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Intraoperative Nursing Care Plan CRANIOFACIAL RECONSTRUCTION Judith A. Claussen, RN Nursing diagnosis Parental anxiety secondary to fear of complicated surgical procedure
Nursing actions Reinforce preoperative teaching as necessary.
Make postoperative visit to evaluate patient/ family teaching.
Parent’s anxiety not transmitted to patient Parents able to take part in patient’s postoperative care
Insert Foley catheter and connect to gravity drainage; record catheter size, balloon size, and time and date inserted.
Urine output adequate for patient’s age and weight
Provide supplies and assist anesthesiologist with insertion of peripheral intraveneous (IV) lines, arterial lines, and cutdown procedures.
Intraoperative and postoperative hematocrit (Hct) at or above preoperative level
Measure, report, and record weight of sponges and irrigation fluids used on sterile field. Provide suction canisters marked in 5 mL increments in full view of anesthesiologist and record and report level of contents every 30 minutes or as requested by anesthesiologist. Follow hospital procedure for patient identification and verification before blood products are given. Provide supplies and equipment for transfusion of blood products. 512
Patient can be comforted by parents
Meet parents preoperatively if possible. Maintain frequent phone contact with parents to report progress of procedure and patient’s condition.
Potential fluid deficit secondary to NPO status and blood loss
Intraoperative and postoperative vital signs at preoperative level
OCTOBER 1986, VOL. 44, NO 4
Nursing diagnosis Potential hypothermia secondary to lengthy surgical procedure
Nursing actions Adjust and maintain the temperature of the operating room suite at a level to maintain the patient's temperature at 37 OC (98.6 OF).
Patient outcomes Postoperative temperature within 0.5 "C (0.9 OF) of preoperative temperature
Provide warming lights to be used a~ needed. Provide warming blanket unit filled to appropriate water level. Provide warming blanket on OR bed and a second blanket to cover patient as requested by anesthesiologist. Maintain warming unit temperature at 38 OC (100.4 OF) unless otherwise requested by
anesthesiologist. Provide blood warming unit for anesthesiologist. Insert lubricated rectal temperature probe and tape securely in place avioding contact with electrocardiogram (ECG) electrodes or electrocautery grounding pad. Provide irrigation fluids warmed to body temperature. Potential infection secondary to disruption of integumentary system
Provide appropriate neurosurgical headrest and adequate materials for padding headrest. Ensure that patient is not lying on wrinkled sheets, IV tubing, Foley catheter tubing, ECG wires. or needles. Place sheepskin under all boney prominences, buttocks, and over penis if necessary.
Afebrile postoperatively Postoperative white blood count and differential within normal limits
No evidence of pressure sores, nerve palsies, or bums postoperatively
Provide knee roll. Provide equipment and supplies to shave and prepare head. Provide tape for neurosurgeon to stabilize head on headrest. 573
OCTOBER 1986, VOL. 44, NO 4
Cover patient with blanket and place safety strap loosely over patient’s knees. Place electrocautery grounding pad on patient’s buttocks or thigh, avoiding bony prominences. Ensure that the anesthesiologist has lubricated the patient’s eyes and lips. Maintain sterile technique and report and correct any breaks in technique. Provide closed drainage systems for postoperative drainage collection.
Caps, Masks, Boots Not Needed in Delivery Rooms
Grant Awarded to Study Hospital Rate Setting
Wearing caps, masks, or boots does not affect the infection rates for vaginal deliveries in hospital delivery rooms, according to a study reported in the April issue of the Canadian Nurse. Researchers from the University of Western Ontario, London, Ontario, compared the infection rates of patients whose nursing staff wore caps, masks, or boots (the control group) to those of patients whose nursing staff did not wear the materials (the study group). There were 648 patients in the study group and 61 1 in the control groups. Follow-up efforts produced a response rate of 37%in the study group and 40%in the control group. A total of 23 infections were identified11 in the control group and 12 in the study group. According to the researchers, the results showed no significant difference between the two groups in postdelivery infection rates. The types of infection identified were puerperal fever, staphylococcal sepsis of the perineum, sepsis at the site of injection, or any septic condition of the infant. Urinary tract infections were not included in the study.
The Johns Hopkins Medical Institutions (JHMI), Baltimore, have been awarded a grant to test a new way to measure how much and what kind of nursing care different patients need. The Maryland Health Services Cost Review Commission made the award to JHMI in an effort to improve the hospital rate-setting system. Hospital nursing budgets in general account for more than 20%of total hospital budgets. The study of the Nursing Intensity Index is expected to show how hospitals spend nursing care dollars. The index, designed by Judy A. Reitz, RN, ScD, is more sensitive than other systems to nursing case mix, a term that describes the proportion of different kinds of patients. The more intense nursing care a patient requires, the more costly are the patient’s services. JMHI will collect data on 7,600 patients at seven Maryland hospitals.A 30%random sample of patients will be selected from all discharges occurring during January, February, and March 1986 in the seven hospitals.