Q7.ppt

QUESTION 7

Question 7 Mr. M is scheduled for exploratory laparatomy under GA. a) State the different of GA and Local or Regional Anaesthesia

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- prepare and check functioning order of anaesthetic machine - prepare and check functioning cycle circuit - prepare and check functioning order of Vaporizer - suction apparatus - monitoring - Pulse oxymeter - Capnograph - Prepare and check functioning order of intubation equipment - provide anesthetic drugs - Receive patient according to SSSL

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Assisting during induction of General Anaesthesia and intubation Receive patient according to SSSL Asses the patient general condition check consent form Anesthesia Surgery Blood Check for investigation results Check for pre-medication Inform and brief explanation to patient regarding the procedure

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Place warming blanket on patient placement of monitoring devices Ensue intravenous line patent assemble laryngoscope Identify correct size of blade to be used connect to laryngoscope handle light source is functioning and adequate Prepare for intubation Positioning of patient Pre oxygenate with 100% oxygen for 3-5 mins

• suction device is functioning • assist the anaesthetist in intubation • Pass the laryngoscope and ETT to the anaesthetist • Inflate the cuff when instructed • secure ETT • Connect to Ventilator • Documentation • Clean and dispose the equipment

Surgery has progressed till the vaginal vault. As a scrub nurse : Explain how would you help to reduce contamination of abdominal cavity during this stage. (7m) • Put dressing towel at ; • top of surgery site to prevent strike through and to prevent surgeon accidently put contaminated instrument at the top of surgery site. • below the surgery site to receive specimen dan contaminated instrument. • Bahagian atas kawasan pembedahan untuk persediaan sekiranya surgeon ‘accidently’ meletakkan instrument yang tercemar

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Bahagian bawah kawasan pembedahan untuk menerima spesimen dan instrumen yang tercemar

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Minimize the usage of instrument; Use the needed instrument only to prevent contamination. (Gunakan instrumen yang diperlukan sahaja untuk mengurangkan kontaminasi)

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Cover resection area with abdominal pack to absorb the spillage. Alas kawasan di bawah ‘resection’ menggunakan abdominal pack untuk ‘collect specimen’ dan ‘prevent spillage’

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• Practice non touch technique during add in another instrument to reduce contamination. • Amalkan ‘non touch technique’ semasa penambahan instrumen untuk mengurangkan kontaminasi •

Receive specimen using kidney dish and cover the kidney dish with dressing towel before passing the kidney dish with specimen to circulating nurse without crossing sterile area. • Gunakan kidney dish untuk menerima specimen ;

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Kidney dish yang mengandungi spesimen dibalut dengan dressing towel dan diberikan kepada circulating nurse tanpa ‘cross’ kawasan sterile. Passing used instrument to circulating nurse to reduce contamination. Asingkan instrumen yang telah tercemar dan berikan kepada circulating nurse agar tidak digunakan semula untuk mengurangkan kontaminasi Change glove after resection of specimen to reduce contamination. Sediakan glove untuk sterile team member menukar glove selepas spesimen dikeluarkan agar dapat mengurangkan kontaminasi Reinforce wet area with new drape or reinforce after washout to prevent strike through.

• ‘Reinforced’ drapping yang baru pada kawasan yang basah untuk mengelakkan ‘strike through’ (reinforced the drape after washout. ) • • Use new instrument for the next procedure to reduce contamination. • Gunakan instrumen yang baru bagi pembedahan yang seterusnya untuk mengelakkan kontaminasi

• Kidney dish yang mengandungi spesimen dibalut dengan dressing • towel dan diberikan kepada circulating nurse tanpa ‘cross’ kawasan sterile. • • Passing used instrument to circulating nurse to reduce contamination. • Asingkan instrumen yang telah tercemar dan berikan kepada circulating nurse agar tidak digunakan semula untuk mengurangkan kontaminasi •

• Change glove after resection of specimen to reduce contamination. • Sediakan glove untuk sterile team member menukar glove selepas spesimen dikeluarkan agar dapat mengurangkan kontaminasi • • Reinforce wet area with new drape or reinforce after washout to prevent strike through.

close monitoring. Described the specific nursing care that will be provided for Mrs. Z in the recovery room (8m) • Preparation of recovery room • • • •

Cleanliness Equipment such as suctions, monitors, emergency trolley, warming blanket. Asked anesthesia teams what type of anesthesia has been given to patient for planned of intervention. Take over case from anesthetist such as nature of surgery and anesthesia, blood loss and level of consciousness.

• Assess level of consciousness patient for patient co-operation by calling patient name if patient given general anaesthesia. • Placed patient in lateral position to encourage secretion out and maintain airway open. • Give oxygen according to anesthetist ordered to maintain oxygen saturation. Monitor the oxygen saturation by putting the SPO2 probe. • Monitor vital sign by applying electrode cable according to defect problem occur post-operatively such as hypotension due to bleeding during surgery. • Check vital sign every 5 minutes until patient fully conscious. Vital sign such as : blood pressure, pulse, respiration rate and SPO2. • Close monitoring to prevent any changes on patient condition. • Pull up side rails to prevent patient fall. • Checked IV fluid for flow and document inside post-op notes. • Checked for drain inserted (if any) and record amount of blood loss. • Checked operation site for sign of active bleeding inform. • Record inside post-operative notes condition of patient, level of • consciousness operation site and vital sign. • Check if patient has catheter inserted for patient confortable due to amount of fluids given during surgery. • If any abnormal observation, inform the doctor to take an action. • Post op pain management as ordered by doctor.