NURSING CARE IN THE PRE-OPERATIVE Perioperative period, divided into three phases: Pre-operative Intra-operative

P ostoperative. Didactically, pre-operatively is divided into: media - is the peri od since the indication of surgery until the eve of its realization. Immediate 24h period before surgery. PROCESS CUSTOMER AND SURGICAL NURSING • History: interview and physical examination. Interview: customer perception and family members and understanding of the surgery. Family support; Occupation; Pre vious experience and methods used for pain control, emotional health, culture an d religion. Clinical history - previous diseases, reason for seeking care. 2 Previous pathologies medical history, reason for seeking care. Fever; Diabetes mellitus Liver disease, heart disease, bleeding disorders, respi ratory infection, chronic respiratory disease (emphysema, bronchitis, asthma), a buse of illicit drugs; Previous surgeries; immunological disorders. 3 Use of medications Antibiotics - may potentiate the action of anesthetics. Neomycin, kanamycin, est reptoquicina, if combined with muscle relaxant curare type, can disrupt nerve tr ansmission and lead to respiratory arrest. Antiarrhythmics - can lead to cardiac contractility and impair cardiac conduction during anesthesia. Anticoagulants increase the risk of bleeding. Should be discontinued at least 48 h before surg ery, or under medical supervision. Anticonvulsants - chronic use of phenytoin, p henobarbital can alter the metabolism of anesthetic agents. At the time of surge ry may be necessary to administer it to avoid seizure. Antihypertensive agents interact with anesthetics, causing bradycardia, hypotension, compromising circu lation. Antidepressants - Increase the hypotensive effects of anesthetics. Corti costeroids - lead to immunosuppression, prolonging healing. Insulin - during fas ting, should be decreased. The stress and the administration of glucose solution s can increase the dosage in DB Diuretics - potentiate electrolyte disorders aft er surgery. 4 Allergies - must be identified in the schedule and on the cover of the handbook. Habit of smoking - Increased risk for pulmonary complications - Request stop sm oking 4-6 weeks before surgery Drinking alcohol and drug use - higher tolerance for anesthetics (requiring larger doses). Age - Infant: immature physiological s tate, greater variation in body temperature, a small blood loss may be severe. - Aged: decreased cardiac reserve and lung, liver and lung decreased, most frag ile skin, subcutaneous tissue decreased with increased heat loss, take longer to eliminate the anesthetic. Nutritional status - Nutritional needs can be assesse d by BMI, skinfolds, serum protein levels. Nutrients are needed for tissue repai r and resistance to infection. After surgery, the patient needs at least 1500Kca l/dia, protein, vitamins A, C and zinc. 5 - Obesity: increases the surgical risk . Physical examination: Vital signs: parameters for future comparisons in the tran s-and postoperatively. General examination: general condition, weight, height, h ydration, muscle strength. Neurological evaluation Nutritional status: weight, t urgor and elasticity of the skin, adipose tissue, edema, anemia, dehydration. Sk

in. Head and neck. Thorax and lung. Syst. Cardiac and vascular. Abdomen. Members : function and motor strength. Important: Informed consent 6 Classification of surgical risk The American Society of Anesthesiologists has de veloped a range of physical state that is commonly used to classify surgical pat ients in risk groups, based on pre-existing clinical disease and abnormalities o f diagnostic tests. Class I II Description Healthy patient mild systemic disease without functional limitations. Severe systemic disease with functional limitations Features No phy siological disorders, biological or organic. Cardiovascular disease with minimal restrictions on the activity. Hypertension, obesity, diabetes. Cardiovascular d isease or lung disease that limits activity, severe diabetes w / systemic compli cations, myocardial infarction, angina, uncontrolled hypertension. Cardiac dysfu nction, pulmonary, renal, hepatic or endocrine impairment. Major brain trauma or multiple trauma, ruptured aneurysm, a large pulmonary embolus. III IV V Severe systemic disease with life-threatening constant moribund patient with lit tle chance of surviving 24 hours with or without operation declared brain-dead p atient whose organs are removed for donation. VI Scale of the physical state of the American Society of Anesthesiologists. 7 The nurse nursing diagnosis groups the defining characteristics collected during the history. Diagnoses establish guidelines for the care that will be provided during all surgical procedures. Examples: Anxiety related to: lack of knowledge about the surgery. Threat of loss of body part. Deficit of knowledge about the s urgical implications related to: lack of experience with the surgery. Misinterpr etation of information. Fear related to: surgery imminent. Anticipation of posto perative pain. Altered nutrition, eating less than body requirements related to preoperative nutrition. Altered nutrition, intake greater than body requirements related to excessive intake of food. Risk for impaired skin integrity related t o: preoperative radiation. Immobilization during surgery. Ineffective airway cle arance related cough decreased. Pulmonary congestion increased. Sleep pattern di sturbance related to: fear of surgery. 8 The prescription plan preoperative care is based on nursing diagnoses, but each client must be subject to basic preparations. Implementation Pre-operatively med iate Education: should be started as soon as possible. The optimum time of pre-o perative is not the day of surgery, but during the period when the tests were be ing conducted. 9 Preoperative Preparation mediate emotional: they explained the sensations that t he patient experiences. Doubts and fears should be allayed. Guide for pain, naus ea and vomiting. Advise the patient on the tracheal tube, CNG, CVD, drains, desc ription of the CC, the surgical team, etc.. Provide guidance regarding the condu ct of deep breathing exercises, two times a day and exercises stimulate coughing . (See

Brunner & Suddarth p.315) Guidance regarding early ambulation. Teaching active exercises with LL in the be d. (See Brunner & Suddarth p.315) Measuring weight and height and record in their records. Check SV for future com parisons. Blood sampling for further investigations. Forward to the x-ray, ECG, CT scan and other exams. Preparation of the bowel when indicated, can be started days before or the night before the surgery. 10 Immediate preoperative fasting - 8 to 12 hours before surgery. Preoperative prep aration of the skin to reduce bacterial sources and without damaging the skin. A nd oral hygiene before going to the SO; germicidal soap can be used in the area to be operated. When indicated, shaving should be done immediately before surger y, preferably with electrical apparatus, or carry only trim the hair. Removal of dental prosthesis, contact lens, jewelry, nail polish, makeup. Emptying the bla dder, the patient should urinate just before being sent to the OS, if necessary, catheterization should be performed in the OR. Check and register SV immediatel y before forwarding to the OS. Checking the records. Examinations, informed cons ent, prescription records, nursing and referral with the patient. Administration of preanesthetic medications should be performed 15-20 min prior to referral to the CC. The patient should be kept in bed with high rails. Keep quiet environme nt to promote relaxation. Dress the patient - jersey, cap, safety footwear (slip pers). Provide cleaning and storage unit. 11 Diagnostic tests Complete blood count denotes infection, blood volume, anemia, implications for o xygenation. N. RBC Hemoglobin 4.7 to 6.1 million / mm ³ 4.2 to 5.4 million / mm ³ 13.5 to 17.1 g / dl 11.5 to 15.5 g / dl 40 - 52% 32-48% in 4500 11000/mm 15000 0-450000 ³ / mm ³ Hematocrit Leukocytes Platelets 12 Serum electrolytes reveals electrolyte imbalances Na - 135-145 mEq / l (diagnosi s and treatment of dehydration and overhydration). K - 3.5 to 5.0 mEq / l (dignó stico and monitoring of hyper-or hypokalemia, when ↑ can be indicative of renal failure). Cl - 100-106 mEq / l (along with Na, K and CO2 is used to evaluate ele ctrolyte and water balance and acid-base). PT coagulation tests (prothrombin tim e) -11 to 12.5 sec, measuring time elapsed until a clot is formed. (Used to cont rol oral anticoagulant therapy in the long term, also assesses coagulation disor ders). PTT (partial thromboplastin time) - 25 to 35s., Measures the time until i t occurred to clot. (Used to assess coagulation disorders). Serum Creatinine - 0 .6 to 1.5 mg / dl Evaluates kidney function. Increased due to the diet rich in m eat and kidney damage. Note: You need 50% loss of renal capacity to raise the pl asma level of 1.0 to 2.0 mg / dl, thus is not sensitive to mild to moderate kidn ey damage. Decreased during pregnancy, and when glucose is> 100 mg / dl. 13 Albumin - 3.7 to 5.6 g / dl Used to evaluate disorders of metabolism, for exampl e, nutritional, Decreases synthesis or increased loss. Glucose - Fasting - 70-11 0 mg / dl Used to diagnose and manage diabetes and diagnosis of hypoglycemia. Ur inalysis and urine culture used to detect urinary tract infection, kidney diseas e and diabetes. X-ray ECG evaluate cardiac rhythm. Other tests may be required,

depending on the patient's condition and needs. 14