Peri / Post Op Care : FOCUS
A2K: A COMPREHENSIVE AND SYSTEMATIC APPROACH TO THE PHYSICAL ASSESSMENT OF POSTOPERATIVE PATIENT By Evan Plowman The physical assessment of postoperative patients is a crucial and potentially lifesaving skill that may be improved with the use of a mnemonic to guide assessment structure. The definition and elements of a primary survey (ABCDE) are generally accepted as including assessment of airway, breathing, circulation, disability and exposure/environment (Parker & Magnusson 2016). There is far less agreement about what should happen next. Studies show knowledge retention is improved with the use of mnemonics (McCabe et al. 2013; Gravel et al. 2010) so we introduced a secondary survey for patient assessment to our undergraduate nursing students, which we called A2K, to establish a systematic and consistent approach to post-operative assessment. In addition to performing a rapid, primary assessment as described above, the A2K assessment goes on to include F for fluids and full set of vital observations, G for glucose, H for
head-to-toe assessment and history, I for investigations and interventions, Jot for jot it down and K for Kin or Kindred. This approach provides a systematic and comprehensive physical assessment for the postsurgical patient that can be used in the acute surgical ward setting and is easily remembered by the student with the help of a mnemonic. Fluid management is vital in the postoperative patient, particularly after undergoing major surgery (Kayilioglu et al. 2015) and collecting a full set of vital signs is equally important to detect early warning signs of deterioration. Assessing glucose in the diabetic patient postoperatively is important in avoiding complications associated with deranged metabolic processes disrupted by surgical intervention (Sudhakaran and Surani
2015). Head-to-toe assessments include a comprehensive physical examination of the patient’s body using inspection, auscultation, percussion and palpation. A patient SAMPLE history includes the assessment of signs/symptoms (particularly pain or nausea), allergies, medications, previous illness, last food or drink consumed and events leading up to the assessment. Investigations and interventions include anything attached to, or testing of, the patient, which would include intravenous access, wound assessment, drain output and any other medication or treatment ordered by the surgical team. Jot it down refers to ensuring complete and accurate documentation has been attended. Finally, Kin or Kindred refers to the need to ensure the patient’s family or person for contact has been updated about the patient’s condition. The A2K assessment provides a structured and comprehensive approach that the nurse can use to guide their assessment in the post-operative setting. This approach requires further research to establish validity and reliability as an assessment method. Evan Plowman is a Lecturer in Nursing at Charles Sturt University in NSW
References Gravel, J., Roy, M., & Carriere, B. 2010. 4455-66-PM, a mnemonic that improves retention of the Ottawa Ankle and Foot Rules: a randomized controlled trial. Academic Emergency Medicine. 17(8): 859-864. Kayilioglu, S. I., Dinc, T., Sozen, I., Bostanoglu, A., Cete, M., & Coskun, F. 2015. Postoperative fluid management. World Journal of Critical Care Medicine. 4(3): 192-201. McCabe, J. A., Osha, K. L., Roche, J. A., & Susser, J. A. 2013. Psychology students’ knowledge and use of mnemonics. Teaching of Psychology. 40(3): 183-192. Parker, M., & Magnusson, C. 2016. Assessment of trauma patients. International Journal of Orthopaedic and Trauma Nursing. 21: 21-30. Sudhakaran, S., & Surani, S. R. 2015. Guidelines for perioperative management of the diabetic patient. Surgery Research and Practice. Article ID 284063.
Nurse Writers Needed Wolters Kluwer a provider of expert solutions in health care is recruiting Nurses to serve as Contributors and Reviewers. Nurses are being invited to contribute to the development of Lippincott Procedures an Evidence Based online product providing step-by-step procedures and skills for nurses in a variety of clinical settings. Your contributions or reviews can be developed in your own home and time to be published and used by nurses at the point-of-care and educational settings. Interested nurses must be Registered Nurses (Division 1) with at least 5 years experience in an acute clinical setting. Experience with policy and procedure creation and maintenance is desirable.
Please submit your expression of interest and Curriculum Vitae to vaughn.curtis@wolterskluwer.com For more information on Lippincott Procedures visit: www.lippincottsolutions.com/solutions/procedures