Eye surgery
Before the ophthalmic operation, it is necessary to conduct a survey of the state of the cardiovascular system, respiratory tract, gastrointestinal tract of the patient;conduct a laboratory study of blood, urine, feces;measure blood pressure, etc. It is extremely important to identify diseases that can cause a postoperative purulent infection( such as purulent otitis, tonsillitis, furunculosis, pustular skin diseases, etc.).In this pathology, as well as in a number of diseases of the cardiovascular system, blood, lungs, diabetes and other, the operation is postponed until the patient recovers or a corresponding improvement occurs. The exception is urgent surgery for penetrating wounds of the eye, acute glaucoma, creeping ulcers of the cornea, when the condition of the eye does not allow to postpone the operation. For the purpose of prevention, antibiotics and sulfonamides, as well as the general medicinal products shown, should be used.
Contraindications to surgery on the eyeball are: purulent inflammation of the lacrimal sac, barley, acute conjunctivitis. Before intraocular operations, wash the lacrimal pathways, examine the smear or seeding from the conjunctiva. When a pathogenic flora is detected( streptococcus, pneumococcus, some Staphylococcus strains, Koch-Wicks sticks, etc.), the operation is postponed and appropriate treatment is performed.
If the patient is prescribed an operation to open the eyeball, then in the preoperative period, to disinfect the conjunctiva, it is necessary to instill a solution of antibiotics 4-5 times a day into the eye. On the eve of surgery, the patient is given an enema, he takes a bath. On the day of surgery, the skin of the eyelids, forehead, cheeks from the ear to the middle of the nose is moistened with a 1% alcoholic solution of brilliant green, a monocular sterile dressing is applied to the eye.
Before surgery, the patient is injected into the preoperative room, where he must take off his clothes and put on special linen stockings. The dressing sister lays a piece of cotton wool in the ear on the side of the operated eye, so that blood does not flow into it, and three times instill in the eye a 0.25% solution of dicaine( 2% solution of lidocaine).Then the patient is injected into the operating room and placed on the operating table, covered with a sheet, skin of eyelids and faces densely lubricated with a 1% alcohol solution of brilliant green, and the face, head and chest are closed with a sterile napkin with an eye hole. Further, local novocaine anesthesia is produced( subconjunctival, subcutaneous, intramuscular, retrobulbar).
In adults, surgery under general anesthesia is performed in exceptional cases, children are given intramuscular or intravenous anesthesia;in recent years, widely used local, as well as naso- or otopharyngeal anesthesia, and sometimes intratracheal, which are conducted by anesthesiologists according to general surgical rules.
The task of the nurse in preparing the patient for surgery is to accurately fulfill the doctor's prescriptions. The average medical personnel monitors the correct and timely dispatch of patients to the operating room( according to the list), the correct placement of the patient on the table and his condition, and the subsequent transportation to the ward-in a lying position on stretchers or on foot.
Postoperative care of the patient is of great importance for the favorable outcome of the operation. The sister accompanies the patient to bed and puts it. In accordance with the appointment of a doctor, the nurse then monitors the position of the patient in bed, his diet, bowel movements, taking medications, digs up drops, and participates in dressings.
On the first day after the operation of opening the eyeball, the patient receives a small amount of liquid food only, as the chewing movements disturb the peace of the eye. Eating large amounts before and especially after surgery can cause vomiting, which threatens to open the operating wound.
After surgery for retinal detachment, removal of intraocular foreign bodies and corneal transplantation, the patient should lie on his back for a long time, so he needs to comfortably arrange a bed. Particular care should be taken in order to avoid divergence of the edges of the surgical wound and other complications when dressing and dropping drops.
For young children in the first days after the operation, it is necessary to fix hands well, using soft, strong bandages for this purpose, and also to provide immobility of the head, using various fixing devices for this.