The Nurses Role In The Positioning Of The Patient Perioperatively Under General Anaesthetic.

1703 words - 7 pages

"Careful patient positioning is an art and a science that affects patient safety and outcomes" (Gruendemann and Fernsebner 1995, p.388). This statement could not be truer but in the age of advancing medicine and technology basic nursing skills such as perioperative patient positioning are gaining more emphasis from nurses as the medical profession disregards their importance. In this dissertation, the author will re-emphasise the significance of safe and conscientious positioning of the patient under general anaesthetic. What are the physiological effects of general anaesthesia? Is the nursing assessment really that central in the safety of the patient intraoperatively? Also some positions utilized intraoperatively will be examined.Anaesthesia has its origins from the early 19th century but these days it is a far cry from when they used alcohol and opium to intoxicate the patient during surgical procedures where analgesia and muscle relaxation were needed (Meeker and Rothrock, 1999) These days new anaesthetic drugs have improved the safety profile of anaesthesia, however, problems with General anaesthesia (GA) which is defined as loss of consciousness and sensation, skeletal muscle relaxation, analgesia, and elimination of the somatic, autonomic, and endocrine responses, including coughing, gagging, vomiting, and sympathetic responsiveness (Lewis, Heitkemper and Dirsken, 2000) have changed focus. Physiological changes, which result from GA, are vasodilation causing reduced perfusion possibly resulting in hypercarbia or hypoxia of the tissues, bronchodilation, depressed pain and pressure receptors. Loss of tone causes muscle relaxation, which is the body's defence mechanism to protect against joint damage, muscle stretch and strain and nerve impulse blockage can result in postoperative discomfort sometimes due to over flexion of limbs. The body's normal defence is 'shut down' when GA is employed, it is therefore essential that the perioperative nurse is familiar and educated with the body's normal limitations in order to act as the patients advocate intraoperatively. So, how can we evaluate the risk with each patient? Find out predisposing disorders they may have which may necessitate alternative positioning?Nursing assessments are imperative in anticipating potential problems intra and postoperatively therefore it is worth training each nurse to a high standard in this process (Lewis et al., 2000). The perioperative nurse does assessments preoperatively at either ward level by a staff nurse or in theatre although this varies according to hospital policy. In assessing the patient the nurse should use all their senses, listening, observation, olfactory to gain both objective and subjective data. In our assessment, the main objective is to search for any disorders that may predispose the patient to injury intraoperatively either from pressure sores, nerve damage or even death. The age of the patient tells us a lot, we know that as we get older that...

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