* Prevention of fluid and electrolyte imbalance, dehydration and sepsis (IV fluids) *Jean is vomiting* (check vomitus for blood) * Fluid balance chart
* The insertion of IV cannula
* Remains Nil by Mouth-insertion of NG tube
* Central Pulse - rate, volume & regularity * Pulse rate on admission – 98 beats/min * Peripheral pulses
* Blood pressure
* *Respiratory rate*
* Capillary refill (teach importance of removal of nail polish/make up – circulatory assessment) * Skin colour, appearance, texture and turgor. *Jean was hot & clammy on admission- Temp 38.1* * Assessment for DVT (prophylaxis, e.g antiembolic stockings stockings) *Jean is on oral contraceptive, a risk factor for DVT* * Involve the physiotherapist for pre-op education (leg movement exercise to improve circulation) * Teach importance of early ambulation post-operatively
* Urinary output (insertion of urinary catheter)
* Bowels open (check for bowel sound)– no laxatives or enema – risk of perforation of the appendix * 12-lead ECG, X-ray, blood test *(including pregnancy test)*
The goal in preparing any patient for surgery is to ensure a well- functioning cardiovascular system to meet the oxygen, fluid, and nutritional needs of the perioperative period (Smeltzer et al., 2008). Jean presented with severe abdominal pain, vomiting and is not to have anything orally to ensure complete emptying of her gastric contents in preparation for her surgery. My first priority in her pre-operative circulation assessment and management would be pain management, promotion of adequate renal function by prevention of fluid and electrolyte imbalance, dehydration and sepsis as stated by Smeltzer et al., (2008). Morgan and Wood (2010) also found that optimum preoperative nursing management of patients with acute appendicitis includes, pain management, elimination of infection due to potential or actual disruption of the GI tract, preventing fluid volume deficit and to keep patient hydrated before surgery is performed. I would call the duty doctor or the site manager according to my trust policy to insert a cannula for Jean’s IV access. In doing this, I will ensure that it is performed under strict aseptic technique to prevent infection as IV cannula are known to be a source of infection according to Morgan and Wood (2010). Once the cannula is inserted, I will commence prescribed IV fluids, analgesics and antibiotic therapy as soon as possible to ensure Jean does not get dehydrated, her pain controlled and possibility of infection reduced. If Jean continues to vomit, she is likely to have paralytic ileus and as such, I will liaise with the doctor for possible insertion of nasogastric tube as suggested by Smeltzer et al., (2008). I will also examine the vomitus for presence of blood to rule out possible haemorrhage. If there is significant presence of blood, I will call the surgical team as a matter of urgency to reassess her. I will also commence and maintain a fluid balance chart, outlining all fluid input (intravenous) and output (e.g. urine, vomitus and nasogastric content), and her output should tell me if she is producing adequate urine (0.5ml/kg body weight per hour (Morgan and Wood, 2010).
These will facilitate the early identification of fluid loss or excess, which I can raise with the surgical team for appropriate management prior to surgery. Jean’s blood pressure (116/60mmHg) and pulse (98beats / min) on admission was not a problem as they were in the normal range of 90/60mmHg – 140/90mmHg and 60-100beats/min according to Morgan and Wood (2010). However, I will keep assessing them every hour as suggested by (Funell et al., 2005) for early detection of deterioration. I will manually check her pulse as this will enable Jean’s pulse rate, volume and regularity to be assessed at the same time as feeling her skin temperature and texture/turgor to know if she is dehydrated. Bounding pulse,...
Please join StudyMode to read the full document