system. Some surgical departments have full-time psychologists. But if there is none, their function is assumed by the attending physician or surgeon. It should prepare a person for surgical intervention, relieve fear, panic, depressive state. The doctor should also explain the essence of the upcoming operation.
Junior and middle staff should not talk about this topic either with the patient’s relatives or with the patient himself. Information about the course of the disease and the risks associated with surgical intervention is allowed to be communicated only to the patient’s closest relatives. The doctor also explains to the relatives how they should behave towards the patient, how and how they can help the patient.
Preparation for surgery on the gastrointestinal tract
Preparations for surgery on the gastrointestinal tract take 1 to 2 weeks. In especially severe forms of stomach pathology, there is a lack of circulating blood and a failure of metabolic processes in the body. For patients suffering, the stomach is washed with 0.25 percent HCl solution every day.
During the period of preparation for surgical intervention on the stomach, enhanced nutrition is prescribed. The day before the operation, the patient is given only sweet tea. Surgery on the intestines requires restriction of foods with high content fiber. The fact that fasting makes the body unstable to infections is taken into account. Therefore, if the state of the gastrointestinal tract does not allow feeding on one’s own, the patient is administered glucose and protein-containing drugs intravenously. Additionally, the lack of proteins is compensated for by transfusions of blood, plasma, and albumin.
If there are no contraindications, the day before surgery the patient is given a laxative in the form of petroleum jelly or petroleum jelly. The evening before surgery, the intestines are cleansed with an enema. Patients with diabetes undergo special preparatory measures. In order to maintain normal blood sugar levels, they are prescribed a low-carbohydrate diet, and insulin is administered to directly monitor blood sugar levels.
Preparing the operating room for a planned operation
The operating room is also being prepared...
Preparing the operating room for a planned operation involves ensuring the cleanliness and sterility of the operating table and instruments. Before each operation, the operating table must be treated with a one percent chloramine solution or other antiseptic, then covered with a sterile sheet.
On top of the first, cover the table with a second sheet, the edges of which should fall about thirty centimeters. Pre-sterilized instruments are laid out on a large instrument table in three rows:
- In the first row are the instruments that the surgeon or his assistant uses primarily - scalpels, scissors, tweezers, Farabeuf hooks, hemostatic clamps;
- In the second row - specialized instruments for operations on the gastrointestinal tract (Mikulich clamp, intestinal pulp);
- In the third row are highly specialized instruments intended for specific pathologies and manipulations.
You will learn how the operating room is prepared for work in the video.
Random articles
-
-
The meaning of the Nautiz rune in love and relationships
We most often overcome all kinds of difficulties encountered along the path of life. Of course, for this we make...
-
Horoscope by year of birth for Pisces
This year your patron Neptune will be in your constellation and this is a good sign, because you will feel...
-
Horoscope for those born in the year of the Rooster
1993 who? 1993 is the year of which animal? — According to the Chinese horoscope, 1873, 1933, 1993 belonged to the years of the Black Water...
-
What is wave-particle duality?
Wave-particle duality of light means that light simultaneously has the properties of continuous electromagnetic...
-
Preparing for the exam: how to learn biology yourself at home from scratch Learning biology from scratch
The role of biology is enormous in our world. Although it is not a priority subject, most students and parents...
Low hemoglobin
-
2024-01-16 01:24:50 
The characteristic properties of lower amines and ammonia are
Amines are organic derivatives of ammonia containing an NH 2 amino group and an organic radical. In general...
-
2024-01-16 01:24:50 
Unified State Exam in Social Studies: reviewing assignments with the teacher
How to answer questions in Part BThe second part of the social studies work consists of 7 tasks with a short answer....
ALT and AST
-
2024-01-15 01:17:34 
Act on damage, damage, scrap of inventory items
Form TORG-15 is drawn up in the case when during transportation, movement between and within the warehouse, when...
-
2024-01-14 01:13:32 
Homemade cereal bars with persimmons
Nutritionists say that for good health and a slim figure, you must include snacks in your...
Lymphocytes
-
2024-01-14 01:13:32 
Carrot salad for the winter: recipes
Delicious pickled carrots for the winter can be prepared in a variety of containers, it can be a wooden...
-
2024-01-14 01:13:32 
Omelet with crab sticks Scrambled eggs with crab sticks and tomatoes
When I have a few minutes left to prepare breakfast, the simplest and fastest recipes are used....
Leukocytes
-
2024-01-14 01:13:32 
Dessert recipes for the New Year
An elegant table, a decorated Christmas tree, tangerine spirit spilled throughout all the rooms, soon the most magical holiday -...
-
2024-01-13 01:35:31 
Strong conspiracies for money and wealth
Each of us has repeatedly faced financial difficulties and difficult periods in life when Fortune...
