Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Oct 1998
ReviewPreoperative assessment criteria and patient teaching for ambulatory surgery patients.
Today's trend is to have the surgical patient return to the comfort of his or her home rather than be admitted to the hospital for expensive nursing and medical care. The perioperative team must initially assess the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity; obtain a medical and surgical history and consent; review laboratory, electrocardiogram, and radiological results; and perform preoperative teaching (e.g., which medications to take or withhold preoperatively, when to withhold food and fluids) and postoperative teaching (e.g., catheter care, dressing changes). In addition, the nurse needs to anticipate and be prepared for medical emergencies such as airway management problems and malignant hyperthermia. ⋯ Proper evaluation is the key to success for positive surgical outcomes. Given the time constraints in the ambulatory surgical setting, assessing and teaching the patient on the day of surgery is not feasible or appropriate. Reaching out to the patient a few days before surgery either in the patient's home, in the ambulatory surgery center, or by telephone is the ultimate goal.
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J. Perianesth. Nurs. · Oct 1998
ReviewMalignant hyperthermia: considerations for ambulatory surgery.
Patient care offered on an ambulatory basis continues to grow as evidenced by the high percentage of surgical procedures now being performed in such a setting. Many ambulatory surgical facilities are free standing and remote from the primary hospital location. ⋯ A comprehensive plan of patient care under these circumstances includes (1) the ability to identify the high-risk patient and to plan their care accordingly, (2) early recognition of the signs and symptoms of malignant hyperthermia, and (3) being prepared to promptly and efficiently treat a malignant hyperthermic event. This review article will offer guidelines for managing the malignant hyperthermia-susceptible patient in the remote ambulatory surgical setting.
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J. Perianesth. Nurs. · Oct 1998
Constant temperature monitoring: a study of temperature patterns in the postanesthesia care unit.
Patients admitted to the PACU from the operating room exhibit fluctuations in core body temperature during the course of their stay in the PACU. Some patients present with normothermia and experience temperature decreases later in their stay. PACU policy does not dictate that temperatures be measured at a predetermined frequency in the absence of hypothermia; thus, it is possible that hypothermia may not be detected at its onset. ⋯ Monitoring temperatures more frequently will result in detecting hypothermia at its onset. Nurses may use the axillary device as a trend for continuous monitoring. Length of stay may be shortened if temperature management is embraced by the PACU nurse.
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Many institutions continue to require surgery patients to take nothing by mouth after midnight despite current research that supports allowing most patients to drink fluids up to 3 hours before surgery. This study of 50 elective surgery patients describes their perceptions of discomfort caused by thirst. Results show that thirst caused significantly more discomfort to the patient than not being able to eat or sleep or worrying about the surgery itself. Given these results, nurses are urged to work within their institutions to change the current practice regarding preoperative fluid restriction.
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J. Perianesth. Nurs. · Aug 1998
Prevalence of inadvertent hypothermia during the perioperative period: a quality assurance and performance improvement study.
The inadvertent hypothermia that is often seen after anesthesia in a cool environment has been associated with delays in recovery from anesthesia and longer stays in the PACU. This quality assurance/performance improvement study was undertaken to determine the following: (1) the effectiveness of current interventions for preventing intraoperative hypothermia, (2) whether there were any apparent differences in effectiveness among the current methods for preventing intraoperative hypothermia, and (3) was intraoperative hypothermia associated with delays in discharge from the PACU. ⋯ Patients who arrived in the PACU hypothermic had longer PACU stays than patients who arrived normothermic. As a result of these findings, changes in nursing practice in the PACU and in the availability of the Bair Hugger in the operating rooms were made.