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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
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)
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)