Other Patient Considerations
Perioperative Nursing Considerations When Caring for Patients with Cancer
Many patients with cancer come to the operating room for resection or debulking of tumors as part of their treatment. For some, this may be the last step after radiation or chemo; or it may be the beginning of a long journey ahead. For others, it may be a temporary step to relieve pressure or pain.
During the intraoperative period, malignant tumor cells could be transferred to other areas of a surgical site, if care is not taken. On top of this, patients with cancer have weakened immune systems and are at risk for infection and post operative complications. Intraoperative precautions during surgery include:
- No-touch or minimal touching of the tumor itself. Tumors must be handled gently as tumor cells could be dislodged with vigorous scrubbing or manipulation. Manipulation of vascular tumors could cause emboli or hemorrhage.
- Often the practice of changing gowns/gloves/drapes/instruments occurs after a biopsy.
- Isolation of instruments that were in direct contact with tumor cells.
- Irrigation of the wound with sterile water rather than normal saline. This is often done during a mastectomy.
- Radiation sources are sometimes provided to a patient in the OR.
Some cancer resection surgeries are booked as long all-day cases. In these instances, providing brief updates to the family may be helpful, such as surgical start time, when the tumor has been removed, and closing. This must be done in collaboration with the surgical team.
Radiation sources are sometimes provided to a patient in the OR. These can include needles, seeds, capsules, or suspensions which are prepared in the lab and transported to the OR in a lead lined container. Any hospital facility that works with radiation sources must have strict guidelines for safe handling. Any radiation source placed in a patient must be documented clearly and only handled with long forceps designed for this purpose. Appropriate documentation must be completed and signage noting that the patient has a radiation source in situ.
(Phillips & Hornacky, 2021)
Perioperative Nursing Considerations When Caring for Patients with Diabetes
Patients with diabetes require additional consideration when coming to the operating room. Preparing for surgery requires patients to fast for specific lengths of time which can lower blood glucose levels. Stress, caused by physical trauma, emotional trauma, infection, or fever from illness can cause blood glucose levels to rise. When a diabetic patient is preparing for surgery, exceptional care must be taken to monitor and maintain normal glucose levels. Each patient is unique, their surgical procedure must be considered, and through consultation with their endocrinologist, the perioperative team will develop a care plan. Blood sugar levels must be carefully monitored throughout the perioperative period.
Diabetic patients undergoing surgery are at higher risk of:
- Dehydration and electrolyte imbalances.
- Infection and or delayed wound healing.
- Decreased or inadequate perfusion.
- Hypothermia.
(Phillips & Hornacky, 2021)