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1
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
2
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
4
Patient Preparation Psychological:
• Patient Education
-Briefing on pre-op preparation, peri-op condition
& post-op care
5
Patient Preparation
Psychological:
• Family Support
• Arrange interview with surgeon for clear
surgical explanation & consent
6
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
7
Patient Preparation
Physical:
• Fasting
• Medication
• Skin Preparation
• Bowel Preparation
• Anti-embolic Stockings measurement &
Preparation
8
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
9
Patient Preparation
Physical: Thoracic/Lumbar Operation
• Prepare the Thoracolumbosacral Orthosis
( TLSO)
10
Equipment Preparation
Cervical Operation:
• Ward bed preparation to OT
• Cervical pillow
• Sand bags
• May need Cervical traction preparation
(Halo Traction , Ice Tong Caliper application)
11
12
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
13
Halo-Traction
Equipment Preparation
Thoracic Spine Operation:
• Ward bed preparation to OT
• May need Thoracic Catheter insertion
( Chest Drain Bottle & Kocker Forceps
preparation)
14
15
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
16
Prevent Post-Op
Complications
Cardiovascular Complication:
• haemorrhage shock bradycardia
• Pre-op Blood Investigation ( X-match, CBP)
• +/- Blood Transfusion Pre-op to ↑ Hb
• ECG Arrhythmia
17
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
18
19
~ The End ~
Thank You!