Medical Surgical Nursing

PERIOPERATIVE NURSING By : Lowell P. Bautista, RN

DEFINITION OF TERMS

SURGERY -It is the branch of medicine concerned with diseases and conditions which require or are amenable to operative procedures. Surgery is the work done by a surgeon. -"Surgery can involve cutting, abrading, suturing, laser or otherwise physically changing body tissues and organs."

SURGEON - A physician who treats disease, injury, or deformity by operative or manual methods. A medical doctor specialized in the removal of organs, masses and tumors and in doing other procedures using a knife (scalpel) STERILE - free from living germs or microorganisms; aseptic: sterile surgical instruments.

especially : septicemia .a toxic condition resulting from the spread of bacteria or their toxic products from a focus of infection.  ASEPSIS .The state of being free of pathogenic microorganisms. SEPSIS . .The process of removing pathogenic microorganisms or protecting against infection by such organisms.

  SEPSIS .is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing bacteria.is caused by bacterial infection that can originate anywhere in the body. DISINFECTANT . . .any chemical agent used chiefly on inanimate objects to destroy or inhibit the growth of harmful organisms.

and spores.is a substance that prevents or arrests the growth or action of microorganisms either by inhibiting their activity or by destroying them. vegetative forms. The term is used especially for preparations applied topically to living tissue STERILIZATION -the destruction of all living microorganisms. as pathogenic bacteria. .  ANTISEPTICS .

An agent. BACTERICIDAL . such as a chemical or biological material. . .   BACTERIOSTATIC -Capable of inhibiting the growth or reproduction of bacteria. antiseptics or antibiotics.is a substance that kills bacteria . BACTERIOCIDES . that inhibits bacterial growth.Capable of killing bacteria.Bactericides are either disinfectants.

PREFIXES & SUFFIXES Prefixes & Suffixes can explain the type of procedure the client will undergo:  PREFIXES  Supra – above . beyond  Ortho – joint  Chole – bile or gall  Cysto – bladder  Encephalo.brain  .

        Entero – intestine Hystero – uterus Mast – breast Meningo – membrane.ovary . meninges Myo – muscle Nephro – kidney Neuro – nerve Oophor .

     Pneumo – lungs Pyelo – kidney pelvis Salphingo – fallopian tube Thoraco – chest Viscero – organ esp. abdomen .

SUFFIXES  Oma – tumor . swelling  Ectomy – removal of an organ or gland  Rhapy – suturing or stitching of a part or an organ  Scopy – looking into  Ostomy – making an opening or a stoma  Otomy – cutting into  .

hernia . swelling Itis – inflammation of .   Plasty – to repair or restore Cele – tumor .

. intraoperative judgement & management.  OPERATION – an invasive modality of treatment.PERIOPERATIVE NURSING  SURGERY – a branch of Medicine that encompasses preoperative care. & postoperative care of patients.

 .k. & the implementation of an individualized program of nursing care in order to restore or maintain the health & welfare of the patient before.PERIOPERATIVE NURSING DEFINITION:  a.a : OPERATING ROOM NURSING  The identification of physiological & sociological needs of the client. during & after surgical intervention.

.PERIOPERATIVE NURSING  PHILOSOPHY :  To give service that aims to provide comprehensive support physically. & socially to a patient undergoing surgery. spiritually. morally. psychologically.

2. . To assist the surgeon by functioning effectively as a member of the surgical team. supportive & comprehensive care. 3. To create & maintain an aseptic / sterile environment.PERIOPERATIVE NURSING  GOALS : 1. To provide safe.

R. 2.PERIOPERATIVE NURSING Fundamental purposes of the O. To create a suitable sterile field for surgical procedures to prevent complications.  . . 3. To correlate theory & practice. To develop skills in assisting the surgeon in the operation. . 1. :  It is a place.

Perioperative Patient-Focused Model .

Includes three phases: Preoperative phase: the period of time from the decision for surgery until the patient is transferred into the operating room.  Postoperative phase: the period of time that begins with admission to the PACU and ends with followup evaluation in the clinical setting or at home  .  Intraoperative phase: the period of time from when the patient is transferred to the operating room to the admission to postanesthesia care unit (PACU). Period of time that constitutes the surgical experience.

disorder maybe life.threatening. > examples : Severe bleeding. > indications for surgery : without delay. 1) According to Urgency : EMERGENT – pt. requires immediate attention . gunshot or stab wounds. CLASSIFICATIONS OF SURGERY . bladder or intestinal obstruction. fractured skull. extensive burns.

> examples : Acute gallbladder infection Kidney / Ureteral stones .CLASSIFICATIONS OF SURGERY 2) URGENT – pt. > indications for surgery : within 24-30 hours. requires prompt attention.

> examples : Prostatic hyperplasia without bladder obstruction. Cataracts. > indications for surgery: plan within few weeks or months. Thyroid disorders.CLASSIFICATIONS OF SURGERY 3) REQUIRED – pt. needs to have surgery. .

> indications for surgery: Failure to have surgery not catastrophic. > examples : Repair of scars Simple hernia Vaginal repair .CLASSIFICATIONS OF SURGERY 4) ELECTIVE – pt should have surgery.

> indications for surgery : Personal preference > examples : Cosmetic surgery .CLASSIFICATIONS OF SURGERY 5) OPTIONAL – decision rests with pt.

CLASSIFICATIONS OF SURGERY Accdg. vital organs maybe involved. To Degree Of Risk :  MAJOR – high degree of risk : >maybe complicated / prolonged. Organ transplant Open heart surgery Removal of a kidney  . >ex. large losses of blood may occur. post-op complications may be likely.

CLASSIFICATIONS OF SURGERY  MINOR – little risk with few complications. . > examples: Breast biopsy Tonsillectomy Knee surgery .often performed in a “day surgery”.

.Ex. Biopsy EXPLORATORY – estimates the extent of the disease or injury.CLASSIFICATIONS OF SURGERY  1. . 2. To Purpose : DIAGNOSTIC – verifies suspected diagnosis . 3.ex. Accdg. Explore laparotomy CURATIVE – removes or repairs damaged tissues .

ABLATIVE – removing diseased organ that can’t wait anymore. 6.CLASSIFICATIONS OF SURGERY 4. 5. PALLIATIVE – relieves symptoms but does not cure the underlying disease process. . RECONSTRUCTIVE – partial or complete restoration of a damaged organ/tissue to bring back the original appearance & function. face-lift) .emergency surgery.(mammoplasty.

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CONSTRUCTIVE – repairing the damaged tissue or congenitally defective organ. (multiple wound repair) Accdg. To Location : INTERNAL – inside the body . Ex. Hysterectomy EXTERNAL – outside the body . Ex. Skin grafting

FOUR BASIC PATHOLOGIC CONDITIONS THAT REQUIRE SURGERY: 1) OBSTRUCTION – a blockage ; are dangerous because they block the flow of blood, air, CSF, urine & bile through the body. 2) PERFORATION – is a rupture of the organ, artery or bleb.

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EROSION – break in the continuity of tissue surface. It can be caused by irritation, infection, ulceration or inflammation. It can damage the walls of blood vessels resulting in serious bleeding. TUMORS – abnormal growth of tissue that serves no physiologic function in the body.

infection/sepsis Pts. with severe trauma or injury. Nutritional deficits Pts.THE SURGICAL RISK PATIENTS        Extremes of age ( very young & very old ) Extremes of weight (emaciation. obesity) Dehydrated pts. with cardiovascular disease Endocrine dysfunction (diabetes mellitus) .

    Hypertensive & hypotensive pts. Hypovolemia Hepatic disease Preexisting mental or physical disability .

3. 5. 2. Pain Hemorrhage Infection UTI . 4. PROBLEMS THAT MAY ARISE IN SURGERY: Surgical risk pts – probability of morbidity or mortality following surgery. 1.

 It ends on the time the client is transferred to the O.R. PREOPERATIVE PHASE  The rendering of nursing care to the surgical client as soon as he is admitted & the decision to undergo surgery is made. NURSING : I.  .R.PHASES OF O.

ensure necessary tests have been performed  Pre-op teaching involving client & support persons.  PREADMISSION TESTING.  . before the day of surgery-interview)  Identification of potential/actual health problems.NURSING ACTIVITIES :  Assessment of the client (baseline evaluation of the pt.

teaching reviewed  informed consent confirmed  pt.  .Day of surgery :  pt.’s identity & surgical site verified  IVF started.

b) Establish trusting relationship with client & significant others. anxieties.  .PREPARATION FOR SURGERY Psychological Support : a) Assess client’s fears. encourage verbalization of fears & allow client to ask questions. support systems & patterns of coping. c) Explain routine procedures.

d) e) Demonstrate confidence in surgeon & staff. . Provide for spiritual care if appropriate.

Answer questions. Assess client’s level of understanding of surgical procedure & its implications.PREOPERATIVE TEACHING     Frequently done on an outpatient basis.& post-op procedures & any special equipment to be used. . clarify & reinforce explanations given by the surgeon. Explain routine pre.

coughing.PREOPERATIVE TEACHING         Preoperative experience Preoperative medication Breathing exercises. support of coping Special considerations related to outpatient surgery . incentive spirometer Leg exercises Position changes and movement Pain management Reducing anxiety and fear.

Diaphragmatic Breathing and Splinting When Coughing .

Leg Exercises and Foot Exercises .

surgical procedures. Perform baseline head-to-toe assessment.Preoperative Nursing Interventions      PHYSICAL PREPARATIONS: Patient safety is a primary concern. Obtain history of past medical conditions. height & weight. Ensure that diagnostic procedures pertinent to surgery are performed as ordered: . including VS. dietary restrictions & medications.

Partial thromboplastin time) Urinalysis ECG Blood typing & crossmatch . 2. 4.1. 5. 6. 3. CBC Electrolytes PT/PTT (Prothrombin Time.

goal of pre-op skin prep is to decrease bacteria without injuring the skin.  NPO. .to prevent aspiration Bowel prep and skin prep . .cleansing enema or laxative before surgery to allow satisfactory visualization of the surgical site.

Attend to family needs . contacts. voiding. removal of dentures. etc. jewelry. to the Presurgical area about 30 to 60 minutes before anesthetics is to be given. Immediate preoperative preparation Complete checklist and chart  Hospital gown.  Preoperative medication    Transporting the pt.

LEGAL PREPARATION:  Surgeon obtains operative permit (informed consent) 1.  . It is part of the nurse’s role as client advocate to confirm that the client understands information given. Surgical procedures. 2. possible complications & disfigurements or removal of body parts are explained. alternatives .

Circumstances: Invasive procedures. such as arteriography Procedures involving radiation . Procedures requiring sedation or anesthesia A non-surgical procedure. biopsy. cystoscopy or paracentesis.     INFORMED CONSENT is necessary in the ff. such as surgical incisions.

If unable to sign. 2. In an emergency. 1. permission via telephone or telegram is acceptable. Adult client (over 18 y/o) signs own permit unless unconcious or mentally incompetent. relative (spouse or next of kin) or guardian will sign. have a 2nd listener on phone when telephone permission is given .

criteria are met: There is an immediate threat to life. A legally authorized person cannot be reached. c. b. d. Experts agree that it is an emergency. . a. Client is unable to consent.3. Consents are not needed for emergency care if all 4 of the ff.

  Minors (under 18 y/o) must have consent signed by an adult (i. Parent or legal guardian) Emancipated minor (married or independently earning his or her own living)may sign his/ her own consent. .e.

Witness to informed consent may be a nurse, another M.D., clerk or any other authorized person. The nurse witnessing informed consent, specifies whether witnessing explanation of surgery or just signature of the client.

PREOPERATIVE MEDICATIONS

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PURPOSES: To relieve fear & anxiety. To reduce dose needed for induction & maintenance of anesthesia. To prevent reflex bradycardia that happens during induction of anesthesia. To minimize oral secretions.

PREOPERATIVE MEDICATIONS

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was admitted to the O. .II.   INTRAOPERATIVE PHASE Giving nursing care to client undergoing surgery. . It starts from the time the pt. during operation until it ends & transferred to the PACU.R.

 Ensuring proper function of equipments.  Positioning pts.  Acting as scrub/circulating nurse.  .NURSING ACTIVITIES:  Activities providing for pt’s safety.  Maintenance of aseptic environment.  Providing surgeons with specific instruments & supplies for surgical field.  Completing documentation.

Members of the Surgical Team Patient  Anesthesiologist or anesthetist  Surgeon  Nurses (Scrub & Circulating)  Surgical technologists  .

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SCRUB TEAM @ WORK .

OPERATING SURGEON – pre-op dx & care.performance of operation.assumes all responsibility for all medical acts of judgement & mgt.is also subject to several risks. . or fearful & highly stressed. .  PATIENT – the most important member of the surgical team. . . May feel relaxed & prepared.post-op mgt & care .

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– practices under the direct supervision of the surgeon. .    SURGEON & ASSISTANTS – scrub & perform the surgery. maintaining hemostasis) ANESTHESIOLOGIST / NURSE ANESTHETIST – administers the anesthetic agent & monitors the pt’s physical status throughout the surgery. REGISTERED NURSE 1ST ASST. (handling tissue. suturing.

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skin prep. .performs surgical hand scrub. managing surgical specimens & documenting intraoperative events. positioning . . CIRCULATING NURSE – coordinates the care of the pt.  SCRUB NURSE – provides sterile instruments & supplies to the surgeon during the procedure. in the O.R. .care provided includes assisting with pt.

 SCRUB NURSE .

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CIRCULATING NURSE .

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where scrub clothes. caps & masks are worn.  Semirestricted zone.  . Located central to all supporting services.where attire consists of scrub clothes & caps. Unrestricted zone – where street clothes are allowed. shoe covers.Prevention of Infection  The surgical environment – stark appearance & cool temperature.  Restricted zone.

THE OPERATING ROOM .

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Basic Guidelines for Surgical Asepsis    All materials in contact with the wound and within the sterile field must be sterile. Only the top of a draped table is considered sterile. . During draping. Gowns are sterile in the front from chest to the level of the sterile field. and sleeves from 2 inches above the elbow to the cuff. the drape is held well above the area and is placed from front to back.

Movement around the sterile field must not cause contamination of the field. . Movements of the surgical team are from sterile to sterile and from unsterile to sterile only.Basic Guidelines for Surgical Asepsis    Items are dispensed by methods to preserve sterility. At least a 1foot distance from the sterile field must be maintained.

Sterile fields are prepared as close as possible to time of use. Items of doubtful sterility are considered unsterile.Basic Guidelines for Surgical Asepsis    Whenever a sterile barrier is breached. the area is considered contaminated. . Every sterile field is constantly maintained and monitored.

The patient's skin and the hands of the members of the surgical team must be thoroughly scrubbed. .SURGICAL ASEPTIC TECHNIQUE  BEFORE AN OPERATION. Every item handled by the surgeon and the surgeon's assistants must be sterile. prepared. materials. and supplies that come in contact with the surgical site. and kept as aseptic as possible. it is necessary to sterilize and keep sterile all instruments.

a willingness to supervise and be supervised by others regarding the adherence to standards. surgeon's assistants. . the surgeon.   DURING THE OPERATION. Each member must develop a surgical conscience. and the scrub nurses must wear sterile gowns and gloves and must not touch anything that is not sterile. Maintaining sterile technique is a cooperative responsibility of the entire surgical team.

. This includes daily bathing and clothing change.BASIC PRINCIPLES OF SURGICAL ASEPSIS   All personnel assigned to the operating room must practice good personal hygiene. open sores. and/or other infections should not be permitted in the operating room. Those personnel having colds. sore throats.

gowns. . head coverings. change all attire before re-entering the clean area. If such occurs.  Operating room attire (which includes scrub suits.") All members of the surgical team having direct contact with the surgical site must perform the surgical hand scrub before the operation. and face masks) should not be worn outside the operating room suite. (The operating room and adjacent supporting areas are classified as "clean areas.

. they are considered contaminated.   All materials and instruments used in contact with the site must be sterile. · The gowns worn by surgeons and scrub corpsmen are considered sterile from shoulder to waist (in the front only). or have touched an unsterile surface or item. punctured. including the gown sleeves. · If sterile surgical gloves are torn.

most practical method of sterilization for most articles is steam under pressure. packaged. and sterilized items with an expiration date. · Use articles packaged and sterilized in cotton muslin wrappers within 28 calendar days.    The safest. · Label all prepared. Use articles sterilized in cotton muslin wrappers and sealed in plastic within 180 calendar days .

.   Unsterile articles must not come in contact with sterile articles. Take every precaution to prevent contamination of sterile areas or supplies by airborne organisms. Make sure the patient's skin is as clean as possible before a surgical procedure.

An article is either sterile or unsterile. there is no in-between. The field should be established on a stable. clean. If there is doubt about the sterility of an item. removing sutures. consider it unsterile .HANDLING STERILE ARTICLES   When you are changing a dressing. it will be necessary to establish a sterile field from which to work. flat. dry surface. or preparing the patient for a surgical procedure.

   Any time the sterility of a field has been compromised. Do not leave sterile articles unattended once they are opened and placed on a sterile field. . Do not open sterile articles until they are ready for use. replace the contaminated field and setup.

Once opened and first poured. When pouring sterile solutions into sterile containers or basins. Never reach over a sterile field. do not touch the sterile container with the solution bottle. If any liquid is left in the bottle.   Do not return sterile articles to a container once they have been removed from the container. . discard it. use bottles of liquid entirely.

Unwrap it. rewrap it in a new wrapper for sterilization. if reusable. Never use an outdated article. . and. inspect it.

Proper hand scrubbing and the wearing of sterile gloves and a sterile gown provide the patient with the best possible barrier against pathogenic bacteria in the environment and against bacteria from the surgical team. .SURGICAL HAND SCRUB   PURPOSE: To reduce resident and transient skin flora (bacteria) to a minimum.

don a surgical cap or hood that covers all hair. 3.1. . Using approximately 6 ml of antiseptic detergent and running water. Before beginning the hand scrub. and a disposable mask covering your nose and mouth. lather your hands and arms to 2 inches above the elbow. 2. using a nail cleaner. Leave detergent on your arms and do not rinse. Under running water. both head and facial. clean your fingernails and cuticles.

scrub across the fingertips using 30 strokes. From a sterile container. . Begin with the fingertips. 6. Always keep your hands above the level of your elbows. take a sterile brush and dispense approximately 6 ml of antiseptic detergent onto the brush and begin scrubbing your hands and arms. 5. Bring your thumb and fingertips together and. Starting with your fingertips.4. using the brush. rinse each hand and arm by passing them through the running water.

beginning at the wrist and progressing to the elbow . lower and upper. Visually divide your forearm into two parts. Scrub all surfaces of each division 20 strokes each. using 20 strokes for each surface area. 8. 9. Scrub the palm and back of the hand in a circular motion.7. including the webbed space between the fingers. Now scrub all four surface planes of the thumb and all surfaces of each finger. using 20 strokes each.

Scrub in a circular motion all surfaces to approximately 2 inches above the elbow. 13. 12. using the same procedure outlined above . Rinse only the brush. 11.10. Pass the rinsed brush to the scrubbed hand and begin scrubbing your other hand and arm. Scrub the elbow in a circular motion using 20 strokes. Do not rinse this arm when you have finished scrubbing.

15. 17. do not touch anything with your scrubbed hands and arms. . When rinsing. and allow water to drain off the elbows.14. Drop the brush into the sink when you are finished. Rinse both hands and arms. The total scrub procedure must include all anatomical surfaces from the fingertips to approximately 2 inches above the elbow. 16. keeping your hands above the level of your elbows.

Do not allow the towel to touch anything other than your scrubbed hands and arms.18. Dry your hands with a sterile towel. . Between operations. 19. follow the same handscrub procedure.

3.Gowning and Gloving     GOWNING 1. with one end of the towel. Dry the other hand and arm with the opposite end of the towel. starting with the hand and ending at the elbow. Allow the gown to unfold downward in front of you. Pick up the gown in such a manner that hands touch only the inside surface at the neck and shoulder seams. . Drop the towel. Dry one hand and arm. 2.

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3. Slip your gloved fingers under the cuff of the other glove.    GLOVING 1. 2. Pull the glove over your fingers and hand. Touching only the cuff. using a stretching side-toside motion. pull the glove onto one hand and anchor the cuff over your thumb. Pick up one glove by the cuff using your thumb and index finger. .

Repeat the preceding step to glove your other hand. pull the cuff up and away from your hand and over the knitted cuff of the gown. With your fingers still under the cuff. Anchor the cuff on your thumb. 5. . The gloving process is complete. 6.   4.

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 To gown and glove the surgeon. Pick up a gown from the sterile linen pack. Step back from the sterile field and let the gown unfold in front of you. . Hold the gown at the shoulder seams with the gown sleeves facing you. follow these steps: 1.

3. Offer the glove to the surgeon. Offer the gown to the surgeon. (Repeat for left hand) . let go of the gown. Be careful that the surgeon's bare hand does not touch your gloved hands. Pick up the right glove. Once the surgeon's arms are in the sleeves.  2. place your fingers and thumbs of both hands in the cuff of the glove and stretch it outward. The circulator will tie the gown. Be careful not to touch anything but the sterile gown. With the thumb of the glove facing the surgeon. making a circle of the cuff.

relaxation & reflex loss. Anesthesia also reduces many of your body's normal stress reactions to surgery. involves the use of medications that block pain sensations (analgesia) during surgery and other medical procedures. .is a state of narcosis.TYPES OF ANESTHESIA    ANESTHESIA . analgesia.

TYPES OF ANESTHESIA      I. Moderate Sedation V. Regional Anesthesia IV. Monitored Anesthesia Care . Local Anesthesia III. General Anesthesia II.

Also causes forgetfulness (amnesia) and relaxation of the muscles throughout your body.GENERAL ANESTHESIA    I. GENERAL ANESTHESIA .affects your entire body and renders you unconscious. The patient would be completely unaware and not feel pain during the surgery or procedure. .

or gagging that prevent foreign material from being inhaled into your lungs (aspiration) . heartbeat. and throat reflexes such as swallowing. coughing. circulation of the blood (such as blood pressure). movements of the digestive system. Suppresses many of your body’s normal automatic functions. such as those that control breathing.

blood pressure. An ET tube is used to prevent aspiration. control and assist breathing. Monitoring of the heart. and other vital functions is important. An endotracheal (ET) tube or a laryngeal mask airway is usually used to give an inhalant anesthetic and oxygen. breathing. .

but inhalation agents also may be used. anesthesia may be maintained with an inhalant anesthetic alone. General anesthesia is commonly begun (induced) with intravenous (IV) anesthetics. with a combination of intravenous anesthetics. Once you are unconscious. or a combination of the two. .

 Noises are exaggerated – even low voices or minor sounds seem loud & unreal.  STAGES OF GENERAL ANESTHESIA . dizziness . & feeling of detachment. roaring or buzzing in the ears.  Still conscious but may sense inability to move the extremities easily.  Ringing.  Unnecessary noises & motions should be avoided.STAGE I – BEGINNING ANESTHESIA  Warmth.

shouting .talking.STAGE II – EXCITEMENT  Struggling.  . laughing or crying – (avoided if given smoothly & quickly)  Pupils dilate ( but contract if exposed to light)  PR rapid & RR irregular. singing.  Restraining the patient may be possible.

 Pupils are small but contract when exposed to light  RR regular. skin pink/flushed  .STAGE III – SURGICAL ANESTHESIA  Reached by continuous administration of anesthetic vapor or gas. is unconscious & lies quietly. PR & volume WNL.  Pt.

pulse weak & thready .  Respirations shallow.STAGE IV – MEDULLARY DEPRESSION  Reached when too much anesthesia has been administered.  CYANOSIS develops & w/o prompt intervention  DEATH  .  Pupils widely dilated & no longer contract when exposed to light.

 Circulatory support initiated.  .Anesthetic is discontinued immediately.

REGIONAL ANESTHESIA     REGIONAL ANESTHESIA involves injection of a local anesthetic (numbing agent) around major nerves or the spinal cord to block pain from a larger but still limited part of the body. TYPES : 1. LOCAL CONDUCTION BLOCKS . SPINAL 3. EPIDURAL 2.

     EPIDURAL ANESTHESIA commonly used conduction block Injecting a local anesthetic into the epidural space that surrounds the dura matter of the SC. motor & autonomic functions. . Doses are much higher than spinal because epidural anesthetic does not make direct contact w/ the SC or nerve roots. Blocks sensory.

   ADVANTAGE: absence of headache DISADVANTAGE: greater technical challenge of introducing the anesthesia in the epidural space. RESPIRATORY DEPRESSION  ARREST . If (+) accidental puncture of the dura happens & the anesthetic travels toward the head HIGH SPINAL ANESTHESIA  SEVERE HYPOTENSION .

 Lumbar puncture done knee –chest position  As soon as the injection has been made position pt on his back  .SPINAL ANESTHESIA  Local anesthetic is introduced @ the lumbar level between L4 & L5. perineum & lower abdomen.  Produces anesthesia of lower extremities.

lower abdomen .chest.    Brachial plexus block. or face. A local anesthetic is injected near a specific nerve or group of nerves to block pain from the area of the body supplied by the nerve. Nerve blocks are most commonly used for procedures on the hands. legs.peineum. feet. Transacral (Caudal) block. abdo wall & ext.arm Paravertebral anesthesia. arms. PERIPHERAL NERVE BLOCKS.

LOCAL ANESTHESIA

LOCAL ANESTHESIA involves injection of a local anesthetic (numbing agent) directly into the surgical area to block pain sensations. It is used only for minor procedures on a limited part of the body. You may remain awake, though you will likely receive medicine to help you relax or sleep during the surgery Often administered in combination with Epinephrine.


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ADVANTAGES : Simple, economical, non-explosive Equipment needed is minimal Post-op recovery is brief Undesirable effects of Gen. Anesthesia are avoided. Ideal for short & superficial surgical procedures.

Intraoperative Complications


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Nausea and vomiting Anaphylaxis Hypoxia and respiratory complications Hypothermia Malignant hyperthermia Disseminated intravascular coagulation (DIC)

and skin. nerve. including burns Hypotension Thrombosis . oral.Potential Adverse Effects of Surgery and Anesthesia       Allergic reactions and drug toxicity or reactions Cardiac dysrhythmias CNS changes and oversedation or undersedation Trauma: laryngeal.

Gerontologic Considerations  Elderly patients are at increased risk for complications due to surgery and anesthesia because of: Increased likelihood of coexisting conditions.  Decreased homeostatic mechanisms.  Changes in responses to drugs and anesthetic agents due to aging changes such as decreased renal function.  Aging heart and pulmonary systems.  . and changes in body composition of fat and water.

Nursing Goals for the Patient in the Intraoperative Period      Reducing anxiety Preventing positioning injuries Maintaining patient safety Maintaining the patient's dignity Avoiding complications .

Lithotomy Position. and Sidelying Position for Kidney Surgery . Trendelenburg Position.Laparotomy Position.

Protecting the Patient from Injury       Patient identification Correct informed consent Verification of records of health history and exam Results of diagnostic tests Allergies (include latex allergy) Monitoring and modifying the physical environment .

and not leaving a sedated patient Verification and accessibility of blood .  Safety measures such as grounding of equipment. restraints.

.  POSTOPERATIVE PHASE Begins with the admission of the client to PACU & ends with discharge of client from hospital or facility providing continuity of care.III.

Post-Anesthesia Care Unit    The PACU environment Beds and other equipment Three phases: Phase I  Phase II  Phase III  .

has stable VS. Frequent skilled assessment of the patient is vital . Patient has resumption of motor and sensory function. and shows no evidence of hemorrhage or other complications of surgery. is oriented.Nursing Management in the PACU    Provide care for the patient until he/she has recovered from the effects of anesthesia.

. Assessments include airway and respirations. surgical site. Provide report and transfer the patient to another unit or discharge the patient to home. function of the central nervous system. also assess IVs and all tubes and equipment. cardiovascular function.Responsibilities of the PACU Nurse     Review pertinent information and baseline assessment upon admission to the unit. Reassess VS and patient status every 15 minutes or more frequently as needed.

activity. wound care. complications. .   Give prescriptions and phone numbers. and diet.Outpatient Surgery/Direct Discharge  Discharge planning and discharge assessment Provide written and verbal instructions regarding follow-up care. Discuss actions to take if complications occur. medications.

Outpatient Surgery/Direct Discharge  Give instructions to the patient and a responsible adult who will accompany the patient.  . Sedation and anesthesia may cloud memory and judgment and affect ability. Patients are not to drive home or be discharged to home alone.

turn patient to the side .Maintaining a Patent Airway       A primary consideration: necessary to maintain ventilation and oxygenation! Provide supplemental oxygen as indicated. If vomiting occurs. May require suctioning. Keep head of bed elevated 15-30o unless contraindicated. Assess breathing by placing hand near face to feel movement of air.

Head and Jaw Positioning to Open Airway .

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Use of Oral Airway Note: Do not remove oral airway until evidence of gag reflex returns .

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