PERIOP
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| Perioperative? | Management and treatment of the client during pre-op, intra-op and post-op phases.
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| Surgical risks? | Age, wounds present, preexisting conditions, mental status, meds, lifestyle/habits and allergies
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| Pre-op? | Agreeing to surgery til on operating table (OR)
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| Intra-op? | OR to PACU
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| Post-op? | PACU to unit to discharge
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| Goals of perioperative phase? | Promote comfort & healing Restore highest level of wellness Prevent risks
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| 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
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| Surgeons belief about admission? | Pt should be admitted for 23 hour stay for observation
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| Types of surgical facilities? | Hospitals – major surgeries Eg heart, orthopedics, neurology, ophthalmology & gynecology Smaller Hospitals – specialities Ambulatory care centers – outpatient surgeries
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| 1) Palliative | decrease spread of disease to prolong life Not curative eg partial tumor removal
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| 2) Conctructive | restore function or improve appearance that’s been lost or reduced Eg rhinoplasty, skin grafts for burns, breast reconstruction after mastectomy
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| 3) Diagnostic | determine origin of present symptoms and extent of disease process Eg breast biopsy
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| 4) Ablative | repair or removal of diseased body part Eg amputation of great toe, aneurism repair, gall bladder removal
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| 5) Transplant | remove disease tissue or organ and replace it with a functioning one
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| 1) Emergent | needs immediate intervention to sustain life eg trauma, ruptured organ, gun shot
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| 2) Urgent | surgery dictates necessity to maintain health not life threatening scheduled 24-48 hours in advance eg bowel resection, hip surgery
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| 3) Elective | performed at a time convenient to the patient eg carpal tunnel, appendectomy
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| 4) Inpatient | client stays in hospital prior to surgery and begins recovery as an inpatient after
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| 5) Outpatient | - no admission to hospital necessary
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| 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
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| Primary goal of pre-op? | To place the client in the best possible condition for surgery through careful assessment and prep
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| 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)
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| 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
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| 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
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| Physical Assessment | Physical prep Mini mental status Respiratory Cardiovascular Other systems eg gastrointestinal Pre-op diagnostic tests eg CAT scan
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| 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
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| Pre – op nursing diagnosis? | Deficient knowledge Anxiety Disturbed sleep pattern Anticipatory grieving Ineffective coping eg breast removal
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| Surgical consent? | Surgeon’s responsibility to obtain Nurse verifies consent is signed Consent must be signed before medicating pt
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| 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
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| Pre-op meds? | All other prep must be completed prior to giving pre-op meds
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| Common pre-op meds? | Narcotics Sedatives Anti-cholinergic Amnesics
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| Pre-op checklist? | Completed for inpatient and outpatient surgery Nurse sign off on anesthesia when pt goes to PACU Nurse places documentation on chart
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| INTRAOPERATIVE | OR to PACU
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| Overall goals of intraop? | Maintain safety e.g. vitals, meds, time out, prevent skin breakdown Maintain homeostasis
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| 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
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| What is anesthesia? | Absence of pain
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| 2 classifications of aneasthesia? | General Regional/Local
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| 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
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| 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)
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| Elderly & anesthesia? | Check circulatory function, renal perfusion and sensory losses Report if change in ABG, electrolytes or urinary output
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| Key position for unconscious pt under anesthesia? | Side lying – head down – opposite arm on pillow
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| Post – op period? | Post – op period?
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| What is used to identify pain if pt is sedated? | Vital signs
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| 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
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| 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
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| 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
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| Discharge from PACU based on? | Respirations Alertness Circulation Temperature – no fever
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| 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
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| 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
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| Respiratory complications of post – op? | Pneumonia Atelectasis Pulmonary embolism
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| Circulatory complications of post – op? | Hypovolemia Hemorrhage Hypovolemic shock Thrombophlebitis Thrombus Embolus
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| Urinary complications of post – op? | Urinary retention UTI
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| GI complications of post – op? | Nausea, vomiting and pain Constipation Tympanites – gas in abdomen Post- op ileus
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| Wound complications of post –op? | Infection Dehiscence Evisceration
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| Psychological complication of post – op? | Post – op depression
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| Elimination complications? | Problems from anesthesia, lack of activity & pain meds Urine elimination 30ml normal Bowel elimination
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| Single most significant measure to prevent complications? | Ambulation
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| GI suction management? | Continuous or intermittent – ng tube may be placed before surgery Replace fluid and electrolytes Irrigate tube if lumen clogged
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| Wound care for post – op pt? | Dressing should be clean, dry and intact Assess for: Appearance Size Drainage Swelling Pain Drains or tubes
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| How do most surgical wounds heal? | By first intention healing
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| Types of drains? | Penrose t-tube Jackson-pratt Hemo-vac Recording Communication
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| Types of drainage? | After surgery – sanguinous Beginning of healing – serous sanguinous End of healing – serous
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| Wound evisceration? | This is a surgical emergency Do not push organs back in Cover with a sterile dressing soaked in normal saline
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| Discharge? | Begins at admission Home care prep Health teaching to pt Psychosocial prep Health care resources
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