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Perioperative Nursing

Perioperative Nursing

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Published by: bajaoc on Apr 21, 2010
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MEDICAL-SURGICAL NURSING
Perioperative Nursing
PERIOPERATIVE OVERVIEWINTRODUCTION
Perioperative nursing is a term used to describe the nursing care provided in the totalsurgical experience of the patient: preoperative, intraoperative, and postoperative.
Preoperative phase
from the time the decision is made for surgical intervention tothe transfer of the patient to the operating room
Intraoperative phase
from the time the patient is received in the operating room untiladmitted to the postanesthesia care unit (PACU).
Postoperative phase
from the time of admission to the PACU to the follow-upevaluation Types of Surgery
Optional. Surgery is scheduled completely at the preference of the patient(eg, cosmetic surgery).
Elective. The approximate time for surgery is at the convenience of thepatient; failure to have surgery is not catastrophic (eg, a superficial cyst).
Required. The condition requires surgery within a few weeks (eg, eyecataract).
Urgent. The surgical problem requires attention within 24 to 48 hours (eg,cancer).
Emergency. The situation requires immediate surgical attention without delay(eg, intestinal obstruction).Common abdominal incisions are pictured in Figure 7-1.
AMBULATORY SURGERY 
Ambulatory surgery (same-day surgery, outpatient surgery) is a common occurrencefor certain types of procedures. The office nurse is in a key position to assess patient
 
status; plan perioperative experience; and monitor, instruct, and evaluate thepatient.
Advantages
1)Reduced cost to the patient, hospital, and insuring and governmental agencies2)Reduced psychological stress to the patient3)Less incidence of hospital-acquired infection4)Less time lost from work by the patient; minimal disruption of the patient'sactivities and family life
Disadvantages
1)Less time to assess the patient and perform preoperative teaching2)Less time to establish rapport between the patient and health care personnel3)Less opportunity to assess for late postoperative complications. This responsibilityis primarily with the patient, although telephone and home care follow-up ispossible.
Patient Selection
Criteria for selection include:1)Surgery of short duration (varies by procedure and institution)2)Noninfected conditions3)Type of operation in which postoperative complications are predictably low4)Age usually not a factor, although too risky in a premature neonate5)Examples of commonly performed procedures:a)Ear-nose-throat (tonsillectomy, adenoidectomy)b)Gynecology (diagnostic laparoscopy, tubal ligation, dilatation and curettage)c)Orthopedics (arthroscopy, fracture or tendon repair)d)Oral surgery (wisdom teeth extraction, dental restorations)e)Urology (circumcision, cystoscopy, vasectomy)f)Ophthalmology (cataract)g)Plastic surgery (mammary implants, reduction mammoplasty, liposuction,blepharoplasty, face lift)h)General surgery (laparoscopic hernia repair, laparoscopic cholecystectomy,biopsy, cyst removal)
Ambulatory Surgery Settings
Ambulatory surgery is performed in a variety of settings. A high percentage of outpatient surgery occurs in traditional hospital operating rooms in hospital-integrated facilities. Other ambulatory surgery settings may be hospital affiliated orindependently owned and operated. Some types of outpatient surgeries can beperformed safely in the health care provider's office.Nursing ManagementInitial Assessment1)Develop a nursing history for the outpatient; this may be initiated in the healthcare provider's office.2)Ensure availability of a signed and witnessed informed consent that includescorrect surgical procedure and site.3)Explain any additional laboratory studies needed and state why.4)Determine the following during initial assessment of the patient's physical andpsychological status: Calm or agitated? Overweight? Disabilities or limitations?Allergies (be sure to include medication, food, and latex allergies)? Medicationsbeing taken (also include herbal medications because certain herbs, such as St. John's wort [a mild antidepressant] and feverfew, can affect clotting)? Conditionof teeth (dentures, caps, crowns)? Blood pressure problems? Major illnesses?Other surgeries? Seizures? Severe headaches? Smoker? Cardiac or respiratoryproblems?5)Begin the health education regimen. Instructions to the patient:a)Notify the health care provider and surgical unit immediately if you get a cold,have a fever, or have any illness before the date of surgery.b)Arrive at the specified time.c)Do not ingest food or fluid before surgery according to institution protocol.Less strict guidelines for fasting have been advocated, but are controversial.
 
 The American Society of Anesthesiology (ASA) guidelines for preoperativefasting are available atd)Do not wear makeup or nail polish.e)Wear comfortable, loose clothing and low-heeled shoes.f)Leave valuables or jewelry at home.g)Brush your teeth in morning and rinse, but do not swallow any liquid.h)Shower the night before or day of the surgery.i)Follow health care provider's instructions for taking medications. j)Have a responsible adult accompany you and drive you home have someonestay with you for 24 hours after the surgery.
PATIENT EDUCATION GUIDELINESOutpatient Postanesthesia and Postsurgery Instructions and Information
 Although you will be awake and alert in the Recovery Room, small amounts of anesthetic will remain in your body for at least 24 hours and you may feeltired and sleepy for the remainder of the day. Once you are home, take it easy and rest as much as possible. It is advisable to have someone with youat home for the remainder of the day.
Eat lightly for the first 12 to 24 hours, then resume a well-balanced, normaldiet. Drink plenty of fluids. Alcoholic beverages are to be avoided for 24 hoursafter your anesthesia or intravenous sedation.
Nausea or vomiting may occur in the first 24 hours. Lie down on your side and breathe deeply. Prolonged nausea, vomiting, or pain should be reported to your surgeon.
Medications, unless prescribed by your physician, should be avoided for 24hours. Check with your surgeon or anesthesiologist for specific instructions if  you have been taking a daily medication.
Your surgeon will discuss your postsurgery instructions with you and prescribemedication for you as indicated. You will also receive additional instructionsspecific to your surgical procedure before leaving the hospital.
Your family will be waiting for you in the hospital's waiting room area near theOutpatient Surgery Department. Your surgeon will speak to them in this areabefore your discharge.
Do not operate a motor vehicle or any mechanical or electrical equipment for 24 hours after your anesthesia.
Do not make any important decisions or sign legal documents for 24 hoursafter your anesthesia.
NURSING ALERT
Prolonged fasting before surgery may result in undue thirst, hunger,irritability, headache; and even dehydration, hypovolemia, and hypoglycemia.Make sure that patients understand preoperative fasting instructions per institution protocol. Nothing by mouth after midnight may not be necessary for surgeries scheduled later in the morning or afternoon.
Preoperative Preparation
1)Administer preprocedure medication; check vital signs.2)Escort the patient to surgery after the patient has urinated.3)Review the patient's chart for witnessed and informed consent, laterality (iapplicable), lab work, and history and physical.4)Verify correct person, correct site, and correct procedure.
Postoperative Care
1)Check vital signs.2)Administer oxygen if necessary; check temperature.3)Change the patient's position and progress activity head of bed elevated,dangling, ambulating. Watch for dizziness or nausea.4)Ascertain, using the following criteria that the patient has recovered adequatelyto be discharged:a)Vital signs stable for at least 1 hourb)Stands without dizziness and nausea; begins to walkc)Comfortable and free of excessive pain or bleedingd)Able to drink fluids and void

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