Professional Documents
Culture Documents
Perioperative Nursing
Definition of Surgery
Surgery is any procedure performed on the human body that uses instruments to alter tissue or organ integrity.
Perioperative Nursing
http://www.viddler.com/v/802cd6a4
Perioperative Nursing- connotes the delivery of patient care in the preoperative,intraoperative, and postoperative periods of the patients surgical experience through the framework of the nursing process. The nurse assesses the patientcollecting,organizing, and prioritizing patient data; establishing nursing diagnosis;identifies desired patient outcomes;develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient.
Perioperative Nursing
Type of Surgery (Purpose)
Diagnostic-Allows to confirm or establishes diagnosis. Corrective- Excision or removal of diseased body part. Reconstructive-Restore function or appearance to traumatized or malfunctioning tissues. Ablative Removes a diseased body parts Palliative Relieves or reduces pain or symptoms of a disease; it does not cure Transplant Replaces malfunctioning structures Cosmetic- Performed to improve personal appearance.
Perioperative Nursing
Types of Surgery (Urgency)
Emergency- performed immediately to preserve function or the life of the client. Elective is performed when surgical intervention is the preferred treatment for a condition that is not imminently life threatening or to improve the clients life. Urgent Necessary for client health to prevent additional problem from developing; not necessarily an emergency. Required has to be performed at some point; can be pre-scheduled.
Perioperative Nursing
Type of Surgery (Degree of Risk)
Major involves a high degree of risk. Minor normally involves little risk. Age very young and elder clients are greater surgical risks than children and adult. General health- surgery is least risky when the clients general health is good. Nutritional Status required for normal tissue repair. Medications regular use of certain medications can increase surgical risk. Mental status disorder that affect cognitive function
Perioperative Nursing
Surgical settings
Surgical suites Ambulatory care setting Clinics Physician offices Community setting Homes
Perioperative Nursing
Surgical settings
Disadvantages Less time for rapport Less time to assess, evaluation, teach Risk of potential complication post D/C. Advantages of outpatient: Low cost Low risk of infection Less interruption of routine Less than from work Less stress
Preoperative Nursing
Consent
Nature and intention of the surgery Name and qualifications of the person performing the surgery. Risks, including tissue damage, disfigurement, or even death Chances of success Possible alternative measures The right of the client to refuse consent or later withdraw consent.
Preoperative Nursing
Assessment (Nursing History)
Current health status Allergies Medications- list all current medications Previous surgeries Understanding of the surgical procedure and anesthesia Smoking Alcohol and other-altering substances Coping Social resources Cultural considerations
Cardiovascular system Respiratory system Renal system Neurological system Musculoskeletal system Nutritional status Gerontological considerations
General survey- gestures and body movements may reflect decreased energy or weakness caused by illness. Cardiovascular system- alterations in cardiac status are responsible for as many as 30% of perioperative death. Respiratory system- a decline in ventilatory function, assessed through breathing pattern and chest excursion, may indicate a clients risk for respiratory complications.
Renal system-abnormal renal function can altered fluid and electrolyte balance and decrease the excretion of preoperative medications and anesthetic agents. Neurologic system- a clients LOC will change as a result of general anesthesia but should return to the preoperative LOC after surgery.
Musculoskeletal system- Deformities may interfere with intraoperative and postoperative positioning. Avoid positioning over an area where the the skin shows signs of pressure over bony prominences. Gastrointestinal system- alteration in function after surgery may result in decreased or absent bowel sound and distention. Head and Neck- the condition of oral mucous membranes reveals the level of hydration.
Cardiovascular Coronary flow decreases Heart rate decreases Response to stress decreases Peripheral vascular decreases Cardiac output decreases Cardiac reserve decreases
Respiratory System Static lung volumes decreases Pulmonary static recoil decreases Sensitivity of the airway receptors decreases Nervous system Increased incidence of post.op. confusion. Increased incidence of delirium Increased sensitivity to anesthetic agents
Renal System Renal blood flow declines 1.5% per year. Renal clearance reduced Gastrointestinal Decreased intestinal motility Decreased liver blood flow Delayed gastric emptying
Musculoskeletal Decreased mass, tone, strength Decreased bone density Integumentary Decreased elasticity Decreased lean body mass Decreased subcutaneous fat
Screening tests depend on the condition of the client and the nature of the surgery. If test reveals severe problems the surgery may be cancel until the condition is stabilized. Routine screening test-CBC,Blood grouping and X-match, Lytes, fasting blood sugar, BUN & Creatinine, ALT,AST, and bilirubin,Serum albumin, and Total protein, Urinalysis, Chest X-ray,ECG
ASA 1: Healthy patient with no disease ASA 11: Mild systemic ds without fx limitations ASA 111:Severe systemic ds associated with definite fx limitations ASA 1V: Severe systemic ds that is a constant threat to life. ASA V: Moribund pt. Who is not expected to survive without the operation. ASA V1: A declared brain-death whose organ are being recovered for donor. E: Emergency
All personal belongings are identified and secured. Jewelry is usually removed. Dentures are removed, labeled and placed in a denture cup. Pt. to verbally confirm the surgical procedures and the surgical site. This verification process is documented in the medical record on the preop. checklist.
Prior to administering check permits Purpose: Allay anxiety Decrease pharyngeal secretionsDecrease gastric secretion. Decrease side effects of anesthesia. Induce amnesia
Intraoperative Phase
Surgical Team
Surgeon-responsible for determining the preoperative diagnosis, the choice and execution of the surgical procedure, the explanation of the risks and benefits, obtaining inform consent and the postoperative management of the patients care. Scrub nurse- (RN or Scrub tech)- preparation of supplies and equipment on the sterile field; maintenance of pt.s safety and integrity: observation of the scrubbed team for breaks in the sterile fields; provision of appropriate sterile instrumentation, sutures, and supplies; sharps count.
1.Type and duration of the procedure 2.Area of the body being operated on 3.Whether the procedure is an emergency 4.Options of management of post. Op. pain 5.How long it has been since the client ate, had any liquids, or any medications 6.Client position for the surgical procedures
Intraoperative Phase
Types of Anesthesia
General- method use when the surgery requires that the patient be unconscious and/or paralyzed. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.
Intraoperative Phase
Stages of General Anesthesia
Stage 1- Analgesia and sedation, relaxation Stage 2- Excitement, delirium Stage 3- Operative anesthesia, surgical anesthesia Stage 4- Danger
Intraoperative Phase
Intraoperative Phase
Local or Regional Anesthesia Temporarily interrupts the transmission of sensory nerve impulses from a specific area or region.
Motor function may or may not be affected Client does not lose consciousness Gag reflex remains intact Supplemented with sedatives, opioids, or hypnotics
Intraoperative Phase
Spinal Anesthesia
Indications -surgical procedures below the diaphragm -patients with cardiac or respiratory disease Advantages -mental status monitoring -shorter recovery Disadvantages -necessary extra expertise -possible patient pain Contraindications -coagulopathy -uncorrected hypovolemia
Spinal Anesthesia
Involved medications -lidocaine -bupivacaine -tetracaine Patient assessment -continuous heart rate, rhythm, and pulse oximetry monitoring -level of anesthesia -motor function and sensation return monitoring
Spinal Anesthesia
Complications
-hypotension -bradycardia -urine retention -postural puncture headache -back pain
Spinal analgesia
Indications -postoperative pain from major surgery Involved medications -lipid-soluble drugs -preservative-free morphine Monitoring recovery -respiratory depression -urine depression -pruritus -nausea and vomiting
Intraoperative Phase
Conscious Sedation
Produces a depressed level of consciousness Retains ability to maintain a patent airway Able to respond to verbal commands or physical stimulation Used for relatively short procedures
Vital signs- presence of artificial airway, 02 sat,BP,pulse, temperature. LOC- ability to follow command, pupillary response Urinary output Skin integrity Pain Condition of surgical wound Presence of IV lines Position of patient
Ineffective airway clearance- increased secretions 2 to anesthesia, ineffective cough, pain Ineffective breathing pattern- anesthetic and drug effects, incisional pain Acute pain Urinary retention Risk for infection
Postoperative Phase
Assessment of the Postanesthesia Client
Airway Vital signs Cardiac monitoring Peripheral vascular assessment Level of consciousness (LOC) Fluid and electrolytes GI system Integumentary system Discomfort/pain
Maintain a patent airway Stabilize vital signs Ensure patient safety Provide pain Recognize & manage complications
Wind: prevent respiratory complications Wound: prevent infection Water: monitor I & O Walk: prevent thrombophlebitis
Postoperative Phase
Complications
Respiratory- atelectasis, pulm. Embolus Cardiovascular- venous thrombosis Gastrointestinal-Hiccoughs, N/V,abd. Distention, paralytic ileus, stress ulcer. GU- urinary retention Hemorrhage-slipping of a ligature(suture) Wound infection Wound dehiscence and evisceration-
Dehiscence
Partial or complete separation of the outer layer of the wound. Possible causes: Poor suturing technique Distention Excessive vomiting Excessive coughing Dehydration Infection
Evisceration
Total separation of the layers & protrusion of internal organs or viscera through the open wound. Causes: same as dehiscence Treatment: Call for help Cover with sterile NS soaked gauze/towels Keep moist DO NOT ATTEMPTS TO REINSERT ORGANS. Keep in supine position with knees/hips bent Assessment/VS q 5 min. until MD arrive Prepare for surgery.
Postoperative Phase
Postoperative Phase
Mental status- attributed to medications, pain, anxiety, depression. Delirium- infection, malignancy, trauma, MI, CHF, opioid use. Dementia-sundowning-sleep disturbances, lack of structure in the afternoon or early morning, sleep apnea.