The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [616]
The patient is especially at risk from damage due to pressure and stretching, so measures to maintain the skin’s integrity are vital (AORN 2001, C).
4 Ensure the patient is covered by the gown or blanket. These items should only be removed immediately before surgery. To maintain the patient’s dignity. To help prevent a reduction in body temperature or accidental hypothermia. E
5 Use a warm air mattress on the operating table. Ensure all fluids used are warmed if possible. To help maintain the patient’s body temperature and prevent postoperative complications due to hypothermia. E
6 Ensure the diathermy patient plate is attached securely in accordance with the manufacturer’s instructions and hospital policy. To ensure that no injury is sustained from the use of diathermy during surgery (Molyneux 2001, C).
7 Follow hospital policy for the checking of swabs, needles and instruments. To ensure that swabs, needles and instruments are accounted for at the end of the operation. C
8 Follow hospital policy for the disposal of sharps and clinical waste that is not needed at this point. To reduce the risk of injury to the patient and staff (Pratt et al. 2007, C).
Intraoperative care: recovery
Definition
Postanaesthetic recovery involves the short-term critical care required by patients during their immediate postoperative period within the recovery room, until they are stable, conscious, orientated and safe to transfer back to the ward. The postanaesthetic recovery room is an area within the operating department specifically designed, equipped and staffed for the support, monitoring and assessment of patients through the reversing stages of anaesthesia.
Evidence-based approaches
Prior to transfer to postanaesthetic recovery unit
Once the procedure in the operating room has been completed and the patient is ready to be transferred to the postanaesthetic unit, the final part of the WHO checklist (part 3) has to be completed (Table 14.5). This is done before any member of the team can leave the operating theatre.
Postanaesthetic care
Postanaesthetic care can best be described and understood as a series of many nursing procedures performed in sequence and simultaneously on patients who are in an artificially induced and traumatized condition. These patients will display varying degrees of responsiveness and physical and emotional states. It is important to establish a rapport with each individual to gain the patient’s confidence and co-operation and to aid assessment. It is also necessary to understand that when emerging from the final stage of anaesthesia, some patients can behave in an emotional and disinhibited fashion, at variance with their normal behaviour (Eckenhoff et al. 1961, Radtke et al. 2008). These displays are always transient and fortunately patients seldom have any recollection of them. Most patients will have an uneventful recovery following surgery.
Hypothermia may be a problem, with the symptoms mimicking those of other postoperative complications, which may result in inappropriate treatment. Hypothermia interferes with the effective reversal of muscle relaxants, so monitor patients who are shivering, restless, confused or with respiratory depression (Feldmann, 1988). Shivering puts an increased demand on cardiopulmonary systems as oxygen consumption is increased (Feldmann 1988, Frank et al., 1993). Other complications such as arrhythmias or myocardial infarct can result and the longer the duration of the postoperative hypothermia, the greater the patient mortality (Crayne and Miner 1988, Frank et al., 1993).
Transfer of patient from operating theatre to peri-anaesthesia care unit
The patient is accompanied from the operating theatre to the peri-anaesthesia care unit (PACU) with the anaesthetist and the scrub assistant. They will refer to the theatre care plan which would have identified care given during