The document discusses perioperative nursing, which involves 3 phases: preoperative, intraoperative, and postoperative care. It describes various types of surgeries based on factors like blood loss and urgency. The preoperative phase involves assessment, consent, and preparation of the patient. Preparation includes education, testing, restriction of food/fluids, and sometimes medications. The intraoperative phase focuses on the surgical procedure and roles of the surgical team.
3. PERIOPERATIVE NURSING Perioperative nursing It is divided into 3 Phases: 1. Preoperative – From the decision for surgical intervention to transfer to operating room
10. Optional Surgery – Surgery at the preference of the client. Surgery is not needed Ex. Cosmetic surgery ; liposuction
11. Elective Surgery – Surgery at the convenience of the patient as failure to have surgery is not life threatening Ex. Excision of superficial cyst.
12. Planned/ Required surgery- The time of the surgery is within a few weeks from time of decision to have surgery as surgery is important ex. Cataract extraction
13. Urgent/ Imperative surgery – Within 24-48 hours from the time of the decision to have surgery Ex. Cancer surgery
14. Emergency Surgery – Immediate surgery without delay to maintain life or organ, to remove damage, to stop bleeding Ex. Intestinal obstruction, gun shot wounds
17. Exploratory – To estimate the extent of the disease & confirm diagnosis Ex. Exploratory Laparotomy
18. Curative Surgery a. Ablative – Removal of diseased organ Ex. Hysterectomy b. Constructive – Repair of congenital defects Ex. Repair of Cleft palate
19. c. Reconstructive – Restoration of damaged organ Ex. Total joint replacement
20. Palliative – Relieves Symptom but does not cure the disease Ex. Rhizotomy for pain relief, Myringotomy
21. CLASSIFICATION of PHYSICAL STATUS: ASA I – Healthy person, with no systemic disease, undergoing elective surgery, Not very Young or very old
22. ASA II – Client w/ 1 system well controlled disease. Diseases does not affect daily activities. Those clients w/ mild obesity, alcoholism, and smokers
23. ASA III – Client w/ multiple system disease or well controlled major system diseases. The disease status limits daily Activities. However there is no immediate threat of death due to individual system disease.
24. ASA IV – Client w/ severe incapacitating disease. Typically the disease is poorly controlled, or end stage disease is present. Danger of death related to organ failure is present
25. ASA V - Client is very ill, in imminent danger of death. Operation is the last attempt in preserving life. The client is not expected to live the next 24 hours.
27. Past Medical Health History Previous Surgery & Experience with anesthesia = any untoward reaction to anesthesia e.g. malignant hyperthermia, intraoperative death in the family= INFORM physician.
28. Serious Illness or Trauma: ABCDE A – Allergy B- Bleeding C- Cortisone use D – Diabetes mellitus E – Emboli (thromoembolism)
29. Age Infant, Young children, & older Adults are at greater risk for surgery
32. Alcohol / Recreational Drug Use Alcohol has an unpredictable reaction with anesthetic agents; Smoking = reduce hemoglobin, Smokers are susceptible to clot formation & Nicotine is a vasoconstrictor
52. Cardiovascular assessment MI, angina pectoris for the last six months, may influence tissue perfusion or wound healing
53. Respiratory assessment – Chronic lung conditions ex. emphysema, asthma, bronchitis, increase the operative risk bec. These diseases impair gas exchange = DOB notify the physician.
54. Musculoskeletal assessment – History of fractures, joint injury, arthritis, may influence the positioning of the client during intraoperative phase, or it may cause additional postop pain
55. Skin integrity assessment- Document & report lesions, pressure ulcers, necrotic skin, skin turgor, erythema, cyanosis of the skin, note the size & location so as to compare post op if lesions are stable or worsening.
56. Renal assessment- Adequate renal function is necessary to eliminate protein wastes, to preserve fluid & electrolyte balance & to remove anesthetic agents from the system
57. Liver function assessment - Liver dse like cirrhosis inc. a client’s surgical risk bec a diseased liver cannot detoxify drugs & anesthetic agents, liver dse. May be manifested through albumin levels= low albumin levels predispose to fluid shifts (fluid imbalance)
58. Cognitive assessment- Uncontrolled epilepsy, severe parkinson’s disease, increase the surgical risk
59. other important neurologic assessment; severe head ache, frequent dizziness, light headdeness, ringing in the ears, unsteady gait, unequal pupils & history of seizures.
60. Hematologic function – Clients w/ blood coagulation disorders are at risk for hemorrhage Ex. History of hemophilia, sickle cell anemia. Manifestations of easy brusing and abnormal bleeding time
92. 4. PREOPERATIVE HEALTH TEACHINGS / INSTRUCTIONS The best time to instruct the client is relatively close to the time of the surgery
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102. b) Non – Barbiturates – chloral hydrate; flurazepam ( Dalmane)
103. The drugs are given after all pre-op treatments have been completed. If a second barbiturate is needed, it must be given at least 4 hours before pre-op medications is due.
111. a) Sedatives – given to decrease the patient’s anxiety to lower BP and pulse and to reduce the amount of General Anesthesia; an overdose of sedatives may lead to respiratory depression
113. b) Tranquilizer – lowers a patient’s anxiety Ex. Thorazine 12.5 – 25 mg IM 1-2 hours prior to surgery
114. Phenergan- 12.5 – 25 mg IM 1-2 hours before surgery Note* these tranquilizers may cause dangerous hypotension both during and after the surgery
115. Narcotic Analgesics – Given to reduce anxiety and to reduce the amount of narcotics given during surgery
116. Ex. Morphine sulfate – 8-15 mg SQ one hr pre-op this drug can cause vomiting, respiratory depression and postural hypotension
117. Vagolytic or drying agents – To reduce the amount of tracheobronchial secretions w/c may clog the pulmonary alveoli and may produce atelectasis (lung collapse)
118. Ex. Atropine sulfate 0.3-0.6 mg IM 45 minutes before surgery overdose can cause severe tachycardia
119. *** Important ! – Nursing intervention after giving pre-op meds immediately raise the side rails of the bed for patient’s safety
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121. Transportation to OR – Make sure that the name tag of the client is in place. While transferring the patient on the stretcher make sure that the side rails are up
122. Woolen or synthetic blankets must never be sent to OR bec. It causes static electricity and may cause combustion of O2 or Other gases in the OR
138. Supine / Dorsal recumbent – Lying on the back – used for hernia repair, bowel resection, eplore lap, mastectomy, cholecystectomy
139. Prone – for back, spine, rectal surgeries, laminectomy- Note** after surgery, the patient will be returned to the supine position. This should be done gradually bec. Sudden turning of the client may cause a rapid drop in BP
140. Trendelenberg – Head and body are flexed by , breaking(bending the head of the table downwards) – pelvic surgeries, lower abdomen.
142. Lithotomy position - Thighs and legs are flexed at right angles and then simultaneously placed in stirrups – vaginal repairs, D&C, rectal surgery,
143. Lateral – used in kidney and chest surgery, hip surgeries
144. Other positions - in Thyroidectomy the head is hyperextended, a small sand bag or pillow on the neck and shoulders to provide exposure of the thyroid gland
149. Stage I . Stage of Analgesia / induction phase
150. This stage extends from the beginning of Administration of an anesthetic to the beginning of the loss of consciousness . The sensation of pain is not lost.
155. Extends from the loss of consciousness to the loss of eyelid reflex. Any stimulation has the potential to cause the client to become difficult to control.
191. Is the removal of as many bacteria as possible from the hands and arms by mechanical washing and chemical disinfection before participating in an operation. Done prior to gowning and gloving.