Positioning the patient for surgery

1. Positioning the patient for surgery Dr Aidah bu Elsoud Alkaissi An Najah National University Faculty of Nursing

2. Positioning the patient for surgery • The choice of patient position is determined by the surgicsl approach • The responsibility for overall patient well-being rests with the surgeon , the anasthesiologist, and the nurse who constantly monitor the patient’s physiologic status • The circulating nurse may coordinate the details of restraints, support to the extrimities, and safe transfers • The surgeon and the circulating nurse determine the position for patients who receive local anesthetic

3. Positioning the patient for surgery • The patient’s position should provide optimum exposure and access to the operative site • Should sustain body alignments and circylatory and respiratory function • Must provide access to the patient for administration of intravenous fluids, drugs and anesthetic agents • Should not compromise neuromuscular structures • Should afford (give) as much comfort to the patient as possible • Good positioning promotes patient well being and safety while meeting these needs

4. Surgical Anatomy • The nurse must be cognizant of the anatomic and physiologic changes associated with anesthesia, positioning of the patient and the operative procedures • Changes are: • The musculoskeletal system • The nervous system • The circulatory system • The respiratory system

5. The musculoskeletal system • Subjected to unusual and exaggerated stress during operative positioning • Normal range of motion is maintained in the alert patient by pain and pressure receptors that warn against stretching and twisting of ligaments, tendon and muscles • The tone of opposing (göra motstånd) muscle group acts to prevent strain (subject to exertion or pressure) and stress to the muscle fibers • bony prominences of the human anatomy are particularly vulnerable to injury by rubbing and sustained pressure • The position chosen should provide physiologic alignment while protecting the patient from pressure, abrasion and other injuries

6. Nervous system depression • Accompanies the administration of anesthetic agents and many other drugs • The degree of depression depends on the type of regional anaesthesia or the level of general anesthesia • Pain and pressure receptors may be affected either regionally or systemically • When nervous system depression occurs, the body´s communication and command system is rendered (cause) totally or partially ineffective • Pressure on superficial nerves must be prevented

7. The circulatory system • Is affected by anesthesia, causing a lack of nervous system control of vascular dilatation and constriction • Affected by direct peripheral pressure on the venous return, blood pools in veins to decrease circulating volume and blood flow is distributed along variations of the horizontal body plane and follows laws of gravity in other manners than when it is upright • Blood pressure responds to redistribution of blood flow and the horizontal body plane in addition to inherent (intrinsic) pathophysiologic processes

8. The respiratory system • Diaphragmatic movement may be impeded or shifting visceral pressure may occur • The horizantal body plane changes the airflow and functional characteristics of the lungs • Not only airflow but also flow of secretion is affected • The combination of circulatory changes and the compromised respiratory efort affets the oxygen saturation of the blood

9. Perioperative nursing consideration • Assessment and nursing diagnosis • Review of the proposed schedule for the room to which the nurse is assigned • Based on the planned surgical intervention , and the operating surgeon´s preferences the basic patient position is anticipatedand • The nurse reviews the patient´s record , hight, weight, physical condition • Skin untegrity, range of motion , reddenedor ecchymotic areas, lesions, decubiti must be documented • Limitation in mobility, presxisting neurovascular problems and complaints of discomfort • Read vulnerable situations include page 104

10. Planning- Determining • the appropriate mode of patient transport and transfer • Equipment and positioning aids • The need for ancillary personel to accomplish the positioning • Individualize the nursing care plan for specific patient problems such as diabetic, malnourished, paralyzed patients

11. implementation • The nurse must be familiar with the normal functions, maintenance, various uses and potential hazards of the operating room beds, their attachments and other mechanical adjuncts to both patient position and the operative procedure /electrosurgical devices, drills, radiologic procedures) • The restraint strap should be snug but should not compromise venous circulation or exert pressure on ponny prominences or nerves • over the blanket covering the patient • If possible patient transfers should be made when the patient is a wake

12. implementation • When the patient is anesthetized or unable to assist, a four person lift or a Davis roller should be used to provide support to the torso, head and all extrimities • Mayo table should positioned enough to prevent pressure on the toe, knees or legs • The surgical team should be reminded not to lean on the patient´s trunk or extrimities, because pressure may comprmise anatomic and physiologic function

13. Modern operating room beds (operating room tables) • To facilitate safe and effective positioning of the patient while providing the surgeon with anatomic accessibility • Judicious (förståndig) • manipulation of the operating room bed obviates (förebygga) • untoward manipulation of the patient perioperative nursing personnel have the responsibility of being well versed in the use of all types of operating room beds available in the instituation

14. Modern operating room beds (operating room tables) • The orthopedic table with its multiple movable and removable parts and suspecsion frames, remains one of few specialty tables required • The urology table designed for custoscopic procedures, har radiologic equipment attached which facilitates intraoperative x rays of the genitourinary system

15. Modern operating room beds (operating room tables • Adjusted for height and length and can be titled laterally to either side and horizontally at the head and foot • Divided into three perts or more sections that support the major body parts and permit their placement in flexion or extension • The head section is usually removable and foot extensions may be added • Head rest of various design enable the general operating room bed to be used for cranial and eye surgery

16. Modern operating room beds (operating room tables • Perineal cutouts and drainage trays to the lumber section adapt the general operating room bed for the perineal approaches used in gynecologic, urologic and proctologic surgery • Most operating room beds are available with x-ray penetrable tunnel tops that permit insertion of cassette holders at any position along the bed • Additional accessories, pillows, pads, bolsters (long narrow pillow or cushion)