The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [602]
At the time of admission it is important to ask patients if they are menstruating and to highlight the dangers of using tampons during surgery. If these are left in situ for longer than 6 hours, infection may develop. Nurses can offer a sanitary pad as an alternative.
Patient education
Research by several authors has shown that preoperative patient education not only meets patients’ information needs but also assists in reducing anxiety levels and promotes the patients’ well-being (Bondy et al. 1999, Jlala et al. 2010, Klopfenstein et al. 2000, Walker 2002).
Patient information booklets can also help patients to gain a greater understanding of surgery and what is expected of them.
Preoperative education can address some of the patients’ concerns and fears. As pain and anaesthesia are patients’ greatest worries, they need to be discussed in the preoperative period so that anxiety can be reduced (Mitchell 2000), which may result in patients requiring less analgesia (Beddows 1997). Preoperative visiting by recovery staff allows patients to ask questions, which could help them to manage their anxiety and provide baseline information about patients, which is important for effective management postoperatively, for example, of pain. It also gives information to the surgical team to allow them to maintain continuity of care in the operating department (Beddows 1997).
The control of pain while the patient is still in the operating theatre and recovering from their surgery is vital to further reduce anxiety and promote general well-being. Use of patient-controlled analgesia (PCA) gives the patient a sense of autonomy, which may decrease anxiety and which will in turn influence the patient’s pain perception (Field and Adams 2001). For further information see Chapter 9.
Information about the equipment and intravenous access extension sets that the patient will be attached to postoperatively should also be provided to ensure they know what to expect and are fully informed as this can be disconcerting to both the patient when they return from theatre and the patient’s relatives when they see them immediately post surgery. Additional information on when the patient will be expected to mobilize, when they can eat and drink and the length of time they can expect to be in hospital is also important at this time.
Assessment of latex allergy
latex is a natural rubber composed of proteins and added chemicals. Its durable, flexible properties give it a high degree of protection from many micro-organisms, which make it an ideal fibre to use for many healthcare products. It currently provides the best protection against infection and gives the sensitivity and control needed in the healthcare field. It is found in the following products (AORN 2004, HSE 2004).
Gloves.
Airways.
Intravenous tubing.
Stethoscopes.
Catheters.
Dressings and bandages.
Some of the proteins in the natural rubber latex can cause allergic reactions and sensitivity and the incidence of latex hypersensitivity seems to be increasing (Rose 2005). Sensitivity can be described as the development of an immunological memory to specific latex proteins, which can be asymptomatic. Allergy is the visible reaction of the sensitivity, for example hives, rhinitis, conjunctivitis, anaphylaxis (AORN 2004). Anyone with sensitivity to latex is at risk of an allergic reaction, which can be serious or potentially life-threatening, and therefore sensitivities and allergies should be treated in the same way (AORN 2004). There are various types of reaction.
Irritation: irritant contact dermatitis, a non-allergenic reaction caused by soaps, gloves, glove powder and hand creams. Symptoms range from dry, crusty, itchy skin to rashes and inflammation, which usually resolves when use is discontinued (AORN 2004, HSE 2004, Rose 2005).
Type IV reaction: delayed hypersensitivity, sometimes known as allergic contact dermatitis caused by exposure to chemicals used in latex manufacturing. Results in red, raised, palpable area with bumps, sores and cracks usually occurring several hours within