TRIGGER 1: Preparing the patient for theatre

Nutrition and hydration

The Royal College of Nursing (2005) recommends clear fluids up to two hours and food up to six
hours before induction in healthy patients of all ages. Many clinical areas have set fasting times for
patients.
Fasting can be difficult to manage when theatre lists can be changed and operations cancelled.
Nurses need to be aware of patient comfort and hydration, and enable them to access food and drink
for as long as is possible, in line with local policy.
All staff should know when patients are nil by mouth (NBM), and this should be documented in
patients records.
Once patients are fasting, mouth care should be available or administered to those unable to perform
it themselves.
When operations are cancelled, poor communication between operating departments and wards may
mean patients NBM status is prolonged (NPSA, 2011). This issue needs to be addressed by senior
nursing and medical staff, and decisions passed to ward and operating department staff.
Other actions
Patients should wash or shower using soap and water the evening before surgery (NICE,
2008);
Prescribed medication should be reviewed pre-operatively and only essential medicines given
- those taken orally should be swallowed with the smallest amount of water possible;
Medicines that will cause drowsiness should be administered once the patient has been
prepared for theatre and the patient should be advised to stay on the bed with a call bell;
Hair around the incision site should be removed on the day of surgery if necessary, using
electric clippers with a single-use disposable head;
Patients comfort and dignity should be maintained when they are changing into their theatre
gown;
Depending on the surgery, patients may wear pants, but women should be asked to remove
bras before surgery;
Anti-embolism stockings should be measured and fitted on admission or immediately before
transfer to theatre, depending on VTE risk;
Jewellery should be removed where possible, although local policy may allow tape to be
applied around jewellery that is difficult to remove;
Dentures and hearing aids should be removed, and patients may prefer this to be done in the
anaesthetic room - these items should be taken to the recovery area, and stored and labelled;
Loose teeth, caps or crowns should be identified as a safety precaution to prevent choking
during anaesthesia;
Wristband details should be checked with patients and to ensure they match those on patient
records, medicine records, X-rays and test results;
Vital signs should be recorded and abnormal readings reported;
Allergies should be documented;
The site of surgery should be marked on the ward or day unit before patients go to theatre or
receive premeds (NPSA, 2005); this should be checked by the nurse on the ward or day unit
who is completing the pre-operative checklist;
Consent should have been obtained in line with Department of Health (2009) guidance, and
checked immediately before surgery. This involves ensuring patients understand the
procedure and that they are happy to go ahead with it. How consent is gained and confirmed

will depend on age and mental capacity.

Liddle C (2012) Preparing patients to undergo surgery. Nursing Times; 108: 48, 12-13.

TRIGGER 4: WHAT ARE THE PRIORITIES OF BENS CARE? (8 breaths per minute, difficult to
rouse, pinpoint pupils)

Triad of Opioid Intoxication

1. Pinpoint pupils
2. Coma
3. Respiratory depression
Nursing Interventions:
1. Notify physician.
2. If hypoglycemic, administer oxygen, 50% dextrose as ordered by the physician.
3. If decreased level of consciousness, give naloxone (antidote for opiate overdose) as ordered.
4. Monitor respiratory, neurovascular and cardiovascular status closely.
5. *If naloxone produces no response at all, the patient may require intubation and a computed
tomography scan of the head to rule out cerebral bleeding or head trauma.

REFERENCES:
Williams, R., & Erickson, T. (2000). Emergency Diagnosis of Opioid Intoxication. Laboratory Medicine,
31(6), 334-342. doi:10.1309/qy8t-kgbn-bva6-h706
Wood, P., Mahoney, P., & Cooper, J. (2009). Trauma and orthopedic surgery in clinical practice.
London: Springer.

TRIGGER 5: What are the psychosocial impacts of surgery for Ben and his parents?
The stress of surgery can produce in children, Physiological, emotional, cognitive, behavioural and
interpersonal changes Jones, B. (2015). , these changes can persist and often fall under categories
such as general anxiety and regression, separation anxiety, anxiety about sleep, eating disturbance,
aggression toward authority and apathy/withdrawal.
These are just a few of many reasons as to why children who have been operated on may have
psychosocial impacts post-surgery. A study was conducted that showed that children who were
operated on without preliminary explanations or sometimes deceiving information regarding the
surgery often felt betrayed by those who they believed would protect them.
Children sometimes not only feel frightened by their doctors but may be also worried about day to day

life post-surgery. Responses are influenced by factors such as the childs developmental level, prior
experiences with illness and medical care, the amount and quality of preparation that is provided and
the supports available to the child and family Jones, B. (2015). Negative psychological responses in
children to surgery can be intense, damaging and prolonged and they should be anticipated prior to
the surgical experience.
Ben could be worried about:
The post-operative complication reoccurring
How long his leg will take to heal
If he will get to ride his quad bike again
What his friends will think of the accident
If his parents will get rid of his quad bike
How long he will have to stay in hospital for
Everyday life changes due to his injuries
Bens Parents could be worried about:
The post-operative complication reoccurring
What they are going to do about the quad bike
Bens overall health and state of mind
Getting rid of the Quad bike and Bens reaction to it
Everyday life changes due to their sons injuries
What the nurse can do
In order to have both Ben and his parents at ease, it would important for the nurse to have a talk
with them and answer any questions either of them may have about Bens condition and his care
post-surgery. The parents should be made aware that there is support available not only from their
family and friends but from the hospital as well.

References
Jones, B. (2015). Preparing Children and Families for Surgery: Psychological Responses to Surgery.
[online] Medscape.com. Available at: http://www.medscape.com/viewarticle/525638_3 [Accessed
11 Mar. 2015].