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
1

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].
3

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

of surgery. This will help to give treatment to mr.smith. In the surgery of mr.smith this
equipment will be used
(http://www.boviemedical.com/downloads/UnderstandingElectrosurgeryLit_r3.pdf).
Use of Electrosurgical Equipment . 2017. [PDF]. Available through:
<http://www.boviemedical.com/downloads/UnderstandingElectrosurgeryLit_r3.pdf>.[Accessed
on 21st October 2017].
7. Role of the circulating nurse and the surgical count (ACORN standards) – The
scrub nurse counts all instruments,sponges and other tools after the operation
(http://perioperativensg.blogspot.in/2011/01/duties-of-scrub-nurse.html).The surgeon is
informed of the count (Role of the circulating nurse and the surgical count, 2017.). In
order to make sure that OR is set up correctly the circulating nurse is responsible
(Pupkiewicz, Kitson and Perry, 2015).
Role of the circulating nurse and the surgical count. 2017. [Online]. Available through:
<http://perioperativensg.blogspot.in/2011/01/duties-of-scrub-nurse.html>.[Accessed on 21st
October 2017].
8. Monitor safety standards and positioning aides – For the surgical procedures
the roles of scrub nurses are so vital. They need to work for long hours even for single
operation (http://perioperativensg.blogspot.in/2011/01/duties-of-scrub-nurse.html). The
Laparoscopic equipments,laser equipments can be used for safety ( Monitor safety
standards and positioning aides, 2017). They work for the safety of patients and make
sure that secure atmosphere is given to patients.
Monitor safety standards and positioning aides. 2017. [Online]. Available through:
<http://perioperativensg.blogspot.in/2011/01/duties-of-scrub-nurse.html>.[Accessed on 21st
October 2017].
9. In case of emergency event,the hospital staff and service personnel agencies will be noted
regarding the event that has taken place (Emergency event, 2017). Based on the event
7

they have to prepare for the surgery the actions for the surgical procedures will be taken
by them (https://www.ncbi.nlm.nih.gov/pubmed/8590297).
Emergency event. 2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/pubmed/8590297>.[Accessed on 21st October 2017].
10. In the operating room hair removal should be performed. The use of iodophor-in-alchol
solution can enhance the drape adhesion to the skin. With TGA approved antimicrobial
agents the surgical site shall be prepared (Operative room, 2017). Before surgery the
patients should perform a preoperative bath .The gross contaminates and oils can
removed by this. Based on patients allergies the antimicrobial agent should be selected
(https://www.nurse.com/blog/2016/11/25/insight-into-perioperative-nursing/).
Operative room .2017. [Online]. Available through:
<https://www.nurse.com/blog/2016/11/25/insight-into-perioperative-nursing/>.[Accessed on 21st
October 2017].
11. Lasers and X rays are widely used in the perioperative environment for patinst mr.smith.
The lasers has a work of emitting the light by a process of optical amplification that is
based on the emission of electromagnetic radiations (Battié and Steelman, 2014). The
rays are of specific wavelength in a laser(Lasers and X rays ,2017). This light is so sharp
and intense that it can even used in cutting the diamonds as well. X rays are also
radiations which are used in taking the photographs for internal structure of a human
body. The rays can penetrate through the skin and the tissues of the body
(https://www.nurse.com/blog/2016/11/25/insight-into-perioperative-nursing/).
Lasers and X rays .2017. [Online]. Available through:
<https://www.nurse.com/blog/2016/11/25/insight-into-perioperative-nursing//>.[Accessed on 21st
October 2017].
12. Control over infections are considered as the procedures and policies that reduces the
overall risk of the spreading of the infections (Risk of spreading of the infectious , 2017.
). There are a variety of infection control practices that can help in the overall
8

transmission of the infections (https://www.ncbi.nlm.nih.gov/books/NBK2683/). Some
very basic infection control principles includes the hygiene of the hands, safety measures
regarding the injections, cleaning of the environment, respiratory hygiene and various
transmission based precautions (Rubino and et.al , 2010).
Risk of spreading of the infectious .2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/books/NBK2683/>.[Accessed on 21st October 2017].
13. In this procedure, various wound drains can be used. These includes Sanguineous,
serous, measuring and purulent drainage (Drain surgery, 2017 ). A drain after a surgery is
must because it helps in a faster healing of the wound and also, helps in preventing the
infection. These helps in excluding the area of pulse, blood or any other fluid that is not
required there and is causing harm to the skin. The dead space can be removed with the
help of a drain surgery(https://www.ncbi.nlm.nih.gov/books/NBK2683/). This, further
minimizes the rate of infection as well.
Drain surgery.2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/books/NBK2683/>.[Accessed on 21st October 2017].
14. There are some key aspects in the standards and licensing for using these equipments
and these are discussed as under :
1. Clinical aspects
This considers the standards of specific areas that are not used to specifically articulated in the
present set of the standards. These aspects includes various management on different operations
such as the pain and continence management, mobility and falls prevention (Karen, 2007).
2. Organisational aspects
The organisational aspects understands the lapses in the delivery of the care reflects all the gaps
in all the organisational systems and along in the human management capabilities.
3. Social aspects
9

The social aspects undertakes the dignity of care for the residents along with the articulated
standards for care. It also ensures the fact that the family members and the related individuals are
to be informed under any circumstances.
(http://usir.salford.ac.uk/2062/1/Thesis_2008_Final_May_2009.pdf)
REFERENCE:
Karen., M. 2007. [Online]. Available through:
<http://usir.salford.ac.uk/2062/1/Thesis_2008_Final_May_2009.pdf>. [Accessed on 21st October
2017].
15. A restrictive protocol is being used for the transfusion of the blood. Along with the direct
and the indirect costs of the transfusions, these protocols are held for a minimum (Jorge,
2008). It helps in restoring the oxygenation of the tissue. Instead the transfusions of the
platelets are quite less than that of others, it results in storage lesion with the concern.
(https://www.medscape.com/viewarticle/575795)
REFERENCE:
Jorge., C. 2008. [Online]. Available through: <https://www.medscape.com/viewarticle/575795>.
[Accessed on 21st October 2017].
16. For admitting in the operation theatre, it is essential to provide some specific documents
which involves the the claim form, admission form, identity card, address proof, previous
investigation reports etc. These are very essential to submit in the hospital by the specific
family of the patients. All these formalities need to completed before the initialisation of
the operation (Wells and et.al., 2013). A patient can be admitted in the operation theatre
but various hospitals had a rule of submitting the payment before starting any operation
or treatment. According to the new rules and regulations, the treatment for the sick is
important to be started and afterwards, the formalities can be completed in the same.
10

(http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionf/
f_theatre.pdf)
REFERENCE:
Admission and identification of patient to Theatre . 2017. [Online]. Available through:
<http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionf/
f_theatre.pdf >. [Accessed on 21st October 2017].
17. There are various types of wound dressing which includes Hydrocolloid, Hydrogel,
alginate and collagen. Hydrocolloid dressing is being used on the burns or necrotic
wounds. It can also be used at the time of pressure and the venous ulcers. Hydrogel
dressing is used for the wounds that has no or very less fluid (Rubino and et.al , 2010).
Also, it is being used in the more painful wounds to provide a sooth or relief to the
wound. Alginate wounds are used when there is a low to higher drainage of the wound.
Collagen dressing is being used for chronic wounds, ulcers, sores and the surgical
wounds etc.
(https://www.advancedtissue.com/different-types-wound-care-dressings/)
REFERENCE:
Choosing the proper wound dressing assists with wound healing., 2017. [Online]. Available
through: <https://www.advancedtissue.com/different-types-wound-care-dressings/>. [Accessed
on 21st October 2017].
18. There are various risk factors that can be maintained while transferring the client from
operating table to the PAR. The hygiene of the bed may not be that good that the patient
may not get affected by any infection or diseases (Pupkiewicz, Kitson and Perry, 2015).
It is not necessary that the patient is that much comfortable in the PAR to that level in
which he were comfortable in the operating room (Alison and et.al.,2017). The beddings
in the PAR may not be that clean and neat as was in the OR.
11

(https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/252436/operating-theatre-
efficiency-guidelines.pdf)
REFERENCE:
Alisonand et.al.,2017 Alisonand et.al.,2017Alisonand et.al.,2017. [Online]. Available through:
<https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/252436/operating-theatre-
efficiency-guidelines.pdf>. [Accessed on 21st October 2017].
19. Nursing actions for cleaning the theatre includes various activities such as the essential
one, consideration of the health and safety issues in the operation theatres. During the
perioperative time, some members of the disciplinary team must be present there so as
they can be able to monitor the staff properly (Alison and et.al, 2017). These should be
those members who are enough skilled and had a great amount of knowledge regarding
the health and safety measures. These cleaning assessments are necessary as it effects
many people inside the operation theatre such as the patient, surgeon, anaesthetic and the
other assistants.
(https://www.ncbi.nlm.nih.gov/books/NBK2661/)
REFERENCE:
Alison., M. and et.al., Personal safety for nurses. 2017. [Online]. Available through:
<https://www.ncbi.nlm.nih.gov/books/NBK2661/>. [Accessed on 21st October 2017].
PART 4
1.
 Airway management acts as an efficient tool in regarding with the care in the
PAR. Inefficient amount may lead to hypoxaemia and may affect bad on the
health of the patient (Siirala and et.al., 2016).
 The level of consciousness is subdivided in three parts named alertness,
awareness and the wakefulness. Clouding in case of consciousness means
altered status of the mental health which makes the patient less alert and in
attentive.
 There should be proper and accurate equipments for observing the patients.
Also, the cleanliness and safety should be measured in order to keep the
12

patient away from any further infection or health issue. It is the responsibility
of the management to keep proper equipments for the observation of the
patient (Rubino and et.al , 2010).
 Pain management can be done by various means. Either by giving the patient,
some sort of pain killer or any injection that can help in providing them a sort
of relief from the pain. It should be given the authority itself but in limited
doses so that it may not affect some internal body part of the patient and had
a side effect.
 PONV is considered as the postoperative nausea and vomiting. It refers to the
condition in which after 24 or 48 hours, the patient is unable to feel good and
is observing a sense of nausea or vomiting. It is often seen in the patients
that they do not feel for a little time after the operation. It may be because of
various reasons or may be the patient has gone through the surgery for the
first time (Lynda, 2017).
 Medical administration is also necessary as the processes and surgeries if
undertaken by the medical administration may have lesser chances of any
risks and more focus will be on a better health of the patient.
 Neurovascular observations consists of the monitoring of five essential
elements which includes the pain, pallor, pulse, paralysis and the paraesthesia
(Havens and et.al, 2010).
 Monitoring of the drains and the dressings is necessary to stay away from
any further infections. This will also help in covering up the wound faster.
 IVT Therapy and PCA education are those two techniques in which the
nurses who have gone through the complete nursing program have been
appointed.
(https://books.google.co.in/books?
id=PoawIB6Pfv8C&pg=PA42&lpg=PA42&dq=nursing+interventions+in+relation+to+care+in+t
he+PAR&source=bl&ots=y-W_1bmUoS&sig=EfLJycRr--
sZhcwQTWKQAfK4XWM&hl=en&sa=X&ved=0ahUKEwiC17Ps_IDXAhXLOY8KHbSNA8
13

AQ6AEIJzAA#v=onepage&q=nursing%20interventions%20in%20relation%20to%20care%20in
%20the%20PAR&f=false)
REFERENCE :
Lynda., J. 2017. [Online]. Available through: <https://books.google.co.in/books?
id=PoawIB6Pfv8C&pg=PA42&lpg=PA42&dq=nursing+interventions+in+relation+to+care+in+t
he+PAR&source=bl&ots=y-W_1bmUoS&sig=EfLJycRr--
sZhcwQTWKQAfK4XWM&hl=en&sa=X&ved=0ahUKEwiC17Ps_IDXAhXLOY8KHbSNA8
AQ6AEIJzAA#v=onepage&q=nursing%20interventions%20in%20relation%20to%20care%20in
%20the%20PAR&f=false >. [Accessed on 21st October 2017].
2. The discharge is being given to the patient only in case if he/she has been recovered well.
The patient is being check one last time for any further medications and clinical
assessment (Jenni, 2003). If all the reports came normal, positive or within the limits, the
patient can be discharged without any issue. Another important thing that needs to be
fulfilled are the formalities of the hospital including the payments about the medicines
etc. After that only, a gate pass has been issues and the patient can be discharged easily.
(https://www.nursingtimes.net/clinical-archive/public-health/criteria-for-the-safe-discharge-of-
patients-from-the-recovery-room/205256.article)
REFERENCE:
Jenni., M. 2003. [Online]. Available through:
<https://www.nursingtimes.net/clinical-archive/public-health/criteria-for-the-safe-discharge-of-
patients-from-the-recovery-room/205256.article>. [Accessed on 21st October 2017].
CONCLUSION
From the report it was concluded that the perioperative nurses works very closely with
the surgeons and so, they assist them in every procedure they do. Also, surgical procedures have
been included for each case study provided along with the proper details of providing
anaesthetics to the patients.
14

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