surgical procedures that were once performed in an inpatient setting now take place in an Ambulatory or Outpatient setting.



60% of elective surgeries are now performed in an ambulatory or outpatient setting.


blogspot.nursinglectures.com PERIOPERATIVE PHASE  Pre-operative Phase – begins when decision to proceed with surgical intervention is made and ends with the transfer into the operating table  Intra-operative Phase – starts from the transfer of patient to the operating table and ends with the admission of the patient to the PACU (post-anesthesia care unit) Post-operative Phase – begins with admission to the PACU and ends with follow-up evaluation in the clinical setting or home  4 .

Mammoplasty or facelift  Palliative – Eg. Biopsy or explorative laparotomy  Curative – Eg.blogspot. Multiple Wound Repair  Reconstructive / Cosmetic – Eg. a PEG tube is inserted to compensate for dysphagia  5 .nursinglectures. To relieve pain. Excision of a tumor or inflamed appendix  Reparative – Eg.com SURGICAL CLASSIFICATIONS Diagnostic – Eg.

Consent must be signed before administration of ANY PSYCHOactive medications .  6 .nursinglectures.blogspot.com PREPARATION FOR SURGERY  Voluntary and written INFORMED consent from the patient is necessary before nonemergent surgery can be performed.

nursinglectures. Description of benefits & alternatives  An EMANCIPATED Minor may sign his consent form  7 . procedure. and comatose CANNOT give consent)  Informed Subject – should be in WRITING.com CRITERIA FOR VALID INFORMED CONSENT Voluntary Consent – given FREELY  Incompetent Patient – (those who are mentally ill.blogspot. Includes explanation of risks.

com CLASSIFICATION ACCDG.nursinglectures. TO URGENCY Brunner & Suddarth’s Textbook 8 .blogspot.

com NURSING ALERT!!! signed consent form is placed in a prominent place on the patient’s chart and accompanies the patient to the operating room. The 9 .nursinglectures.blogspot.

com PRE-OPERATIVE ASSESSMENT The overall goal in the pre-operative period is for the patient to have as many positive health factors as 10 .blogspot.nursinglectures.

com NUTRITIONAL & FLUID STATUS  obesity. 1999)  measurement of body mass index and  waist circumference (National Institutes of Health. 2000) 11 . undernutrition.blogspot.nursinglectures. metabolic abnormalities. deficiencies in specific nutrients. and special problems of the hospitalized patient (Quinn.  the effects of medications on nutrition.  malnutrition. weight loss.

nursinglectures.blogspot.com NUTRIENTS Protein  Calories  Water  Vitamin C  Thiamin. Niacin. Folic Acid. B12  Vitamin A  Vitamin K  Iron  Zinc  12 . Vit. Riboflavin.

nursinglectures.blogspot.com DRUG OR ALCOHOL ABUSE People who abuse drugs attempt to HIDE and DENY it  Acutely intoxicated persons are susceptible to injury  Alcohol withdrawal delirium (delirium tremens) may be anticipated up to 72 hours after alcohol withdrawal.  13 .

blogspot.nursinglectures.com RESPIRATORY STATUS Goal : Optimal Respiratory Function  Breathing Exercises   Use of Incentive Spirometry Surgery is USUALLY postponed if patient have a Respiratory INFECTION  SMOKING urged to STOP 2 Months before surgery (Counseling has a positive effect 24 hours before operation)  14 .

com EFFECTS OF SMOKING increased airway reactivity decreased mucociliary clearance.nursinglectures. physiologic changes in the cardiovascular and immune systems 15 .blogspot.

fluid. 16 .blogspot.nursinglectures.com CARDIOVASCULAR STATUS  GOAL : to ensure a well functioning cardiovascular system to meet the oxygen. and nutritional needs of the perioperative period.

17 . and toxins are adequately processed and removed from the body. anesthetic agents.blogspot.com HEPATIC AND RENAL FUNCTION GOAL :optimal function of the liver and urinary systems so that medications.nursinglectures. body wastes.

nursinglectures.com ENDOCRINE FUNCTION Hypoglycemia and Hyperglycemia  Acidosis  Glucosuria  GOAL : Maintain the blood glucose level at less than 200 mg/dl  Adrenal insufficiency – for those who have received corticosteroids  Thyrotoxicosis (hyperthyroid disorders)  Respiratory failure (hypothyroid disorders)  18 .blogspot.

com IMMUNE FUNCTION Existence of Allergies  Latex Allergy  Immunosuppression  The mildest symptoms or slightest temperature elevation must be investigated.blogspot.nursinglectures.  Great care is taken to ensure strict asepsis  19 .

John’s wort (Hypericum perforatum)  licorice (Glycyhiza glabra)  valerian (Valeriana officinalis)  20 .nursinglectures.blogspot. HPN meds.  ginkgo. ginseng  kava kava (Piper methysticum).  St.com PREVIOUS MEDICATION USE OTC Meds – Aspirin. Insulin  Herbal Meds –  echinacea.  ephedra.  garlic (Allium sativum).

com PSYCHOSOCIAL FACTORS Emotional Reaction  Psychological Distress  Anxiety – Anticipatory response  Different responses of persons to FEAR: 1. avoiding communication 3.blogspot.nursinglectures. Withdrawal. Some talk about it *** NURSE Must be an EMPHATETIC listener  21 . Repeatedly asking questions 2.

blogspot.com MEDS THAT MAY AFFECT SURGERY Corticosteroids – Prednisone(Deltasone)  Diuretics – Hydrochlorothiazide(HydroDIURIL)         PhenoThiazines – Chlorpromazine (Thorazine) Tranquilizers – Diazepam (Valium) Insulin Antibiotics – Erythromycin (Ery-tab) Anticoagulants – Warfarin (Coumadin) Antiseizure – Phenytoin (Dilantin) MAO Inhibitors – Phenelzine sulfate (Nardil) 22 .nursinglectures.

hearing and reduced tactile sensitivity  Arthritis – may affect mobility  Dental assessment – impt to Anesthesiologist  Ability to perspire – fragile skin (dry)  23 .blogspot.nursinglectures.com ELDERLY PATIENTS Less physiologic Reserve  Sensory limitations – vision.

 For Every 30 lbs excess weight.blogspot. thus increasing workload of the heart.nursinglectures. additional 25 miles of blood vessels needed.  24 .com OBESE PATIENTS Fatty Tissues – susceptible to infection  Technical & Mechanical Problems  Wound dehiscence(separation) and wound infections are more common.

blogspot. mobilizes secretions  Deep Breathing  Promote Mobility POST-OP  25 .nursinglectures.com PREOPERATIVE TEACHING IDEAL timing – Pre-admission visit not ON the DAY of SURGERY  GOAL – Promote OPTIMAL Lung Expansion after ANESTHESIA  USE of Incentive SPIROMETER  Splinting of Incision line if possible  GOAL – Coughing.

nursinglectures.blogspot.com DIAPHRAGMATIC BREATHING 26 .

nursinglectures.blogspot.com SPLINTING WHEN COUGHING 27 .

nursinglectures.com LEG EXERCISES 28 .blogspot.

nursinglectures.blogspot.com FOOT EXERCISES 29 .

blogspot.Controlled Epidural Analgesia (PCEA)  Oral Meds for Home Meds  Cognitive Coping Strategies – Imagery. Distraction.nursinglectures. Optimistic Self-recitation  30 .com PAIN MANAGEMENT Identification of ACUTE and CHRONIC Pain  PAIN Scale  Patient Controlled Analgesia (PCA)  Epidural Catheter (Bolus/Infusion)  P.

com PREOPERATIVE FASTING GUIDELINES Watch out! UNNECESSARY LONG FASTINGS  Warn Patients they might feel thirsty and teach strategies(as permitted):brushing teeth.blogspot. rinsing the mouth. and chewing gum  8 hours fasting after eating fatty foods  4 hours after ingesting milk products  2 hours for clear liquids in an elective procedure  31 .nursinglectures.

some allow ring to be taped in finger  All Patients should VOID immediately(except those with UROLOGIC D/O) to promote continence and make abdominal organs more accessible  32 .blogspot. Dentures removed  Jewelries not WORN. If patient refuse.nursinglectures.com PRE-OP NURSING INTERVENTIONS Gown left Untied.OPEN in the BACK  Mouth Inspected.

blogspot.nursinglectures.com PRE-OPERATIVE CHECKLIST 33 .

blogspot.com PRE-OP NURSING DIAGNOSES Anxiety related to the surgical experience (anesthesia. pain) and the outcome of surgery  Fear related to perceived threat of the surgical procedure and separation from support system  Knowledge deficit of preoperative procedures and protocols and postoperative expectations  34 .nursinglectures.

blogspot.During the preoperative assessment of a man scheduled for hand surgery in an ambulatory setting.nursinglectures.com CRITICAL THINKING EXERCISES 1. you think that the patient’s responses indicate that he does not understand the procedure and that he has not made plans for postoperative care. What further assessment and teaching is indicated? What nursing interventions are warranted? 35 .

com CRITICAL THINKING EXERCISES 2.A patient with a long history of the use of several herbal supplements is scheduled for major surgery. What effect would this information have on your preoperative care of this patient? 36 .blogspot.nursinglectures.

com CRITICAL THINKING EXERCISES 3. preoperative teaching. and preparation differ for these two patients? 37 .blogspot. Two patients are admitted to the same-day surgery unit for bilateral knee replacements. How would your assessments.nursinglectures. One patient is a 30-year-old who ambulates with crutches and the other is a 75-year-old who lives alone.

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