Medical and surgical nursing 3

Module Clinical nursing in General Surgery

The student will be able to consider the main nursing problems in perioperative care in general and specialist surgery.

1. Introduction to the course and learning contract
2. Surgical Department (operating unit, pre-hospitalization clinic, post-surgery clinic, Operating Rooms, Day Surgery); The different organizational models (the functional model, the nursing team, primary nursing, nurse case management, by the intensity of care); The different surgical methods (laparotomy, laparoscopic, endoscopic, robotic surgery); The tools of care planning (clinical pathway, personalized care plans, the discharge plan); The different organizational/structural models impact on the patient (fast routes, hospitalization times, presence of a carer, surgical wound, immobility); The different organizational/structural models and the impact on the nurse (necessary skills: relational, organizational, integration, clinical).
3. The PNMDS: (Perioperative Nursing Minimum Data Set): the preoperative assessment: the standards of the AORN (Association of Operating Room Nursing): health conditions and therapies in place, physical conditions, emotional state, culture and beliefs, understanding with respect to procedures, patient perceptions, previous experiences)
4. PNMDS: (Perioperative Nursing Minimum Data Set): preoperative education - the main interventions - (exercises to improve respiratory and circulatory function, strategies for the treatment of pain, reduce anxiety, to regain mobility and autonomy in the ADL); The physical preparation of the patient (trichotomy, bowel preparation, skin preparation); Preparation of the patient on the day of surgery (pre-anesthesia, documentation, preparation of the reception room, assistance to family members, preoperative checklist); Safety in accompanying the patient to the operating room (personal effects of the patient, antibiotic prophylaxis, transport aids).
5. The acceptance of the patient in the operating room and the verification of the identity of the site and the surgical procedure; Preparation of the patient for general and local anesthesia (epidural and spinal): patient positions, monitoring; The safe management of the patient: The insertion of the various devices (tracheal intubation (collaboration), SNG, CVP, CV, CVC (collaboration): procedure -, risks and potential complications, management based on EBN; The patient allergic to latex: ASPN standard (American Society of Perianesthesia Nursing); The positioning of the patient on the operating table and the attention for the prevention of LDD and nerve injuries; The prevention of accidental hypothermia; The intraoperative monitoring (SaO2, diuresis, temperature, PA, ……); The awakening and monitoring phase; The patient's discharge from the operating room (Aldrete Score);
6. Postoperative monitoring (BP, FP, SaO2 and fr, diuresis and wound): in the first 24 hours and after, in low risk stratification; The discomfort of the surgical patient (thirst, local pain and in movements, sore throat): autonomous and collaborative interventions; The postoperative problems with particular reference to the significant data to be collected-assessment scales and the main interventions to be implemented: nausea and vomiting (risk factors and strategies to control PONV); pain (VAS, NRS - the main methods of postoperative pain control, the main drugs used (side effects); haemorrhages (clinical signs and interventions: posture, venous access and nursing implications in the management of blood components transfusion); urinary retention, ileus paralytic (risk factors and strategies to control this complication); respiratory complications ((risk factors and respiratory gymnastics), management of the surgical site (surgical wound and drainage); thrombophlebitis: the nursing role in the administration of anticoagulant therapy and early mobilization); water disorders (risk factors, monitoring through water balance and PVC); post-surgical delirium (risk factors and interventions); resumption of nutrition, encouraging activity and promoting self-care; discharge the surgical patient (information and education of the patient or contact persons, the guarantee of continuity of assistance).
7. Perioperative assistance to the patient undergoing surgery on the gastrointestinal tract (esophagus, stomach, intestine), biliary tract, pancreas, breast, and urinary tract.

1. Berman A., Snyder S., & Jackson C. (2019). Nursing clinico. Tecniche e procedure di Kozier. Edises Hinkle J.L. & Cheever K.H. (2017). Brunner & Suddarth. Infermieristica medico-chirurgica (Vol. 1 e 2). CEA
   
2. Bresadola V. et al. Chirurgia per le professioni sanitarie, EdiSES,  Napoli, 2006 (Capitolo 2 - La presa in carico dei pazienti chirurgici, Capitolo 3 – L’assistenza infermieristica generale perioperatoria, Capitolo 5 – L’anestesia nel paziente chirurgico).
   
3. Saiani L, Brugnolli A, Trattato di cure infermieristiche.  Casa Editrice Idelson - Gnocchi, Napoli, 2020. 
4. Brugnolli A, Saiani L. Trattato di medicina e infermieristica. Un approccio di cure integrato. Casa Editrice Idelson - Gnocchi, Napoli, 2017. 

The assessments will be carried out at the end of the integrated course. The methodology will be communicated at the beginning of the lessons together with the bibliography and with the learning resources necessary for the preparation for the final evaluation.

The test will be written with multiple choice questions. The exam will be assessed according to the following criteria:

1. Not suitable: Poor or lacking knowledge and understanding of the topics; limited capacity for analysis and synthesis, frequent generalizations of the requested contents; inability to use technical language.
2. 18-20: Just sufficient knowledge and understanding of the topics, with obvious imperfections; just sufficient capacity for analysis, synthesis and autonomy of judgment; poor ability to use technical language.
3. 21-23: Sufficient knowledge and understanding of the topics; sufficient ability to analyze and synthesize with the ability to reason with logic and coherence the required contents; sufficient ability to use technical language.
4. 24-26: Fair knowledge and understanding of the topics; discrete ability to analyze and synthesize with the ability to rigorously argue the required contents; good ability to use technical language.
5. 27-29: Good knowledge and understanding of the required contents; good ability to analyze and synthesize with the ability to rigorously argue the required contents; good ability to use technical language.
6. 30-30L: Excellent level of knowledge and understanding of the required content with an excellent ability to analyze and synthesize with the ability to argue the required content in a rigorous, innovative and original way; excellent ability to use technical language

Among the following information, mark the incorrect one.

a) avoid hair removal whenever possible

b) the razor in hair removal can cause small disruptions to skin integrity

c) depilatory creams in hair removal can cause skin irritation

d) perform the hair removal at least two days before surgery

e) perform the hair removal as close as possible to the surgery