Preoperative and Postoperative Care
OCTOBER 28, 2011 Section
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
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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 Â
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
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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
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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.