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PRE-Operative Phase
Begins when the decision to have surgery is made and ends when the client is transferred to the operating table
INTRA-Operative Phase
Begins when the client is transferred to the operating table and ends when the client is admitted to the post-anesthesia unit
Post-operative Phase
Begins with the admission of the client to the PACU and ends when healing is complete
PERIOPERATIVE TEAM
1. ANESTHESIOLOGIST or NURSE ANESTHESIST - makes preoperative assessment to plan type of anesthetic to be administered - to evaluate clients physical status 2. PROFESSIONAL O.R. NURSE - makes preop nursing assessments and documents intraoperative care plan
PERIOPERATIVE TEAM
3. CIRCULATING NURSE - manages the OR - protects clients safety and health needs by monitoring activities of members of the surgical team - monitors conditions in the OR
PERIOPERATIVE TEAM
4. SCRUB NURSE - responsible for scrubbing before surgery - sets up sterile tables & equipment - assists surgeon and surgical assistants during the operation itself 5. PACU NURSE - cares for the client until he/she recovers from the effects of anesthesia
Consent
The surgeon is responsible for obtaining the consent for surgery No sedation should be administered before SIGNING the consent The nurse may serve as witness
TYPES of SURGERY
According to PURPOSE
According to PURPOSE
Diagnostic Establishes a diagnosis
Palliative
Ablative Constructive
Transplant
Elective surgery
Minor Surgery
Surgical Risk
Extremes of age Malnourished Obese Co-morbid conditions Concurrent medications
Pre-operative Interventions
Ensure signed consent form Obtain nursing history, PE and lab exam Provide pre-operative teaching as to the nature of surgery, what to expect and ways to manage post-operative discomforts Perform physical preparations- shaving, hygiene, enema, NPO, medications
Pre-op nutrition
Assess order for NPO Solid foods are withheld for about 8 hours before general anesthesia
Pre-op elimination
Laxatives, enemas or both may be prescribed the night before surgery Have the client void immediately BEFORE transferring them to the OR Foley catheter may be inserted as ordered
Pre-op hygiene
Bath the night before surgery with antiseptic soap Shaving of the skin is usually done in the OR Removal of jewelry and nail polish
Pre-operative medications
Pre-op Drugs Example
Purpose
To decrease nervousness Promote relaxation Decreases secretions Prevent bradycardia To promote muscle relaxation To prevent nausea and vomiting
Anti-anxiety Diazepam
Atropine
Succinylcholine
Promethazine
Pre-operative medications
Pre-op Drugs Example
Purpose
To decrease pain and decrease anesthetic dose
Analgesics
Meperidine
H-2 antagonist
Cimetidine
ALT, AST, Bilirubin Evaluates the liver function Serum albumin CXR and ECG Evaluates nutritional status Respiratory and Cardiac status
Pre-operative teaching
Leg exercises To stimulate blood circulation in the extremities to prevent thrombophlebitis
To facilitate lung aeration and secretion mobilization to prevent atelectasis and hypostatic pneumonia
Done every two to four hours
Anesthesia
General anesthesia
GENERAL Anesthesia
Protective reflexes are lost Amnesia, analgesia and hypnosis occur Administered in two ways:
Inhalational Intravenous
REGIONAL Anesthesia
TOPICAL INFILTRATION NERVE BLOCK SPINAL Subarachnoid EPIDURAL Applied directly on the skin Injected into a specific area of skin Injected around a nerve Low spinal anesthesia Epidural space is injected with anesthesia
Patient Positioning
Provides optimal visualization Provides optimal access for assessing and maintaining anesthesia and function Protects patient from harm
SCRUB NURSE
CIRCULATING NURSE
Assists the surgeon Maintains sterility Handles instruments Drapes patient Counts sponges Wears sterile gown, gloves Assists the Scrub nurse Positions the patient for surgery Positions any equipments
Post-operative interventions
PAIN MANAGEMENT Pain is usually greatest during the 1236 hours after surgery Narcotic analgesics and NSAIDS may be prescribed together for the early period of surgery Provide back rub, massage, diversional activities, position changes
Post-operative Interventions
Deep breathing and coughing exercises Q2-4 hours to remove secretions Leg exercises Q 2 hours to promote circulation Ambulation ASAP prevents respiratory, circulatory, urinary and gastrointestinal complications
Post-operative Interventions
Hydration after NPO to maintain fluid balance Suction, either gastro or respiratory to relieve distention, to remove respi secretions Diet progressive, usually given when bowel sounds and gag reflex return
Wound Care
Inspect dressing hourly Change dressing daily Inspect for signs of infection redness, swelling, purulent exudate Maintain wound drainage
Diet
NPO usually immediately after surgery Progressive diet
Urinary Elimination
Offer bedpans Allow patient to stand at the bedside commode if allowed Report to surgeon if NO URINE output noted within 8 hours post-op
CPT
Chest Physiotherapy Chest physiotherapy is based on the fact that mucus can be knocked or shaken form the walls of the airways and helped to drain from the lungs. The usual PVD SEQUENCE is as follows- POSITIONING, Percussion, Vibration, and removal of secretions by SUCTIONING or Coughing followed lastly by oral hygiene
Incentive Spirometry
This operates on the principle that spontaneous sustained maximal inspiration is most beneficial to the lungs and has virtually no adverse effects. The incentive spirometer measures roughly the inspired volume and offers the incentive of measuring progress
Pneumonia
Inflammation of alveoli
Post-operative Complications
Hypovolemic Loss of Shock circulatory fluid volume
Shock position Determine cause and prevent bleeding O2, IVF
Encourage ambulation Provide privacy Pour warm water Catheterize
Urinary retention
Pulmonary embolism
Post-operative complications
Constipation Infrequent passage of stool
High fiber diet Increased fluid Ambulation
Post-operative complications
Wound dehiscence
Cover the wound Separation of wound edges at with sterile normal the suture line saline dressing Place in lowFowlers Notify MD
Wound evisceration
Cover the wound Protrusion of with saline pad the internal Place in loworgans and tissues through fowlers Notify MD wound
To emphasize
The over-all goal of nursing care during the PRE-OPERATIVE phase is to prepare the patient mentally and physically for the surgery
To emphasize
The over-all goal of nursing care during the INTRA-OPERATIVE phase is to maintain client safety
To emphasize
The over-all goals of nursing care during the POST-OPERATIVE phase are to promote healing and comfort, restore the highest possible wellness and prevent associated risk