Practice in Perioperative Nursing Environment: Detailed Report

This report delves into the multifaceted world of perioperative nursing, encompassing the roles and responsibilities of enrolled nurses, surgical procedures, and patient care planning. It explores various case studies, including Laproscopic Nissen Fundoplication, excision of skin cancers, hemiarthroplasty, Dupuytren's contracture, and breast augmentation, detailing anaesthetic considerations and surgical techniques. The report also covers the scope of practice for enrolled nurses in Australia, emphasizing their role in patient support and care. Furthermore, it examines the development of care plans, the importance of the perioperative team, preoperative assessments, and the preparation of the operating room, including instrument and equipment checks. The report highlights the importance of nursing care before, during, and after surgery, emphasizing the application of best practices to achieve optimal patient outcomes. The report provides an overview of the perioperative nursing environment, focusing on key aspects of patient care and the roles of healthcare professionals involved.

Practice in the perioperative
nursing environment

Table of Contents
INTRODUCTION...........................................................................................................................1
Steps Taken By Enrolled Nurse For Patient Care............................................................................1
Enrolled nurse scope of practice in Australia .................................................................................1
PART 1............................................................................................................................................2
Part-2................................................................................................................................................1
PART-3............................................................................................................................................2
PART 4............................................................................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Perioperative nursing can be considered as a special nursing which involves working for
patients having invasive or operative practices (Cant and Cooper, 2010). Along with the
surgeons, these nurses works closely with them. The report includes different case studies
involving their surgical procedures along with the anaesthetic details.
Steps Taken By Enrolled Nurse For Patient Care
There are some responsibilities that has been assigned to the Enrolled nurses by the Nursing and
Midwifery Board of Australia (NMBA) and these are discussed as under :
 The Enrolled nurses (EN's) have to work under the supervision of a registered nurse and
the supervision can be direct as well as indirect.
 The enrolled nurses provides proper support and care to the patients, emotionally as well
as physically.
 These nurses facilitates the individual along with the family in order to maintain their
mental stability regarding the outcomes of the reports of the patient.
 These nurses utilizes their reflective skills in the whole decision making process of
services and medications which are to be provided to the patient.
 They are well respected members of the nursing fraternity who are well educated and can
go for further studies as well.
 They are meant to provide the delegated acre to the patients.
 If they have completed their study about the administrations of the medicines, they can
administer the medicines as well to the patients without the requirement of any further
preference (Enrolled Nurses and medicine administration, 2017).
 They take part with the registered nurses, in order to provide the patient an efficient and
appropriate care. Attention of two nurses at a time can help the patients in a fast recovery.
Enrolled nurse scope of practice in Australia
The practice of nursing and midwifery in Australia is regulated by the Nursing and
Midwifery Board of Australia (NMBA). The main objective is to protect the public. If the
enrolled nurses have studied the medication administration education at specific point of their
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career then they are able to administer medicines (Fisher, 2017). The medicines can be
administered by the enrolled nurses. Within the NMBA approved standards for practice and
decision-making standards the enrolled nurses are expected to practice. Under the direction and
supervisions of the registered nurse, the enrolled nurse provided the nursing care. The educated,
qualified and regulated nurses must provide nursing care. By the extent of educational
preparation, the scope of practice for enrolled nurses is determined. The acuity of a human that
need nursing care can be determined with the help of scope of practice for nurses (Halcomb and
Ashley, 2017).
PART 1
1. As Laproscopic Nissen Fundoplication surgery is going to be done to Mr Snout. This
operation is being done for the treatment of gastroesophageal reflux disease (GERD) and
also of hiatal hernia. The procedure includes some steps such as operative techniques,
anaesthetic considerations , temperature control and the venous gas embolism.
The surgical procedures of this is done in a way that the fundus portion of the stomach is being
wrapped around the bottom part of the oesophagus and is being sewn there. Two to three hours
are a maximum for this surgery (Paul., 2016).
While the operation of Mr Snout, anaesthesia induced with fentanyl, rocuronium and midazolam
will be used in the whole surgery. Also, it will be maintained with the sevoflurane and
remifentanil.
(https://emedicine.medscape.com/article/1892517-overview?pa=zDoUG
%2BUEvC1UmEoSIWGgM3H4Fj8T3Okci5BJtgnx%2FEYkLbHYm3GSPxhAV
%2FFyvaSYLqFsyV%2Fdhg20ybnRLaHm4urXVu%2Ff6yEbtozmzn9k4Ws%3D)
REFERENCE:
Paul., F. 2016. Laproscopic Nissen Fundoplication. [Online]. Available through:
<https://emedicine.medscape.com/article/1892517-overview?pa=zDoUG
%2BUEvC1UmEoSIWGgM3H4Fj8T3Okci5BJtgnx%2FEYkLbHYm3GSPxhAV
%2FFyvaSYLqFsyV%2Fdhg20ybnRLaHm4urXVu%2Ff6yEbtozmzn9k4Ws%3D>. [Accessed
on 21st October 2017].
2. Mrs Blogs at the time of undergoing the Excision of SCC Left Forearm with SCG from
Left upper arm surgery. Although she has no health issues but is undergoing this surgery
for basal and squamous cell skin cancers. First a thin layer of the skin is getting removed
2

by the surgeon (Wells and et.al., 2013). Then, proper checking of the sample is being
done under the microscope. Another layer of the skin is being reduced if cancer cells are
seen.
Local anaesthesia is being used in this procedure and the cancer cells are being excluded off the
skin.
(https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating/surgery.html)
REFERENCE:
Suregry for Squamous cell skin cancers. 2017. [Online]. Available through:
<https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating/surgery.html>.
[Accessed on 21st October 2017].
3. Mrs Weeding is undergoing a surgery of Hemiathroplasty right knee. Sometimes,
arthroscopic debridement is being observed in mild joint issues which includes
mechanical symptoms. The surgical procedures include the hemiarthroplasty which
replaces the whole ball of the joint (Pupkiewicz, Kitson and Perry, 2015). Also, it permits
the patients to start walking after the surgery itself, in order to get it back as soon as
possible, so that the patient may not have to face any issue.
4. Ms Bell, a stenographer would be under going a surgery, Dupuytrens Contracture Left
hand. Because of this situation, her fingers have bent. A recurrence rate in this problem is
about 39%. The surgical procedure for this should be done on an metacarpophalangeal
joint if the contracture has been observed as 30% or more (Higgs and Fernandez, 2016).
Local anaesthesia will be provided to Ms Bell here but it should be induced with
epinephrine. It is also considered as the wide awake approach and this involves
fascietomy with no tourniquet (William, 2017). This approach provides better outcomes
with the lower risk rate to the patient as well.
https://www.medicinenet.com/dupuytren_contracture/article.htm
REFERENCE:
William., C. 2017. [Online]. Available through :
<https://www.medicinenet.com/dupuytren_contracture/article.htm>. [Accessed on 21st October
2017].
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5. Ms Holly Meredith will be undergoing bilateral breast augmentation. As she is not
satisfied with her body, she plans to have a surgery. This surgery is meant for enhancing
the breasts with the help of surgical placement or implantation. There are two types of
breast implantation which involves silicone or saline filled (Cant and Cooper, 2010). She
is opting the silicon based, although both the methods have their own set of advantages.
General anaesthesia is given in this condition as it provides sufficient relief from the
medications given.
https://www.nhs.uk/conditions/cosmetic-treatments-guide/pages/breast-enlargement.aspx
REFERENCE:
Breast enlargement. 2017. [Online]. Available through:
<https://www.nhs.uk/conditions/cosmetic-treatments-guide/pages/breast-enlargement.aspx>.
[Accessed on 21st October 2017].
6. Mr Smith has been going under an abdominoplasty and liposuction surgery as he was
facing some issues. As he has some issue with his obesity, he is getting treated under this
surgery. It is a cosmetic surgery in which the focus is on making the abdominal flatter. In
this, the excess fat is being removed by the surgeons (Reath, 2013). General anaesthesia
will be given to Mr Smith so as to stay from the pain for a period of time.
https://www.dbreath.com/blog/coolsculpting-vs-liposuction-vs-tummy-tuck-heres-the-skinny/
REFERENCE
Reath. 2013. [Online]. Available through: <https://www.dbreath.com/blog/coolsculpting-vs-
liposuction-vs-tummy-tuck-heres-the-skinny/>. [Accessed on 21st October 2017].
4

Part-2
1. The care for the clients will be planned. The emphasis will be paid on the health care of
clients. All the requirements of the clients regarding the health care will be fulfilled. The
health care plan will be developed in order to monitor the improvement in the health of
clients (Care for patients, 2017 ). For reimbursement the care plan will be serve as a
guide. In order to appoint the nurses to care for the clients they will serve as a guide
(Siirala and et.al., 2016). The clients need to be educated so that awareness regarding the
problem that they are facing can be made. The discharge planing will be done once there
is improvement in the health of the clients
(https://www.ncbi.nlm.nih.gov/pubmed/24978064).
2. The members of perioperative team can be surgeons as direction is provided to achieve
the best results. When the person is in anaesthetised state anaesthesia maintains a
homoeostatic balance(Perioperative team, 2017). In order to hone a technical
competencies a technologists respond to visual and auditory cues (Pupkiewicz, Kitson
and Perry, 2015). The objective of perioperative team is to provide clients with
safe,efficient care. Before and during the period of anaesthesia the anaesthetic nurses
demonstrates competence in caring for patients. The competency for caring by recovery
room nurse is demonstrated for post surgical and post procedural patients. In order to me
the needs patients the perioperative nurses work with other members of multi-disciplinary
health care team(http://www.infectioncontroltoday.com/articles/2001/06/working-as-a-
perioperative-team.aspx)
Perioperative team. 2017. [Online]. Available through:
<http://www.infectioncontroltoday.com/articles/2001/06/working-as-a-perioperative-
team.aspx/>.[Accessed on 21st October 2017].
3. Through perioperative assessment it had been been found in case if there have been
increase in heart beat of client .In this case the nurses need to report this matter to
cardiologist(Perioperative assessment, 2017.) .However there can be case of high BP so
the nurses that are examining that client need to report to this to higher authorities such as

doctors or specialist. These specialist then will give treatment to the clients as per the
requirements(http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/
preventive-medicine/perioperative-evaluation/).
2

Perioperative assessment. 2017. [Online]. Available through:
<http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/
perioperative-evaluation//>.[Accessed on 21st October 2017].
4. The tools that can be used in the preparation for a surgical procedure can be FBC .This
tool will help to demonstrate anaemia (Tools for surgical procedure, 2017). In order to
measure the haemoglobin it is useful. After major surgery U&Rs detects underlying
renal deficiency and the possibility of acute kidney failure. LFTs will help to determine
whether the patient is having any underlying malnutrition (Wells and et.al., 2013) .The
examination will help to determine local skin infection,abnormal breath sounds and heart
murmur etc. For cardiac and pulmonary complications and in order to find out the patient
functional capacity a history and physical examination will focus on factors of risk. The
surgery which is needed should be documented. The overall health status of patients
need to be assessed(http://www.nursingcenter.com/journalarticle?Article_ID=822766).
Tools for surgical procedure. 2017. [Online]. Available through:
<(http://www.nursingcenter.com/journalarticle?Article_ID=822766/>.[Accessed on 21st October
2017].
3

5. During the preoperative period the patients is prepared psychologically and
physiologically for surgery (Preoperative period, 2017). The patients lies on a portable
bed with wheels as they wait. Depending on the surgery there can be requirement of
blood test. Towards treating or minimizing pre-existing medical solutions interventions
are directed. To achieve positive patient outcomes nursing activities are planned (Higgs
and Fernandez, 2016). The nursing activities such collecting of data through assessment
of patients ,family/patient teaching etc. are focused by nurses. In order to address desired
patient outcomes the preoperative assessment provide information. Through the surgical
experience the intervention can provide support to
patients(http://www.healthcommunities.com/before-after-surgery/preoperative-
procedures-surgery.shtml).
Preoperative period. 2017. [Online]. Available through:
<http://www.healthcommunities.com/before-after-surgery/preoperative-procedures-
surgery.shtml/>.[Accessed on 21st October 2017].
PART-3
1. The team of highly trained professionals are hired for the operating rooms who provide a
safe and secure environment for surgery (Operating rooms team, 2017). The different
specialist is there for each OR. The list and equipment are checked that are prepared one
night before. This is done to see whether there is need for additional items or not (Koy
and et.al., 2017). In the OR for the case the orderlies should have extra equipment such as
correct operating table,laser etc. By the orderly and anaesthetic nurse the patients is
brought into theatre(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547842/).
Operating rooms team. 2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547842/>.[Accessed on 21st October 2017].
2. When the patients is brought into by Orderly and Anaesthetic nurse the final check is
conducted to ensure that right patients,right operation and any allergies. To anaesthetise
4

the patients the Anaesthetist is proceeded (Role of nurses, 2017.). The equipments are
then prepared by the scrub nurse and count have been completed by the scout nurse. To
complete the sterline environment the scrub and scout nurse are aware (Wells and et.al.,
2013). After giving anaesthesia to patient they are prepared for the operation. With the
antiseptic solution the skin of patient is then prepared and with sterile drapes it is draped.
The trolley and Mayo instrument are now brought by the scrub nurse in operational
environment(https://www.nursesource.org/perioperative.html/).
Role of nurses. 2017. [Online]. Available through:
<https://www.nursesource.org/perioperative.html/>.[Accessed on 21st October 2017].
3. Before and after the surgery the nursing care to patient will be given. As an
interdisciplinary team the perioperative nursing roles work together. They will work by
applying best practices in order to achieve the optimal patient outcomes. The education to
patient will be provided before and after the surgery (Role of perioperative nursing
during surgery, 2017). The nurses will continuously monitor the patients at regular time
in order to check that whether there is any improvement is there in health or not. They
need to make sure that correct patient,correct site and correct procedural protocol is used
(Battié and Steelman, 2014). In case of nay inconsistencies the time out provide a last
chance to ask questions to each member of team. So the nurses can opt for time out
before commencing the procedure to a perform a final check to ensure that correct
patient is undergo correct procedure on correct
site(http://www.healthcommunities.com/before-after-surgery/preoperative-procedures-
surgery.shtml).
Role of perioperative nursing during surgery. 2017. [Online]. Available through:
<http://www.healthcommunities.com/before-after-surgery/preoperative-procedures-
surgery.shtml/>.[Accessed on 21st October 2017].
4. In anaesthesia management the roles of nurse begins with preoperative assessment of
patients and completes when the patients is recovered from the effect of anaesthesia. The
5

nurses can provide medicines such as people as it is an intravenous drugs that will
maintain general anaesthesia. For sedation during procedures or in the ICU it can be used
(Cant and Cooper, 2010). For oral premedes the nurses can use Benzodiazepines.The IV
therapy can be used as a therapeutic treatment and the nurse can make use of other drugs
and gain knowledge regarding anaesthetic drugs (Anaesthesia management, 2017.). In
order to evaluate and ,manage hospitalized patients whose conditions is deteriorating the
emergency response teams have been introduced by hospitals .In order to deliver care to
patients the ERT is designed. The patients are given special care by the nurses during
emergency .All he nurses make sure that all needs of patients are fulfilled
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942834/ ) .
Anaesthesia management. 2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942834/ >.[Accessed on 21st October 2017].
5. Aseptic Technique (ACORN standards) – For handling of sterline articles the
perioperative team shall follow a standardised procedure in order to reduce the risk of
the clients to micro-organism surgery(Aseptic Technique (ACORN standards), 2017. ).
The patient surgical outcome can be influenced by knowledge and application of aseptic
technique
(https://www.rch.org.au/surgery/local_procedures/Aseptic_Technique_in_the_Perioperati
ve_Unit/).
Aseptic Technique (ACORN standards). 2017. [Online]. Available through:
<https://www.rch.org.au/surgery/local_procedures/Aseptic_Technique_in_the_Perioperative_Un
it/>.[Accessed on 21st October 2017].
6. Use of Electrosurgical Equipment – In eye surgery to cut,dissect and shrink
tissue electrosurgery is used ( Use of Electrosurgical Equipment 2017.). Both the active
electrode and return electrode functions are performed in bipolar electrosurgery at the site
6