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Preoperative and Postoperative Care

6.  


OCTOBER  28,  2011   Section    

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Title   Administrative     Mission  Statement                             Governing  Body   Administrative  Operational  Guidelines   Description  of  Services  Provided   Organizational  Chart       Crisis  Notification  Plan   Patient  Recruitment   Quality  Management   Infection  Control  Program   Employee  Hepatitis  B  Vaccination   Infection  Prevention  in  the  Operating  Room   Surgical  Scrub   Operating  Room  A ttire   Surgical  Gowning  and  Gloving   Exposure  Control  Plan   Quality  Assurance  Program   Incident  Reporting   Morbidity  &  Mortality  Conference   Mortality  

Policy    

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Safety,  Equipment,  and  Supplies  Management   Biomedical  Maintenance  Program   Electrocautery  Unit   Surgical    Count   Patient  Identification   Emergency  Readiness   Fire,  Electrical,  and  Gas  Safety   Post  Operative  Intensive  Care/Transfer   Throat  Packs   Patient  Services   Patient  C oordinator           Patient  C ounselor  Program   Patient  Screening  Process   Surgical  Schedule   Patient  Surgical  Process   Surgery  Standard  of  Care   Anesthesia  Standard  of  Care           Pediatric  Standards  of  Care   Dental  Standard  of  Care   Nursing  Standards  of  Care   Operating  Room  Nurse  Protocol   Perianesthesia  Nurse  Protocol   Pre-­‐Post  Operative  Nurse  Protocol   Child  Life  Program   Speech  Therapy  Program   Blood  Administration            (Kristin  working  on)   Outside  Medical  Services   Pharmaceuticals  and  Consumables   Laboratory  and  Diagnostic  Exams   Blood  Service   Laundry  Services   Information  Management   Informed  Consent   The  Medical  Record   Publication  of  Information  Policy              (to  be  completed)     Policy  Format   Human  Resources   Professional  Credentialing     Job  Descriptions       Conduct  Code  for  C ontractors  and  Volunteers  Living  in  Guwahati   Vacation  Notification  and  Coverage   Disciplinary  Action/Dismissal   Evaluations  –  Nursing     Orientation  –  Nursing   Nurse  Attendance  Policy   Education   Patient  and  Family  Education     § Lip  C are  English,  Lip  Care  Assamase     § Palate  Care  English,  Palate  Care  Assamase     Staff  Education                       Nutrition  Program   Research  Projects   Division  of  Research  and  Outcomes   Approval  Process  –  “IRB”           Outcomes  Image  Data  

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GC4 Medical Record: Safety and Quality  


The Pediatric Patient §

Infants and children under 10 years of age have important physiological differences that influence the way in which they should be cared for before, during and after surgery.

Children are not just little adults. § Children have a more rapid metabolic rate than adults. Compensatory Mechanisms Shock: Increased Heart Rate § Tachycardia in an infant may signal impending circulatory collapse Bradycardia in a child is hypoxia until proven otherwise Temperature Regulation § Hypothermia can affect drug metabolism, anesthesia, and coagulation § Prevent hypothermia: § OR temperature § Cover areas not in field § Avoid long procedures § Warm IVF


Blood Volume Children have smaller blood volumes than adults Even small amounts of blood loss can be devastating Intravenous fluid replacement is needed when blood loss exceeds 10% of the total blood volume Chronic anemia should be slowly corrected before elective operations with iron, folic acid, or other supplements as appropriate

§ § §

Nutrition and Hypoglycemia Infants and children are at special risk for malnutrition because of higher caloric needs for growth Good nutrition helps healing; poor nutrition prevents it. Infants are at risk for developing hypoglycemia because of limited ability to utilize fat & protein to synthesize glucose. If prolonged fasting periods anticipated (>6hrs), give intravenous fluids with glucose

§ § § §

Fluids  and  Electrolytes     § § §         §

§

Baseline  fluid  requirements  are  related  to  weight   Maintenance  fluid  needs  in  pediatric  patients  can  be  calculated  using  the  4:2:1  rule.   Fluid  requirements  in  surgical  patients  often  exceed  maintenance  requirements  

The  most  sensitive   indicator  of  fluid   status  in  children  is   urine  output.   Normal  urine   output    

Infants  1-­‐2  mL/kg/hr   Children  1  mL/kg/hr  


Parents: The “Other Patients” § § §

It is very difficult and stressful to have a child undergo a surgical procedure The parents must be informed, educated and involved throughout the preoperative, operative and postoperative processes. Parents will be primary caregivers when patient is not in the hospital.

Suggested Reading: Operation Smile Global Standards of Care. Operation Smile Guwahati Comprehensive Cleft Care Center Policies Manuel (2013). Operation Smile Guwahati Comprehensive Cleft Care Center Procedures  Manuel (2013).   Operation Smile Guwahati Comprehensive Cleft Care Center Forms  Manuel (2013).   Heike C, Cunningham M. (2009) Pediatric Assessment and Management of Children with Cleft Lip and Palate. In: Losse J, Kirschner R: Comprehensive Cleft Care (pp. 171186). McGraw-Hill Companies.  


6. Preoperative and Postoperative Care