PERIOPERATIVE NURSING

SURGERY

Branch of medicine that encompasses preoperative, intraoperative, and postoperative care of patients. The discipline of surgery is both an art and a science.

SURGICAL PROCEDURE

Invasive incision into body tissues or a minimally invasive entrance into a body cavity for either therapeutic or diagnostic purposes during which protective reflexes or self-care abilities are potentially compromised

CONDITIONS REQUIRING SURGERY
OBSTRUCTION  PERFORATION  EROSION  TUMOR

TYPES OF SURGERY According to Purpose
Diagnostic

Exploratory
Curative
• Ablative • Reconstructive • Constructive

Palliative

TYPES OF SURGERY According to Degree of Risk Major Surgery Minor Surgery • Involves vital organs • Prolonged • • • • Involves non-vital parts Generally not prolonged Lesser blood loss Lesser complications .

TYPES OF SURGERY According to Urgency Emergent Urgent Required Elective Optional Without delay Within 24-30 hours Within few weeks or months Failure to have surgery is not catastrophic Personal preference .

AMBULATORY SURGERY      OUTPATIENT. SAME-DAY or SHORT-STAY surgery Laparosopic and minimally invasive surgery Admission to an inpatient hospital setting for less than 24 hours Requires Preadmission Testing (PAT) Admitted in preoperative holding area of the Operating Room and stays in the PostAnesthesia Care Unit (PACU) prior to discharge .

removal cut into or incision make artificial opening plastic repair suturing. repair .SURGICAL TERMINOLOGIES Suffixes -ectomy -otomy -ostomy -plasty -orrhaphy Meaning excision.

SURGICAL TERMINOLOGIES Root Word angio aorto arterio cardio / corono phlebo cholecysto colo or colono duodeno esophago gastro hepato Meaning vessel aorta artery heart vein gallbladder colon duodenum esophagus stomach liver cholangio lapar procto Root Word jejuno oro / stomato Meaning jejunum mouth pancreato pharyngo choledocho pancreas pharynx common bile duct common bile duct abdomen rectum ano adreno hypophyso thyro anus adrenal gland pituitary gland thyroid ileo ileum .

SURGICAL TERMINOLOGIES Root Word Meaning Root Word pyelo urethro balano prostato scroto vaso arthro chondro costo cranio ligamento myo / myoso Meaning renal pelvis urethra penis prostate scrotum vas deferens joint cartilage rib skull ligament muscle orchio / orchido testis oophoro salphingo ovary fallopian tube cervico colpo / vagino hystero / utero mammo lymphadeno spleno nephro / reno uretero cervix vagina uterus breast lymph node spleen kidney ureter cysto / vesico urinary bladder .

SURGICAL TERMINOLOGIES Root Word osteo pelvo spondyl tendino cerebello cerebro encephalo neuro alveolo broncho epiglotto rhino Meaning bone pelvis vertebra tendon cerebellum cerebrum brain nerve alveoli bronchial tube epiglottis nose phako retino eye lens retina Root Word phreno pneumono/pulmo tracheo auro /oto lung trachea ear Meaning diaphragm myringo/tympano oculo/ophthalmo eardrum eye blephar cheilo palato/urano eyelid lip palate cutaneo/dermo skin .

SURGICAL TERMINOLOGIES Abbreviation / Acronym Meaning MRM ORIF ADSF Modified Radical Mastectomy Open Reduction Internal Fixation Anterior Decompression Spinal Fusion ECCE TAHBSO TURP CS AKA BKA CABG APR ExtraCapsular Cataract Extraction Total Abdominal Hysterectomy Bilateral Salphingooophorectomy TransUrethral Resection of the Prostate Ceasarean Section Above the Knee Amputation Below the Knee Amputation Coronary Artery Bypass Graft Abdomino-Perineal Resection .

PERIOPERATIVE NURSING  Refers to activities performed by the professional nurse which encompasses a client’s total surgical experience .

PHASES OF PERIOPERATIVE NURSING PreOperative Phase IntraOperative Phase PostOperative Phase .

PREOPERATIVE PHASE .

PREOPERATIVE PHASE  Begins at the time of decision for surgery and ends when the client is transferred to the OR This period is used to physically and psychologically prepare the client for surgery   The nurse plays a major role in client teaching and in relieving the client’s and the family’s anxieties .

PREOPERATIVE PHASE: GOALS OF CARE  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-op period Planning for discharge and any projected changes in lifestyle due to surgery    .

. employment. social and family roles The MOST DEVASTATING FEAR of a surgical client is the FEAR OF THE UNKNOWN. vulnerability while unconscious Fear of death Fear of disturbance of body image Worries: loss of finances.PSYCHOLOGIC PREPARATION: CAUSES OF FEARS      Fear of pain Fear of anesthesia.

PSYCHOLOGIC PREPARATION: MANIFESTATIONS OF FEARS          Anxiousness Confusion Anger Tendency to exaggerate Sad. clinging Inability to concentrate Short attention span Failure to carry out simple directions Dazed . tearful. evasive.

PSYCHOLOGIC PREPARATION: NURSING INTERVENTIONS  Assess client’s fears. support systems and patterns of coping Establish a trusting relationship with the client and significant others   Encourage verbalization of fears Explain routine procedures and allow client to ask questions   Provide spiritual care if appropriate . anxieties.

LEGAL ASPECT OF PREOPERATIVE PHASE All invasive procedures requires for an INFORMED CONSENT .

SURGICAL CONSENT  OPERATIVE PERMIT / INFORMED CONSENT A document describing that the client has full knowledge of the instructions of the exact surgical procedure to be performed and has given permission to have the procedure performed on him  .

disfigurement.SURGICAL CONSENT  The SURGEON is the ultimate responsible for obtaining the surgical consent.  . disability and removal of body parts. alternatives. possible risks. The Surgeon must inform the patient of the benefits. complications.

without coercion The patient signing the consent must be MENTALLY COMPETENT and of LEGAL AGE (at least 18 years of age). the parent.VALID SURGICAL CONSENT  Consent should be FREELY GIVEN. legal guardian. spouse or relative next of kin will sign the consent  EMANCIPATED MINORS (minors who are married and self-sufficient) can sign their own consent  .  For minors or mentally incompetent patient.

VALID SURGICAL CONSENT  It must be witnessed by an authorized person – a nurse or another doctor  It is part of the nurse’s role as a witness and a client advocate to confirm that the client understands information given It must be obtained before the patient receives sedation It has been signed at least a day before the surgery   .

. permission via the telephone is acceptable.SURGICAL CONSENT  In an emergency. Have a second listener on phone when telephone permission being given.

SURGICAL CONSENT CONSENTS ARE NOT NEEDED for emergency care if all four of the following criteria are met:     There is an immediate threat to life Experts agree that it is an emergency Client is unable to consent A legally authorized person cannot be reached .

what is the best nursing action? . An emergency craniotomy is required. The name of the client is not known.Case Analysis A client is brought to the ER after being hit by a car. In regard to informed consent for the surgical procedure. The client has sustained a severe head injury and multiple fractures and is unconscious.

is brought to the ER with an apparent head injury after being involved in a serious motor vehicle accident. She is unconscious on arrival and exhibits signs of increasing ICP. He is accompanied by an adult friend and fiancé. What is the best nursing action on a legal stand point? .Case Analysis A client. 22 year old female.

PREOPERATIVE ASSESSMENT: NURSING HISTORY Allergies  Bleeding tendencies  Cortisone use  Diabetes Mellitus  Emboli  .

PREOPERATIVE ASSESSMENT         Nutritional and Fluid Status Dentition Drug or Alcohol Use Respiratory Status Cardiovascular Status Hepatic and Renal Function Endocrine Function Immune Function .

PREOPERATIVE ASSESSMENT: PREVIOUS MEDICATION USE Agents Effects of Interactions with Anesthesia / Surgery Corticosteroids Prednisone (Deltasone) Diuretics Hydrochlorothiazide (HydroDIURIL) Phenothiazines Chlorpromazine(Thorazin e) Tranquilizers Diazepam(Valium) Insulin Cardiovascular collapse may occur if discontinued suddenly Respiratory depression may occur with anesthesia use Increases hypotensive effects of anesthesia Anxiety. tension and seizures may occur when withdrawn suddenly Intravenous insulin may be needed to regulate blood glucose level during surgery .

PREOPERATIVE ASSESSMENT: PREVIOUS MEDICATION USE Agents Effects of Interactions with Anesthesia / Surgery Risk for respiratory paralysis when combined with muscle relaxant Increases the risk of bleeding during the intraoperative and postoperative period Intravenous administration is needed to prevent seizure during surgery Intravenous administration may be needed during the postoperative period to maintain thyroid levels Antibiotics Erythromycin(Ery-Tab) Anticoagulants Warfarin(Coumadin) Antiseizure agents Thyroid Hormone Levothyroxine sodium (Levothroid) Opioids Chronic use may alter response to analgesic agents .

PREOPERATIVE ASSESSMENT  All diagnostic examination should be completed before surgery which include:  Chest  ECG  Complete X-ray Blood Count (CBC)  Coagulation studies  Urinalysis .

PREOPERATIVE TEACHINGS  Assess the client’s level of understanding of surgical procedure and its implications Answer questions. clarify and reinforce explanations given by surgeon Explain routine pre and post procedures and any special equipment to be used   .

PREOPERATIVE TEACHINGS  Demonstrate exercises that prevents postoperative complications  Deep breathing / Diaphragmatic breathing  Coughing  Incentive Spirometry  Leg Exercises  Turning to Side .

PHYSICAL PREPARATION THE DAY BEFORE SURGERY Withholding food and fluid  Preparing the Bowel  Preparing the Skin  .

IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS      Hospital gown is worn that is left untied and open in the back Braid long hair and remove hair pins Provide oral care Inspect the mouth and remove dentures or plates Remove eyeglasses and prosthetic devices .

IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS       Remove make-up Remove all jewelry and body piercings Remove nail polish Obtain baseline vital signs Complete the Preoperative Checklist Administer Preop Medications as ordered .

Mandaluyong City PRE-OPERATIVE CHECKLIST Name of Patient _______________________________ Room No. ________________ Attending Physician _____________________________ SURGERY Contemplated ________________________ Anesthesiologist _______________________________ Date of Surgery _______________ Time ___________ Consent for Surgery Yes No Anesthesia Consent Yes To O. External Preparation ____________________________ (Specify Area) Enema Voided Foley Catheter Nasogastric Tube (NGT) IVF Line Removed: Dentures Nail Polish Wigs Lipstick Hairpins Jewelry Laboratory Results: CBC Stool Exam Blood Typing Request for Blood Urinalysis Reserved Prepared X-Ray Results History Physical Examination ECG X-Ray Plates Vital Signs Blood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________ Temperature ___________________________ Others: ______________________________________ ______________________________________ Pre-Operative Medication Drug Dosage Route Time ____________________________________________ ____________________________________________ ____________________________________________ Signature of Floor Nurse _________________________ Signature of OR Nurse __________________________ V-GWU-016-03 Vital Signs Blood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________ Temperature ___________________________ Others: ______________________________________ ______________________________________ Pre-Operative Medication Name Dosage Route Time ____________________________________________ ____________________________________________ ____________________________________________ Signature of Floor Nurse _________________________ Signature of OR Nurse __________________________ V-GWU-016-03 .R. External Preparation ____________________________ (Specify Area) Enema Voided Foley Catheter Nasogastric Tube (NGT) IVF Line Removed: Dentures Nail Polish Wigs Lipstick Hairpins Jewelry Laboratory Results: CBC Stool Exam Blood Typing Request for Blood Urinalysis Reserved Prepared X-Ray Results History Physical Examination ECG X-Ray Plates PRE-OPERATIVE CHECKLIST Name of Patient _______________________________ Room No. Mandaluyong City VRP MEDICAL CENTER 163 EDSA. ________________ Attending Physician _____________________________ SURGERY Contemplated ________________________ Anesthesiologist _______________________________ Date of Surgery_______________ Time ____________ Consent for Surgery Yes No Anesthesia Consent Yes To O.VRP MEDICAL CENTER 163 EDSA.R.

PREANESTHETIC MEDICATION  PREOP MEDICATION Usually given 30 to 45 minutes before the patient is transported to the OR or “On call to OR” Given in the holding area of the OR for ambulatory surgery   .

PURPOSES OF PREOP MEDICATIONS       To allay fear and anxiety To produce some amnesia To reduce reflex irritability To raise the pain threshold To lower the body metabolism To decrease respiratory and mouth secretions .

COMMON PREOP MEDICATIONS Sedative and Tranquilizers Narcotic Analgesics Anticholinergics Histamine-receptor antagonists Secobarbital Diazepam (Valium) Morphine Meperidine HCl (Demerol) Atropine sulfate Scopolamine Cimetidine (Tagamet) .

Nursing Responsibilities Before Administration of Preop Medication     Check for drug allergy Ensure the surgical consent has been signed Instruct the patient to void Obtain the baseline vital signs .

Nursing Responsibilities After Administration of Preop Medication   Instruct the patient to stay in bed Raise the side rails up to ensure safety .

SAFETY PROTOCOLS Joint Commission on Accreditation of Healthcare Organizations (JCAHO)   2003 Universal Protocol for Preventing Wrong Site. Wrong Procedure. Wrong Person Surgery 2009 National Patient Safety Goals .

Universal Protocol for Preventing Wrong Site. Wrong Person Surgery    Preoperative verification process Marking the operative site in an unambiguous manner “Time Out” . Wrong Procedure.

2009 National Patient Safety Goals        Improve the accuracy of patient identification Improve effectiveness of communication among caregivers Improve safety of using medications Reduce the risk of health care-associated infections Accurately and completely reconcile medications across continuum of care Reduce the risk of patient harm resulting from falls Reduce the risk of influenza and pneumococcal disease in institutionalized older adults .

2009 National Patient Safety Goals       Reduce the risk of surgical fires Implement applicable National Patient Safety Goals and associated requirements by components and practitioner sites Encourage patient’s active involvement in their own care as a patient safety strategy Prevent health care-associated pressure ulcers Identify safety risks inherent in the organization’s patient population Improve recognition and response to changes in a patient’s condition .

Patient Transport to the Operating Room    The patient is transferred to the holding area or presurgical suite in a bed or a stretcher about 30 to 60 minutes before the anesthetic is given The stretcher should be comfortable with a small pillow and sufficient blankets Ensure safety during transport .

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