Laces Haan igen Nari Frspradiy Mon reer ABS XMS MEDICAL AND SURGICAL NURSING PERIOPERATIVE NURSING Lecturer: Mark Frederick R. Abejo RN, MAN PERIOPERATIVE NURSING. Perioperative Nursing ~ used to describe the nursing care provided in the total surgical experience of the [palient; pasoperaiive, intraoperative and postoperative, Preoperative Phase, extends thom the time the client admitted in the surgical unit, 10 the time heishe is prepared for the surgical procedure, until be is fansported into the operating row, Intraoperative Phase, exten from the time the elient is admitted to the OR, to the time of administration of anesthesia, surgical procedure is dane, until he/she is Iransported to the RPACU. Postoperative Phase, extends frorn the time the client is aadmiticd to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow-up eare 4 Major ‘Types of Pathologic Process Requiring Surgical Intervention (PET) Obstruction ~ impaitment to the Mlow of vital Muids (blood urine,[Link]) Perforation — rupture of an ofan. Erosion ~ wearing off ofa surtace or membrane. “Tumors — abnormal new growths. Classification of Surgical Pravedure According to PURPOSE: ® Diagnostic ~ to establish the presence of a disease condition. (e.g biopsy ) © Exploratory = to determine the extent of discase condition ( e,¢ Ex-Lap ) + Curative — to treat the disease condition, * Ablative — removal of an organ * Constructive — repair of congenitally defective organ. + Reconstructive— repair of damage organ © Palliative ~to relieve distressing sign and symptoms, not necessarily to cure the disease. Me Regent Nag ordi (Classification Tndication | Examples Sor Surgery. Emergent = patient = severe requires immediate Without | bleeding attention, Hife delay | ~ gunsha! threatening condition, stab wounds - Fractured skull Urgent /Tmperative— = kidney patient requines prompt ureteral tention. stones Required patient | Pian withina | - cataract niceds tohave surgery. | few weeksor | + thyroid do months Hlcetive — patient = repairer shuld have surgery. sear = vaginal seatasirophie_| repair ‘Optional — pavient’s Personal | - cosmetic decision preference _| surgery According to DEGREE OF RISK © Major Surgery = High risk / Greater Risk for Infection Extensive = Prolonged! = Lange amount af blood loss = Vital organ may be handled or removed ‘| Minor Surgery = Generally not protonget - Lends to few serious complication = Invotves tess risk Ambulatory Surgery! Samie-lay Surgery / Outpatient Surgery Advaniages: ‘= Reduces length of hospital stay and cuts costs = Reduices stress for the patient += Less incidence of haspital acquired infection = Les time lost from work by the patient; minimal disruptions on the patient's activities and family lie, isadvanrages: = Less time to assess the patient and: perform preuperative teaching. ~ Less time to establish rapport = Less opportunity 1 assess for late postoperative complication, ory Surgery Circumcision Vasectomy Cyst removal ‘Tubal ligation ‘Surgieal Risks Obesity Poor Nutrition Fluid and Etectrolyte Imbalances AgeLaces Haan igen Nari Frspradiy Mon reer ABS XMS + Presence of Disease (Cardiovaseular dse,, DM, Respiratory de. + Coneurrent of Prior Pharmacotherapy © other ficars: nature af condition, = loe. of the condition = magnitude / urgency of the surgery + mental attitude of the patient - caliber of the health care team PREOPERATIVE PHASE Goals Assessing ancl correcting physiologic and sychologic problems that may increase surgical risk. + Giving the person and significant others. complete leaming teaching guidelines regarding surgery + Instructing and demonstrating exercises that ill benefits the person during postop peri. Planning for diseharge and any projected changes in lifestyle due to surzery. Physiologic Assessment of the Client Undergoing Surgery Age Presence of Pain Nutritional 4 Fluid and Elestrolyte Balance Cardiovascular / Pulmonary Function Renal Function Gastointestnal / Liver Function Endoerine Function Neurologic Function Hematologic Fs Use of Medication Presence of Trauma & Infection Routine Preoperative Sereening Test Tat Rationale cAC RBC HgbHet are important two the oxygen carrying capacity af blood, WIC are indicator of immune fienction, Blood grouping? X mutch ‘Serum To evaluate Auld and electrolyte Blesirolyie situs PTET Measure time required for cloning to eur: Fasting Blood | High level may indicate undiagnosed Glucose DM BUN’ ‘Evaluate renal unetion Creat [ALWASTILDA | Evaluate liver finction snd Bilirubin ‘Serum albumin | Evaluate nuieiional status sind total CHON Urinalysis Determine urine composition Chest X13 Evaluate resp. status’ heat siz6 ECG Identify preexisting ealine problem, Poychosocial Assessment ad Care Causes of Fears of the Preoperative # Fearof Unknown ( Ansiety ) «Fear of Anesthesia M6 Negev Nang Fear of Pain Fear of Dea Fear of disturbance on Bosy image Worries ~ lass of finances, employment, social and faiy oles, Manifestation of Fears sanxisstess = bewilderment canger tendency to exaggerate sad, evasive, tearful clinging inability © concentrate short attention span failure to exery: dace imple direstions Nursing Intervention to Mininize Anwiety ‘© Explore client's fx Allow client's to speak openly about fears/eoncems 4 Give accurate information regarding surgery Abriet, direct to the point ancl in sinmple terms) Give empathetic support Consider the person's religious preference and arrange far visit by priest / minister as desired. INFORMED CONSENT. ysure that the client understand the nature of the treatment inching the potential complications and disfigurement (explained by AMD) = Tos indicate that the client's decision was made without pressure. © To protect” the client against procedure, © To protect the surgeon and hospital against legs! action by a client whe claims that an authorized procedure was performed unauthorized Circumstances Requieing Consent ‘© Any surgical procedure whore sealpe, setssors; suture, hemosiats of eletrocoagulation may be used, ‘+ Entrance into boty cavity, Radiologic procedures, paniculrly if a contrast rrteral 1s required General anesthesia, focal infiltration and regional block Essential Elements of Informed Consent ‘= thedliagnosis and explanation of the condition, ‘© 8 fair explanation of the procedure to be done and used and the sensequences, 1 description of alternative treutment or procedure, 44 description of the benefits to be expected. material rights ifamy. the prognosis, ifthe recommended care, procedure ix refused, equisites for Vatidity of taformed Consent ‘© Written permission is hest and legally accepted. ‘© Signmure is obtained with the client's complete understanding af what to ogcur. AeLice Noein Posies Nein Proprio Pronk AES MINN udu sign their own operative permit ~abiained before sedation ‘© For minors, parents or someone standing in theit bochalf, gives the consent, Notes Fok 4 married emancipated minor parental consent is not necded anvinare, spouse ie aceepred ‘+ For mentally ill and unconscious patient, consent must be taken froma the parents or legat guardian ‘+ the patient is unable fo write, an"X" fa accepted ifthere is a-witness to his mark ‘+ Sccuitec without pressure aid treat A witness. is. desirable ~ nue, physician or suthorized persons. ‘© When an emergency situation exists, no consent is necessary Because inaction at such time may cause sreater injury. permission via telephone/cellphone {accepted but must be signed within 2ahrs,) Physi ation Before Surgery Correct any dietary deficiencies Reduce an obese person's weight Correct fluid and electrolyte imbalances Restore adequate blood volume with BT ‘Treat chronie diseases Halt or treat any infectious process ‘Treat an alcoholic person with vit. supplementation, IVF or fluids if dehydrated Preoperative Teaching Incemive Spirametry © Encouraged to use incentive spirometer about 10-10 12 times per bour. > Deep inhalations expand alveoli, which prevents atcleciasis and other pulmonary complication, > Theres less pain with inspiratory concentration than with expiratory eoneeniration, Diaphragmatic Breashing > Refers to a flattening of the dome of the digphragsn during inspiration, with resultnt enlargement of upper abdomen at sir rushes in, During expiration, abdominal muscles contract, > Ina semi-Fowlers pesition, with your lunds loose: fist allow to rest lightly on the froni of lower nibs. Breathe out gently and Fully-as the ribs sink down and inward toward midline, > Then take a deep breath through the nose and mouth, letting the abdomen rise asthe lungs fill with air Hold breath for acount of S, Exhale and let out all the air through your nose and mouth, > Repeat this exercise 18 times ith i short rest after cach group of $. ve Coughing 2» Promotes removal of chest secretions. M6 Nepean Vouirunesy Babess out? Vinseney dup panos on ff. 19 Gow bo SEvitLay- Bans zares ~ Interluce his fingers and place hands over the ppropased incision site, this will act as a splint and ‘will not harm the incision. Lean forsiard slighily whi Breath, using diaphragm Inhale fully with the mouth slightly open. Let out 3-4 sharp hacks. With mouth apen, take ina deep breath and quickly sive 1-2 strong coughs. ~ siti in bea, vee Tuning > Changing positions fom back to side-lying (vice vers) stimulates circulation, encourages deeper ‘breathing and relicue pressure areas Help the patient to move onto his 3 needed. Place the uppermost feg in a more fleet position than that of the lower leg and place » pillow comfortably between the leps, % Make sure that the patient is turned from one side to the back and! nto the other side every 2 hours ” assistance is ne Foot und Leg Exercise % Moving the logs improves circulation and musete tone. Have the patient tic supine, instruct patient wo bend a knee and raise the foot — hold ita few seconds and forwer it tothe bed, Repeat above about $ times with one leg and then with the other Repest the set $ times every 3:5 hours. ‘Then have the patient fie on one side an! exercise the legs by preiseding to pedal a bicycle. For foot exervise, trace a complete circle with the greattoe, = ¥ v ‘Turning t0 the Side > Tuen on your side with the uppermost leg flexed most and supported on a pillow, jap the side rails as an aia (0 maneuver to the side. i PRE 0p CHECK sTy/” GPa i erin 4 is. oF LON wd \ gniedasea, ike comatena/ Face VLaBs x RAYS WCONSENT FORMS VPRE ons, vere. SKIN PREP sonalLice Nevin Posies Nein Freprad iy Mo reer ABE, MAS Breparing the Patient the Evening Hofore Surgery Pregraring the Skin + have a full bath to reduce microorganisms in the skin, should be removed within 1-2 mm of the skin to avoid skin breakdown, use of electric clipper is preferable. & Preparing the G1 trace = NPO, cleansing enema 2 required ASA (American Society of Anesthesiotogists) Guldetines for Preoperative Fasting Tiquid and Food Intake Mininvm Fasting Period ‘Clear Liquids 2 Breast Milk ri ‘Nonhuman Milk 6 Light Meal 6 ‘Regular / Heavy Meals 8 & Preparing for Anesthesia + Avoid alcohol and cigarette smoking fir at least 24 hours betire surgery. % Promoting rest and step + Administer cedatives as ordered Preparing the Person on the Day OF Surgery Barty A.M Care Awaken | hour before preop medications © Moming bath, mouth wash Provide clean gown + Remave hairpins, brad long hair, cover hair with cap if available. + Remove dentures, colored nail polish, hearing aid, contact lenses, jewelries. + Take baseline vital sign before preop medication. Trench Pancnouees Rarwes Dr BREATHING. TURNING. Pm pa on scoumeeT ne Pouey prasing eabaners Check ID band, skin prep Check for special orders ~ enema, 1V tne Cheek NPO- Have client void before preop medication Gontinus to support emotionally Accomplished "preop care checklist Goals: ©) Toad in the administration of an anesthetics. * To minimize respiratory tract secretion and changes, inheart rate. © Torelas the nd reduce anxiety. ‘Commonly used Preop Meds, “Teanquilizer & Sedutves * Midazolam * Diacspam( Valium ) = Lorazepam (Ativan ) * Diphenbydramine Analgesics * Natluphine (ubsin ) Anlicholinergics * Atropine Suite Proton Pump Inhibitors * Omeprazole ( Losee } * Famotidine ‘Tramsporting the Patient to the OR © Adhere (o the principle of maintaining: the comfort ‘and safety of the patient. ‘© Accompany OR attendants to the patient's bedside for introduction and proper identification, © Assist in transferring the patient from bed to sites, ‘© Complete the ehart and preoperative eheeklist + Make supe that the pation srft2H thE Tees!" HEMT Ceo (erent oe (agit \; review: Pracert ion OF IANS —Curnenr Bistesronr eeuimions SIGNIFICANT OTHERS PaveHOSOCAL rete. MEDICATIONS NURSING. ADEE ASMENT cues rorLae ae an gens Nari Ferd Ma Peer WABI LX, MAN Patient's Family © Diroct to the proper waiting toon + Tel the family tha the surgeon wil probably contact then immediately after the surgery. «Explain reason for long. interval of waiting: anesthesia prep, skin prep, surgical procedure, RR, Toll the Family what wo expect postop when they see he patignt INTRAOPERATIVE PHAS! Goals © Asopsis + Homeostasis © Safe Administration of Anesthesia + Hemostasis wurgical Unrestricted Arca = provides an entrance and exit from the surgical suite for personnel, equipsent abd patient ~ street elothes are permitted in this area, and the area provides access to communication with personne! within The suite and with personnel aed patient's families outside the Semf-resteicied Area ® provides access to the procedure rooms and Peripheral support areas within the surgical suite, * personnel entering this area must be in proper operating room and tafe control must be Assigned ta prevent violation of this area by unauthorized persons = peripheral support areas consists off storage areas for clean and sterils supplies, sterilization equipment and ccrridors leading to procedure room Restricted Area = inclules the procedure wom where surgery is performed and adjacent substerile areas where the serub sinks and utociaves are located = personnel wor ‘operating room attire ing in this area must be in proper + "The size of the procedure room > Usually rectangular or square in shape > 20.e 20 10 with @ minimum floor space of 360 square feet + Temperature and humidity control The temperature in the procedure room should Imuintined between 8 F - 75 F (20 - 24 degrees C) lumidity level between $0 - 55 % at all times + Ventilation and air exchange system ir exchange in each procedure room should be al least 25 air exchanges every hour, and five of that should be fresh ait. > A high filtration particulate fier, working at ‘95% efficiency is recommended. M6 Negev Nasing > fi + Electrieal Safety re ch prosedure room should maintained with positive pressure, which forces the old ir out of the room and prevents the air from surrounding seus froin eilering into the procedure room ity wiring, excessive use of extension conls, poorly maintained equipment and lack of current safety measures are just some of the hazardous factors that must be constantly checked All clestrical equipment new oF used, should be % Equipment that + Communication System routinely checked by qualified personnel, function at 100% efficiency should be taken out of service immediately ‘The Surgical Team Surgeon Assist Anes Primary responsible for the preoperative medical history and physical assessment, Pevformance of the operative procedure according to the needs of the patients. The primary decision maker regarding surgical technique to use during the procedure, May assist with positioning and prepping the patient oF may dcleyste this task to other members af the team tant Surgean May be a resident, intern , physician's assistant OF a perioperative nurse, Assists with retracting, hemostasis, suturing and any other tasks requested by the surgean to ciliate speod while maintaining quality during the procedure, ibesiologist Selects the anesthesia, administers i, int the clicat if necessary, manages problems related to the administration of anesthetic agents, and supervises. the client's condition throughout the surgical procedure. ‘A physician who specialives in the Administration and monitoring of anesthesia while maintaining the overall well-being of the patient. Scrub Nurse May be either a nurse or a surgical technician, Reviews anatomy, physiology and the surgical Procedures “Assists withthe preparation ofthe room. Semubs. gowns and gloves. self and other members af the surgical team, Prepares the instrument table and organizes sterite equipment for functional se ‘Assists withthe drapping procedure. Passes instruments to the surgeon and assistants by anticipating their need Counts sponges, needles and instruments Monitor practices of aseptic technique in self and others. Keeps track of irrigations used for calculations of blood lassLice Noein Posies Nein Fyre iy Mak Freer ABE LS AIAN Circulating Nurse Surges! tncsions + Must be a registered nurse who, after additional ‘education and training. specialized in Teton Site “Type Surgery perioperative nursing prastis, Buitcily For eranintom, + Responsible and accoumiable for all act Limibal For eye surgeries occurring during a surgical procedure including Halstead ( ical_| For breast surgeries the management of personne! equipment, ‘Subeostal Gallbladder and biliary tract supplies and the environment during 9 surgical a Procedure, Paramedian Right side — gallbladder, * itient adwoeate, teacher, research consumer, tract Feader and role model. Leh #5 = sploncctomy, + May be responsible for monitoring the paticat ‘Tamene ‘Gasiectorny during local procedures if a second Rectus Right side ~ small bowel operative muse is nat available. rie + Ensure al equipment is working property. Et Les Gd ISK Ee ee Eat esi + Assists with positioning. 5 + Monitor the room and team members for breaks ebunss Abhendecton ce ee Plamnenstich ‘Gynecologic surgery b vat Lumbotomy For kidney surgeries indies specimens. + Cogedinates activities with other departments, ‘such as radiology and pathology. Position During Surgery i Position ‘Type of Surgery + Documents eare provided, + Minimizes conversation and traffic within the 2 SOREN: ‘Trondclenburg Feivie Surgeries Lithotomy- Vaginal repair, D&C, etal Principles of Surgical Asepsis surgery. APR Prone Spinal surgery, nino ‘Stele object remains sterile only when toushed Ener Kidney, chest. hip surecry nother stcrile object Tack Knife Postion | Rectal procedures, + Only sterile objecis may be placed ona sterile field sigmoidoscopy and eolonose # A sterile objector field out of range of vision or an Reverse] Upperabomins, head neck] ‘object held below 9 person's watt is contaminated ‘Trondelenbune and facial surgery When a sterile surface comes in contact with @ et, Position contaminated surface, the sterile object or fel becomes saniaminated by eupillary action Explain the purpose of postion ‘© Fluid flows in the direction of gravity ‘Avoid undue expotuck The edges of a sicrile field or container are considered to be contaminated (1 inch) trap the person to prevent falls Maintain adequate respirsiory and circulatory functions. ‘Mainiain good body Metical Asepsis vs. Surgical Asepais igrament State of “Marvosis” + Anesthetics can produce muscle rebixation, block transmission of pain nerve impulses anc suppress reflexes. + Ihean also tempormry decrease memory retrieval andl recall ‘The effects of anesthesia are monitored by considering pies WL the faowing parm waa = Respinition a | was actos] > Et tt CEN EE eae’ = Urine ouipat STEAME ECON ~ USED ins ‘Types of Anesthesia anes DRESSING CHANGES se CATHETERIZATIONS DALY HYGIENE AGC. FADCEDARES i wasn 15 suoer Ast ‘+ protective reflexes such as cough and gag are last + © provides anulgesia, muscle relaxation and sedation, MEDICAL ASEPSIS: SURGICAL ASEPSIS |» [Link] andl hypnosis. General Anesthes reversible stale consisting of complete loss of ‘consciousness and sensation, Me Negev Nang Ae,Laces Hae an gens Nari Foyt Ma Peer Rab LN, MAN Techniques used in General Anesthesia A. Intravenous Anesthesia + This is being administered fmravenousy and extremely rapid, + itseffet will immediacy tke place ater tiny: minutes of introduetion Itprepares the clint far smooth transition to the © temporary interruption of the transmission of nerve impulses to and from specific area or region of the body. achieved by injecting toca! anesthetics in close proximity to appropriate nerves. reduce all painfal sensation in one region of the body without inducing unconssiousness, ‘© agents used are lidocaine and bupivacaine: Techniques used in Regional Anesthesia: Ac Tapical Anesthesia ‘© applied directly to the skin and mucous membrane, fopen skin surfaces, [Link] burns. © readily absorbed and act rapial used topical agents are lidocaine and benzocaine, 1B, Spinal Ancsthesta ( Subarachnoid block } © local anesthetic is injected through lumbar puncture, between L2 and $1 ‘esthetic agent is injected into subarachoid space ssurrouriding the spinal cord, Low spinal for psrincalirestal areas = Mid spinal T10 ( below level of umbitieus) for hernia repair and appenideston + High spinal 4 (nipple tine), for CS + anesthetic block conduction in spinal nerve roots and dorsal ganglia; paralysis and analgesia occur below level of injestion + agents used are procaine, tetracaine, lidocaine and bupivacaine. C. Epidural Anesthesia achieved by injecting Jocal anesthetic into epidural space by way of a lumbar puncture. ‘© result similar to spinal analge agents use are chloroprocaine, lidocaine and upivacsine. D, Peripheral Nerve Block achieved by injecting a tocal anesthe the surgieal ste agents use are chloroprocaine, lidocaine and bupivacaine. to anesthetize M6 Nepean Intravenous Block ( Beir block } 4 often used for arm,wrist and hand procedure + an ovslusion tourniquet és applied to the extremity to prevent infiliration and absorption of the injected IN” agents beyond the involved extremity. Indicating a site for lasertion of the lumber puncture needle into the subarachnoid space of the spinal canal. Subarachnoid space Spinous process of vatabra lun terminate, F. Caudal Anesthesia ‘+ Is produced by injection of the local anesthetic into the eaudal or sneral canal G, Ficld Black Anesthesia © The area proximal t planned incision ean be injected and infiltrated with loeal anesthetic agents. rt Onset / Induction. Exicnds from the administration of anesthesia to the time of toss of consciousness, Excitement / Delirium, Extends from the time of loss of consciousness to the time of loss of lid reflex. Increase in wvionomic activity and irregular breathing. It may be characterized by shouting, strugeling ofthe client, > Surgical, Exiends from the loss of lid reflen to the loss of mast reflexes, surgical procedure is started. Medullary (Stage of Danger. it is chamecterized by respiratory and cardise depression or arrest. It is duc to overdose of snestiesin, Resuscitation must be done.Lise Haan gens Nar Frsyrediy lo reer ABO, MANS ‘Complication and Discomforts of Anesthesia # Hypoventitation - inadequate ventilatory support after paralysis of respiratory mussles, + Oral Trauma Malignant Hyperthermia # Hypotension - due to preoperative hypovolemia oF untoward reaetions to anesthetic agents # Cardiac Bysriythmia «duc to pre cardiovascular compromise, electrolyte imbalangs or untoward reaction Yo anesthesia. + Hypothermia - dus to exposure t coo! ambient ORenvironment and loss of thermoregulation capacity fom anesthesia. + Peripheral Nerve amaze ~ due io improper positioning of patient or use of restraints. + Nausea and Vomiting Headache NuRsinG DX v FEAR RELATED To EXPERIENCE, Loss OF conTRaL § UNKNOWN KNOWLEDGE DEF ICT RELATED TD PRE OP ‘post oF PROCEDURES, M6 Reger Nang NURSING RESPONSIBILITIES Goals POSTOPERATIVE PHASE ‘Maintain adequate boxy system functions Restore homeostasis Alleviate pain and discomfort Prevent postop complication Ensure adequate discharye planning and teaching. ‘Transport af client from OR to RR. avoid exposure avoid rough handling avoid hurried movement and rapid changes in position. FoLuew CUENT ROUTINE. RECORD VS Remove. JEWELRY t REMOVE. NAIL POLISH 1 REMOVE. DENTURES ETC. { NPO i ID BAND ! 7 SKIN PREP i ID FAMILY E WCinaT COMPLETENESS a PuRPose GéNERAL. oat =OPAN — GIVEN BY DR. = May Cause & BP ~ MAY GIVE READACHE = Blocks AuToraic stetes ~ ASSESSMENT OF CLIENT = oT FoR WwPOVOLEMIC.Laces Hae an gens Nari Foyt Ma Feerch ABO ALN, MAN nital Nursing Assessment Verify patient's islemtity, operative procedure and the ssirgson who performed the procedure, Evaluate the following sign and verify their level of sibility with the anesthesiologist: Respiratory stares ~ Circulatory status Pulses > Temperature - Oxygen Saturation level Hemodynamic values * Determine swallowing and gag reflex , LOC and patients response to stimu + Evaluate fines, uibes, or drains, estimate blood loss, condition of wound, medication used, transfusions and output. Evaluate the patint's level of comfort and sty Perform safety check; side rails up and restraints are properly in plased. = Eviluate activity status, movement of extremities. + Review the health care provider's orders, Anitial Nursing Interventions Muinsaining o Patent Airway Allow the airway (ET tube )to-remain in place unl the patent begins to walker and is trying to eject the airway. The airway Keeps the passage open and prevents the tongue fom falling backward and obstructing the air passages > Aspirate exeessive secretions when they are heard in the nusopharyns an oropharyne, Assessing Status af Cireulatary System Take VS per protocol, until pationt ix well stabilized > Monitor intoke and ougput closely, Recognized carly symptoms of shock or hemorrhage: col extremities + decreased urine oatput (less than 30rnl ar} + slow capillary refill (greater than 3 see. ) = lowered BP + narrowing pulse pressure + increased heart rate te 02 therapy, to increase O2 availability from the blood. * place the patie i shock posi fect elevated { unless contraindicated ) Mointaining Adequote Respiratory Function Place the pation in tateral position with neck extended ( if not contraindicated ) ane) upper arm supported on 8 pillow, > Tur the patient every | to 2 hours to facilitate breathing and ventilaion. > Encourage the patient 10 take deep breaths, use an ingentive spirometer, > Asscos hung fields frequently by auscultation. Periodically evaluate the patient's orientation — response to name and command. Note: Alerasions in cerebral function muy sugaest impaired 02 del Administer humidified oxygen i required. M6 Nepean > Use mechanical ventilation to mintain adequate pulmonary ventilation if required. Assessing Thermoregulatory Status Monitor temperature per protocol te be alert for malignant hyperthormi. oe to detect hypothermia, Report a temperature aver 37.8 © or under 36,1 C Monitor for pastanesthesia shivering, 30-45 minutes afler admission ta the PACU, > Provide a therapeutic environment with proper temperature and humidity. Matniaining Adequate Ptuid Volume jons as ordered, balance such as NRW Administer LY sol % Monitor evidence of FAKE and weakness, Evaluate mental satus, skin color and turgor > Recognized signs o a. Hypovolemia decrease BP = doerease urine output decreased CVP creased pulse Hypervotemia crease BP changes in lung sounds (S3 gallop ) eased CNP % Monitor 1&0, Minimizing Complications of Skin tmpairment Perform handwashing befors and afier contact with the patient Inspset dressings routinely and reinforce thoen if necessary, Record the amount and type af wound drainage. ‘Tom patient froquceily and msiotain. good Mody alignmen we wy Maintaining Safety > Keep the side rails up until the patient is filly awake. % Protect the extremity info which LV fluids. are running 30 needle will not become aecidentally dislodged. Avoid nerve damage and muscle simin by properly ‘supporting and pauding pressure areas. Recognized that the patient may not be able to complain of injury such as the pricking of an open safety pin or clamp that is exerting pressure. > Check dressing for constriction @ ¥ Promoting Comfort Assess pain by observing bchavioral and physiologic imanifesations. > Administer anilgesie and document efficacy. Position the pater to maximize comnfort. Eorameter for Discharge from PACURR Activity, Able to obey commands Respiratory. Easy, noiseless reathing Circulation. BP within 20mmHfy-0f proop tevel Consciousness, Responsive olor. Pinkish skin and mucus membraneTv Augo §98rE pug. FAD bikeoures BEORAINASE Ranat, Funcro TAB VALUES o Bowl. SIND HPo TIL GI FUNCTION NG? ENCOURAGE FLUIDS ASSESS Fluid TOLERANCE PRrostess DIET Reconn Bal's (S865 OUTPUT: ELIMINATION Concer te OF NURSING PRACTICE hie fe. "ey ek pt Blog, é % ee out RHRATERY See, “ey, e FUNCTION te, % Saat, e "as ‘ Nursing Care of 1 " op Period (RR = Unit Goals: © Restore hameustesis and prevent complication, Baxeline Assesment © Maintain adequate cardiovascular and tissue + Respiratory Status © Cardiovascular Status -VS += Color and Temperature of Skin * Level of Conssiousness. © Tubes - Drain -NGT - Taube Position Me Reet Nang perfusion. ain adequate respiratory Funetion. nin adequate nutrition and elimination, te adequate rest, comfort sna safety. Promote adequate wound healing Promote and maintain activity and mobitity. Profi aden pgchologial suppor coogoceeCi AbD KN. AN Altay TIL GAG RELEX OK POSITION Suction F CouGi/DéeP BAEATHE PMECHANICAL SUPPORT Breer SOUND, s> SPERK CALALY oa ere Boot ALIGNMENT, : enue! pun WRATE, ie REMEMEER REARING on at LST @ RAIDER DsreTey 4 { ar fuectTaowres i ane AYDRATION : CURRIER OF i peeesnts ok IRCHSONAL AREA L vst? % DRAINAGE, ’ ; Preven. i ASRAATION Me Negev Nang AAy lige ing Nee Hed pm R WOUND CARE, Frequently used Dressing ‘Materials Common dressing Irvigating a wound ‘The strips of tape should be placed at the ends of tke dressing and mnust be sinfficienty lon at wile to secure the dressing. The tape should adhere to intact skin, © Cleaning 0 wound “from the incision €Xeaniag. frome 1 ba ‘Cleaning araund a ‘Starting at the enter Penrose drain site 2S Peper ing veiReta tf enn re ome 1B Rome aie age RN ‘with tha other hand. The patient ts in- coughs. and releasing ‘structed to take teveral deep breaths, dunng deep breaths. Jinalo, and then cough forcibly, D The patient ean be taught to held ‘pila firmly against the incision 2S Peper ing toPb gf Ny Cee Ree 14 Riera nrc ge POST OPERATIVE COMPLICATIONS Problem Description Cane Clinical Signs ‘Nursing tntervention RESPIRATORY Faeumonia Tnflamamation ofthe | Tafeetion evated (emp. | © Deep breathing exercises Jung parenchyma’ | ® Toxin irritants | ~cough # Coughing exercise alveoli causing = biood tinged #Esely ambulation inflammatory spatuen process dyspnea ~ehest pain Infectious © Cause by Paewmonia streptococeus ‘pneumoniae / Staphylococcus aurcus Mypostatie © Immobitity Pacemonia & inpaaed ventilation Aspiration © Aspiration of Paevmonla sistric contents, food Aielectasis ‘A condiaon in * Mucouspligs | -Exverl 1°24 | Deep breathing exercises which alveoti blocking bronchial | hours) = Coughing exercise callapsed and are passageways =Dyspnca Early ambulation rot ventilated © Inadequate lung | ~Tachycareli expan © Immobility Pulmonary Biood clorthathas | © Tmmobility = Tuming Embotism moved tothe lungs |e Use of eral * Ambulation and blocks a contraceptives: | © Ami cmbatic stockings putmonary artery |e Coagulation = Cyanasis © Compression devises and obstruct blood problem > Tachycardia © Prevent massaging the flow to the lungs: -Low BP lower extremities. CIRCULATION Hiypovolemia | Tnadequate © Hemorrhage ~ Tachycardia © Fhuidand blood circulating blood — | «Fluid defies =Dec. urine replacement volume Vemorrhage Tniemal orextemal | » Disruption of + Fiuidand blood bleeding sutures replacement © Insecure ligation of | -Deep, rapid RR |e Vik und hemostat Capitlaey ~ stow blood vessels © Ligation of bleeders generalized oozing ©: Pressure dressing Fenous — dark i color and bale out - Swelling or Asteria ~ spurts, brsini arotind bright red in color 7 19 Poona Nerng ve‘Overt Bleeding =Dressing saturated with bright blood = Bright, free= lowing blood in drains or tubes. “Thrombaphiebitis Taflammation oF the veins, uswally of the legs and associated with a blood © Slowed venous blood flow due to mobility or prolonged siting © Traumato the vein © Increased blood coagulability, Homans Sign pain, discomfort in Calf when foot is dorsiflexed > Aching, cramping pain ~ Swollen, sed and hot to toueh ~ Vein fses hie Early ambulation Anti-embolic siocking Encourage leg exercise Hydrate adequately Avoid any restricting sdevices that impaired sircalation ‘Avoid massage on the salf ofthe leg Initiate anticoagulant therapy affected [Bood cl antached extremities towall of vein or = Dewabsent of Thrombus anery periphora pulse Nowe: Fifa inte |* Hee anno Foreign body or clot st | sesons system sathsters itn body + Broken IV calbiter that has maved from | ¢ pay tually becomes t Embolus itssite offormation |2 Armjotic uid | redmonary toranother area of ombotus the body TRINARY Urinary Tnabiliy w emply |» Depressed bladder | Larger tard > Retention the badder, muscle tone fom | fake than output | « excessive tarcoties and ‘voiding accumulation of anesthetics © Urinary Catheterization urine in the bladder | 6 Handling oftissue | distention eam during surgery on | -Suprapubic ‘xian organs comfort © Spasmof the = Resilessness bladder sphincter Urinary = Loss oftone ofthe |=30— omar |e Monlarl&O Incontinence bladdersphincter | urine g 15-30-mins accumulated urine Urinary Tract | Inflammation of he |» mmobiliaion |- Poxer(4@ ious |» Adequate fad intake Infection bladder, ureters or |e Limited uid | poston) Early ambutation urethra intake = Burning sensation | «septic eatheterization as when voiding ood © Good perineal hyuéene = Lower abdominal pain 5 Fath Ning avoS10 Elie an egy et Foe 16 GASTRO- INTESTINAL Nausea and + Pain =Conplannis oF [TW fide wnil perisialsis ‘Vomiting © Abdominal feeling sick to the | returns distention stomaeh # Progressive dict clear © Ingestion of uid | -Rewhing ‘quid then fal fluids, som cr food before the | - Gagging shen regular dict) retum of peristalsis © Anticmoties as ordered “Tympanities Retention of gases | * Slowed moillity of | - Abdominal = aly ambulation within the intestines | dhe intestines duc wo | distersion © Avoid using straw effects oF anesthesia * Provide ice chips Hiccups Tniermiticnt pasmy | + Tnitation oF insertion as neoded of the diaphragm phrenienerve'bet, | “hie*that result | © Hild breath white taking the spinal cord and | fromthe vibration | a Large swallow of water " ofelosed vocal | «Breath in and out ona ramifications on | cordsas aie rushes | paper bag undersurface ofthe | suddenly into the | 6 "Anti emeties as orders diaptiragm lungs Abdominal distention Tatestii Kink op oF > Duet = Inter oa NOT msertion as needed Obstruction intestines inflammatory sharp. colicky Administered IVF 2s Coes" day adhesions abdominal pains sonlered postop) x © Prepare for passile omiting su ~ Abdominal eS distention ~ Hiccups =No bowel movement ‘Constipation Taikequcntoray |» Lack of diciary | -Absonce ot Wool |» Adequate hydration stool passage for roughage climination High fiber diet abnormal length of | * Analgesics - Abclominall Encourage early time = Imma stention ambulation (within a8 hours = Abdominal afer solid dict discomfort started ) Paralytie Meus | Lack of peristalic ['® Duetoanesthoticy | =Abdominal pain | ® Encourage early activity = Tinmobiity - Abdominal ambulation distention = Constipation Absence of bowel sounds WOUND Wound Infection | Inflammation and] * Poor aseptic = Keep wound clean and infection of incision | techniques posto) ay ordrain site Redness, swelling | » Surgical aseplic technique «pain and varmth | when changing dressing ~Pus or discharge |e Antibiotic therapy ‘on the wound site = Foul smelling discharge 19 Poona: Narn ve14d Clie ening I ere Med Ema the incision heals Malnutrition maciationlobesity Excessive strain on Increased incision drainage Tissues underlying skin become visible “Apply abdominal binders Encourape high protein ict aed VitC intake Keep in bed rest ‘suture line ‘Wound Extrusion of internal | © Poor circulution © Semi-Fowlers, bend Evisceration organ or tissues incision and visible knees to relieve tension on, through the incision protrusion of she abdontinal muscles organs Spliming on coughing Cover exposed organ with sterile , moist sessing © Reassure, kop hiner ‘quite and relaxed © Prepare for surgery and ‘repair of wound PSYCHOLOGIC Postoperative ‘Altered Mood © Weakness ~ Anorexia Adcquate rest Depression © Surprise nature of | = Tearfulness Physical activity “E" surgery = Withdrawal Opportunity to express © Newor =Rejection of anger and other negative snulignaney others feelings © Severely altered ee pets disturbances Delirium / Acute Dehydration ~Poornisinery | + Sedaives to esp client ‘Confusional State Insufficient ~ Restlessness ‘quite and comfortable ‘oxygenation inattentive © Explain reasons for appropriate interventions Infestion Trum behavior = Wild excitement Listen and tall to the client Provide physical comfort 2 Perera sing aoia aaa Foviows oineerigns? sufroor vous sou . Aves Toswitou? wre nae : BARGE YOLUAL Ory TESTING: ae, { y 4 RECTAL J smc pl Em NASAL eyes EARS ‘ON SKI S21 Clie ering QIN ep Mid 18 vara wWooHims a one Leaning Bg = mepication ZATARCK UE a Te 2 posace =I Roure AABN ISTERON ‘WHAT W2 PRGPARE ene Pas an GEKA. abo ‘Tanuers & Cueny SIDE EFFECTS. iesiiaiice ONT HEN TS Pou eas EVALUATE SCENTS CoM DITION ShAITS Nye coumira anuity sa, £ RSEOTIC TECHN ta ff ASEPTIC TECHNIQUE a NO Mebs STORED AY BEDSIDE ‘EHV LSIONS Lovions Review MED ADMINISTRATION IF CLIENT 18 TO Do RY HIMSELF S STUDY HARD, GoD BLESS YOU THANKS ‘Mark Frederick R. Abeja R.N, MAAN Clinical Instructor 2 Pevpertve Nes a