PERIOPERATIVE NURSING

SURGERY Is the use of instruments during an operation to treat injuries, diseases, and deformities SURGICAL PROCEDURE SUFFIXES ectomy - Removal by cutting orrhaphy - Suture of or repair oscopy - Looking into ostomy - Formation of a permanent artificial opening otomy - Incision or cutting into plasty - Formation or repair ACCORDING TO URGENCY Emergent - Patient requires immediate attention; disorder may be life threatening; Urgent/ Imperative - Patient requires prompt attention; within 24 30/48 hours Required/ Planned - Patient needs to have surgery; plan within a few weeks or months Elective - Patient should have surgery; failure to have surgery not catastrophic; planned/scheduled with no time requirements Optional - Decision rests with patient; at the preference of patient ACCORDING TO PURPOSE Aesthetic - Requested by patient for improvement Diagnostic - To obtain tissue samples, make an incision, or use a scope to make a diagnosis Exploratory - Confirmation or measurement of extent of condition Preventive - Removal of tissue before it causes a problem Curative (Ablative) - Removal of diseased or abnormal tissue Reconstructive - Correction of defects of body parts Palliative - Alleviation of symptoms without curing disease ACCORDING TO EXTENT Major - Extensive surgery that involves serious risk and complications, as it involves major organ Minor - Involves minimal complications & blood loss PRINCIPLES OF SURGICAL ASEPSIS
   Moisture causes contamination Rationale: microorganisms travel more easily through moist environment Never assume that an object is sterile Rationale: packages that are torn, punctured, or moist are considered unsterile Always face the sterile field Rationale: objects that are out of the line of vision may be inadvertently contaminated Sterile articles may touch only sterile articles or surfaces if they are to maintain their sterility Rationale: anything considered unsterile may transfer microorganisms to the sterile object it touches Sterile equipment or areas must be kept above the waist and on top of the sterile field Prevent unnecessary traffic and air currents around the sterile area Open, unused sterile articles are no longer sterile after the procedure.

THE SURGICAL TEAM

    CIRCULATING NURSE SCRUB ROLE/NURSE SURGEON ANESTHESIOLOGIST AND ANESTHETIST

PREOPERATIVE PHASE  the client is a admitted in the surgical unit, to the time he/she is prepared physically, psychosocially, spiritually, and legally for the surgical procedure, until he is transported into the operating room.  On the day of surgery, patient teaching is reviewed, the patients identity and surgical site are verified, informed consent is confirmed, and an IV infusion is started Requisites for Validity of Informed Consent written permission is best and is legally acceptable signature is obtained with the clients complete understanding of what is to occur adults sign their own operative permit obtained before sedation secured without pressure or duress a witness is desirable nurse physicians or authorized persons in an emergency, permission via telephone or telefax is acceptable for minor (below 18), unconscious, psychologically incapacitated, permission is required from responsible family member (parent/legal guardian) Informed Consent Should Contain the Following: explanation of procedure and its risks description of benefits and its alternatives an offer to answer questions about procedure instructions that the patient may withdraw consent a statement informing the patient if the protocol differs from customary procedure Teaching Preoperative Exercises Deep breathing exercises Incentive spirometry Coughing exercises Turning exercises Preparing the Person Before Surgery Preparing the skin Have full bath to reduce microorganisms in the skin Preparing the GI tract NPO; cleansing enema as required Preparing for anesthesia Avoid alcohol and cigarette smoking for at least 24 hours before surgery Promoting rest and sleep Administer sedatives as ordered Early morning care Awaken one hour before preoperative medications Morning bath, mouth wash Provide clean gown Remove hairpins, braid long hairs, cover hair with cap Remove dentures, foreign materials (chewing gum), colored nail polish, hearing aid, contact lens Take baseline vital signs before preoperative medication Check ID band and skin preparation Check for special orders enema, GI tube insertion, IV line Check NPO Have client void before preoperative medication Continue to support emotionally Accomplish preoperative care checklist

 

FOUR MAJOR TYPES OF PATHOLOGIC PROCESSES REQUIRING SURGICAL INTERVENTION (POET)

Perforation - rupture of an organ Obstruction impairment to the flow of vital fluids Erosion - wearing off of a surface or membrane Tumors - abnormal new growths
Irish C. Moro a

Intraoperative Phase Begins when the client is transferred onto the OR table and ends with admission to the PACU Nursing activities include: providing safety, maintaining an aseptic environment, ensure proper functioning of equipment, providing the surgeon with specific instruments and supplies for the surgical field, and proper documentation Positions During Surgery Dorsal Recumbent hernia repair, mastectomy, bowel resection Trendelenburg lower abdomen, pelvic surgeries Lithotomy vaginal repairs, D and C, rectal surgery Prone spinal surgeries, laminectomy Lateral kidney, chest, hip surgeries Postoperative Phase Begins when the client is admitted to the PACU or a nursing unit and ends with the clients postoperative evaluation in the physicians office Extends from the time the client is admitted to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow-up care Admission to PACU Goal is to promote safe recovery from anesthesia Administer oxygen by nasal cannula or mask as ordered Continuous monitoring is done for ECG, pulse oximetry, and BP measurements Assess surgical site and dressing Check for patency of catheter, drains and tubes Measure body temperature Provide warming blanket Control shivering by administering Meperidine (Demerol) when anesthesia is the cause Provide supplemental oxygen during shivering Perform hand washing between clients VS taking every 5 to 15 minutes Transfer from recovery room to surgical unit Parameters for Discharge from Recovery Room Activity: able to obey commands Respiration: easy, noiseless breathing Circulation: BP is within +/-20 mmHg of the preop level Consciousness: responsive Color: pinkish skin and mucus membrane Nursing Care of client during the extended postoperative period: 2-3 days after surgery (discharge planning/teaching) Self-care activities Activity limitation Diet and medications Complications Referrals, follow-up check up

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Irish C. Moro a