Perioperative Nursing Report 2022

Running head: PERIOPERATIVE NURSING 1
Perioperative Nursing
Student Name
Institutional Affiliation

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Perioperative Nursing
Model 1: Patient safety
Patient misidentification is a medical error that involves mistaking a patient for another
during a medical, surgical, or radiological procedure. It usually occurs in patients who bear the
same initial names or surname. It is among the medical errors that can be avoided in the hospital
setting since it can lead to patient injury, complications, or even death (Kawauchi et al., 2019).
The nurse has a significant role in patient identification and confirmation of the right patient
before a procedure is commenced.
From the case scenario, two patients in the same room happened to be sharing the first
name; John Adams and John smith. John Adams was scheduled for an x-ray, and a porter was
sent to transport the patient to the radiology department bearing in mind the first name. John
Adams was out, and upon calling out the first name, the porter ended up transporting the wrong
patient. This is an area of concern since the wrong patient underwent a procedure that he was not
scheduled. In hospital settings, patients have been identified to undergo incorrect procedures due
to identity errors (Mansouri, Aran, Shaqdan, & Abujudeh, 2016). Identity area results in wrong
medication administration and patient misdiagnosis hence leading to poor patient outcomes.
Best practices have been put in place to minimize identification errors in the hospital
setting. The WHO has set in place safety strategies to decrease errors in hospital setting. It
suggested handover rules such as use of electronic medical records to provide adequate
information for the next clinician. The panel put in place rules on error reporting and the
disciplinary action incurred to educate clinicians. WHO advocated on the virtue of teamwork and
sharing of responsibility in the hospital to minimize toning down at work hence avoiding medical

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errors. The hospital should take patient photos on arrival and add to the medical records to avoid
confusion. After giving the patient with the wrist band branded with the demographic data, the
patient should be asked to confirm the details listed before proceeding to the ward (de Souza
Macedo et al., 2017). Hospitals should initiate electronic patient identifiers to monitor patient
management hence reducing the human error of misidentification.
The nurse has a role in involving the patient in the identification process during the first
contact. The nurse ensures an accurate demographic date is taken and recorded and put an
identification tag on the patient before admission to the ward. During patient handover or
transfer for procedures or medication, the nurse should use at least two patient identifiers to
confirm if it is the right patient for the procedure, the nurse can use the patient name, residential
address or phone number (Durham, Suhayda, Normand, Jankiewicz, & Fogg, 2016). During
patient questioning or calling out for the procedure, the clinician should not lead the patient to
answer questions but rather ask open-ended questions and give time for the patient to confirm
their identity. In major procedures, the leading clinician should validate the patient's identity by
asking the patient, establishing with the report on the file, and the identification band before
commencing the procedure.
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Module 2: Environmental aspects
The perioperative environment is a regulated and specially formulated area that plays a
critical role in the safety of the patient before, during and after a surgical procedure. It is

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composed of a controlled setting with equipment and instruments that aid in patient management
during the perioperative period. Ensuring the safety of patients has emerged to rely on
technological processes for many healthcare givers (East et al., 2018). Tracking and traceability
measures of equipment and instruments are applied in the perioperative setting to promote
patient safety hence result in quality patient outcomes after the procedure (Paaske, Bauer, Moser,
& Seckman, 2017). Tracking defines that the movement of equipment is monitored at all times
while traceability is defined as the ability to account for an instrument, its application and
confirm its history in terms of documented information.
Automated tracking assets helps in cost-saving and improves efficiency in
hospitals with several types of equipment. Quick location of instruments enables prompt
commencement of emergency surgical procedures saving patient lives. Tracking allows bridge
the human error where one cannot correctly account for all the tools before and after the surgical
procedure and also during the sterilization process. The process enables accurate measurements
to be applied in the perioperative setting (Lugez et al., 2015). Manual counting of instruments
and cross-checking consumes turnover time in the operating room affecting the patient safety
and quality of care. Comprehensive medical instrument tracking enables accrediting and
following regulatory measures of the government. Traceability ensures instruments are
inventoried and recounted after a surgical procedure to prevent errors such as; instrument loss or
remaining inside the patient during surgery.
Radio-frequency identification is another method used in tracking and traceability in the
hospital environment to promote patient safety. This method is used by manufacturers to tag
equipment with a unique code enabling recording of its vital characteristics for more accessible
location hence protect patient use in the surgical setting (Dey, Vijayaraman, & Choi, 2016). In

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the sterilization of instruments, the method scans a specific group of instruments before
packaging, and in case of instrumental loss, the particular package is revoked. This ensures no
tool is lacking in the surgical procedure hence promotes patient safety.
Lack of tracking and traceability processes in the surgical setting directly affects patient
care, safety and outcome. The surgical setting is a critical area and requires adamant performance
of all the equipment. Lack of tracking instruments leads to missing instruments in surgical sets,
and the surgical procedure can be compromised, putting the patient at risk. When health
professionals lack knowledge on the location of equipment; it leads to a slow reaction to
emergencies in the perioperative period compromising patient safety.
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Model 3: surgical risks
Old age is a significant risk factor when it comes to surgery. Older people tend to have
comorbidities such as hypertension, blocked arteries, heart, and lung diseases. These conditions
affect the perioperative setting of the patient since the patient is susceptible to complications due
to the superimposed risks of the procedure, the anesthesia, and the recovery period.
In the elderly, the brain is more vulnerable to the anesthetic agent. The maximum
anesthetic concentration can cause a series of complications during and after the procedure. The
patient may incur respiratory depression during the procedure due to insufficient ventilation

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leading to decreased oxygen supply to the organs (Izrailtyan, Qiu, Overdyk, Erslon, & Gan,
2018). The patient may experience postoperative delirium where the patient portrays signs of
memory loss, confusion, unaware of the environment, and disorientation due to the effect of
general anesthesia. The patient may also experience postoperative cognitive dysfunction, which
involves permanent memory loss and disorientation. This complication occurs in the old since
they are previously suffered from the comorbidities before the procedure. Old age impacts
surgical procedures since a lot of care is to be considered to avoid complication and at the old
age, most surgical procedures cannot be performed due to the risks involved and complications
that can arise. Surgical stress leads to resistance to insulin in the body leading to hyperglycemia.
The trauma also causes immunosuppression, which, in combination with the hyperglycemia,
increases the chances of wound infection post-surgery.
The nurse has a role in patient preparation and assessment before surgery. In elderly
patients who have a higher perioperative risk, the nurse should identify the existing risk and
mitigate it before the procedure to prevent further complications (Hedrick et al., 2017). The
nurse should take a detailed history of the chronic conditions of the patient and the medications
he is taking. The nurse should then perform a comprehensive physical exam systematically to
identify any vulnerability to surgical setting risks. Patients with hypertension or diabetes should
be managed before surgery until the parameters are within the normal ranges.
Before surgery, the nurse should perform a pre-cognitive assessment of the mental
function to compare with the patient's mental state after surgery to detect the presence of
complications. The nurse should ensure the patient's caregiver is present in the patient's
management to report any changes in the patient’s condition (Mohun, Spitznagel, Gunstad,

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Rochette, & Heinberg, 2018). The nurse has a role in recording vital signs and analyzing them in
comparison to their standard rates.
Elderly patients with heart or lung diseases should be monitored closely before initiation
of anesthesia, checking the respiration and patient oxygenation together with the cardiac activity.
The nurse should anticipate complications during surgery and hence should work closely with
the other surgical team in monitoring the patient, administering the medications prescribed, and
ensuring the patient has followed the required food and fluid intake restriction before surgery.
The nurse should provide the patient has been well hydrated via intravenous fluid administration
to minimize complications of hypotension during the procedure due to blood loss.
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etail&mid=C10AE94F946C99E3DDC3C10AE94F946C99E3DDC3&&FORM=VRDGAR
Model 4 Intra and post-operative patient safety
General anesthesia involves a combination of inhaled gases and intravenous drugs that
are administered to the patient during surgery to provide analgesia, amnesia, hypnosis, and
reduced level of consciousness. The patient under general anesthesia has reduced the perception
of reflexes and pain. It is indicated in procedures that take a long time, where there is significant
blood loss anticipated, where exposure to cold is inevitable and in procedures that can affect the
breathing such as abdominal and chest surgeries (Löwhagen Hendén et al., 2017). Post-operative
care required in patients who were under general anesthesia includes monitoring the vital signs
postoperatively.

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Under general anesthesia, the patient is intubated and ventilated due to a reduced level of
consciousness hence; the nurse has a role in monitoring the patient can maintain normal
breathing after the reversal of the patient from anesthesia. The nurse has a position to assess the
level of consciousness by the use of the Glasgow coma scale to ensure whether the effect of the
anesthesia has been eliminated (Hausman, Jewell, & Engoren, 2015). The nurse has the role of
monitoring the patient's ability to swallow after general anesthesia. Intubation during anesthesia
may lead to trauma to the throat, making it difficult for the patient to take it easy. Nausea and
vomiting are the anticipated effects post general anesthesia; hence, the nurse should administer
antiemetic and position the patient to prevent aspiration of vomitus.
Local infiltration is the injection of an anesthetic agent into terminal nerve endings to
provide analgesia to the specific part of the body. In intra-op, it is used in minor surgical
procedures and dental procedures. It is used in procedures such as suturing, intravenous cannula
placement, superficial biopsy, and in pain management. The patient post-operatively requires
education on how to take care of the surrounding tissues.
The local anesthetic agent produces numbness to the surrounding tissue; hence, patients
are educated to prevent injury to the muscles during the numb periods (Yoshida, Tanaka,
Kawaai, & Yamazaki, 2016). Hematoma formation is a common complication when a local
anesthetic agent is used. It occurs when the agent is injected into the blood vessel instead of the
nerve hence lead to bleeding, causing hematoma that can cause severe complications. The nurse
should assess for signs of hematoma formation as it may affect tissue perfusion leading to tissue
ischemia and death. Special consideration, such as monitoring of vital signs, should be monitored
closely since toxicity from the agent can cause CNS depression and respiratory compromise.

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Spinal and epidural anesthesia provide numbness and analgesia in some parts of the body
during a surgical procedure. It is administered by an injection of the anesthetic agent into the
spine and is used in the abdominal, lower extremity and pelvic procedures as well as to provide
analgesia after significant surgeries (Huang, Hsieh, Wei, Sun, & Tsao, 2015). Spinal anesthesia
is applied through a single shot while in epidural, a catheter is inserted into the spine to deliver
timely anesthetic agents. Hematoma formation is a common complication of this type of
anesthesia. The patient is prone to drop in blood pressure hence requires close monitoring and
intravenous fluid administration to correct the low pressure. The patient needs special
consideration as he is susceptible to infection. The agent is injected directly into the spine hence
can act as a port for microorganism entry. The nurse should administer analgesics to the patient
after the procedure since this type of anesthesia causes severe headaches due to the disturbance
of the cerebrospinal fluid.
Adjuncts
Adjuncts are chemical agents that are used to amplify the effects of general anesthetic
agents, allowing their minimal dose usage hence reducing their side effects. Muscle relaxants are
agents such as succinylcholine and are used in blocking nerve impulse transmission to the
muscles. They are used to relax of the throat and neck to avoid injury during endotracheal tube
insertion (Julien-Marsollier et al., 2017). They also relax particular muscles during surgery to
enable smooth joint movement. Analgesics used in surgery are opioids and they act on opioid
receptors to reduce pain sensation. They are used preoperatively to prevent visceral and muscle
pain during the surgery and postoperatively.

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References
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