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Perioperative? Management and treatment of the client during pre-op, intra-op and post-op phases.
Surgical risks? Age, wounds present, preexisting conditions, mental status, meds, lifestyle/habits and allergies
Pre-op? Agreeing to surgery til on operating table (OR)
Intra-op? OR to PACU
Post-op? PACU to unit to discharge
Goals of perioperative phase? Promote comfort & healing Restore highest level of wellness Prevent risks
Reasons for surgical interventions? To correct anatomical or physiological defect/ provide therapeutic interventions Invasive medical procedure eg laproscopy Surgeries categorize according to level of urgency
Surgeons belief about admission? Pt should be admitted for 23 hour stay for observation
Types of surgical facilities? Hospitals – major surgeries Eg heart, orthopedics, neurology, ophthalmology & gynecology Smaller Hospitals – specialities Ambulatory care centers – outpatient surgeries
1) Palliative decrease spread of disease to prolong life Not curative eg partial tumor removal
2) Conctructive restore function or improve appearance that’s been lost or reduced Eg rhinoplasty, skin grafts for burns, breast reconstruction after mastectomy
3) Diagnostic determine origin of present symptoms and extent of disease process Eg breast biopsy
4) Ablative repair or removal of diseased body part Eg amputation of great toe, aneurism repair, gall bladder removal
5) Transplant remove disease tissue or organ and replace it with a functioning one
1) Emergent needs immediate intervention to sustain life eg trauma, ruptured organ, gun shot
2) Urgent surgery dictates necessity to maintain health not life threatening scheduled 24-48 hours in advance eg bowel resection, hip surgery
3) Elective performed at a time convenient to the patient eg carpal tunnel, appendectomy
4) Inpatient client stays in hospital prior to surgery and begins recovery as an inpatient after
5) Outpatient - no admission to hospital necessary
Types of pre-op surgical facilities Free standing surgical center – usually owned by doctor Doctors offices – local procedures requiring local anesthesia eg removal of skin lesions
Primary goal of pre-op? To place the client in the best possible condition for surgery through careful assessment and prep
Overall goal of pre – op? Ensure client is mentally and physically prepared for surgery Pre-op teaching, psychological prep and discharge planning (starts from pt enters hospital)
Dimensions of pre-op teaching? Explain procedure and what client will experience Psychological support – reduce anxiety Explain role of client and support ppl in pre-op, intra-op and post-op
Pre-op Assessment Current health status Allergies Meds Previous surgeries Mental status Understanding of procedure and anesthesia Smoking, alcohol….. Coping Social resources Cultural and spiritual considerations
Physical Assessment Physical prep Mini mental status Respiratory Cardiovascular Other systems eg gastrointestinal Pre-op diagnostic tests eg CAT scan
Common diagnostic tests? Urinanalysis Cbc Pt & ptt – coagulation Chemistry profile – electrolytes (acidosis or alkalosis?) ECG/EKG – heart HIV test Chest x-ray – if over 60, smoker or scheduled for general anesthesia
Pre – op nursing diagnosis? Deficient knowledge Anxiety Disturbed sleep pattern Anticipatory grieving Ineffective coping eg breast removal
Surgical consent? Surgeon’s responsibility to obtain Nurse verifies consent is signed Consent must be signed before medicating pt
Common orders? Client’s routine eg don’t eat after midnight Specific prep orders by doc eg scrub with antiseptic NPO status – decrease vomiting & prevent aspiration Pre-op meds – bring list of all meds
Pre-op meds? All other prep must be completed prior to giving pre-op meds
Common pre-op meds? Narcotics Sedatives Anti-cholinergic Amnesics
Pre-op checklist? Completed for inpatient and outpatient surgery Nurse sign off on anesthesia when pt goes to PACU Nurse places documentation on chart
Overall goals of intraop? Maintain safety e.g. vitals, meds, time out, prevent skin breakdown Maintain homeostasis
Preparing client for surgery? Nutrition and fluids Elimination Hygiene Meds Rest and sleep Valuables- take off any jewelery Special orders Skin prep Safety Vitals Antiemboli stockings – teds Sequential compression devices
What is anesthesia? Absence of pain
2 classifications of aneasthesia? General Regional/Local
General anesthesia? Loss of sensation & consciousness Loss of protective reflexes Causes: amnesia, analgesia, hypnosis and relaxation Given via inhalation or IV Complications – risk for cardiac & respiratory
Regional/Local? Loss of sensation to a specific region Client remains conscious e.g. topical, nerve block, spinal, epidural or conscious sedation(using analgesic with sedative)
Elderly & anesthesia? Check circulatory function, renal perfusion and sensory losses Report if change in ABG, electrolytes or urinary output
Key position for unconscious pt under anesthesia? Side lying – head down – opposite arm on pillow
Post – op period? Post – op period?
What is used to identify pain if pt is sedated? Vital signs
Role of PACU nurse? ID pt Check airway Check oxygenation Check ventilation Check cardiovascular status- ABG Check wound and drains Level of consciousness Presence of protective reflexes Activity, ability to move extremities
Immediate post anesthetic phase? Skin color Fluid status – large urine output normal Condition of operative site Patency, amount and character of drainage Discomfort Safety Return of sensation to feet after spinal block – distal perfusion is last to return
Immediate Post- anesthetic phase interventions? Position client on side with face down Elevate upper arm on pillow Suction as needed Cough and deep breathe – splint if abdominal surgery Keep flat if spinal anesthesia
Discharge from PACU based on? Respirations Alertness Circulation Temperature – no fever
Post – op initial assessment? ID pt Level of consciousness Vital signs – q 15 min for 1 hour Skin color and temp Comfort Fluid balance Dressing and bed clothes – any pooling of blood underneath Drains and tubes
Post – op nursing interventions Pain management Positioning Incentive spirometer Coughing and deep breathing Leg exercises Early ambulation Adequate hydration Diet Promoting urinary and bowel elimination Suction maintenance as needed Wound care
Respiratory complications of post – op? Pneumonia Atelectasis Pulmonary embolism
Circulatory complications of post – op? Hypovolemia Hemorrhage Hypovolemic shock Thrombophlebitis Thrombus Embolus
Urinary complications of post – op? Urinary retention UTI
GI complications of post – op? Nausea, vomiting and pain Constipation Tympanites – gas in abdomen Post- op ileus
Wound complications of post –op? Infection Dehiscence Evisceration
Psychological complication of post – op? Post – op depression
Elimination complications? Problems from anesthesia, lack of activity & pain meds Urine elimination 30ml normal Bowel elimination
Single most significant measure to prevent complications? Ambulation
GI suction management? Continuous or intermittent – ng tube may be placed before surgery Replace fluid and electrolytes Irrigate tube if lumen clogged
Wound care for post – op pt? Dressing should be clean, dry and intact Assess for: Appearance Size Drainage Swelling Pain Drains or tubes
How do most surgical wounds heal? By first intention healing
Types of drains? Penrose t-tube Jackson-pratt Hemo-vac Recording Communication
Types of drainage? After surgery – sanguinous Beginning of healing – serous sanguinous End of healing – serous
Wound evisceration? This is a surgical emergency Do not push organs back in Cover with a sterile dressing soaked in normal saline
Discharge? Begins at admission Home care prep Health teaching to pt Psychosocial prep Health care resources
Created by: gashasweets1
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