Question

Case Study, Intraoperative Nursing Management 1. Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient's age? b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.

Answer 1

-A.Nursing interventions to reduce the sugical risk include

-Preoperative evaluation of blood values such as Hb,BT,CT,PT,INR,platelet count,Sodium, potassium,LFT,RFT, TSH, Serology to ensure anaesthesia fitness.

-Preoperative cardiac evaluation including ECG and Echocadriography to assess cardiac compliance

-Strict monitoring of Bp and necessary adjustments in dose of antihypertensives to maintain optimum level of blood pressure.

-Antibiotic prophylaxis as the patient may be immunocompromised due to advanced age and other

co-morbidities.

-Encourage deep breathing and coughing exercises,pursed lip breathing to achieve Optimum airentry which prevents hypoxia.

-Strict monitoring of intake and output chart

-Use of pneumatic compressive devices or compression stockings to prevent Deep vein thrombosis

-Provide psychological support and reassurance by providing adequate explanation in simple and understanding manner.

-Advice need for smoking cessation

B-Intraoperative nursing interventions-Safety measures

-Ensure strict surgical asepsis throughout the procedure

-Proper positioning and draping-while positioning ensure patient's body is in alignment and that joints and muscles are not in unnatural position that they Will be damaged if they remain in that position for -Ensure padding of body prominences that directly contact with OT table to prevent skin trauma.

-Maintain count of instruments and sponges and all other materials using for surgery

-Ensure proper working of all instruments on time

-Correct location of aneurysm should be displayed (MRI,CT) in OR

--Monitor blood loss and be prepared for transfusions if required

-Early identification and prompt management of hemodynamic instability during procedure