Part Two
- Policy of preparation, care and control of patient prevention
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Policy:
preparing the patient's skin before operations
Purpose:
- Clean the skin as much as possible, remove skin fat, and all possible microbes from the operation site, so that the skin is incised with the least risk of contamination coming from this side.
- Leaving residues of antimicrobials on the skin that prevent the multiplication of microbes during the procedure.
- Reduce the presence of microbes in the shortest period of time with the lowest percentage of skin irritation
Working procedures:
A-pre - ' sterilization”
* The nurse in charge reviews the doctor's orders regarding the quality of the pre - “ sterilization” procedures (sterile or non-sterile), the quality of the soap to be used, the duration of the preparation and the patient's history of allergy is reviewed before using any chemicals on the patient's skin.
* The patient is transferred from the department to the operating room, then the patient is placed on the operating room table and anesthetized, the operation site and the area around it are cleaned with gauze 4×14 (10 cm × 10 cm) in a circular motion in circles widening and starting from the center to the extremities.
* The operation nurse starts to clean the operation site and then pass on the surrounding area, receiving the sponge gauze piece, never bring the 4×14 (10cm × 10cm) gauze contaminated towards the center.
· The “ sterilization ' process is repeated with 4×14 (10 cm × 10 cm) clean gauze each time.
* The area to be 'sterilized' is prepared in a time period according to the request.
B-preparation
* The responsible nurse reviews the doctor's preference for the quality of the solution and the preparation that should be used.
· After the nursing handler finishes the pre-sterilization stage, and before it is covered, the doctor or the person responsible for the sterilization process uses a sterile method to add antiseptic solution to the operation site and the surrounding area.
* The excess solution is squeezed out of a spongy gauze
* Sponge gauze is used on the patient's skin in a circular motion, starting from the operation site in a movement towards the surrounding area, the sponge is discarded, it is forbidden to use a contaminated sponge towards the center.
* Repeat the previous stage with a new sponge.
The type of solution used is recorded on the patient's own record.
C-sterilization by type of operation:
1. Abdomen
* Laparotomy-from the nipple to the bottom of the pubic bone
* Full - from the nipple line to the anus
· A special point-the navel is well cleaned with a thin rod, the tip of which is wrapped with something cotton.
2. Vaginal-all hair is removed at the confluence of the pubic bones, pubis, anus area, inner part of the thigh, if requested, do not use alcohol.
3. Anal cases-the area around the anus is prepared.
4. Venous ligation (vein to the thigh) - the origin of the thigh, vagina, pubic area, the area of the man where the operation will be performed is shaved, wiped and cleaned, if requested. If there are marks on the legs, please do not remove the marks (as they will be used by the surgeon during the operation) (the operating body).
5. Chest conditions-shaving, wiping and cleaning of the arm and chest is done from the affected side starting from below the back armpit line, to the nipple line of the uninjured side and from the clavicle to the navel, be sure to shave the armpit.
6. Behind-the-ear osteotomy and ear microsurgery-shaving, wiping and cleaning are done two inches above the ear to the back of the hairline from behind. All hair located at the site of the operation is braided or shaved.
7. Lumpectomy - a six-inch radius (except for the scalp) is prepared around the location of the tumor.
8. Capillary vesicle (coccygeal fistula) - is shaved, wiped and cleaned from the middle of the back to the bottom of the anus. If requested.
9. Amputation-six inches of skin is prepared below and six inches above the position to be amputated, whether it is a back or front part.
10. Preparation for bone sterilization (for all orthopaedic surgeons) - the position is cleaned with a soapy sponge (gauze) - depending on the selected area. A soap foam is applied and the area is shaved with a razor, if requested. Be sure to remove all hair, including thin ones. The site is wiped and cleaned for ten minutes with a soapy sponge (gauze), left to dry. The position is covered with sterile towels and the towel is fixed with a gauze bandage (an adhesive belt is used if necessary, do not use a pin). If the process involves a hand or foot, be sure to cut and clean the nails of the hand or foot, they are also wiped, cleaned and with a brush. If there is a part that is fixed with corsets or a splint, do not prepare it unless the doctor asks for it.
11. Arthroscopic examination of the knee joint: - preparation is carried out from the middle of the thigh to the heel with the front and back sides.
12. Foot and heel surgery-the man is prepared starting from (6) six inches below the knee to the end of the limbs, cleaning and manicure are done.
13. Hand and wrist surgery-the arm is prepared starting from (2) inches below the elbow to the fingertips.
14. Open splinting of the ulna and radius bone-the arm is prepared from the armpit to the wrist.
15. Open splinting of the humerus - the upper arm is prepared from the shoulder to just below the elbow.
16. Shoulder surgery (clavicle) - the shoulder is prepared from the upper middle part of the arm to the neck, the front and back of the chest and up to the middle line, the armpit hair is shaved.
17. Special points to remember:
* The doctor's orders on the patient's record are always checked to see if the preparation has been requested and to find out any special orders related to the preparation of the skin.
* Make the patient feel confident and discuss the operation with him within the limits allowed.
* Avoid cutting the patient with a razor.
* Make sure the navel is clean.
* Regular shaving is done in the case of patients undergoing operations around the face and neck.
* Limbs are sterilized in cases of orthosis.
D-types of disinfectants used :
1. Eudophore (Betadine):
* Compositions of cleanser and iodine do not cause irritation of the skin or mucous membranes.
* Iodine 1% is applied slowly to ensure the effectiveness of its bactericidal effect, and it is noted that iodine leaves a brown color on the skin that determines the place of the operation.
* Has an effective effect on Gram-negative and Gram-positive bacteria
2. Chlorhexidine gluconate :
* It is considered an alternative suitable for patients with allergies to iodine compounds .
· It has an effective effect on Gram-positive bacteria, and a less effective effect than iodophor compounds on Gram-negative bacteria.
3. Alcohol ( ethyl and isopropyl ) :
* It is used if the surgeon wishes to see the normal skin color and not the brown color of iodine.
· It should not be used for disinfection of mucous membranes.
* Loses its deadly effect when evaporating
* Alcohol can be used after Betadine
Responsible: nursing operations
Models:
References: Egyptian accreditation standards.
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Objective
Making sure the surgical procedures are safe for the patient
Nursing care before the operation :
1. receiving the patient and confirming the data written on the ticket and making bracelets for the patient
2. preparation of the medical file, including (signing the necessary declarations of operations)
3. conducting the necessary tests as recorded in the medical file
4. determining the blood group of the patient by taking a blood sample from the patient
5. Prepare the patient fasting 6-8 hours before the operation
6. prepare blood for the patient if necessary
7. determining the place of the operation by the doctor
8. give the necessary treatment before the operation according to the doctor's instructions
9. measuring vital signs and recording them with the file
10. preparing the patient psychologically
Nursing care during the operation :
1. confirm the patient's name and the place of the operation
2. measuring vital signs and recording them with the file
3. wearing the patient's Operation Clothes and handing him over to the surgery nurse with the medical file
4. preparing the patient psychologically
5. ensure the safety of devices and connections
6. ensure the safety of surgical instruments
7. help the doctor during the operation
8. observe the patient and notice any changes that occur to the patient
9. ensure the counting of pads and machines before the end of the process
10. recording and recording the consumables of the process
11. transfer the patient from the operating room to the recovery room
Nursing care after the operation :
1. the patient is transferred immediately after the completion of the operation and the approval of the anesthesiologist
2. placing the patient in the appropriate position according to the operation
3. connecting the patient to the monitor device
4. observation of vital signs
5. note The Color of the skin
6. note the degree of awareness
7. note all connections and inform the doctor
8. review and implement the treatment plan written in the file
9. after the patient completely wakes up, when the anesthesiologist decides to transfer him to the internal department, the following is performed :
* Notifying the nursing department to come to receive the patient
* Receive the nursing to the patient at the clean area of the operating room and sign the receipt and the date of receipt in the operations statement
* The responsible nurse delivers all the patient's papers and the medical file to the nursing department
* Record all observations in the observation map and inform the doctor of any abnormal symptoms
Executive Officer :
Operational nursing (sterile and Palliative Nursing )
Operating doctor
Anesthesiologist
References :
Surgical Nursing textbook for Technical Secondary Schools of nursing
Manual of procedural work in the operations unit
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Policy:
adjust the patient's position for surgery
Purpose:
- Providing an appropriate possibility for the surgeon to reach the surgical position while maintaining the following physiological functions:
* Breathing
* Blood circulation
* Nerves
* Muscles
Working procedures:
1. The surgeon chooses the position in which the patient is fixed for the surgical procedure.
2. Consultation is carried out with the anesthesiologist responsible for administering the anesthetic
3. The following are the parameters for adjusting the patient's posture:
* Achieve maximum safety and comfort.
* No interference with breathing
* No interference with blood circulation.
* No pressure on any nerves.
* Accessibility of Operation positions.
* Accessibility of Drug Administration sites.
* Meet individual needs and requests.
4. Supine position on the back
* The head is on the same line with the body
· The arms are on the side of the body or stretched out on padded armrests.
* A safety belt is fastened across the patient's body.
* The patient lies completely supine (straight).
5. Setting the 'trend for lenberg'
* The patient's head is at a lower level than the level of the knees.
· The patient is placed on his back.
· The arms are on the side of the body or stretched out on padded armrests.
* A safety belt is fastened across the patient's body.
6. The 'Lindenberg trend' situation is reversed
* The patient is placed on his back
* A safety belt is fastened across the patient's body
* The head should be higher than the lower ends
7. 'Fuller / or semi-Fuller' position (sitting / or semi-sitting)
* Supports the patient's head with a headrest, if necessary
* Fix the arms in a comfortable position
* A safety belt is fastened across the patient's body
8. 'Lithotomy'mode
* The patient is placed so that his buttocks are above the rear brake (joint) of the table.
· Both legs are placed in padded stirrups and secured in position with belts (thongs)
· The arms are placed on armrests fixed down at the sides or resting on the patient's stomach.
* Reduces the portion reserved for the feet at the table.
9. Lateral position
* The patient is placed on his right or left side and his back is at the edge of the table, the butt and shoulders are on one line.
· The lower leg is bent (at the pelvic and knee joints), while the upper leg is on the same line with the shoulders with pillows placed between the legs
* Arms are placed along the body
* Support the abdomen and back with sandbags or any other supporting tool.
* A safety belt is placed over the patient
10. The situation is down
* The patient is given total anesthesia in the supine position and then turned over on the abdomen.
* Chest cylinders are placed under the sides of the chest to lift the weight of the body off the chest
· Arms extended on armrests
* Feet and ankles rest on cushions.
Responsible: nursing operations
References: Egyptian accreditation standards
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Policy: training nurses on the use of a defibrillator, which is the main pillar in cases of cardiopulmonary resuscitation in emergency departments .
Tools used :
* Generation.
* Emergency vehicle and be equipped under any circumstances.
* Anesthesia, as directed by the doctor.
Steps: make sure that all tools are prepared and make sure that the shock device is loaded.
In case of cardiac arrest :
* Ensure that the environment is safe for all those around and for the patient (no water - no contact with the bed during the discharge of the charge).
* Put a gel on the patient's chest where the charge is discharged to prevent the patient from being burned .
* Carry out the doctor's instructions regarding the unloading of the shipment specified by the doctor after making sure aloud that it will start with the observation of Al-Monitor .
The conscious patient :
* Introduce the patient to the reception Department and calm the patient .
* Connect the patient on the monitor device with the measurement of vital signs in a regular way to follow his condition moment by moment while monitoring the degree of awareness of the patient .
* Carry out the doctor's instructions in charging the device according to the doctor's instructions .
* The patient was placed on oxygen according to the doctor's instructions after the shock was given .
* Note the degree of consciousness after shock administration .
* Making an electrocardiogram of the patient after trauma .
References: Manual of procedural work in intensive care (Nursing Guide Line).