Day_Surgery_Course

What This assessment will be in the form of a critical reflective account, demonstrating competency in pre-assessing the patient suitability for day surgery and discharging day surgical patient. discroll’s model of structured reflection will be used, the hospital’s name will not be mentioned and the patient`s name has been changed to John respecting patient confidentiality according to Nursing and Midwifery Council (NMC) 2008. John was a 40 year old man and he worked as a lorry driver. He was referred by his general practioner (GP). He had episodes of acute onset pain due to cholecystitis. The issues to be discussed in depth will be obesity and smoking prior and after surgery. Pre-operative assessment establishes that the patient is fully informed and wishes to undergo the procedure. It ensures that the patient is fit for the surgery and anaesthetic. It minimises the risk of late cancellations by ensuring that all essential resources and discharge requirements are identified and coordinated (NHS Modernisation Agency, 2003). My aim was to provide a standardised high quality of care and accurate assessment of the patient. Fitness for anaesthetic is vital in day surgery to be successful and uncomplicated. I will be presenting a laparoscopic cholecystectomy utilising the evidence available from the literature. Before I called John in the pre-assessment room, I read through his notes which confirmed that he has been suffering from cholecystitis. Both GP and surgeon felt that he would benefit from having his gall bladder removed. John was call into the room and was made comfortable and he appeared friendly and relaxed. now What Pre-assessment aims to minimise patient risk by assessing fitness for surgery, I explained to John the procedure of the assessment and I provided information to facilitate informed choice, which reduced his anxiety about hospital admission. I also obtained consent from him. John confirmed that he smokes 40 cigarettes a day and he was overweight. Full pre-assessment was performed where the vital signs were monitored and appeared to be normal, urine dip stick was done and it was all clear. Bloods taken, his height and weight were checked as well. On calculating his body mass index (BMI) I realised that it was high but acceptable. John didn`t have any past medical history, however the unit routinely screens patients preoperatively for methicillin-resistant Staphylococcus aureus (MRSA) to prevent the transmission of MRSA, as it is a major morbidity and mortality (Bisset, 2005). In order to reduce anxiety, the rationale for screening was explained to John and he was advised that in the event of a positive result, treatment is available and will be prescribed for use prior to admission. His ASA (American Society of Anaesthesiologists) status was graded as ASA1 according to the National Institute for Clinical Excellence (2003) guidance on what investigations to carry out dependent upon the grade. John was given information about fasting prior to surgery. It was explained that he will be admitted on the day of surgery and that he will be already fasting. The guidelines on fasting were clear six hours of solid food, two hours for clear non-particulate and non-carbonated fluids. (Royal College of Nursing, 2005). John also explained the he regularly takes food supplements and herbal remedies, including garlic supplements, Echinacea and St John`s wort. (Larkin, 2001) supports that many of these have an effect on perioperative bleeding or may interact with anaesthetic drugs, thus John was advised to discontinue them for at least a week preoperatively. John was given information sheets to supplement what has been discussed e.g. nil by mouth, anaesthetics, pain control post operatively, about the surgery, stop smoking. John was advised to stop smoking prior and after surgery. Effects of smoking were explained during and after surgery, how smoking can affect wound healing and that it can lead to deficiency of vitamin C which is an essential factor needed for tissue repair. His date of surgery was within three months therefore John was strongly advised to contact the unit should there be any changes in his health prior to his surgery. His wife was the next of kin and responsible for his care at home. John seemed very interested, he was asking questions and said that he found the information given during the pre-assessment meaningful and he appreciated the significance of that information. His wife was the responsible adult who will stay with look after surgery. I carefully documented all the information discussed went through it again and John was happy to sign as he understood everything as it was explained to him.