PERIOPERATIVE

NURSING
SURGERY

 Is the use of instruments during an operation to

treat injuries, diseases, and deformities

 Is a stressful, complex event

 The branch of medicine concerned with diseases

and trauma requiring operative procedures
 Surgical procedures are named according to (1)
the involved body organ, part, or location and (2)
the suffix that describes what is done during the
procedure

 Physicians who perform surgery include surgeons

or other physicians trained to do certain surgical
procedures
SURGICAL PROCEDURE SUFFIXES
 
 -ectomy - Removal by cutting

 -orrhaphy - Suture of or repair

 -oscopy - Looking into

 -ostomy - Formation of a permanent artificial

opening
 -otomy - Incision or cutting into

 -plasty - Formation or repair

CLASSIFICATION OF
SURGERY
ACCORDING TO URGENCY

 Emergent - Patient requires immediate attention;

disorder may be life threatening; immediately
without delay to maintain life or organ, remove
damage, stop bleeding

 Urgent/ Imperative - Patient requires prompt

attention; within 24 – 30/48 hours
 Required/ Planned - Patient needs to have
surgery; plan within a few weeks or months

 Elective - Patient should have surgery; failure to

have surgery not catastrophic; planned/scheduled
with no time requirements

 Optional - Decision rests with patient; at the

preference of patient
ACCORDING TO PURPOSE
 Aesthetic - Requested by patient for improvement

 Diagnostic - To obtain tissue samples, make an

incision, or use a scope to make a diagnosis

 Exploratory - Confirmation or measurement of

extent of condition
 Preventive - Removal of tissue before it causes a
problem

 Curative (Ablative) - Removal of diseased or

abnormal tissue

 Reconstructive - Correction of defects of body parts

 Palliative - Alleviation of symptoms without curing

disease
ACCORDING TO EXTENT
 Major - Extensive surgery that involves serious
risk and complications, as it involves major organ

 High risk, extensive, prolonged, large amount of

blood loss, vital organs may be handled or
removed, great risk of complications
 Minor - Involves minimal complications & blood
loss

 Generally not prolonged, leads to few serious

complications, involves less risk
PRINCIPLES OF SURGICAL
ASEPSIS
MOISTURE CAUSES CONTAMINATION
 Prevent splashing of liquids in the sterile fields

 Place wet objects on sterile, water-impermeable

surfaces, such as sterile basin

 Rationale: microorganisms travel more easily

through moist environment. When sterile surface
becomes moist, microorganisms from the
unsterile surface may be transmitted into the
sterile surface
NEVER ASSUME THAT AN OBJECT IS STERILE

 Ensure that it is labeled as sterile

 Always check the integrity of the packaging

 Always verify the expiration date on the

package

 Whenever in doubt of the sterility of an object,

consider it unsterile
 Rationale: commercially prepared products are
labeled as sterile on their packaging; special
indicators are used to show that objects have
completed their sterilization process; packages
that are torn, punctured, or moist are considered
unsterile
ALWAYS FACE THE STERILE FIELD

 Rationale: objects that are out of the line of

vision may be inadvertently contaminated
STERILE ARTICLES MAY TOUCH ONLY STERILE
ARTICLES OR SURFACES IF THEY ARE TO
MAINTAIN THEIR STERILITY

 Rationale: anything considered unsterile may

transfer microorganisms to the sterile object it
touches
STERILE EQUIPMENT OR AREAS MUST BE KEPT
ABOVE THE WAIST AND ON TOP OF THE STERILE
FIELD

 Waist level is the limit of good visual field.

Maximum visibility of all sterile objects prevents
inadvertent contamination
PREVENT UNNECESSARY TRAFFIC AND AIR
CURRENTS AROUND THE STERILE AREA

 Close doors

 Unfold drapes or wrappers properly

 Do not sneeze, cough, or talk excessively over

the sterile field
 Do not reach across sterile fields

 Move around a sterile field to reach for an

object, if necessary

 Rationale: microorganisms cannot be

completely excluded from the air; overreaching
across sterile fields will render sterile objects
unsterile
 OPEN, UNUSED STERILE ARTICLES ARE NO
LONGER STERILE AFTER THE PROCEDURE
 
 Rationale: once protective wrapping have been

removed, the article is being contaminated by

air so, it must be discarded or sterilized before it
is used; liquids opened during the procedure
that remain in the container are also considered
contaminated
A PERSON WHO IS CONSIDERED STERILE WHO
BECOMES CONTAMINATED MUST
REESTABLISH STERILITY

 Rationale: if a “scrubbed” person punctures the

gloves or is contaminated by touching an
unsterile object, he or she must change the
contaminated articles; if a “scrubbed” person
leaves the area of the sterile field, he or she must
go through the procedure of rescrubbing,
gowning, and gloving
SURGICAL TECHNIQUE IS A TEAM EFFORT

 A collective and individual “sterile conscience” is

the best method of enhancing sterile technique

 Rationale: staff members must rely on one

another to maintain sterile technique; periodic
review of procedures and infection control
surveillance reports enhance everyone’s sterile
technique
FOUR MAJOR TYPES OF PATHOLOGIC
PROCESSES REQUIRING SURGICAL
INTERVENTION (POET)
 
P – PERFORATION
 rupture of an organ
O – OBSTRUCTION
 impairment to the
flow of vital fluids
e.g. blood, urine,
CSF, bile
E – EROSION
 wearing off of a
surface or
membrane
T – TUMORS

 abnormal new
growths
EFFECTS OF SURGERY TO THE
CLIENT
 Stress response is elicited

 Defense against infection is lowered

 Vascular system is disrupted

 Organ functions are disturbed

 Body image may be disturbed

 Lifestyles may change

SURGICAL RISK FACTORS
NUTRITIONAL AND FLUID STATUS

 Optimal nutrition is an essential factor in

promoting healing an resisting infection and
other surgical complications

 obesity, undernutrition, weight loss,

malnutrition, deficiencies in specific nutrients,
metabolic abnormalities, and the effects of
medication on nutrition
 Nutritional needs may be measured through
BMI and waist circumference

 Nutritional deficiency should be corrected

before surgery

 Nutrients important for wound healing are:

protein, arginine, carbohydrates and fats, water,
vitamin C, vitamin B complex, vitamin A,
vitamin K, magnesium, copper, zinc
DRUG OR ALCOHOL USE

 The person with a history of chronic alcoholism

often suffers from malnutrition and other
systemic problems that increase surgical risk
AGE

 very young

 very old
PRESENCE OF DISEASE/S

 Respiratory
 Renal/urinary
 Cardiovascular
 Endocrine
 Hepatic
CONCURRENT OR PRIOR PHARMACOTHERAPY

 A medication history is obtained from each

patient because of the possible effects of
medications on the patient’s perioperative course,
including the possibility of drug interactions

 Document all medications

 Stop aspirin 7-10 days before surgery

 Currently it is recommended that the use of

herbal products be discontinued 2 to 3 weeks
before surgery
OTHER SURGICAL RISK FACTORS

 Nature of condition
 Location of the condition
 Magnitude and urgency of the surgical procedure
 Mental attitude of the person toward surgery
 Caliber of the professional staff and health care
facilities
THE SURGICAL TEAM
THE CIRCULATING NURSE

 Also known as the circulator

 manages the OR and protects the patient’s

safety and health by monitoring the activities of
the surgical team, checking the OR conditions,
and continually assessing the patient for signs of
injury and implementing appropriate
interventions
 verifying consent, coordinating the team, and
ensuring cleanliness, proper temperature,
humidity, lighting, safe function of equipment,
and the availability of supplies and materials

 Monitors aseptic practices to avoid breaks in

technique

 “surgical or pre-procedure pause” or time-out”

THE SCRUB ROLE

 Performs a surgical hand scrub

 Setting up the sterile tables

 Prepares sutures, ligatures, and special equipment

 Assists the surgeon and the surgical assistants
during the procedure by anticipating the
instruments and supplies that will be required

 As the surgical incision is closed, the scrub

person and the circulator count all needles,
sponges, and instruments
 Standards call for all sponges to be visible on x-
ray and for sponge counts to take place at the
beginning of surgery and twice at the end

 Tissue specimens obtained during surgery are

labeled by the scrub person and sent to the
laboratory by the circulator
 
THE SURGEON

 Performs the surgical procedure and heads the

surgical team
THE ANESTHESIOLOGIST AND ANESTHETIST

 An anesthesiologist is a physician specifically

trained in the art and science of anesthesiology

 An anesthetist is a qualified health care

professional who administers anesthetics
 They assess the patient before surgery, selects
the anesthesia, administers it, intubates the
patient if necessary, manages any technical
problems related to the administration of the
anesthetic agent, and supervises the patient’s
condition throughout the surgical procedure
THE SURGICAL
ENVIRONMENT
 Known for its stark appearance and cool temperature

 Access is limited to authorized personnel

 The OR must be situated in a location that is central

to all supporting services

 The OR must have a specific air filtration devices to

screen out contaminating particles, dust, and
pollutants
 the unrestricted zone (street clothes are
allowed); the semi restricted zone (attire
consists of scrub clothes and caps); and the
restricted zone (scrub clothes, shoe covers, caps,
and masks are worn)

 Shirts and waist drawstrings should be tucked

inside the pants
 Wet or soiled garments should be changed

 Masks are worn at all times at the restricted

zone

 Upper respiratory tract infections and skin

infections in staff and patients are sources of
pathogens and must be reported
PREOPERATIVE PHASE
 Extends from the time the client is a admitted in
the surgical unit, to the time he/she is prepared
physically, psychosocially, spiritually, and legally
for the surgical procedure, until he is transported
into the operating room

 Begins when the decision to proceed with

surgical intervention is made and ends with the
transfer of the patient onto the OR table
 involves establishing a baseline evaluation of the
patient before surgery by carrying out a
preoperative interview

 ensuring that necessary tests have been or will be

performed

 arranging appropriate consultations; and

providing education about recovery from
anesthesia and postoperative care
 On the day of surgery, patient teaching is
reviewed, the patient’s identity and surgical site
are verified, informed consent is confirmed, and
an IV infusion is started
GOALS

 Assessing and correcting physiologic and

psychologic problems that might increase
surgical risk

 Giving the person and significant others complete

learning/teaching guidelines regarding surgery
 Instructing and demonstrating exercises that will
benefit the person during post operative period

 Planning for discharge and any projected changes

in lifestyle due to surgery
PHYSIOLOGIC ASSESSMENT OF THE CLIENT UNDERGOING SURGERY

 Age
 Presence of pain
 Nutritional status
 Fluid and electrolyte balance
 Infection
 Cardiovascular function
 Pulmonary function
 Renal function
 Gastrointestinal function
 Liver function
 Endocrine function
 Hematologic function
 Use of medication
 Presence of trauma
PSYCHOSOCIAL ASSESSMENT AND CARE

 Causes of fears of the preoperative clients

 Fear of the unknown
 Fear of anesthesia, vulnerability while unconscious
 Fear of pain
 Fear of death
 Fear of disturbance of body image
 Worries – loss of finances, employment, social and
family roles
 Manifestations of fears
 Anxiousness
 Bewilderment
 Anger
 Tendency to exaggerate
 Sad, evasive, tearful, clinging
 Inability to concentrate
 Short attention span
 Failure to carry out simple directions
 Dazed
NURSING INTERVENTIONS TO MINIMIZE ANXIETY

 Explore client’s feelings

 Assist client to identify coping strategies that he

or she has previously used to decrease fear

 Allow client to speak openly about fears/concerns

 Give accurate information regarding surgery

 Give empathetic support

 Consider the person’s religious preferences and

arrange visit by priest/minister as desired

 Music therapy
INFORMED CONSENT (OPERATIVE PERMIT/SURGICAL CONSENT)

 necessary before non emergent surgery can be

performed

 permission obtained from a patient to perform a

specific test or procedure
PURPOSES:

 to ensure that the client understands the nature of

the treatment including the potential
complications and disfigurement (explained by
AMD)

 to indicate that the client’s decision was made

without pressure
 to protect the client against unauthorized
procedure

 to protect the surgeon and hospital against legal

actions by a client who claims that an
unauthorized procedure was performed
CIRCUMSTANCES REQUIRING A PERMIT:

 any surgical procedure where scalpel, scissors, or

sutures may be used

 any invasive procedure such as surgical incision,

a biopsy, a cystoscopy, or paracentesis
 a nonsurgical procedure, such as an
arteriography, that carries more than slight risk to
the patient

 procedures involving radiation

 procedures requiring sedation and/or anesthesia

REQUISITES FOR VALIDITY OF INFORMED CONSENT

 written permission is best and is legally

acceptable

 signature is obtained with the client’s complete

understanding of what is to occur
 adults sign their own operative permit
 obtained before sedation
 secured without pressure or duress

 a witness is desirable – nurse physicians or

authorized persons

 in an emergency, permission via telephone or

telefax is acceptable
 for minor (below 18), unconscious,
psychologically incapacitated, permission is
required from responsible family member
(parent/legal guardian)
INFORMED CONSENT SHOULD CONTAIN THE
FOLLOWING:

 explanation of procedure and its risks

 description of benefits and its alternatives

 an offer to answer questions about procedure

 instructions that the patient may withdraw
consent

 a statement informing the patient if the protocol

differs from customary procedure
PHYSICAL PREPARATION
 Before Surgery
 Correct any dietary deficiencies

 Reduce an obese person’s weight

 Correct fluid and electrolyte imbalances

 Restore adequate blood volume with blood

transfusion
 Treat chronic diseases

 Halt or treat any infectious process

 Treat an alcoholic person with vitamin

supplementation, IVF’s or oral fluids if dehydrated
TEACHING PREOPERATIVE EXERCISES

 Deep breathing exercises

 Practice in the same position client would assume in
bed after surgery

 Allow hands in a loose fist position to rest lightly on

the front of the lower ribs with your finger tips against
lower chest to feel the movement
 Breathe out gently and fully as the ribs sink down
and inward toward midline

 Take a deep breath your nose and mouth, letting the

abdomen rise as the lungs fill with air

 Hold this breath for a count of five

 Exhale and let out all the air through your nose and
mouth
 Repeat this exercise 15 times with a short rest after
each group of five

 Practice twice daily preoperatively

 Incentive spirometry

 Let client sit upright, at 45 degrees minimum

 Take two normal breaths. Place mouthpiece of

spirometer in mouth

 Inhale until target, designated by spirometer light or

rising ball, is reached, and hold breath for 3 to 5
seconds
 Exhale completely

 Perform 10 sets of breaths each hour

 Coughing exercises

 Have client sit up and lean forward

 Show client how to splint incision with hands,

pillow, or blanket

 Have client inhale and exhale deeply three times

through mouth
 Have client take in deep breath and cough out the
breath forcefully with three short coughs using
diaphragmatic muscles. Take in quick deep breath
through mouth, cough deeply, and deep breathe
 Turning exercises

 Turn on your side with the uppermost leg flexed

most and supported on a pillow

 Grasp the side rail as an aid to maneuver to the side

 Practice diaphragmatic breathing and coughing while

on your side
 Foot and leg exercises
 Lie in a semi-Fowler’s position

 Bend your knee and raise your foot – hold it a few

seconds, then extend the leg and lower it to the bed

 Do this five times with each leg

 Then trace circles with the feet by bending them

down, in toward each other, up, and then out
PREPARING THE PERSON BEFORE SURGERY

 Preparing the skin

 Have full bath to reduce microorganisms in the skin

 Preparing the GI tract

 NPO; cleansing enema as required

 Preparing for anesthesia

 Avoid alcohol and cigarette smoking for at least 24
hours before surgery
 Promoting rest and sleep
 Administer sedatives as ordered
PREPARING THE PERSON ON THE DAY OF SURGERY

 Early morning care

 Awaken one hour before preoperative medications

 Morning bath, mouth wash

 Provide clean gown

 Remove hairpins, braid long hairs, cover hair with cap

 Remove dentures, foreign materials (chewing gum),
colored nail polish, hearing aid, contact lens

 Take baseline vital signs before preoperative

medication

 Check ID band and skin preparation

 Check for special orders – enema, GI tube insertion,

IV line
 Check NPO

 Have client void before preoperative medication

 Continue to support emotionally

 Accomplish “preoperative care checklist”

PREOPERATIVE MEDICATIONS/ PREANESTHETIC DRUGS

 Goals:

 To facilitate the administration of any anesthetic

 To minimize respiratory tract secretions and changes

in heart rate

 To relax the client and reduce anxiety

 Narcotics
 Morphine sulfate

 Fentanyl (Sublimaze)

 Meperidine (Demerol)

 Analgesia; enhancement of postoperative pain relief

 Antianxiety and sedative hypnotics
 Diazepam (Valium)
 Hydroxyzine hcl (Vistaril)
 Lorazepam (Ativan)
 Midazolam (Versed)
 Phenobarnital sodium
 Sedation; anxiety reduction
 Anticholinergic

 Atropine sulfate

 Scopolamine hydrobromide

 Secretion reduction
 Antiemetic

 Ondansetron (Zofran)

 Metoclopramide (Reglan)

 Promethazine hcl (Phenergan)

 Control nausea and vomiting; may be effective into

the postoperative period
 H2 antagonist

 Cimetidine (Tagamet)

 Ranitidine (Zantac)

 Famotidine (Pepcid)

 Reduction of acidic gastric secretions in case

aspiration occurs
 Antibiotic

 Cefazolin (Ancef)

 Ampicillin (Omnipen

 Prevention of postoperative infection

INTRAOPERATIVE PHASE
 Begins when the client is transferred onto the OR
table and ends with admission to the PACU

 Extends from the time the client is admitted to

the operating room, to the time of administration
of anesthesia, surgical procedure is done, until
he/she is transported to the recovery room/PACU
 Nursing activities include: providing safety,
maintaining an aseptic environment, ensure
proper functioning of equipment, providing the
surgeon with specific instruments and supplies
for the surgical field, and proper documentation
GOALS OF CARE (HASH)

 H – homeostasis

 A – asepsis

 S – safe administration of anesthesia

 H – hemostasis
POSITIONS DURING SURGERY

 Dorsal Recumbent – hernia repair, mastectomy,

bowel resection

 Trendelenburg – lower abdomen, pelvic surgeries

 Lithotomy – vaginal repairs, D and C, rectal
surgery

 Prone – spinal surgeries, laminectomy

 Lateral – kidney, chest, hip surgeries

 Explain purpose of position

 Avoid undue exposure

 Strap the person to prevent falls

 Maintain adequate respiratory and circulatory

function

 Maintain good body alignment

TYPES OF ANESTHESIA

 General
 Anesthesia is a state of narcosis, analgesia,
relaxation, and reflex loss

 Clients under general anesthesia are not arousable,

not even to painful stimuli

 Produces amnesia

 Can be administered through IV or inhalation

 Gas anesthetics are administered by inhalation and
are always combined with oxygen

 Nitrous oxide is the most commonly used gas

anesthetic agent

 When inhaled, the anesthetics enter the blood

through the pulmonary capillaries and act on cerebral
centers to produce loss of consciousness and
sensation

 General anesthesia consists of four stages

 Stage I (beginning anesthesia)
 extends from the administration of anesthesia to the
time of loss of consciousness

 The client may have a ringing, roaring or buzzing in

the ears, and although still conscious, may sense an
inability to move the extremities easily

 During this stage, noises are exaggerated

 During this stage, noises are exaggerated.

Unnecessary noises and motions are avoided when
anesthesia begins.
 Stage II (excitement/delirium)
 extends from the time of loss of consciousness to the
time of loss of lid reflex

 It may be characterized by shouting, struggling,

talking, singing, laughing, or crying of the client but
often avoided if anesthetic is administered smoothly
and quickly

 Assist anesthesiologist/ anesthetist if needed to

restrain client. Client should not be touched except
for purposes of restraint.
 Stage III (surgical anesthesia)
 extends from the loss of lid reflex to the loss of most
reflexes. Surgical procedure is started

 Stage IV (medullary depression)

 it is characterized by respiratory/cardiac depression
or arrest. It is due to overdose of anesthesia.
Resuscitation must be done
 Regional
 Reduce all painful sensations in one region of the
body without inducing unconsciousness

 Topical, local infiltration, epidural, spinal

 Client receiving regional anesthesia is awake and

aware of his/her surroundings unless medications are
given to produce mild sedation or to relieve anxiety
 Nurse must avoid careless conversation, unnecessary
noise, and unpleasant odors

 Diagnosis must not be stated allowed if the client is

not to know it at this time

 A postdural puncture headache may occur after

spinal and epidural blocks caused by leakage of CSF.
Small-gauge spinal needle (less than gauge 25) helps
prevent headaches. Position the client flat and force
fluids to relieve headache. A blood patch treatment
can be done if headache continues
TRANSFER FROM SURGERY
 After surgery client is stabilized for transfer

 After local anesthesia, the client may return

directly to a nursing unit

 After general and spinal anesthesia, the client

goes to the PACU or in some cases, the intensive
care unit
 SAFETY is always a priority at this time!

 Never leave client alone

 Ensure patent airways and prevent falls an injury

 Continuous monitoring of client

POSTOPERATIVE PHASE
 Extends from the time the client is admitted to
the recovery room, to the time he is transported
back into the surgical unit, discharged from the
hospital, until the follow-up care

 Begins when the client is admitted to the PACU

or a nursing unit and ends with the client’s
postoperative evaluation in the physician’s office
GOALS:
 Maintain adequate body system functions

 Restore homeostasis

 Alleviate pain and discomfort

 Prevent postoperative complications

 Ensure adequate discharge planning and teaching

ADMISSION TO PACU
 Goal is to promote safe recovery from anesthesia

 Administer oxygen by nasal cannula or mask as

ordered

 Continuous monitoring is done for ECG, pulse

oximetry, and BP measurements
 Assess surgical site and dressing

 Check for patency of catheter, drains and tubes

 Measure body temperature

 Provide warming blanket

 Control shivering by administering Meperidine
(Demerol) when anesthesia is the cause

 Provide supplemental oxygen during shivering

 Perform hand washing between clients

 VS taking every 5 to 15 minutes

GENERAL INTERVENTIONS
 Avoid exposure

 Avoid rough handling

 Avoid hurried movement and rapid changes

 Assessment
 Appraise air exchange status and note skin color

 Verify identity, operative procedure, surgeon

 Assess neurologic status

 Determine VS

 Perform safety checks

 Ensure maintenance of patent airway and
adequate respiratory function
 Lateral position with neck extended

 Keep airway in place until fully awake

 Suction secretions

 Encourage deep breathing

 Administer humidified oxygen as ordered

TRANSFER FROM RECOVERY ROOM TO SURGICAL UNIT

 Parameters for Discharge from Recovery Room

 Activity: able to obey commands

 Respiration: easy, noiseless breathing

 Circulation: BP is within +/-20 mmHg of the preop

level
 Consciousness: responsive

 Color: pinkish skin and mucus membrane

NURSING CARE OF CLIENT DURING THE
EXTENDED POSTOPERATIVE PERIOD
 2-3 days after surgery (discharge
planning/teaching)

 Self-care activities
 Activity limitation
 Diet and medications
 Complications
 Referrals, follow-up check up
 Postoperative discomforts
 Nausea and vomiting

 Restlessness & sleeplessness

 Thirst

 Constipation

 Pain
POSTOPERATIVE
COMPLICATIONS
SHOCK
 Response of the body to a decrease in the
circulating blood volume, which results to poor
tissue perfusion and inadequate tissue
oxygenation
HEMORRHAGE
 Copious escape of blood from the blood vessel
 Capillary – slow, generalized oozing
 Venous – dark in color and bubble out
 Arterial – spurts and is bright red in color
 Manifestations
 Apprehension, restlessness, thirst, cold, moist, pale
skin

 Deep rapid respiration, low body temperature

 Low blood pressure, low hemoglobin

 Circumoral pallor

 Progressive weakness
 Management
 Administer Vitamin K as ordered

 Pressure dressings

 Blood transfusion

 IV fluids
FEMORAL PHLEBITIS/ DEEP THROMBOPHLEBITIS

 Often occurs after operations on the lower

abdomen or during the course of septic
conditions as rupture ulcer or peritonitis

 Causes
 Injury – damage to vein
 Hemorrhage
 Prolonged immobility
 Obesity/ debilitation
 Manifestations
 Pain
 Redness
 Swelling
 Heat/warmth
 Positive Homan’s sign
 Nursing Interventions (prevention)
 Hydrate adequately to prevent hemoconcentration

 Encourage leg exercises and ambulate early

 Avoid any restricting devices that can constrict and

impair circulation

 Prevent use of bed rolls or dangling over the side of

the bed with pressure on popliteal area
 Nursing Interventions (Active)
 Bed rest, elevate the affected leg with pillow support

 Wear antiembolic support hose from the toes to the

groin

 Avoid massage on the calf of the leg

 Initiate anticoagulant therapy as ordered

PULMONARY COMPLICATIONS
 Atelectasis
 Bronchitis
 Bronchopneumonia
 Lobar pneumonia
 Pleurisy
 Nursing Interventions

 Reinforce deep breathing, coughing, and turning

exercises

 Encourage early ambulation

 Incentive spirometry
INTESTINAL OBSTRUCTION
 Loop of intestine may kink due to inflamatory
adhesions

 Manifestations
 Intermittent, sharp, colicky abdominal pains

 Nausea and vomiting

 Abdominal distention

 Diarrhea(incomplete obstruction), no bowel

movement (complete)

 Return flow of enema is clear

 Nursing Interventions
 NGT insertion

 Administer electrolyte/ IV as ordered

 Prepare for possible surgical intervention

WOUND INFECTIONS
 Causes
 Staphylococcus aureus

 Escherichia coli

 Proteus vulgaris

 Pseudomonas aeruginosa

 Anaerobic bacteria
 Clinical manifestations
 Redness, swelling, pain, warmth

 Pus or other discharge on the wound

 Foul smell from the wound

 Elevated temperature; chills

 Tender lymph nodes

 Rule of thumb:
 Fever within first 24 hours – pulmonary infection

 Within 48 hours – urinary tract infection

 Within 72 hours – wound infection

 Preventive interventions
 Strict aseptic technique

 Wound care

 Keep unit clean

 Antibiotic therapy as ordered

WOUND COMPLICATIONS
 Hemorrhage

 Wound dehiscence – disruption in the coaptation

of wound edges (wound breakdown)

 Wound evisceration – dehiscence + outpouching

of abdominal organs
 Nursing interventions
 Apply abdominal binders

 Encourage proper nutrition (high protein, vitamin C)

 Stay with client, have someone call for the doctor

 Keep in bed rest

 Supine or Semi-Fowler’s position, bend knees to

relieve
 Cover exposed intestine with sterile, moist saline
dressing

 Reassure, keep him/her quiet and relaxed

 Prepare for surgery and repair of wound