Perioperative Patient Care

Purposes of Surgery 1. Diagnostic establish the presence of disease condition 2. Exploratory determine the extent of disease condition 3. Curative treats the disease condition ABLATIVE removal (EG: Appendectomy) CONSTRUCTIVE repair of Congenital defects (EG: Cheiloplasty) RECONSTRUCTIVE repair of damaged organ 4. Palliative placement of PEG tubes for Stomach Cancer

Magnitude of Surgery MAJOR High risk for Cx; (EG: Craniotomy, Explore Lap) MEDIUM (EG: appendectomy, hemorrhoidectomy) MINOR decreased Cx is involved (EG: Excision, Removal of ingrown)

Urgency Emergency done immediately. Hemorrhage, VA Imperative done within 24-48 Gangrene, Amputation Planned in weeks or months Thyroidectomy, MRM Elective delay will not cause adverse effects Cauterization of warts, Lumps Optional - requested by the client; for Aesthetic purposes Rhinoplasty, Blepharoplasty

PRE OP

ASSESSMENT * Prep pts at least a day before Age Pain (Presence vs Tolerance) Nutritional status Hydration (IVF 1 prior to Surgery) Infection (prophylaxis @ least 1 before Sx thru IV push; Skin Testing is done b4 giving) Operation time: ATBC or other drugs given? Skin testing

Medications STOP ASA at least 1 week before the Sx Current drug therapy Allergy

Others Prepare 3 units of blood prior to Sx

Religion (not allowed if pt is Jehovahs witness) Occupation (post insertion of Harrington rod, he can no longer bear heavy objects) SO (close relationships)

Review of Systems (for clearance) Hematologic = CBC, Hct, Hgb Pulmonary = Far advanced PTB, Asthma Cardiovascular = pacemakers Neurological = hemiphlegia Renal = status post kidney transplant; BPH

GI = Ulcers because NPO is instructed Endocrinological = BSL defers Sx; CBG q1 Reproductive

CONSENT * valid only for 24 only * pt understands the nature of the Tx, potential Cx, alternatives * w/o pressure; voluntary * protection against legal action

PREPARATIONS

PRE-OP Rounds * skin test * personal hygiene the night before * diet = Liquid, NPO * bowel abdominal Sx = bowel prep; Cleansing enema * skin Ortho prep (sa OR); Skin prep (shaving only) * IV Line

INTRA OP
* Verification * Quick assessment

POST OP

exercise (DBE)

Contraptions Abdominal: NGT, IVF, O2 Explore lap: NGT

Miscellaneous

40 y/o & above needs Cardiovascular clearance Clearance from APs Monitoring VS of pts Check op site Blood request (SOP: 2 units of blood) Bill settlement

Expectations Possible Cx Health teachings: Abd Sx (Teach DBE & Side lying position = Adhesionlysis) Limitations: Hip prosthesis (do logroll)

IMMEDIATE POST OP (post anesthesia recovery stage)

EXTENDED POST OP Sphygmo Stethoscope IV equipment Suction Tongue depressor

Oral A/W Emesis basin Cardiac monitor