nursing management of patient who will undergo spinal ... · nursing management of patient who will...

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Nursing Management of

Patient Who Will Undergo

Spinal Surgery

APN Eve Yu

Department of Orthopaedics &

Traumatology

Prince of Wales Hospital

Introduction

1. Aim of care

2. Patient Preparation: Psychological &

physical

3. Equipment Preparation

4. Prevent Post-op Complications

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Aim

• Ensure Patient Safety

• Facilitate Surgery

• Prevent Complications

3

Patient Preparation Psychological:

• 1 in 5 Spine Surgery Patients Develop Post

Traumatic Stress Disorder (PTSD ) (By John M. Grohol, Psy.D. 2012)

• Patient Psychological Assessment

• Patient Education

- Pamphlets, Video, Pre-op Class , Return

Demonstration

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Patient Preparation Psychological:

• Patient Education

-Briefing on pre-op preparation, peri-op condition

& post-op care

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Patient Preparation

Psychological:

• Family Support

• Arrange interview with surgeon for clear

surgical explanation & consent

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Patient Preparation

Physical:

• Valid Consent

• Spinal Imaging Available (e.g.X-ray, MRI film,

CT or CD-DICOM for navigation)

• Medical Clearance: Blood Investigation (e.g.

X-match, CBP, R/LFT), ECG, Chest X-ray

• Pre-op Chest Physiotherapy and limbs

mobilization exercise

• +/- Arrange Lung Function Test or Refer to

Sensory & Motor Charting

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Patient Preparation

Physical:

• Fasting

• Medication

• Skin Preparation

• Bowel Preparation

• Anti-embolic Stockings measurement &

Preparation

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Patient Preparation

Physical: Cervical Operation

• Shaving hair

• Prepare the rigid neck collar

• If Halo Traction will be applied, measure the

head circumference & select a halo-ring which

allows 1-1.5 cm clearance

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Patient Preparation

Physical: Thoracic/Lumbar Operation

• Prepare the Thoracolumbosacral Orthosis

( TLSO)

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Equipment Preparation

Cervical Operation:

• Ward bed preparation to OT

• Cervical pillow

• Sand bags

• May need Cervical traction preparation

(Halo Traction , Ice Tong Caliper application)

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Preparation for Halo -Traction

• Prepare the following items:

- Halo-jig

- Halo-ring

- a set of 3 position pins

- 4 titanium pins + pin locks

- a pair of torque screw drivers

- a halo bail for traction

- traction kit with appropriate weight

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Halo-Traction

Equipment Preparation

Thoracic Spine Operation:

• Ward bed preparation to OT

• May need Thoracic Catheter insertion

( Chest Drain Bottle & Kocker Forceps

preparation)

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Spinal injury Care before OT

• Continuously monitor the vital signs.

• Repeated assessment the Neurological status ( Intact/ total loss / deteriorating)

• Monitor other structures

(e.g. C-spine for head injury, retro-peritoneal structure injury.)

Prevent Post-Op

Complications

Respiratory Complication:

• Hyper secretion, Expiratory muscle weakness , Aspiration of gastric contents

• Pre-op Chest Physiotherapy

• Educate the deep breathing exercise

• Pre-op Chest x-ray

• +/- Arrange Lung Function Test

• Stop Smoking

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Prevent Post-Op

Complications

Cardiovascular Complication:

• haemorrhage shock bradycardia

• Pre-op Blood Investigation ( X-match, CBP)

• +/- Blood Transfusion Pre-op to ↑ Hb

• ECG Arrhythmia

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Prevent Post-Op

Complications

Deep Vein Thrombosis:

• Changes in the normal neurologic control of the

blood vessels that can result blood stasis of

lower limbs

• Anti-embolic Stockings measurement &

Preparation

• Educate the Ankle pump exercise

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~ The End ~

Thank You!