General guidelines for a patient having surgery at an outpatient center are:
Patient weighs less than 400lbs and BMI less than 45.
Post-op ventilation due to the procedure or pre-existing condition is not anticipated. Extensive blood loss requiring transfusion is not anticipated.
Case is not an emergency or life threatening.
Outpatient center has all appropriate surgical equipment to perform surgery.
Surgery does not require prolonged invasion of body cavity.
No involvement of major blood vessels.
Patient is not intended to transfer to another facility.
The advantages of having outpatient surgery over inpatient surgery are:
The convenience of recovering in your home.
Lower cost, since there are no hospital room charges.
In many cases, outpatient surgery is less stressful than inpatient surgery.
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The patients’ risk factors for poor surgical outcomes are important considerations for the surgical team and the patient. If patients’ vulnerabilities cannot be lessened, they need to at least be identified so they can be managed if the need arises.
Special Considerations for Surgical Client
In an obese patient, surgical staff must be aware of comorbidities that put the patient at a greater risk for complications. Nurses must also select appropriate OR equipment such as a table that will support the obese client’s weight, extra padding or addition of arm rests to the table, larger blood pressure cuff, longer staples, larger retractors, and long instruments. They must also formulate an airway management plan and ensure there is adequate staffing to move the sedated patient for transfer.
Age affects the reaction to certain anesthetic drugs. Short-acting drugs often take a longer time to be metabolized by the elderly. Elderly patients may also have more medical conditions that could make an outpatient surgery
As a post-anesthesia care unit (PACU) Registered Nurse (RN), I care for patients of all races, ages, gender and ethnic backgrounds. However, a majority of the people I care for are of advanced age. Therefore, one must be aware of changes in the body related to aging. The purpose of this discussion is to present a case that addresses the considerations and issues of the perioperative care of an elderly patient.
In the case listed here Dr. Loren J. Borud was scheduled to perform surgery on Mr. Michael Hicks early on a Friday morning. The surgery was liposuction and a scar repair procedure. Dr. Loren informed the patient the procedure would take approximately ninety minutes, but ultimately ended up over seven hours long due to the fact Dr. Loren kept falling asleep during Mr. Hick’s surgery! Seven hours is way too long to be put under anesthesia for something as simple as liposuction. The longer a patient is under anesthesia they are higher chances of more risk and complications can occur during or even after the operation.
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Bariatrics is the branch of medicine that focuses on the causes, prevention, and treatment of obesity. Bariatric surgery is a specific discourse community connecting individuals through mutual interests, shared knowledge, and expertise of treating obese populations. The field of bariatrics is a discourse community with several purposes. It encourages innovative surgical and nonsurgical solutions in obesity care. It formulates hypotheses and develops and conducts experimental designs to test the hypotheses’ reliability and validity. Furthermore, it aims to stimulate discussion about its findings.
The only way that Medicare would make payments to an ASC for procedures performed, is if the procedure was on the Medicare’s list of ASC approved procedures. When the ASC facility bills Medicare, they would use the procedure code performed, then the claims processing system would determine which of the nine ASC payment groups it would be assign to. The new ASC payment system is based on the hospital outpatient prospective payment system (OPPS). The Government Accountability Office studied and reported in November 2006, that ASC’s experience greater efficiencies in providing surgical services then hospital outpatient departments, resulting in surgical procedures being less costly when performed in that setting of care. With the new reimbursement system for ASCs, facility reimbursement is two thirds of the hospital reimbursement and all surgical procedures would be eligible for reimbursement in the ASC.
Saint John’s One Day Surgery (ODS) offers patients a convenient and efficient same day surgical procedure that allows most patients to return home on the same day to recover. The objectives of this paper is to describe the physical environment of the ODS unit and explain the unit’s criteria so that the patient’s surgery may proceed as planned. It will also discuss some of the many roles of the ODS nurse and list one actual diagnosis and two potential nursing diagnoses, with associated supporting evidence, for a patient in the ODS on this particular day. This paper will conclude with my personal experience, both positive and negative, during
In this research paper we will be looking at obesity, gastric bypass surgery, the cautions that the surgical technologist face working with a bariatric surgery. What is obesity? Obesity is having too much body fat. It’s not the same as being overweight which means that a person weighs too much. A person that is overweight maybe overweight due to extra muscle, bone, water, and having too much body fat.
According to agency of health care research and quality it is estimated that almost one third of health care spending is due to inpatient surgical procedures and it also estimates that average hospital costs has been increased from $ 9,100 in 2003 to $11,000 in 2013. [4] Some major reasons for this increase in costs includes lack of coordination, risk associated with complicated surgical procedures, poor patient engagement in decision making, quality requirements and etc. The perioperative surgical homes are very effective in solving these problems and achieve better surgical outcomes as it is a coordinated care which is led by multi specialty physicians who provides continuum of care to patients from the time of decision to 30 days after discharge of the patient i.e., it is incorporated in to include all three phases of surgery; perioperative, intra-operative and postoperative
Obesity is now considered a global epidemic, with particularly concentrated numbers in the United States. In 2011-2012 more than one-third of U.S. adults were estimated to be obese (National Center for Health Statistics, 2013). Due to the increasing prevalence of the epidemic, anesthesiologists must manage a significant number of clinically obese patients. A large range of physiological variations are associated with obesity, including cardiac, respiratory, and metabolic functions (Leykin, v). The areas of concern for anesthesiologists when operating on the obese can be separated into three perioperative stages: preoperative, intraoperative, and postoperative.
There are many outpatient surgical procedures and one of them is an incision and drainage
Bariatric surgery or the weight-loss surgery is an operation performed on abnormally obese people with a body mass index greater than 40 and is a service provided by an inter-disciplinary team – psychiatric, endocrine, rehab, nutritionist, cardiologist, and pulmonologist. Studies have shown that in seriously obese people, having weight loss surgery means they are likely to live longer because of the less risk of stroke, heart attacks, some types of cancer, and liver diseases. By dividin...
...le feel comfortable yet not feel any pain before, during, and after surgery requires much more responsibility than it sounds but in the end it is probably one of the most rewarding careers out there.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.