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REY VINCENT H. LABADAN, RN

EARL KRISTOFFER L. PIRANTE, RN
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Patient
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 h
a. Obstruction or blockage (Impairment to the flow of vital
fluids)
b. Perforation or rupture of an organ
c. Erosion or wearing away of the surface of a tissue
d. Tumors or abnormal growth

  !c h

|



 
a. Diagnostich to verify suspected diagnosis, e.g. biopsy
b. Exploratoryh to estimate the extent of the disease, e.g.
exploratory laparotomy
c. Curativeh to remove or repair damaged or diseased organs or
tissues
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"

 

  

 
 
i. Ablativeh removal of diseased organs. (-ectomy) e.g.
appendectomy, hysterectomy
ii. Reconstructiveh partial or complete restoration of a
damaged organ, e.g. plastic surgery after burns
iii. Constructiveh repair of a congenitally defective organ,
(-plasty, -orrhaphy, -pexy) e.g. cheiloplasty, orchidopexy

d. Palliativeh to relieve pain, relieve distressing S/Sx

|

  

 

a. Major surgery
b. Minor surgery
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Criteriah
a. Major surgeryh   

‰ Prolonged intraoperative period
‰ Large amount of blood loss
‰ Extensive, vital organs may be handled or removed
‰ Great risk of complications, e. g. liver biopsy

b. Minor surgeryh     

  

‰ Generally not prolonged; described as ͞one-day
surgery͟ or outpatient surgery
‰ Leads to few serious complications
‰ Involves less risk, e.g. cyst removal
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a. Emergencyh must be performed immediately without delay,
e.g. gunshot wound, severe bleeding,
b. Imperative or Urgenth must be performed as soon as possible
within ü
 
, e.g. appendectomy
c. Requiredh necessary for the well-being of the patient, usually
within



, e. g. cholecystectomy, cataract

extraction, thyriodectomy
d. Electiveh should be performed for the patient͛s well being but
which is not absolutely necessary, e.g. simple hernia, vaginal
repair, repair of scar
e. Optionalh surgery that a patient requests, e.g. rhinoplasty,
liposuction, mammoplasty
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‰ Ageh premature babies and elderly persons are at risk
‰ Nutritional statush malnourished and obese are at risk
‰ State of fluid and electrolytes balanceh dehydration and
hypovolemia predispose a person to complications
‰ General healthh infectious process increase operative risk
‰ Mental health
‰ Economic and occupational status
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i. Steroidsh may improve the body͛s ability to response to
the stress of anesthesia and surgery
ii. Anticoagulants and salicylatesh may increase bleeding
during surgery
iii. Antibioticsh maybe incompatible with or potentiate
anesthetic agents
iv. Tranquilizersh potentiate the effect of narcotics and can
cause hypotension
v. Antihypertensivesh may predispose to shock by the
combined effect of blood pressure reduction and
anesthetic vasodilation
vi. Diureticsh may increase potassium loss
vii. Alcoholh will place the surgical patient at risk when used
chronically
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-ostomy (make artificial opening) Colostomy

-otomy (cut into or incision) Phlebotomy
-plasty (plastic repair) Rinoplasty
-orrhaphy (suturing; repair) Herniorrhaphy
-oscopy (visual examination) Endoscopy
-ectomy (excision; removal) Cholecystectomy
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M Because patients experience varying degrees of anxiety and

deficient knowledge related to surgery, careful planning by the
nurse can help ensure a positive outcome.

M Encompasses a patient͛s total surgical experience, including

preoperative, intra-operative, and postoperative phases

M Refers to activities performed by the professional nurse during

these phases.
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a. Pre-Operative Phaseh begins with the decision to perform

surgery and ends with the patient͛s transfer to the operating
room table

b. Intra-Operative Phaseh begins with the patient is received in the

OR and ends with his admission to the PARR or PACU

c. Post-Operative Phaseh begins with the patient is admitted to

PARR or PACU and extends through follow-up home or clinic
evaluation
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Makes the preoperative assessment to plan for the type of
anesthesia to be administered and to evaluate the patient͛s status

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Makes preoperative assessment and documents the perioperative
patient care plan (Scrub, Circulating, PACU Nurse)
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a. The Circulating Nurse
Manages the OR and protects the safety and health needs of the
patient by monitoring the activities of the members of the
surgical team and monitoring the conditions in the OR

b. The Scrub Nurse

Responsible for scrubbing for surgery, including setting up sterile
tables and equipment and assisting the surgeon and surgical
technicians during the surgical procedure

c. The PACU Nurse

Responsible for caring for the patient until the patient has
recovered from the effects of anesthesia, is oriented, has stable
vital signs, and shows no evidence of hemorrhage
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a. Keep sterile supplies dry and unopened
b. Check package sterilization expiration date to verify sterility
c. Maintain general cleanliness in surgical suite
d. Maintain surgical asepsish activities designed to keep sites
free from the presence of microorganisms throughout the
procedure

c!"
a. Personnel with signs of illness should not report to work
b. Surgical scrub, a specific hand washing technique used by
operating room personnel designed to reduce
microorganisms in the hands and arms, is done for the length
of time designed by hospital policy
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i. A sensor-controlled or knee- or foot-operated faucet allows the
water to be turned on and off without the use of the hands
ii. Remove all rings and watches
iii. Use liquid soaps to prevent the spread of organisms
iv. Keep the finger nails short and well-trimmed
v. Clean fingernails with a nail stick under running water
vi. Hold the hands higher than the elbows throughout the hand
washing procedure so that run-off goes to the elbows
vii. Allows the cleanest part of the arms to be the hands
viii. A scrub brush facilitates the removal of microorganisms
ix. Clean all areas of skin on the hands and arms in sequence starting
at the hands and ending at the elbows
x. After rinsing, dry the hands with paper towels, drying first one
arm from the hand to the elbow, then using a second towel to dry
the second hand
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a. Create a sterile field using sterile drapes
b. Use the sterile field to place sterile supplies where they will
be available during the procedure
c. Drape equipment prior to use
d. Keep drapes dry and out of contact with nonsterile objects
e. Utilize sterile technique while adding or removing supplies
from sterile fields

! **! !"

a. Check expiration dates for sterility
b. Don͛t use solutions that were opened prior to current use
c. ͞Lip͟ the solution after initial use by pouring a small amount
of liquid out of the bottle into a waste container to cleanse
the bottle lip
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w. OR personnel must practice strict Standard Precautions (i.e.,
blood and body substance isolation)
2. All items used in the sterile field must be sterile
3. Sterile objects become unsterile when touched by unsterile
objects
4. Sterile items that are out of vision sterile or below the waist level
of the nurse are considered unsterile
5. Sterile objects can become unsterile by prolonged exposure to
air-born organism
6. The skin can not be sterilized and is unsterile
‰ All personnel must perform a surgical scrub
c
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. All OR personnel are required to wear specific, clean attire, with
the goal of ͞shedding͟ the outside environment.
‰ Specific clothing requirements are prescribed and
standardized for all ORsh
a. OR personnel must wear a sterile gown, gloves, and
specific shoe covers
b. Hair must be completely cover
c. Masks must be worn at all times in the OR for the
purpose of minimizing air-borne contamination and
must be changed between operations or more often,
if necessary
8. Any personnel who harbors pathogenic organisms must report
themselves unable to be in the OR to protect the patient from
outside pathogens
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›. Scrubbed personnel wearing sterile attire should touch only
sterile items
w . Sterile gowns and sterile drapes have defined borders for
sterility.
‰ Sterile surfaces or articles may touch other sterile surfaces or
articles and remain sterile.
‰ Contact with unsterile objects at any point renders a sterile
area contaminated.
ww. The circulator and unsterile personnel must stay at the periphery
of the of the sterile operating area to keep the sterile area free
from contamination
w2. Sterile supplies are unwrapped and delivered by the circulator
following specific standard protocol so as not to cause
contamination
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w3. The utmost caution and vigilance must be used when handling
sterile fluids to prevent splashing or spillage
w4. Anything that is used for one patient must be discarded or, in
some cases, resterilized
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M Begins at the time of decision for surgery and ends when the
patient is transferred to the OR

M This period is used to physically and psychologically prepare the

patient for surgery

M The nurse plays a major role in patient teaching and in relieving

the patient͛s and the family͛s anxieties
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a. Assessing and correcting physiologic and psychologic
problems that might increase surgical risk

b. Giving the person and significant others complete learning/

teaching guidelines regarding surgery

c. Instructing and demonstrating exercises that will benefits the

person during post-op period

d. Planning for discharge and any projected changes in lifestyle

due to surgery
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M Preparation for hospital admissionh includes explanation of the

procedure to be done, probable outcome, expected duration of
hospitalization, cost, length of absence from work, and residual
effects


 
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‰ Fear of the unknown
‰ Fear of anesthesia, vulnerability while unconscious
‰ Fear of pain
‰ Fear of death
‰ Fear of disturbance of body image
‰ Worriesh loss of finances, employment, social and family
roles
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Manifestations of Fearsh
‰ Anxiousness
‰ Confusion
‰ Anger
‰ Tendency to exaggerate
‰ Sad, evasive, tearful, clinging
‰ Inability to concentrate
‰ Short attention span
‰ Failure to carry out simple directions
‰ Dazed
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Nursing Interventions to Minimize Anxietyh

‰ Assess patient͛s fears, anxieties, support systems, and

patterns of coping

‰ Establish trusting relationship with patient and significant

others

‰ Explain routine procedures, encourage verbalization of

fears, and allow patient to ask questions

‰ Demonstrate confidence in surgeon and staff

‰ Provide for spiritual care if appropriate

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!* "+$,-*.*$- !


M This is to protect the surgeon and the hospital against claims that
unauthorized surgery has been performed and that the patient
was unaware of the potential risks of complications involved

M Protects the patient from undergoing unauthorized surgery

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a. The Surgeon obtains operative permit or informed consenth
‰ Surgical procedure, alternatives, possible complications,
disfigurements, or removal of body parts are explained
#
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b. Informed consent is necessary for each operation performed,

however minor
‰ It is also necessary for major diagnostic procedures
where major body cavity is entered, e.g. thoracentesis

c. Adult patient (over w8 years of age) signs own permit unless

unconscious or mentally incompetent
‰ If unable to sign, relative, (spouse or next of kin) or
guardian will sign
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‰ In an emergency, permission via the telephone is
acceptable; have a second listener on phone when
telephone permission being given


  
  
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(   ' 
i. There is an immediate threat to life
ii. Experts agree that it is an emergency
iii. patient is unable to consent
iv. A legally authorized person cannot be reached
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d. Minors (under w8) must have consent signed by an adult (i.e.
parent or legal guardian). An '  '
 may sign own
consenth
i. Married,
ii. College student living away from home,
iii. In military service,
iv. Any pregnant female or anybody who has given birth

e. Witness to informed consent may be nurse, other physician,

clerk, or authorized person

f. If nurse witnesses informed consent, specify whether witnessing

explanation of surgery or just signature of patient
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a. Respiratory preparationh chest x-ray
b. Cardiovascular preparationh ECG, CBC, blood typing, cross-
matching, PT/PTT (prothrombin time, partial thromboplastin
time), serum electrolytes
c. Renal preparationh urinalysis

!Ä

'  

"  " 

  
"'  

 * Allergy to medications, chemicals, and other environmental
products such as latex
‰ All allergies are reported anesthesia and surgical
personnel before the beginning of surgery
‰ %  " Ä'
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u * Bleeding tendencies or the use of medications that deter
clotting, such as aspirin, heparin, and warfarin sodium.
‰ Herbal medications may also increase bleeding time or
mask potential blood-related problems

* Cortisone and steroid use

* Diabetes mellitus, a condition that not only requires strict

control of blood glucose levels but also known to delay
wound healing

* Emboli; previous embolic events ( such as lower leg blood

clots) may recur because of prolonged immobility
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‰ Frequently done on an out-patient basis

‰ Assess the patient͛s 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

‰ Deep breathing exercisesh use of diaphragmatic and

abdominal breathing
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‰ Coughing exerciseh deep breath, exhale through the mouth,
and then follow with a short breath while coughing; splint
thoracic and abdominal incision to minimize pain

‰ Turning exerciseh every w-2 hours post-operative

‰ Extremity exerciseh prevents circulatory problems and post

operative gas pains or flatus

‰ Assure that pain medications will be available post-op

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a. Preparing the patient͛s skinh shave against the grain of the hair
shaft to ensure clean and close shave

b. Preparing the GITh

‰ NPO after midnight
‰ Administration of enema may be necessary
‰ Insertion of gastric or intestinal tubes
 
|  
‰ Promoting rest and sleeph use of drugs
ь Barbituratesh Secobarbital Na, Pentobarbital Na
ь Non barbituratesh chloral hydrate, Flurazepam
#
  given after all pre-op treatments have been
completed.
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a. Early morning careh about w hour before the pre-operative
medication schedule
‰ Vital signs taken and recorded promptly
‰ Patient changes into hospital gown that is left untied and
open at the back
‰ Braid long hair and remove hair pin
‰ Provide oral hygiene
‰ Prosthetic devices, eyeglasses, dentures removed
‰ Remove jewelries
‰ Remove nail polish
‰ Patient should void immediately before going to the OR
‰ Make sure that the patient has not taken food for the
last w hours by asking the patient
‰ Urinary catheterization may be performed in the OR
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b. Pre-Operative Medicationsh
Generally administered 6 -› min before induction of anesthesia


 
i. To allay anxietyh the primary reason for pre-operative
medications
ii. To decrease the flow of pharyngeal secretions
iii. To reduce the amount of anesthesia to be given
iv. To create amnesia for the events that precedes surgery

 
  )!    


w. Sedativeh
‰ Given to decrease patient͛s anxiety to lower BP and
PR
‰ Reduce the amount of general anesthesiah an
overdose can result to respiratory depression
ь e.g. Phenobarbital
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2. Tranquilizerh
‰ Lowers the patient͛s anxiety level
ь e.g. Thorazine w2.5 - 25 mg IM w-2 hours prior to
surgery

3. Narcotic analgesiah
‰ Given to reduce patients to reduce anxiety and to
reduce the amount of narcotics given during surgery
ь e.g. Morphine sulfate 8-w5 mg SC w hour prior to
preoperative; *Can cause vomiting, respiratory
depression and postural hypotension
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4. Vagolytic or drying agentsh
‰ To reduce the amount of tracheobronchial secretions
which can clog the pulmonary tree and result in
atelectasis and pneumonia
ь e.g. Atropine sulfate .3- .6 mg IM 45 min before
surgery; * An overdose can result to severe
tachycardia

c. Recordingh all final preparation and emotional response before

surgery should be noted down

d. Transportation to the OR, *Woolen or synthetic blankets must

never be sent to the OR because they are source of static
electricity
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M Anxiety related to lack of knowledge about preoperative

routines, physical preparation for surgery, post operative care
and potential body image change
c
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M Begins the moment the patient is anesthetized and ends when

the last stitch or dressing is in place

M Anesthesia * A state or narcosis, analgesia, relaxation and reflex

loss (severe central nervous system [CNS] depression produced
by pharmacologic agent)
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a. Stage Ih Onset [Beginning of Anesthesia]
‰ Patient breath in the anesthetic mixture
‰ Warmth, dizziness, & feeling of detachment may be
experienced
‰ Ringing, roaring, or buzzing in the ears
‰ Inability to move extremities
‰ Surrounding noise is exaggerated
‰ Still conscious

b. Stage IIh Excitement

‰ Struggling, shouting, singing, laughing or crying may be
experienced
‰ Pupils dilate but PERRLA, rapid PR, irregular RR
‰ Patient restrain might be necessary
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c. Stage IIIh Surgical Anesthesia
‰ Continued administration of anesthetic agent
‰ RR, PR normal, skin pink and flushed
‰ Patient is unconscious

d. Stage IVh Danger Stage [Medullary Depression]

‰ Reached when to much anesthesia has been administered
‰ Respiration shallow, pulse weak, pupils dilate
‰ Cyanosis develops, without prompt intervention death may
ensue
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  .
 Ë Anesthetic Ë Loss of Ë patient maybe drowsy, Ë Close operating room doors, keep
Ë administration consciousness or dizzy room quiet
Ë Possible auditory and Ë Stand by to assist the patient
visual hallucinations

& $ Ë Loss of Ë Loss of eyelid Ë Increase in autonomic Ë Remain quietly at patient͛s side
Ë consciousness reflexes activity Ë Assist anesthetist, as needed
Ë Irregular breathing
Ë patient may struggle
 ! Ë Loss of eyelid Ë Loss of most Ë patient is unconscious Ë Begin preparation (if indicated) only
# Ë reflexes reflexes Ë Muscles are relaxed when anesthesia indicates stage III
Ë Depression of vital Ë No blink or gag reflexes has been reached and patient is
functions breathing well, with stable vital signs

 Ë Functions Ë Respiratory and Ë patient is not breathing Ë If arrest occurs, respond immediately
(#) excessively circulatory failure Ë A heartbeat may or may to assist in establishing airway,
Ë depressed not be present provide cardiac arrest tray, drugs
syringes, long needles
Ë Assist surgeon with closed or open
cardiac massage
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a. General Anesthesiah a state of analgesia, amnesia, and
unconsciousness characterized by the loss of reflexes and muscle
tone
i. Inhalation Anesthesia
| h prevention of pain and anxiety
 h circulatory and respiratory depression
* Highly inflammable and explosive
 
 
‰ Do not wear slips, nylons, wool, or any material which can set-off
sparks
‰ No smoking w2 hours after the operation
‰ Do not wear shoes that are not conductive
‰ Do not rise bed materials that are not conductive, e.g. volatile
liquidh halothane, ether; gas anesthetich e.g. nitrous oxide,
cyclopropane
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ii. Intravenous Anesthesiah usually employed as an
induction prior to administration of the more potent
inhalation anesthetic agents. Used commonly in minor
procedure
| 
‰ Rapid pleasant induction
‰ Absence of explosive hazards
‰ Low incidence of nausea and vomiting
 
‰ Laryngeal spasm and bronchospasm
‰ Hypotension
‰ Respiratory arrest, e.g. Thiopental Na (Pentothal
Na), Ketamine ( Ketalar), Fentanyl ( Innovar)
c
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b. Regional Anesthesiah it is the injection or application of a local
anesthetic agent to produce a loss of painful sensation in only
one region of the body and does not result to unconsciousness

i. Topical anesthesiah e.g. lidocaine

ii. Infiltration anesthesia

‰ Nerve block
‰ Epidural block
‰ Caudal block
‰ Pudendal block

iii. Spinal anesthesia, e.g. Saddle block for vaginal delivery

iv. Local anesthesia, e.g. Procaine, Lidocaine (Xylocaine)

c
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c. Specialized Methods of Producing Anesthesiah

i. Muscle relaxantsh it is a neuromuscular blocking agent

used to provide muscle relaxation
‰   for endotracheal intubation, e.g.
Pancuronium bromide (Pavulon), Curarine
chloride (Curare)

ii. Hypothermiah it refers to the deliberate reduction of the

patient͛s body temperature between 28°-3 ° C
‰   Heart surgery, Brain surgery, Surgery on
large vessels supplying major organs
c
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‰ Ice water immersion
‰ Ice bags
‰ Cooling blanket

' 

‰ Cardiac arrest
‰ Respiratory depression
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 !  


‰ Supineh hernia repair, explore lap, cholecystectomy,
mastectomy
‰ Proneh spine surgery, rectal surgery
‰ Trendelenburg
‰ Reverse Trendelenburg
‰ Lithotomy position
‰ Lateral positionh kidney and chest surgery
‰ Othersh for thyroidectomy- head hyperextended
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h
‰ Position the patient to side lying or semi-prone position to
prevent aspiration

‰ Oropharyngeal or nasopharyngeal airwayh

* Is left in place following administration of general
anesthetic until pharyngeal reflexes have returned
ËIt is only removed as soon as the patient begins to awaken
and has regained the cough and swallowing reflexes

‰ All patients should received O2 at least until they are

conscious and are able to take deep breaths on command
c
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‰ Shivering of the patient must be avoided to prevent an
increase in O2, and should be administered until shivering
has ceased

 




‰ 

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' 
h
i. Hypotension

 
ь Jarring the patient during transport while
moving patient from the OR to his bed
ь Reaction to drug and anesthesia
ь Loss of blood and other body fluids
ь Cardiac arrhythmias and cardiac failure
ь Inadequate ventilation
ь Pain
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ii. Cardiac arrhythmias

  Hypoxemia, Hypercapnea
%  
O2 therapy, Drug administrationh
Lidocaine, Procainamide

 




 

 
‰ 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
‰ Post-operative dose usually reduced to half the dose the
patient will be taking after fully recovered from anesthesia
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a. Activity * able to move four extremities voluntarily on
command
b. Respiration * able to breath effortlessly and deeply, and
cough freely
c. Circulation * BP is (+ 2
) or (- 2
) of pre-anesthetic level
d. Consciousness * fully awake, oriented to time, place and
person
e. Color * pink (lips), for blacksh tongue
c
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Muscle activity ‰ Ability to move all extremities 2

‰ Ability to move 2 extremities w
‰ Unable to control any extremity
Respiration ‰ Ability to breath deeply and cough 2
‰ Limited respiratory effort (dyspnea) w
‰ No spontaneous effort
Circulation ‰ BP +/- 2
of pre-anesthetic level 2
‰ BP +/- 2
-4
of pre-anesthetic level w
‰ BP +/- 5
pre-anesthetic level
Consciousness ‰ Fully awake 2
Level ‰ Arousable on calling w
‰ Not responding
O2 Saturation ‰ Unable to maintain O2 sat >›2
on room air 2
‰ Needs O2 inhalation to maintain O2 sat >›
w
‰ O2 sat <›
even with O2 supplement
!c
Required for discharge from PACUh -8
c
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M Begins when the patient returns from the recovery room or

surgical suite to the nursing unit and ends when the patient is
discharged

M It is directed toward prevention of complication and post-

operative discomfort

)!  
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 h atelectasis and pneumonia
‰ Suspected when ever there is a sudden rise of temperature
24-48 hours after surgery
‰ Collapse of the alveoli is highly susceptible to infectionh
pneumonia
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‰ Occurs usually in high abdominal surgery when prolonged
inhalation anesthesia has been necessary and vomiting has
occurred during the operation or while the patient is
recovered from anesthesia

NURSING MANAGEMENTh
i. Measures to prevent pooling of secretionsh
‰ Frequent changing of position
‰ High fowler͛s position
‰ Moving out of bed

ii. Measures to liquefy and remove secretionsh

‰ Increase oral fluid intake
‰ Breathing moist air
c
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‰ Deep breathing followed by coughing
‰ Administer analgesics before coughing is attempted after
thoracic and abdominal surgery
‰ Splint operative area with draw sheet or towel to
promote comfort while coughing

iii. Other measures to increase pulmonary ventilation

‰ Blow bottle exercise
‰ Rebreathing tubesh increase CO2 stimulates the
respiratory center to increase the depth of breathing thus
increasing the amount of inspired air
‰ IPPBh intermittent positive pressure breathing apparatus
c
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 h venous stasis
‰ Causes of venous stasis
о Muscular inactivity
о Respiratory and circulatory depression
о Increased pressure on blood vessels due to tight dressing
о Intestinal distention
о Prolonged maintenance of sitting


Ä
 

 


Ë Obesity
Ë CV disease
Ë Debility
Ë Malnutrition
Ë Old age
c
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' 

‰ Phlebothrombosis
‰ Thrombophlebitis

NURSING MANAGEMENTh
‰ Limbs must never be massaged for a post-op patient
‰ If possible, patient should lie on his abdomen for 3
min several time a day to prevent pooling of blood in
the pelvic cavity
‰ Do not allow the patient to stand unless pulse has
returned close to baseline to prevent orthostatic
hypotension
‰ Wear elastic bandages or stockings when in bed and
when walking for the first time.
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‰ Blood loss
‰ Increased insensible fluid loss through the skin;
о After surgery through vomiting, from copious
wound drainage, and from the tube drainage as in
NGT
‰ Since surgery is a stressor, there is an increased
production of ADH for the first w2-24 hours following
surgery resulting to fluid retention by the kidney
о The potential for over hydration therefore exists
since fluids being given IV may exceed fluid
output by the kidney
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‰ Particularly Na and K imbalance as a result of blood
loss
‰ Stress of surgery increases adrenal hormonal activity
resulting to increased aldosterone and
glucocorticoids, resulting in sodium reabsorption by
the kidney
‰ And as Na is reabsorbed, K coming from tissue
breakdown is excreted
| 
h IV of D5W alternate with D5NSS or half
strength NSS to prevent Na excess
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c! !h Cessation of peristalsis due to excessive
handling of GI organs
NURSING MANAGEMENTh
NPO until peristalsis has returned as evidenced by
auscultation of bowel sounds or by passing out of flatus

$h usually the effect of certain anesthetics on the

stomach, or eating food or drinking water before peristalsis
returns. Psychologic factors also contribute to vomiting
NURSING MANAGEMENTh
‰ Position the patient on the side to prevent aspiration
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‰ When vomiting has subsided, give ice chips, sips of ginger
ale or hot tea, or eating small frequent amounts of dry
foods thus relieving nausea
‰ Administer anti-emetic drugs as orderedh
Trimethobenzamide Hcl (Tigan); Prochiorperasine
dimaleate (Compazine)

2$!h results from the accumulation of non-

absorbable gas in the intestine

 
‰ Reaction to the handling of the bowel during surgery
‰ Swallowing of air during recovery from anesthesia
‰ Passage of gases from the blood stream to the atonic
portion of the bowel
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*h results from contraction of the unaffected portion
of the bowel in order to move accumulated gas in the
intestinal tract
Managementh
‰ Aspiration of fluid or gash with the insertion of an NGT
‰ Ambulationh stimulates the return of peristalsis and the
expulsion of flatus
‰ Enema
о Rectal tube insertionh inserted just passed the anal
sphincter and removal after approximately 2
minutes
о Adulth 2-4 inches, childrenh w-3 inches
о Prolonged stimulation of the anal sphincter
may cause loss of neuromuscular response,
and pressure necrosis of the mucous surface
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*h due to decreased food intake and inactivity
‰ Regular bowel movement will return 3-4 days after
surgery when resumption of regular diet and adequate
fluid intake and ambulation

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‰
 h usually after 6-8 hours
о First voiding may not be more than 2 ml, and total
out put may not be more than w5 ml
о Due to the loss of fluids during surgery, perspiration,
hyperventilation, vomiting, and increased secretion of
ADH
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Complicationh urinary retention
Causesh
‰ Prolonged recumbent position
‰ Nervous tension
‰ Effect of anesthetics interfering with bladder
sensation and the ability to void
‰ Use of narcotics that reduce the sensation of
bladder distention
‰ Pain at the surgical site and on movement

‰   

Managementh
о Instruct the patient to empty the bladder completely
during voiding
о Catheterize if needed, done by sterile technique
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( 
i. Post-operative pain
‰ Narcotics can be given every 3-4 hours during the first 48
hours post-operatively for severe pain without danger of
addiction

ii. Singultus
‰ Brought about by the distention of the stomach,
irritation of the diaphragm, peritonitis and uremia
causing a reflex or stimulation of the phrenic nerve
Managementh
о Paper bag blowing; CO2 inhalationh 5
CO2 and ›5

O2 x 5 minutes every hour
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‰ Sutures are usually removed about 5th-th day post-op with
the exception of wire retention sutures placed deep in the
muscles and removed w4-2w days after surgery

3 '$#$#4

‰ Most likely to occur within the first 48 hours post-op or as
late as 6th-th post-op day

 
‰  '
 



 
 

mechanical dislodging of a blood clot or caused by
the reestablished blood flow through the vessel
‰  '
   (Sloughing off of blood
clot or of a tissue
‰ Infection
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‰ Bright red blood
‰ Decreased BP
‰ Increased PR and RR
‰ Restlessness
‰ Pallor
‰ Weakness
‰ Cold, moist skin

3  

‰ 
 streptococcus and staphylococcus
‰ | ' 3-6 days after surgery, low grade fever, and
the wound becomes painful and swollen. There maybe
purulent drainage on the dressing
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(


or wound disruptionh Refers to a partial-to-
complete separation of the wound edges
"
h Refers to protrusion of the abdominal viscera
through the incision and onto the abdominal wall
| ' 
‰ Complain of a ͞giving͟ sensation in the incision
‰ Sudden, profuse leakage of fluid from the incision
‰ The dressing is saturated with clear, pink drainage
 ' 
‰ Position the patient to low Fowler͛s position
‰ Instruct the patient not to cough, sneeze, eat or drink,
and remain quiet until the surgeon arrives
‰ Protruding viscera should be covered warm, sterile,
saline dressing
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M Early discharge, which has become common, typically

increases patient teaching needs

M Be sure to provide information about wound care, activity

restrictions, dietary management, medication
administration, symptoms to report, and follow-up care

M A patient recovering from same-day surgery in an outpatient

surgical unit must be in stable condition before discharge

M This patient must not drive home, make sure a responsible

adult takes the patient home
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M Textbook of Medical Surgical Nursing th Edition by Joyce Black

M Brunner and Suddarth͛s Textbook of Medical Surgical Nursing wwth

Edition by Suzanne Smeltzer

M Berry & Kohn͛s Operating Room Technique w th edition by Nancymarie

Philips

M The Lippincott Manual of Nursing Practice th Edition by Sandra

Nettina

M Mastering Medical-Surgical Nursing 2nd edition by Josie Udan

M NCLEX-RN Review Materials

# !$5
!$5
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