Peri-Operative Nursing

Presented by: Alrene D. Balce, RM, RN  Cherry May B. Olesco, RN

testicl es

Peri - Operative Nursing
It is used to describe the nursing care provided in the total surgical experience of a patient. The provision of nursing care by an RN preoperatively, intraoperatively, and postoperatively to a patient undergoing an operative or invasive procedure

Areas in Which Perioperative Nursing Is Practiced
Hospital operating rooms Interventional radiology suites Cardiac catheterization labs Endoscopy suites Ambulatory surgery centers Trauma centers Pediatric specialty

Conditions Requiring Surgery

or bleb

Perforation

-

rupture of an organ, artery blockage

Obstruction Erosion

surface of a tissue

-

wearing away of a

Tumor

-

abnormal growth

DEGREE OF üU RGENCY .Categories of SURGERY According to : URPOSE üP üR ISK . DEGREE OF .

According to : P URPOSE Diagnosti To verify a suspected diagnosis Ex. Nephrectomy . biopsy c Palliativ Relieves or reduces pain or symptoms e Ablative Removes a diseased body part Ex.

repair of a e congenitally defective Transplant Replaces. Heart transplant To estimate extent of a . Exploratory Laparotomy structures ex.According to : P URPOSE Constructiv Restores function or appearance. malfunctioning organ ex Cleft palate Explorato disease ry Ex.

According to : P URPOSE Curati To remove or repair damaged or diseased ve organs or tissues .

g. appendectomy partial or complete restoration of a damaged organ e. cheiloplasty . plastic surgery after burns repair of a congenitally defective organ e.g.Types of Curative Surgery: Ablative Reconstruct ive Constructiv e Palliative removal of diseased organs e. plastic surgery of a cleft to relieve pain palate. nephrectomy.g.

colectomy . DEGREE Major Involves high degree of risk Surger Complicated or prolonged y Large amount of blood   loss Extensive: Vital organs may be handled or removed Ex: liver biopsy.According to : OF  R ISK.

DEGREE Minor Involves low risk Produces few Surger complications y Generally not prolonged.According to : OF   R ISK.  described as “one-day surgery” or outpatient surgery Ex: cyst removal .

g.According to : DEGREE OF Emergenc y Imperati ve Planned Required   U RGENCY.g.e. must be performed immediately e. tonsillectomy  . gunshot wound must be performed as soon as possible within 24-48 hours  e.necessary for client well being . severe bleeding .g.

hernia repair the client. face lift should be performed for the client’s well being but which is not absolutely necessary necessary for the well-being of e.g.According to : DEGREE OF Optional Elective Required   U RGENCY. usually within weeks to months e.g. cholecystectomy     . g. surgery that a client requests e.

Other types of Surgery PROPHYLACTIC PREVENTATIVE INPATIENT SURGERY OUTPATIENT SURGERY Prevents a more serious condition from developing Client has been in the hospital prior to the decision to have a surgery Client enters the hospital to have surgery done .

1 . Physical and Mental Condition of the Clien t a)Age: premature babies and elderly   Factors that Affects Surgical Risk Estimation persons are at risk b)Nutritional status: malnourished and obese are at risk c)State of fluid and electrolytes balance: dehydration and hypovolemia predispose a person to complications d)General health: infectious process increase operative risk e)Mental health f Economic and occupational status ) 03/06/11  16 .

1 . Physical and Mental Condition of the Client g) Types of drugs taken regularly:  1). Steroids - may improve the body’s ability to response to the stress of anesthesia and surgery 2). Anticoagulants and salicylates - may increase bleeding during surgery 3). Antibiotics - maybe incompatible with or potentiate anesthetic agents


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Factors that Affects Surgical Risk Estimation

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1 . Physical and Mental Condition of the Client g) Types of drugs taken regularly:

Factors that Affects Surgical Risk Estimation
4). Tranquilizers - potentiate the effect of narcotics and can cause hypotension 5). Antihypertensives - may predispose to shock by the combined effect of blood pressure reduction and anesthetic vasodilation 6). Diuretics - may increase potassium loss 7). Alcohol - will place the surgical client at risk when used chronically
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1 8

Factors that Affects Surgical Risk Estimation

2 . The Extent of the Disease 3. The Magnitude of the Required Operation 4. Resources and Preparation of the Surgeon, Nurses, and the Hospital


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Phases of Peri - operative period

re Operative Operativ Nursing

Pre-Operative 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 03/06/11  22 .

Pre-Operative Phase  Goals: üAssessing and correcting physiologic and psychologic problems that might increase surgical risk üGiving the person and significant others complete learning/ teaching guidelines regarding surgery üInstructing and demonstrating exercises that will benefits the person during post-op period üPlanning for discharge and any projected changes in lifestyle due to surgery 03/06/11  23 .

) PSYCHOLOGIC PREPARATION FOR SURGERY 1.Pre-Operative Phase   A.Preparation for hospital admission includes: üExplanation of the procedure to be done üProbable outcome üExpected duration of hospitalization üCost üLength of absence from work üResidual effects 03/06/11 24 .

Nursing Diagnosis for Preoperative Client  üAnxiety related to lack of knowledge about preoperative routines. post operative care and potential body image change 03/06/11 25 . physical preparation for surgery.Pre-Operative Phase A.) PSYCHOLOGIC PREPARATION FOR SURGERY  2 .

) PSYCHOLOGIC PREPARATION FOR SURGERY  2 . Nursing Diagnosis for Preoperative Client  Causes of Fears: üFear of the unknown üFear of anesthesia. social and family roles 03/06/11 26 . employment.Pre-Operative Phase A. vulnerability while unconscious üFear of pain üFear of death üFear of disturbance of body image üWorries: loss of finances.

Nursing Diagnosis for Preoperative Client Manifestations of Fears : üAnxiousness and bewilderment üAnger üTendency to exaggerate üSad. clinging üInability to concentrate üShort attention span üFailure to carry out simple directions üDazed 03/06/11 27 . evasive.) PSYCHOLOGIC PREPARATION FOR SURGERY   2 .Pre-Operative Phase A. tearful.

and patterns of coping üEstablish trusting relationship with client and significant others 03/06/11 28 . support systems.Pre-Operative Phase A. Nursing Interventions to Minimize Anxiety  üAssess client’s fears.) PSYCHOLOGIC PREPARATION FOR SURGERY  3. anxieties.

Pre-Operative Phase A. Nursing Interventions to Minimize Anxiety  üExplain routine procedures. and allow client to ask questions üDemonstrate confidence in surgeon and staff üProvide for spiritual care if appropriate 00 /00 /00 00 . encourage verbalization of fears.) PSYCHOLOGIC PREPARATION FOR SURGERY  3.

OPERATIVE PERMIT .Pre-Operative Phase B .) LEGAL ASPECT : “ INFORMED CONSENT ”. SURGICAL CONSENT This is to protect the surgeon and the hospital against claims that unauthorized surgery has been performed and that the client was unaware of the potential risks of complications involved Protects the client from undergoing unauthorized surgery 03/06/11 30 .

SURGICAL CONSENT 1 . alternatives.) LEGAL ASPECT : “ INFORMED CONSENT ”.Pre-Operative Phase B .) The Surgeon obtains operative permit or informed consent üSurgical procedure. or removal of body parts are explained üIt is part of the nurse’s role as a client advocate to confirm that the client understands information given 03/06/11 31 . disfigurements. OPERATIVE PERMIT . possible complications.

) LEGAL ASPECT : “ INFORMED CONSENT ”. SURGICAL CONSENT 2 . they are allowed to sign the consent 03/06/11 32 . OPERATIVE PERMIT .) Minor Patients üIf the client is minor allow the parents or the nearest relative to sign the consent for the procedure üFor EMANCIPATED CLIENTS.Pre-Operative Phase B .

(spouse or next of kin) or guardian will sign üIn an emergency. OPERATIVE PERMIT .) Adult Patients ( over 18 y / o ) üSigns own permit unless unconscious or mentally incompetent üIf unable to sign.) LEGAL ASPECT : “ INFORMED CONSENT ”. permission via the telephone or telegram is acceptable: have a second listener on phone when telephone permission being given ü 03/06/11 33 . relative.Pre-Operative Phase B . SURGICAL CONSENT 3 .

Client is unable to consent 4. SURGICAL CONSENT Consents are not needed for emergency care if all four of the following criteria are met : 1. A legally authorized person cannot be reached 03/06/11 34 . There is an immediate threat to life 2. OPERATIVE PERMIT . Experts agree that it is an emergency 3.) LEGAL ASPECT : “ INFORMED CONSENT ”.Pre-Operative Phase B .

chest x-ray 3 ) Renal preparation : ü 03/06/11 35 . serum electrolytes .) PHYSIOLOGIC PREPARATION 1 ) Respiratory preparation : 2 ) Cardiovascular preparation : .ECG. CBC. PT/PTT (prothrombin time. partial thromboplastin time).Urinalysis .Pre-Operative Phase C . blood typing. crossmatching.

an allergy band must be placed in the client’s arm immediately 03/06/11 36 .) PHYSIOLOGIC PREPARATION 4 . and other environmental products such as latex üAll allergies are reported to anesthesia and surgical personnel before the beginning of surgery. chemicals.Pre-Operative Phase C . Past Medical History A- Allergy to medications. üIf allergy exist.

and warfarin sodium.Pre-Operative Phase C . heparin. üHerbal medications may also increase bleeding time or mask potential blood-related problems 03/06/11 37 .) PHYSIOLOGIC PREPARATION 4 . such as aspirin. Past Medical History B- Bleeding tendencies or the use of medications that deter clotting.

) PHYSIOLOGIC PREPARATION 4 . Past Medical History C- Cortisone and steroid use üThis predisposes client to infection 03/06/11 38 .Pre-Operative Phase C .

) PHYSIOLOGIC PREPARATION 4 . a condition that not only requires strict control of blood glucose levels but also known to delay wound healing 03/06/11 39 .Pre-Operative Phase C . Past Medical History D- Diabetes mellitus.

Past Medical History E- Emboli. previous embolic events ( such as lower leg blood clots) may recur because of prolonged immobility 03/06/11 40 .Pre-Operative Phase C .) PHYSIOLOGIC PREPARATION 4 .

) INSTRUCTIONAL AND PREVENTIVE ASPECTS üAssess the client’s level of understanding of surgical procedure and its implications üAnswer questions.Pre-Operative Phase D . clarify and reinforce explanations given by surgeon üExplain routine pre and post procedures and any special equipment to be used üDeep breathing exercises: use of diaphragmatic and abdominal 03/06/1 1 41 .

splint thoracic and abdominal incision to minimize pain üTurning exercise: every 1-2 hours post-operative üAssure that pain medications will be available post-op 03/06/11 42 .) INSTRUCTIONAL AND PREVENTIVE ASPECTS üCoughing exercise: deep breath.Pre-Operative Phase D . and then follow with a short breath while coughing. exhale through the mouth.

Pre-Operative Phase D .) INSTRUCTIONAL AND PREVENTIVE ASPECTS üExtremity exercise: prevents circulatory problems and post operative gas pains or flatus 03/06/11 43 .

Preparing the client’s skin: shave against the grain of the hair shaft to ensure clean and close shave 03/06/11 44 .) PHYSICAL PREPARATION On the night of the surgery 1.Pre-Operative Phase E .

Pre-Operative Phase E .) PHYSICAL PREPARATION On the night of the surgery 2. Preparing the GIT: -NPO after midnight -Note: the age of the client should be taken in to consideration -Infants and children has a higher metabolic rate than adult -This makes it essential for the child or infant to receive CHO regularly to prevent acidosis from occurring 03/06/11 45 .

Pre-Operative Phase E .) PHYSICAL PREPARATION On the night of the surgery 3. Administration of enema 4. Insertion of gastric or intestinal tubes 03/06/11 46 .

Flurazepam (Dalmane) -Note : given after all pre .op treatments have been completed .op47 03/06/11 . Pentobarbital Na (Nembutal) -Non barbiturates: chloral hydrate.Pre-Operative Phase E . Preparing for Anesthesia üPromoting rest and sleep : use of drugs -Barbiturates: Secobarbital Na (Seconal). it must be given at least 4 hours before the pre . -If a second barbiturate is needed .) PHYSICAL PREPARATION On the night of the surgery 5 .

Vital signs taken and recorded promptly 2.Make sure that the patient has not taken food for the last 10 hours by asking the client 03/06/11 48 .Pre-Operative Phase E .Remove jewelries and dentures 4.) PHYSICAL PREPARATION On the day of the surgery * Early morning care: about 1 hour before the pre-operative medication schedule 1.Provide oral hygiene 3.Remove nail polish 5.

Pre-Operative Phase E .) PHYSICAL PREPARATION On the day of the surgery PRE-OPERATIVE MEDICATIONS Generally administered 60-90 min before induction of anesthesia Purpose: üTo allay anxiety: the primary reason for pre-operative medications üTo decrease the flow of pharyngeal secretions üTo reduce the amount of anesthesia to be given üTo create amnesia for the events that 49 precedes surgery 03/06/11 .

) PHYSICAL PREPARATION On the day of the surgery PRE-OPERATIVE MEDICATIONS Types of Pre . Nembutal Na) 03/06/11 50 .Operative Medications : 1 ) Sedative : a)Given to decrease the client’s anxiety to lower BP and pulse b)Reduce the amount of general anesthesia: an overdose can result to respiratory depression Ex: Phenobarbital (Seconal Na.Pre-Operative Phase E .

) PHYSICAL PREPARATION On the day of the surgery PRE-OPERATIVE MEDICATIONS Types of Pre .5 .25 mg IM 1-2 hours prior to surgery 51 * Note: can cause a dangerous hypotension .lowers the client’s anxiety level (ataractic) .Operative Medications : 2 ) Tranquilizer . both during and 03/06/11 after surgery .25 mg IM 1-2 hours prior to Phenergan 12.5 .Pre-Operative Phase E .Ex: Thorazine surgery 12.

respiratory depression and postural hypotension 03/06/11 52 .) PHYSICAL PREPARATION On the day of the surgery PRE-OPERATIVE MEDICATIONS Types of Pre .Pre-Operative Phase E .Operative Medications : 3 ) Narcotic analgesia -given to reduce patients to reduce anxiety and to reduce the amount of narcotics given during surgery -Ex: Morphine sulfate 8-15 mg SC 1 hour prior to preoperative * Can cause vomiting .

3-0.Operative Medications : 4 ) Vagolytic or drying agents -to reduce the amount of tracheobronchial secretions which can clog the pulmonary tree and result in atelectasis and pneumonia -Ex: Atropine sulfate * An overdose can result to severe tachycardia 03/06/11 0.6 mg IM 45 min before surgery 53 .Pre-Operative Phase E .) PHYSICAL PREPARATION On the day of the surgery PRE-OPERATIVE MEDICATIONS Types of Pre .

Pre-Operative Phase Recording: all final preparation and emotional response before surgery should be noted down Transportation to the OR Woolen or synthetic blankets must never be sent to the OR because they are source of static electricity 03/06/11 54 .

Intra .Operative phase .

Begins when the client is transferred to the operating table and ends when the client is admitted to the post anesthesia unit .

Surgical Attire 0Gowns Gloves Masks Hair covering Protective eyewear  .

ROLES OF PERIOPERATIVE NURSES Scrub Nurse •Circulating Nurse •Registered Nurse First Assistant ( RNFA ) •Perioperative Educator •OR Manager / Director   .Intra Operative Nursing A .

ROLES OF PERIOPERATIVE NURSES üScrub Nurse   •Responsible for scrubbing for surgery. including setting up sterile tables and equipment and assisting the surgeon and surgical technicians during the surgical procedure •Gathering all equipment for the procedure .Intra Operative Nursing A .

Intra Operative Nursing A . ROLES OF PERIOPERATIVE NURSES üScrub Nurse   •Preparing all supplies and instruments using sterile technique •Maintaining sterility within the sterile field during surgery •Handling instruments and supplies during surgery .

and instruments on the sterile field and counts the same materials with the circulating nurse before and after the surgery •Cleaning up after the case . the scrub nurse maintains an accurate count of sponges. sharps.Intra Operative Nursing A . ROLES OF PERIOPERATIVE NURSES üScrub Nurse   •During the surgery.

Intra Operative Nursing A . safe environment •Helps all team members work together . ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   •Manages the individual operating room and care of the patient in the OR •Creates and maintains comfortable.

Intra Operative Nursing A . ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   •Works in the OR in the area outside the sterile field Ensuring all equipment is working properly Guaranteeing sterility of instruments and supplies .

ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   Assisting with positioning Performing with the surgical skin preparation .Intra Operative Nursing A .

ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   •Works in the OR in the area outside the sterile field Ensuring all equipment is working properly Guaranteeing sterility of instruments and supplies .Intra Operative Nursing A .

ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   Monitoring the room and team members for breaks in sterile technique Assisting anesthesia personnel with induction and physiologic monitoring • .Intra Operative Nursing A .

Intra Operative Nursing A . ROLES OF PERIOPERATIVE NURSES üCirculating Nurse   Handling specimens Documenting care provided .

ROLES OF PERIOPERATIVE NURSESFirst Assistant üRN •Directly assists surgeon •Controls patient ’ s bleeding •Provides wound exposure and suturing Using instruments to hold and cut   .Intra Operative Nursing A .

during .Intra Operative Nursing A . and after surgery . ROLES OF PERIOPERATIVE NURSES üRN First Assistant   Retracting and handling the tissue •Involved in care before .

ROLES OF PERIOPERATIVE NURSES üPerioperative Educator   Responsible in giving health teachings to the client who will undergo and already undergone surgical operation .Intra Operative Nursing A .

ROLES OF PERIOPERATIVE NURSES üOR Manager / Director   Makes preoperative assessment and documents the intra-operative client care plan .Intra Operative Nursing A .

Intra Operative Nursing   INTERVENTIONS : üDetermine the type of surgery and anesthesia used üPosition client appropriately for surgery üAssist the surgeon as circulating or scrub nurse üMaintain the sterility of the surgical field üMonitor for developing complications .

Intra Operative Nursing   B . SURGICAL SCRUB 1. A sensorcontrolled or knee.or footoperated faucet allows the water to be turned on and off without the use of the hands .

SURGICAL SCRUB 2) Remove all rings and watches 3) Use liquid soaps to prevent the spread of organisms .Intra Operative Nursing   B .

SURGICAL SCRUB 4) Hold the hands higher than the elbows throughout the handwashing procedure so that run-off goes to the elbows - Allows the cleanest part of the arms to be the hands .Intra Operative Nursing   B .

SURGICAL SCRUB 5) A scrub brush facilitates the removal of microorganisms .Clean all areas of skin on the hands and arms in sequence starting at the hands and ending at the elbows .Intra Operative Nursing   B .

Intra Operative Nursing   B . drying first one arm from the hand to the elbow. dry the hands with paper towels. SURGICAL SCRUB 6) After rinsing. then using a second towel to dry the second hand .

Intra Operative Nursing   B . dry the hands with paper towels. SURGICAL SCRUB 6) After rinsing. drying first one arm from the hand to the elbow. then using a second towel to dry the second hand .

.

Sterile Technique   The patient is the center of the sterile field. which includes the: -areas of the patient -the operating table -furniture covered with sterile drapes -the personnel .Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 1.

Intra Operative Nursing C . This adherence reflects one’s surgical conscience . PRINCIPLES OF STERILE TECHNIQUE 1. Sterile Technique   Strict adherence to sound principles of sterile technique and recommended practices is mandatory for the safety of the patient.

Application   Preparation for operation by sterilization of necessary materials and supplies Preparation of the operating team to handle sterile supplies and intimately contact wound .Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 2.

Application   Creation and maintenance of the sterile field. to prevent contamination of the surgical wound Maintenance of sterility and asepsis throughout the operative procedure . PRINCIPLES OF STERILE TECHNIQUE 2.Intra Operative Nursing C . including the preparation and draping of the patient.

Intra Operative Nursing C . Application   Terminal sterilization and disinfection at the conclusion of the operation . PRINCIPLES OF STERILE TECHNIQUE 2.

PRINCIPLES OF STERILE TECHNIQUE   1.Intra Operative Nursing C . -All supplies for the sterile team - members reach them by means of the circulating nurse. Persons who are sterile touch only sterile articles . Persons who are not sterile touch only unsterile articles . Sterile persons have scrubbed and are gowned and gloved . through the medium of sterile forceps or wrappers on sterile packages. Unsterile persons have not . .

. PRINCIPLES OF STERILE TECHNIQUE   2 . Only sterile items are used within the sterile field . . sponges. such as instruments.Some items such as linen. Others.Intra Operative Nursing C . or basins may be obtained from the stock supply of sterile packages. may be sterilized immediately preceding the operation and removed directly from the sterilizer to the sterile table.

sterilizing. and handling should provide such assurance. PRINCIPLES OF STERILE TECHNIQUE   2 . Only sterile items are used within the sterile field . Proper packaging. .Intra Operative Nursing C . Every person who dispenses a sterile article must be sure of its sterility and of its remaining sterile until used.

Only sterile items are used   within the sterile field . If uncertain about actual timing or operation of sterilizer : Items processed in a suspect load are .Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 2 . -If you are in doubt about the sterility of anything. consider it not sterile. If sterile package is found in the nonsterile workroom 2 . Known or potentially contaminated items must not be transferred to the sterile field. for example: 1 .

Known or potentially contaminated items must not be transferred to the sterile field.versa 4 . PRINCIPLES OF STERILE TECHNIQUE 2 . for example: 3 . -If you are in doubt about the sterility of anything. Only sterile items are used   within the sterile field .Intra Operative Nursing C . If sterile package falls to the floor . If unsterile person comes into close contact with a sterile table and vice . it must then be . consider it not sterile.

Intra Operative Nursing C . -If you are in doubt about the sterility of anything. Only sterile items are used   within the sterile field . consider it not sterile. If sterile table or unwrapped sterile items are not under constant observation . if a sterile table or sterile articles are . PRINCIPLES OF STERILE TECHNIQUE 2 . for example: 5. Known or potentially contaminated items must not be transferred to the sterile field.

Hands are kept away from the face . Hands are never folded under arms because of perspiration in the axillary region - .Intra Operative Nursing C . and the sleeves . PRINCIPLES OF STERILE TECHNIQUE 3 . Sterile persons keep hands in sight and at or above waist level . Elbows are kept close to sides . Gowns are considered sterile   only from the waist to shoulder level in front .

PRINCIPLES OF STERILE TECHNIQUE 3 . the area of the gown below waist must not brush against sterile tables or draped areas . Gowns are considered sterile   only from the waist to shoulder level in front .Intra Operative Nursing C . If sterile person must stand on a platform to reach the operative field . and the sleeves . .Changing table levels is avoided .

-Items dropped below waist level are considered unsterile and must be discarded .Intra Operative Nursing C . Example : when picking up a gown . it is discarded . and the sleeves . if the top of the gown drops below waist level . Gowns are considered sterile   only from the waist to shoulder level in front . PRINCIPLES OF STERILE TECHNIQUE 3 .

Tables at table level   -Only the top of a sterile draped table is considered sterile . Scrub nurse does not touch the part hanging below table level . PRINCIPLES OF STERILE TECHNIQUE are sterile only 4 . such as sutures are considered unsterile and are discarded .Intra Operative Nursing C . Edges and sides of drape extending below the table level are considered unsterile -Anything falling over or extending over table edge .

Tables are sterile only at table level   -In unfolding part that surface is up to table - sterile drape .Intra Operative Nursing C . the drops below table not brought back level . PRINCIPLES OF STERILE TECHNIQUE 4 .

PRINCIPLES OF STERILE TECHNIQUE 5 . . Persons who are sterile touch only sterile items or areas . Persons who are not sterile touch only unsterile items or areas   -Sterile team members maintain contact with sterile field by means of gowns and gloves .Intra Operative Nursing C .

Persons who are sterile touch only sterile items or areas . Persons who are not sterile touch only unsterile items or areas   circulating nurse -Nonsterile does not directly come into contact with the sterile field . PRINCIPLES OF STERILE TECHNIQUE 5 .Intra Operative Nursing C .

Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 5 . Persons who are not sterile touch only unsterile items or areas   for sterile team -Supplies members reach them by means of the circulating nurse who opens wrapper on sterile packages . Persons who are sterile touch only sterile items or areas .

Sterile persons avoid leaning over an unsterile nurse sets basin or The scrub area   glasses to edge of the circulating the edge of them be filled at the sterile table . Unsterile persons avoid reaching over a sterile field .Intra Operative Nursing C . The nurse stands near the table to fill . PRINCIPLES OF STERILE TECHNIQUE 6 .

Unsterile persons avoid reaching over a sterile field . Sterile persons avoid leaning over an unsterile area circulating nurse -The   stands at a distance from the sterile field to adjust the light over it . PRINCIPLES OF STERILE TECHNIQUE 6 .Intra Operative Nursing C .

Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 6 . Sterile persons avoid leaning over an unsterile area -The surgeon turns away from   the sterile field to have perspiration mopped from his brow . Unsterile persons avoid reaching over a sterile field .

PRINCIPLES OF STERILE TECHNIQUE 6 . Sterile persons avoid leaning over an unsterile area . Unsterile persons avoid reaching over a sterile field .The sterile nurse drapes a   nonsterile table toward self first to protect gown .Intra Operative Nursing C .

PRINCIPLES OF STERILE TECHNIQUE 6 . drapes a table away from her first . Unsterile persons avoid reaching over a sterile field .   using sterile forceps .Intra Operative Nursing C . Sterile persons avoid leaning over an unsterile area The circulating nurse .

Ex : the edges of wrappers on sterile packages . PRINCIPLES OF STERILE TECHNIQUE of anything that 7.Intra Operative Nursing C . Edges   encloses sterile contents are considered unsterile . caps on solution bottles and test tube covers Sterile persons lift contents from packages by reaching down and lifting them straight up . holding elbows high .

Edges   encloses sterile contents are considered unsterile . Ex : the edges of wrappers on sterile packages . Instrument trays should not touch the edge of the sterilizer outside the .Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE of anything that 7. caps on solution bottles and test tube covers .Steam reaches only the area within the gasket of a sterilizer.

The circulating nurse peels the cover of a solution bottle or test tube . PRINCIPLES OF STERILE TECHNIQUE of anything that 7. Ex : the edges of wrappers on sterile packages . Edges   encloses sterile contents are considered unsterile .Intra Operative Nursing C . caps on solution bottles and test tube covers . the edge of the cover never touches the lip .

caps on solution bottles and test tube covers instruments are . PRINCIPLES OF STERILE TECHNIQUE of anything that 7. the tray must not touch the edge of the sterilizer when lifting it out . Edges   encloses sterile contents are considered unsterile .If the boiled . Ex : the edges of wrappers on sterile packages .Intra Operative Nursing C .

PRINCIPLES OF STERILE TECHNIQUE field is created as 8 . ” . Sterile   close as possible to time of use “ Degree of contamination is proportionate to length of time sterile items are uncovered and exposed to the environment .Intra Operative Nursing C .

Sterile field is created as close as possible to time of use   -Sterile tables are set up just prior to the operation . PRINCIPLES OF STERILE TECHNIQUE 8 . Covering sterile tables for later use is not .Intra Operative Nursing C . -It is difficult to uncover a table of sterile contents without contamination .

someone must remain in the room . Sterile areas are continuously kept in view   persons face -Sterile sterile areas . or a sterile field is set up . PRINCIPLES OF STERILE TECHNIQUE 9. . sterile packs are -When opened in a room .Intra Operative Nursing C .

Intra Operative Nursing C . Sterile persons keep well within the sterile area   -Sterile persons stand back at a safe distance from the operating table when draping the patient . -Sterile persons pass each other back to back . PRINCIPLES OF STERILE TECHNIQUE 10 . .

PRINCIPLES OF STERILE TECHNIQUE 10 . Sterile persons keep well within the sterile area   -Sterile person turns back to nonsterile person or area when passing. -Sterile person asks nonsterile individual to step aside rather than risk contamination . -Sterile person faces sterile area to pass it.Intra Operative Nursing C .

Sterile persons keep well within the sterile area   -Sterile persons stay within and around a sterile field. PRINCIPLES OF STERILE TECHNIQUE 10 . -Movement within and around a sterile area is kept to a minimum to avoid contamination of sterile items or persons . They do not walk around or go outside the room.Intra Operative Nursing C .

Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 11 . -Sitting or leaning against a nonsterile surface is a break in technique. If the sterile team sits to operate. they do so without proximity to nonsterile . Sterile persons keep contact with sterile areas to a minimum   -Sterile persons do not lean on sterile tables and on the draped patient.

PRINCIPLES OF STERILE TECHNIQUE 12 .Intra Operative Nursing C . Unsterile persons avoid sterile areas . -Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it .   -Unsterile persons maintain at least one foot distance from any area of the sterile field .

  -Unsterile persons never walk between two sterile areas. Unsterile persons avoid sterile areas .Intra Operative Nursing C . eg. PRINCIPLES OF STERILE TECHNIQUE 12 . between sterile instrument tables. -Circulating nurse restricts to a minimum activity near sterile field .

between sterile instrument tables. eg. -Circulating nurse restricts to a minimum activity near . PRINCIPLES OF STERILE TECHNIQUE 13 . Destruction of the integrity of microbial barriers results in contamination   -Unsterile persons never walk between two sterile areas.Intra Operative Nursing C .

may transport bacteria to sterile area).Intra Operative Nursing C . PRINCIPLES OF STERILE TECHNIQUE 13 . To ensure sterility: integrity of microbial barriers results in contamination . puncture or strikethrough (soaking of moisture through unsterile layers to sterile layers or vice versa. Destruction of the   The integrity of a sterile package or sterile drape is destroyed by perforation.

PRINCIPLES OF STERILE TECHNIQUE 13 . Destruction of the   integrity of microbial barriers results in contamination -Sterile packages are laid on dry surfaces. -If sterile packages become damp or wet. it is re-sterilized or discarded.Intra Operative Nursing C . . A package is considered nonsterile if any of it comes in contact with moisture.

Intra Operative Nursing C . the wet area is covered with impervious sterile drape or towels . PRINCIPLES OF STERILE TECHNIQUE 13 . Destruction of the   integrity of microbial barriers results in contamination -Drapes are placed on a dry field solution soaks through -If sterile drape to nonsterile area.

Destruction of the   integrity of microbial barriers results in contamination -Packages wrapped in muslin or paper are permitted to cool after removal from the sterilizer to avoid steam condensation and resultant contamination -Sterile areas are stored in clean dry areas . PRINCIPLES OF STERILE TECHNIQUE 13 .Intra Operative Nursing C .

Destruction of the   -Sterile packages are handled with clean dry hands -Undue pressure on sterile pack is avoided to prevent forcing sterile air out and pulling unsterile air into the pack integrity of microbial barriers results in contamination . PRINCIPLES OF STERILE TECHNIQUE 13 .Intra Operative Nursing C .

Intra Operative Nursing C . It is generally agreed that : . Although all the microorganisms cannot be eliminated . PRINCIPLES OF STERILE TECHNIQUE 14 . Microorganisms must be kept   to an irreducible minimum Perfect asepsis in the operative field is the ideal . this does not obviate the necessity for sterile technique .

Intra Operative Nursing C . Skin cannot be sterilized .All possible means are used to prevent entrance of microorganisms into wound . PRINCIPLES OF STERILE TECHNIQUE 14 . Microorganisms must be kept   to an irreducible minimum a .Skin is a potential source of contamination in every operation. .

throat or anus . Various parts of the body .Intra Operative Nursing C . the number of microorganisms is great . PRINCIPLES OF STERILE TECHNIQUE 14 . Some areas cannot be scrubbed When the operative field includes the mouth . such as the GIT and the vagina . Microorganisms must be kept   to an irreducible minimum b . nose . usually are resistant to infection from .

Intra Operative Nursing C . Microorganisms must be kept   to an irreducible minimum c . Infected areas are grossly contaminated team . PRINCIPLES OF STERILE TECHNIQUE 14 .The spreading contamination avoids the .

Air is contaminated by dust and droplets . PRINCIPLES OF STERILE TECHNIQUE 14 .Intra Operative Nursing C . Microorganisms must be kept   to an irreducible minimum d . .

Intra Operative Nursing  D . Minimal sedation .drug induced state in which a patient can respond normally in verbal commands cognitive function and coordination may be impaired . ANESTHESIA  1 . Levels of Anesthesia ( Sedation ) a.

Moderate sedation level of . ANESTHESIA  1 .depressed consciousness that does not impair ability to maintain a patent airway sedate a patient . combined with analgesic .Midazolam/Diazepam . Levels of Anesthesia ( Sedation ) b.calm.Intra Operative Nursing  D .

( Deep Sedation - deep sedation is a drug induced state in which a patient cannot easily be aroused but can respond purposefully after repeated stimulation . Isoflurane ) . Levels of Anesthesia Sedation ) c.Intra Operative Nursing  D . ANESTHESIA  1 .Volatile anesthetic ( halothane .inhaled or intravenously . .

Stages of Anesthesia Start point Anestheti c administr ation End .point Physical Nursing reactions interventi Loss of Client Close on Consciousnes maybe operating s drowsy . Possible keep room auditory quiet and Stand by visual to assist hallucinat the client ion  Stage I. Onset . or room dizzy doors . ANESTHESIA 2 .Intra Operative Nursing  D .

Stages of Anesthesia Start point Loss of Nursing interventi Remain on quietly at client ’ s side Assist anesthetis t . as needed  Stage End Physical point reactions II . Loss of Increase Excitement consciousnes eyelid in s reflexe autonomic s activity Irregular breathing Client may struggle . ANESTHESIA 2 .Intra Operative Nursing  D .

Stages of Anesthesia Start . Surgical Loss of Loss of Client is eyelid most unconscio reflexes reflexes us anesthesia Depressio Muscles n of are vital relaxed functions No blink or gag reflexes . ANESTHESIA  2 . with stable vital Stage III .End point point Physical Nursing reaction intervention s Begin preparation ( if indicated ) only when anesthesia indicates stage III has been reached and client is breathing well .Intra Operative Nursing  D .

long needles Assist surgeon with closed or . Stages of Anesthesia Start point Functions excessive ly depressed Stage IV . not respond breathing immediately to A assist in heartbeat establishing may or may airway . drugs syringes . provide not be cardiac arrest present tray .point Physical Nursing reaction intervention s Respirator y and circulator y failure Client is If arrest occurs .Intra Operative Nursing  D . Danger ( death ) End . ANESTHESIA  2 .

Intra Operative Nursing  D . provide not be cardiac arrest present tray . long needles Assist surgeon with closed or .point Physical Nursing reaction intervention s Respirator y and circulator y failure Client is If arrest occurs . ANESTHESIA  2 . Danger ( death ) End . not respond breathing immediately to A assist in heartbeat establishing may or may airway . Stages of Anesthesia Start point Functions excessive ly depressed Stage IV . drugs syringes .

ANESTHESIA  3 .Intra Operative Nursing  D . and unconsciousness characterized by the loss of reflexes and muscle tone -Administered by using a combination of agents based on the client's need with consideration of the type of surgery to be performed . Types of Anesthesia a . amnesia . General Anesthesia -A state of analgesia .

ANESTHESIA  1 . Types of GA Administration .Intra Operative Nursing  D .

üUsed commonly in minor procedure üDental extraction üUnconsciousness generally occurs 30 seconds after administration üRapid and smooth transition from .G A : INTRAVENOUS ADMINISTRATION üUsually employed as an induction prior to administration of the more potent inhalation anesthetic agents .

G A : INTRAVENOUS ADMINISTRATION Advantage of IV Anesthesia : 1.Absence of explosive hazards 3.Low incidence of nausea and vomiting .Rapid pleasant induction 2.

Respiratory arrest Examples: Thiopental Na (Pentothal Na) Ketamine (Ketalar) Fentanyl (Innovar) .G A : INTRAVENOUS ADMINISTRATION Disadvantage of IV Anesthesia : 1. Hypotension 3. Laryngeal spasm and bronchospasm 2.

G A : INHALATION ADMINISTRATION üA mixture of volatile liquids or gas and O2 is used üUsually used to maintain the client in stage III anesthesia following induction ü üThe mixture is given through a mask or through an endotracheal tube which is inserted once the client is .

G A : INHALATION ADMINISTRATION Administration by a mask : üThe gases flow into the mask via a finely calibrated vaporizer that is controlled by a machine .

G A : INHALATION ADMINISTRATION Administration by ETT : üThe gases flow directly into the client’s tracheobronchial tree. resulting in a quick response .

G A : INHALATION ADMINISTRATION Advantage : üEase of administration and elimination through the respiratory system üRapid onset üPrevention of pain and anxiety .

G A : INHALATION ADMINISTRATION Disadvantage: ücirculatory and respiratory depression * Highly flammable and explosive .

Nitrous oxide ( Blue tank ) .Halothane .Isoflurane Commonly used Gas Anesthetic : .G A : INHALATION ADMINISTRATION Two commonly used Inhalation Anesthetics : .

including blurred or double vision shivering or trembling muscle pain dizziness .POST GA EFFECT Headache vision problems . lightheadedness . or faintness drowsiness mood or mental changes nausea or vomiting sore throat nightmares or unusual dreams .

ANESTHESIA  3 .Intra Operative Nursing  D . Regional Anesthesia üIt is the injection or application of a local anesthetic agent to produce a loss of painful sensation in only one region of the body üDoes not result to unconsciousness üBlocks the conduction of impulses in the nerve fibers . Types of Anesthesia b .

ANESTHESIA  Types of Regional Anesthesia .Intra Operative Nursing  D .

R A : SPINAL ADMINISTRATION üOften the anesthetic technique of choice of older adults üCan be used for almost any type of major procedure performed below the level of the diaphragm üCholecystec .

chest position üLevel of anesthesia : Intervertebral space between üL2 and L3 üL3 and L4 üAutonomic nerve fibers are affected first and also the last to recover .R A : SPINAL ADMINISTRATION üSpinal Anesthesia is achieved by injecting local anesthetics into the subarachnoid space üPosition of client : genu pectal or knee .

COMPLICATIONS OF SA : üHypotension üParalysis of vasomotor nerves . occurring shortly after induction of anesthesia üRapid IVF administration before the block üAdminister O2 by inhalation üTrendelenburg .

COMPLICATIONS OF SA : üNausea and vomiting -Occurs mainly from abdominal surgery because of traction placed on various structures within the abdomen or from hypotension -Drugs used : antiemetics .

COMPLICATIONS OF SA : üHeadache -Can be extremely painful and may last a week -CSF .8 hours postoperatively . which cushions the brain . is lost through dural hole -Leakage of fluid with loss of cushioning effect is increased by : Use of large spinal needle Poor hydration .Keep client flat 6 .

COMPLICATIONS OF SA : üRespiratory paralysis -Occurs when drug reaches upper thoracic or cervical spinal levels in large amounts or in heavy concentrations -Do artificial respiration .

existing diseases of the CNS Transient response to anesthetics .COMPLICATIONS OF SA : üNeurologic complications : -Paraplegia -Severe muscle weakness in legs -Postoperative paralysis may be due to : Unsterile needles . syringes and anesthetic agent Pre .

ADVANTAGES OF SA : üRelatively safe üExcellent lower .body muscle relaxant üAbsence of effect on consciousness üDoe not require empty stomach .

R A : EPIDURAL ADMINISTRATION vIntroduction of anesthetic agent into the epidural space vThe needle is carefully positioned in the epidural space without penetrating the dura and without entering the subarachnoid space .

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sacral .R A : EPIDURAL ADMINISTRATION vEpidural block produces a blockade of the autonomic nerves and can result to hypotension v vIf the level of block is too high and respiratory muscles are affected . or caudal interspace . respiratory depression or paralysis may occur v vThe epidural space is generally entered by a needle at a thoracic . lumbar .

R A : CAUDAL ADMINISTRATION vA variation of epidural anesthesia vProduced by injection of the local anesthetic into the caudal or sacral canal vThis method is commonly used with obstetric clients .

R A : TOPICAL ADMINISTRATION vApplication of the agent directly to the skin . or open surface to be desensitized vThe anesthetic may be a solution . an ointment . a gel . mucous membranes . or a powder . a cream .

and bronchoscopy v . rectum .R A : TOPICAL ADMINISTRATION vA short . and mouth vUsed in minor procedures : rectal examination with painful hemorrhoids .acting form of anesthesia can block peripheral nerve endings in the mucous membranes of the vagina . nasopharynx .

and urethra -Highly toxic agent .10 % cocaine -For topical used only primarily to anesthetize the eye and the mucous membrane of nose .R A : TOPICAL ADMINISTRATION vCommonly used topical anesthesia : §Solution of 4 . mouth .

R A : TOPICAL ADMINISTRATION Other topical anesthetic agents : -Tetracaine -Procaine -Mepivacaine -Lidocaine ( Xylocaine ) .

aspiration should be done to ensure that the needle is not in the blood vessel üInadvertent intravenous injection of the agent can result to cardiovascular collapse or convulsions .R A : LOCAL INFILTRATION ADMINISTRATION üInvolves the injection of an anesthetic agent into the skin and subcutaneous tissue of the area to be anesthesized üBlocks the peripheral nerves around the area of the incision üDuring administration of the agent .

The block forms a barrier between the incision and the nervous system A field block actually walls in the area around the incision and prevent transmission of sensory impulses to the brain from that area .R A : FIELD BLOCK ADMINISTRATION The area proximal to a planned incision can be injected and infiltrated with local anesthetic agents to produce field block .

R A : PERIPHERAL NERVE BLOCK ADMINISTRATION vAnesthetizes individual nerves or nerve plexuses Examples : -Digital nerve block : fingers -Brachial plexus nerve block : entire upper arm -Intercostal nerve block : chest or abdominal wall .

and Mepivacaine Epinephrine .containing agents are not used for surgery involving the extremities . . like below the wrist and ankle .R A : PERIPHERAL NERVE BLOCK ADMINISTRATION Injection of anesthetic agents along the nerve rather done into the nerve in an effort to decrease the risk of nerve damage Agents commonly used : lidocaine . bupivacaine .

cuff tourniquet applied to the anesthetized area prevents the lidocaine from circulating beyond the area undergoing the .R A : REGIONAL EXTREMITY BLOCK ADMINISTRATION ( BIER BLOCK) Regional anesthesia of a limb can be achieved with an agent when it is injected into a vein of the limb to be anesthetized A pneumatic dual .

R A : REGIONAL EXTREMITY BLOCK ADMINISTRATION ( BIER BLOCK) This type of anesthesia is used most commonly for procedures of the extremities that are of short duration Agent used : lidocaine .

POSITIONS FOR SURGERY .

Positions for Surgery Supine/ Dorsal – usual position for induction of general anesthesia and for entering the major body cavities Modified Trendelenburg – used for lower abdominal surgery and some lower extremity surgery Reverse Modified Trendelenburg – used for upper abdominal. lungs or hips Modified Fowler’s – sitting position. used mostly in neurosurgery Modified jacknife – for rectal surgery  . neck and face surgery Lithotomy – used in operation requiring perineal approach Prone – used in surgery on the posterior part of the body Lateral – used for operation on the kidneys.

Abdominal surgeries Bladder surgery Position Patient during Surgery Supine Slightly trendelenburg Perineal surgery Lithotomy Brain surgery Spinal cord surgeries Lumbar puncture Semi . flexed body .fowler ’ s Prone mostly Side lying .

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Paramedian Abdominal Surgical Incision Longitudinal Midline Right Subcostal ( Kochers ) vertical incision ( rarely used – intestinal problems)) ( middle laparotomy begins at the level of the xiphoid to the from epigastric area supra pubic region and extends laterally & ( for gastrectomy & obliquely below the intestinal resection ) . lower margin – biliary spleen and liver .

hysterectomy or CS inguinal herniorrhaphy .Abdominal Surgical Incision liver transplant Bilateral subcostal – Mc BurneyBenz or for appendectomy Mercedes Chevron incision Rocky Davis for appendectomy Pfannenstiel Inguinal pelvic procedures.

ABDOMINAL SURGERY        1 . Abdominal Laparotomy 2 . Herniorrhaphy 3 . Pancreaticoduodenectom y ( Whipple ’ s ) 5 .Different Surgeries According to Location   A . Cholecystectomy 4. Bariatric Surgery . Splenectomy 7 . Pancreatectomy 6 .

Breast Lifting  . Breast Repair .Different Surgeries According to Location   B . Breast Biopsy  3 . Breast Augmentation . Mastectomy  2 . Mammoplasty  4 . BREAST SURGERY 1 .

GENITOURINARY SURGERY    1 . Circumcision 2 . Nephrectomy 7 . Cystectomy 5 . Ureterolithotomy 8 .Different Surgeries According to Location      D . Transurethral Resection of the Prostate / Bladder ( TURP / TURB ) 6 . Pyelolithotomy . Vasectomy 3 . Orchiectomy 4 .

OK ARE YOU READY SIR FOR YOUR .

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Post-operative phase

Post - Operative Phase

Begins with the admission of the client to the PACU and ends when healing is complete

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PACU Nurse
 Responsible for caring for the client until the client :

- Has recovered from the effects of anesthesia
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- Is oriented - Has stable vital signs

POSTANESTHESIA CARE UNIT §Design §Equipment §Staffing § .

POSTANESTHESIA CARE UNIT   Design .Located near the operating rooms Proximity to radiographic.Open ward design Each patient space should be well lighted Multiple electrical outlets and at . and other intensive care facilities on the same floor . laboratory.

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Air warming device. .Temperature 6.Pulse oximetry (SpO2) 2.Electrocardiogram (ECG) 3.Automated noninvasive blood pressure (NIBP) monitors 4.POSTANESTHESIA CARE UNIT Equipment  1.Capnography 5.

POSTANESTHESIA CARE UNIT

Emergency Equipment

1.Oxygen cannulas 2.Masks 3.Oral and nasal airways 4.Laryngoscopes , ndotracheal tubes, laryngeal mask airways, and selfinflating bags for ventilation 5.Defibrillation device 6.Tracheostomy, chest tube, and vascular cutdown trays

POSTANESTHESIA CARE UNIT Respiratory therapy equipment

1.Continuous positive airway pressure (CPAP) 2.Ventilators 3.Bronchoscope

POSTANESTHESIA CARE UNIT

Staffing

- Nurses specifically trained in the care of patients emerging from anesthesia - PACU should be under the medical direction of an anesthesiologist - One nurse to one patient is often needed - A charge nurse should be

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access to drugs. and are hemodynamically stable     . or resuscitative equipment Patients should not leave the operating room unless they have a stable and patent airway .CARE OF THE PATIENT TRANSPORT FROM THE OPERATING ROOM  This period is usually complicated by the lack of adequate monitors. have adequate ventilation and oxygenation .

CARE OF THE PATIENT  TRANSPORT FROM THE OPERATING ROOM  All patients should be taken to the PACU on a bed or trolley that can be placed in either:  .

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Post-Operative Phase A) Post Anesthetic Care Nursing responsibilities:   1) Maintenance of Pulmonary Ventilation:  Position the client to side lying or semiprone position to prevent aspiration 03/06/11 206 .

Post-Operative Phase Oropharyngeal or nasopharyngeal airway:   Is left in place following administration of general anesthetic until pharyngeal reflexes have returned It is only removed as soon as the client begins to awaken and has regained the cough and swallowing reflexes 03/06/11   207 .

and should be administered until shivering has ceased  03/06/11 208 .Post-Operative Phase All clients should received O2 at least until they are conscious and are able to take deep breaths on command   Shivering of the client must be avoided to prevent an increase in O2.

Post-Operative Phase  2) Maintenance of Circulation:   Most common cardiovascular complications: a) Hypotension    Causes: Jarring the client during transport while moving client from the OR to his bed Reaction to drug and 03/06/11 209 .

C. Post-Operative Phase  Causes: vLoss of blood and other body fluids vCardiac arrhythmias and cardiac failure vInadequate ventilation vPain 03/06/11 210 .

Post-Operative Phase  b) Cardiac arrhythmias   Causes:  Hypoxemia  Hypercapnea Interventions:  O2 therapy  Drug administration:  Lidocaine  Procainamide (Pronestyl) 03/06/11 211 .

Post-Operative Phase 3) Protection from injury and promotion of comfort  § Provide side rails § Turning frequently and placed in good body alignment to prevent nerve damage from pressure § Administration of narcotic analgesics to relieve incisional pain 03/06/11 212 .

Post-Operative Phase  B) Dismissal of client from recovery room: Modified Aldrete Score for Anesthesia Recovery Criteria  The Five Physiological Parameters:     1. Activity 2. Respiration 3. Circulation 03/06/11 213 .

Post Anesthesia Care Unit MODIFIED ALDRETE SCORE  After Area of assessment Muscle activity: Moves spontaneously or on command Ability to move all extremities Ability to move 2 extremities Respiration: Unable to control any extremity Ability to breath deeply and cough Limited respiratory effort (dyspnea and splinting) No spontaneous effort  Point Score 1 hour 2 hours 3 hours 2 1 0 2 1 0 03/06/11 214 .

20% of pre-anesthetic level BP +/.P o st A n e sth e sia C a re U n it M O D IF IE D A L D R E T E S C O R E After Area of assessment Circulation: BP +/.50% pre-anesthetic level Consciousness Level: Fully awake Arousable on calling Not responding  Point Score 1 hour 2 1 0 2 1 0 2 hours 3 hours 03/06/11 215 .20%-40% of pre-anesthetic level BP +/.

P o st A n e sth e sia C a re U n it M O D IF IE D A L D R E T E S C O R E After Area of assessment O2 Saturation: Unable to maintain O2 sat >92% on room air Needs O2 inhalation to maintain O2 sat >90% O2 sat <90% even with O2 supplement Required for discharge from PACU: 78 Total Points  Point Score 1 hour 2 1 0 2 hours 3 hours 03/06/11 216 .

and oxygenation should be checked immediately on arrival b)Blood pressure. pulse rate. vital signs.CARE OF THE PATIENT ROUTINE RECOVERY a)Airway patency. and every 15 min thereafter c)Pulse oximetry should be monitored continuously d)Neuromuscular function should be assessed clinically  . and respiratory rate measurements are routinely made at least every 5 min for 15 min or until stable.

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Post - operative interventions

PAIN MANAGEMENT
Pain is usually greatest during the 12 - 36 hours after surgery Narcotic analgesics and NSAIDS may be prescribed together for the early period of surgery Provide back rub , massage , diversional activities , position changes

Post - operative interventions

POSITIONING
vClients who have spinal anesthesia is usually placed FLAT on bed for 8 - 12 hours vUnconscious client is placed side lying to drain secretions vOther positions are utilized BASED on the

Post - operative interventions Deep breathing and coughing exercises Q2 - 4 hours 0 to remove secretions

Post - operative interventions
§ Leg exercises

Q 2 hours 0 to promote circulation § Ambulation ASAP0 prevents respiratory , circulatory , urinary and gastrointest inal

Post . to remove respi secretions .operative interventions § Hydration after NPO to maintain fluid balance § Suction. either gastro or respiratory to relieve distention.

Liquid Diet VS Soft diet Clear liquid Coffee Tea Carbonated drink Bouillon Clear fruit juice Popsicle Gelatin Hard candy Full liquid Soft diet Clear liquid PLUS: All CL and FL Milk/Milk prod plus: Vegetable juices Meat Cream. butter Vegetables Yogurt Fruits Puddings Breads and Custard cereals Ice cream and Pureed foods sherbet .

wound drainage .

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Hemovac .

Jackson-Pratt .

Penrose drain .

T-tube .

Salem Sump tube .

Chest Physiotherapy Chest Physiotherapy  Chest physiotherapy is based on the fact that mucus can be knocked or shaken form the walls of the airways and helped to drain from the lungs. Percussion. Vibration.    The usual SEQUENCE is as followsPOSITIONING. and removal of secretions by SUCTIONING or Coughing followed lastly by oral hygiene .

C h e st P h y sio th e ra p y .

ü The incentive spirometer measures roughly the inspired volume and offers the “ incentive ” of measuring progress .Incentive Spirometry ü ü This operates on the principle that spontaneous sustained maximal inspiration is most beneficial to the lungs and has virtually no adverse effects .

Incentive Spirometry .

Post operative complications Atelectasis Collapsed Pneumonia Thrombophlebitis Assess breath alveoli due to sounds Repositioning secretions Deep breathing and coughing Inflammation Chest physio Inflammation Leg exercises of alveoli Suctioning swelling Monitor for of the veins Ambulation Elevated extremities  .

ATELECTASIS .

PNEUMONIA .

DEEP VENOUS THROMBOSIS *HOMAN’S SIGN .

EMBOLUS: MIGRATION OF A CLOT .

IVF   Encourage ambulation Provide privacy Pour warm water Catheterize  Notify physician Administer O2w   .Post-operative Complications Hypovolemic Loss of Shock circulatory fluid volume Urinary retention Pulmonary embolism Involuntary accumulation of urine Embolus blocking the lung blood flow Shock position Determine cause and prevent bleeding O2.

HYPOVOLEMIC SHOCK MODIFIED TRENDELENBURG .

Post-operative complications Constipation Infrequent passage of stool High fiber diet Increased fluid Ambulation   Paralytic ileus Absent bowel Encourage ambulation sound  NPO until peristalsis returns  Wound infection Occurs about 3 Daily wound dressing days after Antibiotics surgery Maintain drain    Maintain drain .

WOUND DISRUPTION .

Wound dehiscence Post .operative complications Separation of wound edges at the suture line Cover the wound with sterile normal saline dressing Place in lowFowler’s Notify MD   Wound evisceration Protrusion of the Cover the wound internal organs with saline pad Place in lowand tissues fowler’s through wound Notify MD   .

Wound DEHISCENCE .

Wound evisceration .

INCISIONAL HERNIA .

INCISIONAL HERNIA .

safety in ADL .Perioperative Care Discharge Plans •Patient/Family Education and Psychosocial Support is throughout.circulatory function. analgesic) –Adequate hydration and body temperature –Adequate renal function. –Return MD Visit –Dressing Care and Comfort –Optimum respiratory. diet. meds(antibiotics.

DISCHARGE INSTRUCTIONS •CARE OF THE INCISION •SIGNS OF COMPLICATIONS •DRUGS FOR PAIN MANAGEMENT •HOW TO SELF ADMINISTER PRESCRIBED MEDICATIONS •ACTIVITY LEVEL •AMOUNT OF WEIGHT THAT CAN BE LIFTED •DIET •RETURN FOR A MEDICAL APPOINTMENT .

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