PRE & POST OPERATIVE CARE.

 

LEARNING LOG                                                  12/07/24

 

The lesson started with an introduction of the module, followed by the learning outcomes, its aims and objectives. There were questions asked in class, regarding the tools used to identify a sick person and why? What are some of the challenges when assessing a patient using A – E framework?

The question regarding the challenges when assessing a patient using A- E. the following are some thing we identify in class. 

• Learning disability
• Language barrier
• Mental health.

In the pre-operative care, we look at the airway. It is a comprehensive evaluation that looks for upper airway pathologies or anatomical anomalies. We consider the mouth opening, dentition, thyromental distance and neck circumference etc. LEMON is an acronyms use by anaesthetics to assess before operation.

 

For breathing, –

• Obstructive Sleep Apnea (OSA), 
• Any previous history
• Any respiratory diagnosis
• Recent chest infections
• Immunisation history
• Chest x-ray to name but a few.

For circulation –

• We look for any infection risk.
• Ask about drug history(anticoagulants, insulin)
• Any cardiac history including cardiac surgeries
• Pacemaker, ICD.
• Chest x-ray, ECG, and routine blood tests.
• Surgical site prep.

The post- operative nausea and vomiting (PONV), we look for 

• History of PONV
• History of motion sickness
• Age 
• Sex
• Non-smoker
• Post op opioids(side effects)

With regards the post operative care , we continue monitoring :

• Airway
• Breathing
• Circulation
• Disability
• Medications

Postoperative nausea and vomiting:

• Nauseous or nauseated.

For the anaesthesia related causes:

• Opioids
• Nitrous oxide
• Duration of anaesthesia
• Induction drugs eg propofol

 

The following are the common complications:

• Infection
• GI complications
• Respiratory complications
• Renal
• CVS(cardiovascular)
• Neuro
• haematological(bleeding, clotting)
• Others (wound dehiscence eg open wound)

With regards the missed opportunities:

• Poor monitoring of vital signs
• ABC not recognised
• Not acting on clear documentation
• Failure to use systematic approach
• Poor team work and communication
• Late referrals.

 

                            

 

                                    KSB ADDRESSED

 

                                                      KNOWLEDGE 

 

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfill all registration requirements 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice 

K8: Understand how discriminatory behaviour is exhibited 

K11: Understand the factors that may lead to inequalities in health outcomes 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care 

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care 

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care 

K18: Understand and apply the principles and processes for making reasonable adjustments 

K19: Know how and when to escalate to the appropriate professional for expert help and advice 

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met 

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health 

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies 

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions 

K29: Understand the different ways by which medicines can be prescribed 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs 

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services 

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

                                                          SKILLS     

 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements 

S2: Keep complete, clear, accurate and timely records 

S3: Recognise and report any factors that may adversely impact safe and effective care provision 

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep 

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

 

                               

                                                  BEHAVIOURS

 

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness