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com/19372508/nurs-1613-labor-delivery-flash-cards/ Perioperative Nursing PREOPERATIVE PERIOD Psychologic Support Assess client's fears, anxieties, support systems, and patterns of coping. Establish trusting relationship with client and significant other Explain routine procedures, encourage verbalization of fears, and allow client to ask questions. Demonstrate confidence in surgeon and staff. Provide for spiritual care if appropriate. Preoperative Teaching Frequently done on an outpatient basis. Assess client's level of understanding of surgical procedure and its implications. Answer questions, clarify and reinforce explanations given by surgeon. Explain routine pre- and post-op procedures and any special equipment to be used. Teach coughing and deep-breathing exercises, splinting of incision, turning side to side in bed, and leg exercises; explain their importance in preventing complications; provide opportunity for return demonstration. Assure client that pain medication will be available post-op. Physical Preparation

1. Obtain history of past medical conditions, surgical procedures, allergies, dietary restrictions, and medications. 2. Perform baseline head-to-toe assessment, including vital signs, height, and weight. 3. Ensure that diagnostic procedures are performed as ordered: common tests are a. CBC (complete blood count) b. Electrolytes c. PT/PTT (prothrombin time; partial thromboplastin time) d. Urinalysis e. ECG (electrocardiogram)

f. Type and crossmatch

4. Prepare client's skin. a. Shower with antibacterial soap to cleanse skin if ordered; client may do this at home the night before surgery if outpatient admission. b. Skin prep if ordered: shave or clip hairs and cleanse appropriate areas to reduce bacteria on skin and minimize chance of infection.

5. Administer enema if ordered (usually for surgery on GI tract, gynecologic surgery). 6. Promote adequate rest and sleep. a. Provide back rub, clean linens. b. Administer bedtime sedation.

7. Instruct client to remain NPO after midnight to prevent vomiting and aspiration during surgery. Legal Responsibilities

1. Surgeon obtains operative permit (informed consent). a. Surgical procedure, alternatives, possible complications, disfigurements, or removal of body parts are explained. b. It is part of the nurse's role as client advocate to confirm that the client understands information given.

2. Informed consent is necessary for each operation performed, however minor. It is also necessary for major diagnostic procedures, e.g., bronchoscopy, thoracentesis, etc., where a major body cavity is entered. 3. Adult client (over 18 years of age) signs own permit unless unconscious or mentally

incompetent. a. If unable to sign, relative (spouse or next of kin) or guardian will sign. b. In an emergency, permission via telephone or telegram is acceptable; have a second listener on phone when telephone permission being given. c. Consents are not needed for emergency care if all four of the following criteria are met. 1. There is an immediate threat to life. 2. Experts agree that it is an emergency. 3. Client is unable to consent. 4. A legally authorized person cannot be reached. 4. Minors (under 18) must have consent signed by an adult (i.e., parent or legal guardian). An emancipated minor (married, college student living away from home, in military service) may sign own consent. 5. Witness to informed consent may be nurse, another physician, clerk, or other authorized person. 6. If nurse witnesses informed consent, specify whether witnessing explanation of surgery or just signature of client.

Preparation Immediately Before Surgery

1. Obtain baseline vital signs; report any elevated temperature. 2. Provide oral hygiene and remove dentures. 3. Remove client's clothing and dress in clean gown. 4. Remove nail polish, cosmetics, hair pins, prostheses. 5. Instruct client to empty bladder. 6. Check identification band. 7. Administer pre-op medications as ordered. a. Narcotic analgesics (meperidine [Demerol], morphine sulfate) relax client, reduce anxiety, and enhance effectiveness of general anesthesia. b. Sedatives (secobarbital sodium [Seconal]), sodium pentobarbital [Nembutal] decrease anxiety and promote relaxation and sleep.

c. Anticholinergics (atropine sulfate, scopolamine [Hyoscine]) and glycopyrrolate (Robinul) decrease tracheobronchial secretions to minimize danger of aspirating secretions in lungs, decrease vagal response to inhibit undesirable effects of general anesthesia (bradycardia). d. Droperidol, fentanyl or a combination may be ordered; should not be given with sedatives because of danger of respiratory depression; also helpful in control of postoperative nausea and vomiting. 8. Elevate side rails and provide quiet environment. 9. Prepare client's chart for OR including operative permit and complete pre-op check list. No comments: Post a Comment

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