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Perioperative Nursing

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Elizabeth E

on 15 October 2013

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Transcript of Perioperative Nursing

Perioperative Nursing
Chapter 30 (Taylor)
Chap 16-18 (Iggy)

See TABLE 30-1 pg 821 (Taylor)

See TABLE 16-2 pg 243 (Iggy)
B.Classification of Surgical Procedures


A. Phases of the Perioperative Period
-preoperative
-intraoperative
-postoperative
C. Anesthesia
1. General Anesthesia
-pt is unconscious
-phases: induction, maintenance, and emergence
-major risks: circulatory and resp depression, postoperative
nausea and vomiting, and alterations in thermoregulation
-malignant hyperthermia

2. Regional Anesthesia
-pt is awake but loses sensation to a certain area of body

3. Topical and Local Anesthesia
-numbed with cocaine (Lidocaine)
-wounds, burns, tissue biopsies

4. Moderate Sedation/Analgesia
D. Informed Consent and Advance Directives
-Consent implies that the pt has sufficient info to
understand:
+the nature of and reason for surgery
+ description of the procedure or treatment along with
potential alternative therapies
+the underlying disease process and its natural course
+name and qualifications of the person performing the
procedure or treatment
+explanations of the risks involved, including risk for
damage, disfigurement, or death, and how oftenthey
occur
+explanation that the pt has right to refuse and
consent may be withdrawn
+explanation of expected outcome/recovery plan
The surgeon is responsible for having the consent form signed
before sedation is given and before surgery is performed. You as
a nurse are not responsible for providing detailed information
about the surgical procedure. Rather, your role is to clarify facts
that have been presented by the physician and dispel myths. You
verify that the consent form is signed and you serve as a witness
to the signature, not to the fact that the pt is informed.

-Make sure pt is alert and aware at time of signature
Advance Directives:
1. Living wills
2. Durable power or attorney

DNR
II.The Nursing Process For
Preoperative Care
I. The Surgical Experience
-Perioperative nurses base their plans of care on already known and recognized desired outcomes.
>be free of DVT
>be free from injury r/t positioning
>have pain managed
>be free from infection

A. Assessing
-preoperative assessments identify factors that may place
the pt at greater risk for complications during and after
surgery
1. Health History
-Age (complications arise at both end of spectrum)
-Medical History (past/current illnesses)
ex: Diabetes = poor wound healing
-Medications
ex: anticoagulants (hemorrhage)
metformin + xray = acute renal failure
-Previous Surgeries
-Nutritional Status
ex: protein intake?
-Use of Drugs/Alcohol
-Activities of Daily Living
-Coping Patterns and Support Systems
ex: religion? family?
-Sociocultural Needs
-CAM/CAT
ex: is pt taking garlic?




2. Physical Assessment
-obtain baseline data
-vital signs
-report and abnormal findings to surgeon or
anesthesia personnel
-cardiovascular, respiratory status, kidney
function
-skin assessment
3. Psychosocial Assessment
-anxiety
4. Laboratory Assessment
-electrolyte levels (K+)
-Clotting studies (PT, INR)
-complete blood count
5. Imaging Assessment
-chest x-ray
-ECG

B. Diagnosing
C. Outcome Identification and Planning
D. Implementing
-preoperative nursing interventions provide the pt with the necessary
psychological and physical preparation for surgery and the postoperative
phase. (LOTS AND LOTS TEACHING and COMMUNICATING)
2. Preparing the Pt Psychologically Through Teaching
a. surgical events and sensations (noises, lights)
b. pain management
-prn, TENS unit
c. physical activities
-prevent atelectasis, pneumonia, thrombophlebitis, emboli
-TCDB, IS, turning in bed, leg exercises (increase venous return)
3.Preparing the Pt Physically
-clean skin, elimination
-nutrition/fluids
>NPO
-meds (sedatives to relieve anxiety)

III. The Nursing Process for
Intraoperative Care

A. Assessing
-checklist
-placing sequential compression devices to prevent DVT
-proving comfort
-etc.
B. Diagnosing
-Risk for Perioperative Positioning Injury
-etc.
C. Outcome Identification and Planning
-The pt will:
>remain free neuromuscular injury
>maintain skin integrity
>have symmetric breathing patterns
>maintain normothermia
>remain free of injury from burns/ retain foreign objects
D. Implementing
-Positioning (prevent alterations in integumentary, resp, vascular,
and neuromuscular function)
-Draping (for sterility)
-Surgical Asepsis
-Documenting
>item counts, vital signs, positioning etc.
-transferring pt to PACU + hand-off report
IV. The Nursing Process for
Postoperative Care


A. Assessing
-assessments should be conducted every 15/20 min until stable
then every 1 to 2 hours for the first 24 hrs
and every 4 hours there after
B. Diagosing
-Risk for Infection
-Acute Pain
C. Outcome Id and Planning
-REMEMBER: teaching begins during preoperative phase
>the pt will:
-carry out leg exercises every 2 to 4 hrs
-regain normal bowel and bladder elimination
-etc
Care in the PACU involves assessing the postoperative
pt, with emphasis on preventing complications from
anesthesia or the surgery.

-use baseline data for comparison
-assess every 15 to 20 min
-resp status: ensure airway maintains patent by
positioning on the side/ HOB elevated, encourage pt to take
deep breaths
-cardiovascular: look out for hypotension, hypothermia (give
warm blankets), shock
-CNS status
-Fluid Status: children/older adults
-wound status: report signs/symptoms of hemorrhage
immediately (large amounts of red drainage, pallor, cold/moist
skin, ^pulse, ^resp rate, decreasing BP)
-pain management


D. Implementing
-nursing care is discussed to prevent complications, promote a return to
health, and facilitate coping with alterations
1. Preventing Cardiovascular Complications
a. Hemorrhage
-look for common manifestations such as:
>anxiety, restlessness, cold, clammy skin, deep/rapid resp,
decreased urine output, thirst, apprehension
-if bleeding occurs apply pressure and notify dr immediately
b.Shock
-hypovolemic shock occurs from a decrease in blood volume
-same manifestations as hemorrhage
-flat position with legs elevated
c. Thrombophlebitis
-anticoagulants, apply external heat, antiembolic stockings,
pneumatic compression devices, do NOT massage
2. Preventing Resp Complications
a. Pulmonary Embolus
-avoid Valsalva 's maneuver, maintain pt in Semi-Fowler's
b. Pneumonia
-manifestations: rust/purulent sputum, fever, chills
-oxygen, semi-fowlers, frequent oral hygiene, antibiotics
c. Atelectasis
-collapse of alveoli
-administer oxygen
3. Preventing Surgical Site Complications
-assess for s/s of infection (fever)
-maintain nutritional status (protein, carbs, vit)
-aseptic technique

4. Promoting a Return to Health
a. elimination needs
-altered by anesthesia
-altered fluid intake
-assess for bowel sounds/ BM/ pass gas
-intake/output
b. fluid and nutrition needs
-clear to full liquids > soft to regular diet
c. comfort and rest needs


5. Helping the pt Cope
-allow pt to verbalize fears/concerns
-therapeutic communication

By: Elizabeth Espinoza VVC
Full transcript