LICEO DE CAGAYAN UNIVERSITY

BACHELOR OF SCIENCE IN NURSING

LEVEL 3

NCM 112: CARE OF CLIENTS WITH PROBLEMS (Medical Surgical Nursing)

LECTURE PRELIM TERM
Clinical Instructor: Bobby Suazo, MSc, MSN, RN /Clinical Instructor/Lecturer S.Y. 2023 - 2024 1ST SEMESTER
TRANSCRIBE BY: MA. EM CONCEPCION LAGARE (MECTL)

MEETING NO. 02

NOTES- September 01, 2023 – Continuation

PREPARATION ON THE DAY BEFORE SURGERY which a surgeon removes part or all of the vertebral bone
(lamina))
B. PRE – OPERATIVE MEDICATION
Lateral Kidney, chest, & hip surgeries
1. To allay anxiety, reduce pharyngeal secretions, reduce effect of
anesthesia and create amnesia

C. TRANSPORTING THE PATIENT TO SURGERY

1. Gently move the patient to the stretcher and transport smoothly and
gently to prevent nausea and vomiting, and cover the patient with a
blanket to prevent exposure.

*******

INTRAOPERATIVE PHASE
Goals of care:

1. Asepsis
2. Homeostasis
3. Safe administration of anesthesia

INTRAOPERATIVE PHASE: BASIC RULES

1. Only sterile materials may be used within a sterile field. If there is any doubt about
the sterility of the item, it’s considered UNSTERILE. Prep again!
2. Gowns of scrubbed team members are sterile in the front from shoulder to waist
level and sleeves 2 inches above the elbow.
3. Draped tables are considered to be sterile on top only.
4. Sterile surface should contact only sterile areas.
5. Edges of any sterile package or container are considered unsterile.
6. The sterile field should be created as close to the time it is going to be used as
possible

SAFETY MEASURES NURSING RESPONSIBILITIES:

1. OR tables are securely locked. 1. Explain the purpose of the position

2. Muscles, nerves, and bony prominences are positioned or padded to avoid injury. 2. Avoid undue exposure
3. Heavily sedated patients and the elderly are moved slowly & gently. 3. Strap the person to prevent falls
4. Ensure tubing are not dislodged or obstructed. – tubing needs to be check- suction; 4. Maintain adequate respiratory and circulatory function
make sure all the machines work. 5. Maintain good body alignment
5. Straps should not interfere with blood circulation.
6. Sterile team members should not lean on any part of the patient’s body. TYPES OF ANESTHESIA:

General Anesthesia  Total loss of consciousness and sensation.

 Produces amnesia, IV, inhalation,& rectal
POSITION DURING SURGERY  Pt is unconscious
 Rectal mostly for baby
Dorsal recumbent Hernia repair, mastectomy, & bowel resection  “if you wake up not remembering anything after having a
GA, it means you have the best anesthetist

Regional Anesthesia  Reduce all painful sensations in one region of the body
Trendelenburg’s Lower abdomen and pelvic surgeries
without inducing unconsciousness.
 “localization”
Lithotomy Vaginal repairs, D & C, rectal surgery, & abdominal– perineal
 Option for pt who are not a good candidate for GA
resection

Prone Spinal surgeries and Laminectomy (- a type of surgery in

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NCM 112: CARE OF CLIENTS WITH PROBLEMS (Medical Surgical Nursing)
LECTURE
Clinical Instructor: Bobby Suazo, MSc, MSN, RN /Clinical Instructor/Lecturer
TRANSCRIBE BY: MA. EM CONCEPCION LAGARE (MECTL)
LEVELS OF SEDATION & ANESTHESIA
Minimal sedation
Moderate sedation
LEVELS OF SEDATION & ANESTHESIA Cont.
Deep Sedation
STAGES OF ANESTHESIA
Stage 1: Onset/Induction
Stage 2: Excitement/Delirium
Stage 3: Surgical
Stage 4: Medullary/Stage of
Danger
METHODS OF ANESTHESIA ADMINISTRATION:
1. Inhalation
2. Intravenous
LICEO DE CAGAYAN UNIVERSITY
BACHELOR OF SCIENCE IN NURSING
LEVEL 3
PRELIM TERM
S.Y. 2023 - 2024 1ST SEMESTER
 IV anesthesia is useful for short periods but less often
used for longer abdominal surgery procedures
Cognitive and coordination may be impaired, but ventilatory &
cardiovascular functions are not affected.
It depressed the level of consciousness that does not impair
the patient’s ability to maintain a patent airway and to respond
appropriately to physical stimulation and verbal command.
Intravenous Cont.  Advantageous because the onset of anesthesia is
pleasant; there is none of buzzing, roaring, or dizziness
known to follow the administration of an inhalation
anesthetic.
a drug induced state during which Patient cannot be easily
aroused but can responds purposefully after repeated  Duration of action is brief, and the patient awakens with
stimulation. little nausea or vomiting.
 Thiopental is the agent of choice, but it causes
powerful respiratory depressant.
3. Regional anesthesia  Is a form of local anesthesia in which an anesthetic
agent is injected around the nerve.
 The patient is awake and aware of his or her
 Extends from the administration of anesthesia to the time
surroundings unless medication is given to produce
of loss of consciousness.
mild sedation or to relieve anxiety
 During this stage, noises are exaggerated; even low
 Nurses must avoid careless conversation, unnecessary
voices or a low or minor sound seem loud and unreal.
noise, and unpleasant odors.
For this reason, the nurse avoids making unnecessary
noises or motions when anesthesia begins.
4. Conduction Block and Spinal  There are many types of conduction block:
Anesthesia
 Extends from the time of loss of consciousness to the
Epidural Anesthesia
time of loss of lid reflex. It may be characterized by the
- Achieved by injecting a local anesthetic into the
shouting struggling of the client.
spinal canal in the space surrounding the dura
 The pupils dilate but constrict if exposed tolight, the
mater
pulse is rapid.
- Block sensory, motor and autonomic functions.
 Extend from the loss of lid reflex to the loss of most REMEMBER:
reflexes.
 Surgical procedure is started.  Makes sure when removing the tubing, the
 Patient is unconscious and lies quietly at the table. “tip” is also removed!
 Pupils are small but constrict when they are exposed to  Pt must stay supine for 4 hrs after removal
light.
 Respiration is regular, the pulse rate and volume are
Epidural Anesthesia  Are much higher in doses because it is not in direct
normal, and the skin is pink or slightly flushed.
contact with the cord or nerve roots
 Advantageous because of the absence of headaches.
 It is characterized by respiratory/cardiac depression or  Disadvantage because of the greater technical
arrest. It is due to an overdose of anesthesia. challenge of introducing the anesthetic into the epidural
 Respirations become shallow, the pulse is weak and matter than the subarachnoid.
thready.
 Pupils become widely dilated and no longer constrict
when exposed to light.
 Cyanosis develops, and without prompt intervention,
death rapidly follows.
 Scariest part: this is a dangerous part of the operation bc
we would not exactly the effects of anesthesia to the pt
bc each pt is unique.
 May be administered by mixing the vapor with oxygen
or nitrous oxide-oxygen and then having the patient
inhale the mixture.
 Administered through a tube or a mask.
 It can also be administered using a laryngeal mask.
 It can be also administered using the endotracheal
technique.
 When it is in place, the tube seals off the lung from the
esophagus so that if the patient vomits, the stomach
does not enter the lungs.
 IV anesthetics agents are non- explosive. They require
little equipment and easy to administer
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 LICEO DE CAGAYAN UNIVERSITY
BACHELOR OF SCIENCE IN NURSING
LEVEL 3

NCM 112: CARE OF CLIENTS WITH PROBLEMS (Medical Surgical Nursing)

LECTURE PRELIM TERM
Clinical Instructor: Bobby Suazo, MSc, MSN, RN /Clinical Instructor/Lecturer S.Y. 2023 - 2024 1ST SEMESTER
TRANSCRIBE BY: MA. EM CONCEPCION LAGARE (MECTL)
5. Spinal Anesthesia  Type of extensive conduction nerve block that is
introduced into the subarachnoid space at the lumbar
level between L4 and L5.
 Anesthesia of the lower extremities, perineum, and
lower abdomen.

Spinal Anesthesia cont.
 Nausea, vomiting, & pain may occur during surgery
due to the manipulation of those structures.
 Administration of a weak solution of thiopental and
inhalation of nitrous oxide may prevent such reactions.
 Headache may be an after-effect due to many factors,
such as:
1. a spinal needle used
2. the leakage of fluid from the subarachnoid space
through the puncture site
3. patient’s hydration status
4. Use measures to increase the cerebrospinal pressure
of the patient to relieve headache
5. keep the patient lying flat on the bed and well-hydrated.

6. Local Infiltration Anesthesia
 Injection of the local anesthetic into the tissue at the
planned incision site combined with the local regional
block.
 Local anesthesia is administered with epinephrine
 Constrict blood vessels and prevent rapid absorption of
anesthetic agent, thus it prolongs its effect.

POTENTIAL INTRAOPERATIVE COMPLICATIONS

1. Nausea and Vomiting

2. Anaphylaxis
3. Hypoxia and other
4. respiratory complications
5. Hypothermia
6. Malignant hyperthermia

TRANSPORT OF THE CLIENT FROM THE OR TO RR/PACU

 avoid exposure.
 avoid rough handling.
 avoid hurried movement and
 rapid changes in position

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 LICEO DE CAGAYAN UNIVERSITY
BACHELOR OF SCIENCE IN NURSING
LEVEL 3

NCM 112: CARE OF CLIENTS WITH PROBLEMS (Medical Surgical Nursing)

LECTURE PRELIM TERM
Clinical Instructor: Bobby Suazo, MSc, MSN, RN /Clinical Instructor/Lecturer S.Y. 2023 - 2024 1ST SEMESTER
TRANSCRIBE BY: MA. EM CONCEPCION LAGARE (MECTL)

POSTOPERATIVE PHASE  Application of therapeutic heat

 Cooling of an area of inflammation
 Distraction
 Maintain adequate body system function
 Reassurance and psychological support
 Restore homeostasis
 Alleviate pain and discomfort
 Prevent post-op complications
 Ensure adequate discharge planning and teaching UNRELIEVED PAIN HAS SERIOUS SIDE EFFECTS, WHICH CAN RESULT HARMFUL
MULTISYSTEM EFFECTS
NURSING CARE: IMMEDIATE POSTOP CARE (PACU/RR)
Endocrine Metabolic Cardiovascular Respiratory Genitourinary GI
(ASSESSMENT)
Increase the ff: Increase the ff:
1. Appraise air exchange status and note skin color
2. Verify identity, operative procedure, surgeon ACTH Hyperglycemi Heart rate Atelectasis Decrease Decreased
3. Assess Neurologic status (LOC) a urinary output gastric
4. Determine VS and skin temperature (CV status) motility

NURSING ASSESSMENT & INTERVENTIONS Cortisol Glucose Cardiac output Hypoxemia Urinary Decreased
intolerance retention bowel
motility
1. Examine the operative site and check dressings
2. Perform safety checks: position for good body alignment; side rails; Antidiuretic Insulin Hypertension Decreased Fluid overload
3. restraints for IVF’s, Blood transfusion. hormone resistance cough
4. Require briefing on problems encountered in OR
Epinephrine Myocardial Sputum Hypokalemia
INTERVENTIONS (RR) oxygen retention
consumption
Ensure maintenance of patent airway and adequate respiratory function:
Norepinephrine DVT Infection
1. lateral position with neck extended
Renin
2. Keep airway in place until fully away
3. Suction secretions
4. Encourage deep breathing Angiotensin
5. Administer humidified oxygen as ordered

ASSESS STATUS OF CIRCULATORY SYSTEM Aldosterone

1. Monitor vital signs and report abnormalities.

Glucagon
2. Observe signs and symptoms of shock and hemorrhage.
3. Promote comfort and maintain safety.
4. Continuous, constant patient surveillance until he is completely out of anesthesia.

UNRELIEVED PAIN HAS SERIOUS SIDE EFFECTS, WHICH CAN RESULT HARMFUL
MULTISYSTEM EFFECTS
PAIN MANAGEMENT
Musculoskeletal Cognitive Immune Developmental Future pain Quality of LFE
 PAIN - An “unpleasant, subjective, sensory and emotional experience associated with
actual or potential tissue damage or described in terms of such tissue” (The International Muscle spasm Reduction in Depression of Altered Post – Sleeplessness
Association for the Study of Pain, 2005). cognitive immune temperaments mastectomy
function response
PATIENT’S RIGHTS
Fatigue Mental Infant distress Phantom pain Anxiety
 It is every person’s right to have their pain appropriately and aggressively managed confusion behavior
(Agency for Health Care Research Joint Commission, 2004).
Immobility Anxiety states Fear
 Pain relief is a “basic human right” (The American Pain Society, 2005).
 It is “not the responsibility of patients to prove they are in pain; it is the nurses’
Hopelessness
responsibility to accept the client’s report of pain” (The American Pain Society, 2005).
Ref: Last two slides. Pain and Comfort Management, PeriAnesthesia Nursing Core Curriculum, 2004
PAIN ASSESSMENT / INTERVENTION / RE- ASSESSMENT (AIR) CYCLE INDICATOR
OVERALL MESSAGE
Pain Assessment:  Comprehensive evaluation of pain.
 How do you assess pain?  Pain relief is a “basic human right” (American Pain Society, 2005).
 “Pain is the enemy, not the patient” (Greg Holmquist, 2008).
Pain Intervention:  Selection and implementation of various measures to facilitate pain  Golden Rule: Good assessment, intervention, and reassessment (AIR cycle).
relief.
 What nurse interventions could be used to manage pain? TRANSFER OF PATIENTS FROM PACU TO THE SURGICAL UNIT/WARD
 What non-nursing interventions could be used to manage pain?
1. Parameters for discharge from RR
Pain Reassessment:  Subsequent evaluation of the effectiveness of pain relief measures 2. Activity- able to obey commands, e.g., deep breathing, & coughing
following the interventions. 3. Respiration – easy, noiseless breathing
4. Circulation – BP is within 20 mmHg of the preop level
5. Consciousness – responsive
NON-PHARMACOLOGIC INTERVENTIONS
6. Color – pinkish skin and mucus membrane
What are the examples of  Splinting of a fracture
non- pharmacologic /  Immobilization of an inflamed joint
nursing interventions? SURGICAL UNIT – ASSESSMENT CONTINUE
 Repositioning
1. Vital signs
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 LICEO DE CAGAYAN UNIVERSITY
BACHELOR OF SCIENCE IN NURSING
LEVEL 3

NCM 112: CARE OF CLIENTS WITH PROBLEMS (Medical Surgical Nursing)

LECTURE PRELIM TERM
Clinical Instructor: Bobby Suazo, MSc, MSN, RN /Clinical Instructor/Lecturer S.Y. 2023 - 2024 1ST SEMESTER
TRANSCRIBE BY: MA. EM CONCEPCION LAGARE (MECTL)

2. Bowel sounds
3. Breath sounds
4. Level of consciousness
5. Wound dressing
6. Tubings

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