Caring for the Perioperative Patient, Second Edition

436 Pages·2010·5.05 MB·English

Caring for the
Perioperative Patient
Second Edition
Caring for the Perioperative Patient, Second Edition Paul Wicker and Joy O'Neill
© 2010 Paul Wicker and Joy O'Neill. ISBN: 978-1-405-18850-0
Caring for the
Perioperative Patient
Second Edition
Paul Wicker
Head of Perioperative Studies
Visiting Professor, First Hospital and Medical
School, Nanjing, China
Faculty of Health
Edge Hill University
Ormskirk
Address for correspondence: [email protected]
AND
Joy O’Neill
Practice Placement Facilitator
Faculty of Health
Edge Hill University
Ormskirk
Address for correspondence: [email protected]
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2010
First edition published 2006
© 2010 Paul Wicker and Joy O’Neill
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Library of Congress Cataloging-in-Publication Data
Wicker, Paul.
Caring for the perioperative patient / Paul Wicker and Joy O’Neill. – 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-8850-0 (pbk. : alk. paper) 1. Operating room nursing.
2. Preoperative care. 3. Postoperative care. I. O’Neill, Joy. II. Title.
[DNLM: 1. Perioperative Care–nursing. 2. Perioperative Nursing–
methods. WY 161 W636c 2010]
RD32.3.W53 2010
617′.917–dc22
2009049072
A catalogue record for this book is available from the British Library.
Set in 9 on 11 pt Palatino by Toppan Best-set Premedia Limited
Printed in Malaysia
1 2010
Contents
Foreword by Mary Moore Associate Director, National
Orthopaedic Project, Department of Health, London vi
Preface viii
Acknowledgements xii
Section 1 Core Issues 1
1 Perioperative homeostasis 2
Paul Wicker
2 Managing perioperative equipment 51
Joy O’Neill
3 Perioperative pharmacology 101
Paul Wicker and Africa Bocos
4 Perioperative communication 134
Joy O’Neill
5 Managing perioperative risks 179
Joy O’Neill
Section 2 Perioperative Practice 229
6 A route to enhanced competence in perioperative
care 230
Paul Wicker and Jill Ferbrache
7 Preoperative preparation of perioperative patients 247
Paul Wicker
8 Patient care during anaesthesia 271
Joy O’Neill
9 Patient care during surgery 339
Paul Wicker and Adele Nightingale
10 Patient care during recovery 379
Paul Wicker and Felicia Cox
Index 413
v
Foreword
In recent years the NHS has seen unprecedented change, result-
ing in signifi cant healthcare improvement for patients and
increased career opportunities within the NHS and its partners.
These developments in innovative and advancing levels of
practice are also refl ected across Europe and many parts of the
world.
The dynamic pace of this change has presented signifi cant
challenges for clinicians as they endeavour to acquire high - level
clinical skills and deliver care while adapting to many new
ways of working.
The UK NHS has had to respond dramatically to the changing
demographics of its workforce and to high - level policy to drive
down waiting times for patients and to increase the capacity for
surgery. The perioperative workforce has been at the forefront
of such changes and has had to undergo signifi cant transforma-
tion in the way it works, crossing traditional healthcare bound-
aries. The aspirations of health professionals, structured NHS
career frameworks, pay modernisation, working practice legis-
lation, advancing levels of practice and the skills escalator
concept of skills progression all contribute to the complexity of
delivering care to patients.
The provision of education to health professionals giving
perioperative care has also undergone signifi cant change, with
much more cross - profession delivery of core skills, increased
e - learning opportunities and the development of nationally led
Advanced Practitioner programmes. This education and expo-
sure to hands - on learning is against a backdrop of increasing
workload and advances in technology that now support clinical
intervention.
Clinical input for trainees is a vital component in the educa-
tion of our perioperative workforce, but both students and
teachers within the many specialisms that encompass peri-
vi
Foreword
operative practice need access to a knowledge base that is
modern, comprehensive and fi t for purpose. The publication of
such a clinically based and up - to - date resource is well overdue,
and this book promises to fi ll that gap.
This text is well structured for easy reference and lends itself
to detailed underpinning of knowledge, while at the same time
being suitable for use as a quick reference guide. I am confi dent
that it will fulfi ll a need for both learners and teachers within
perioperative care.
Mary Moore
Associate Director, National Orthopaedic Project
Department of Health, London
vii
Preface
Perioperative care has been through a number of changes and
has now developed into a truly patient - centred, holistic, evi-
dence- based speciality that offers practitioners challenges and
opportunities that are rarely seen outside the perioperative
environment. Perioperative practitioners are defi ned in this
book as nurses or operating department practitioners (ODPs)
who perform scrub, circulating, anaesthetic and recovery roles
whilst caring for perioperative patients.
The pressures brought about by initiatives such as the NHS
Plan, Clinical Governance and Agenda for Change mean that
the care of the patient undergoing surgery is now carried out
by many different professionals. Old technique - centred practice
has given way to a patient - centred, evidence - based approach.
A diverse and challenging perioperative environment has there-
fore developed with subsequent challenges for the practitioners
who work there.
The purpose of this book is to identify and discuss the essen-
tial core skills and knowledge required by perioperative practi-
tioners to care for their patients. It is primarily aimed at the
period following registration but before the development of
advanced perioperative skills, such as those displayed by
advanced practitioners. As such it is also a source of informa-
tion for nursing and ODP students working in perioperative
care.
This evidence - based and innovative book has been written to
embrace the changes in the perioperative role. It is skills - orien-
tated and uses examples of techniques or procedures to illus-
trate how those skills can be applied in perioperative practice.
It refers to practitioners rather than nurses or ODPs to ensure
the inclusion of all practitioners working in the perioperative
environment.
viii
Preface
This book is arranged in two sections: Core Issues and more
specifi c Perioperative Practice.
CORE ISSUES
Chapter 1 describes the practitioner ’ s role in the delivery of
therapeutic interventions required because of the anatomical
and physiological infl uences of anaesthesia and surgery. The
chapter reviews the concept of homeostasis in the context of
holistic perioperative care and identifi es the impact of anaesthe-
sia and surgery on the systems of the body. Topics include
principles of perioperative homeostasis, fl uid balance, cardio-
vascular homeostasis, the respiratory system, wound healing
and trauma.
Chapter 2 discusses the overall management of perioperative
equipment with specifi c reference to the most common types
currently in use in the perioperative environment. There is an
emphasis on the safe use and maintenance of anaesthetic and
surgical equipment.
Chapter 3 discusses the implications of the use of various
drugs on perioperative care. There is a discussion on the metab-
olism of drugs, and the uses, administration and side effects of
common perioperative drugs. Drugs included in this chapter
include opiates, muscle relaxants, analgesics, local anaesthetic
agents, general anaesthetic agents and antiemetics.
Chapter 4 considers ways to enhance communication in the
perioperative environment. There is an exploration of impor-
tant aspects of communication in relation to perioperative
patients to ensure safe and effective care. There is also reference
to the different roles of the perioperative practitioner within the
perioperative team. Topics include perioperative patient check-
lists, patient advocacy, consent, clinical governance, change
management, principles of record keeping and NHS and patient
agencies.
Chapter 5 looks at risk management in the perioperative envi-
ronment. It explores the main principles of risk management
and identifi es some of the common perioperative risks to
patients. Topics include discussion on specifi c perioperative
risks, such as infection control, pressure area care, deep vein
ix
Preface
thrombosis prophylaxis, inadvertent hypothermia, latex allergy
and smoke inhalation.
The following chapters explore the indicators further and
discuss some of the important skills and knowledge displayed
by practitioners in anaesthesia, surgery and recovery.
PERIOPERATIVE PRACTICE
Chapter 6 presents the competencies associated with the role of
the perioperative practitioner. It is based on the work carried
out by NHS Education Scotland (NES) working parties in 2001 –
2002 and 2006 – 2008. This chapter presents a discussion of peri-
operative competencies and their associated indicators for
perioperative practitioners and also specifi cally anaesthetic
assistants. The indicators are measurable markers of the achieve-
ment of the competencies and are provided as examples of the
competencies that practitioners develop in specifi c clinical
areas.
Chapter 7 considers the role of the practitioner in the preop-
erative preparation of perioperative patients. It explores the
techniques and methods of perioperative assessment and the
role of the perioperative practitioner in preoperative visiting
and care planning. Topics include selection of patients for
surgery, assessment of patient ’ s condition, common concurrent
diseases, illnesses and conditions, and preoperative planning to
prevent intraoperative and postoperative complications.
Chapter 8 explores the skills and knowledge required by
anaesthetic practitioners in the assistance of the establishment
and maintenance of anaesthesia. It discusses the different types
of anaesthesia, many of the clinical techniques used in anaes-
thesia and the role of the anaesthetic practitioner in the anaes-
thetic team. Topics include patient care during different types
of anaesthesia, airway management and patient monitoring.
Chapter 9 discusses the roles of the scrub and circulating
practitioners. It explores some of the clinical techniques that
practitioners use during surgery and the part that the practitio-
ner plays within the surgical team. Content includes discussion
on surgical scrubbing, haemostasis, wound closure, positioning
the patient and wound care.
x
Preface
Finally, Chapter 10 considers unique aspects of the role of the
recovery practitioner and the main clinical techniques used in
recovery. Content includes discussion on the principles of
patient care after clinical intervention, patient assessment,
airway maintenance, pain management and discharge criteria
in postoperative patients. Topics also include common post-
operative complications such as nausea and vomiting, shock,
hypothermia and airway complications.
We hope that you enjoy using this book to enhance your prac-
tice and that it helps you to provide optimum patient care.
Joy O ’ Neill and Paul Wicker
Readers’ note: Every effort has been made to check the accuracy
of drug and product information, and clinical content. However,
readers should check the manufacturer ’ s product information
and local workplace policies and protocols before undertaking
any intervention.
xi