8Ch 42-Perioperative Nursing

Chapter 42
Care of the Surgical Patient

- Perioperative Nursing
- Influencing Factor - Psychosocial Needs - Socioeconomic & Cultural Needs - Medications - Education & Experiences
Copyright 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 1
Introduction to the Surgical Patient

Surgery

The branch of medicine concerned with diseases and trauma requiring operative procedures Gave physicians means to treat conditions that were difficult or impossible to manage only with meds Nurses in first OR cleaned rooms and equipment, performed technical tasks like obtaining supplies, accompanied patient to surgical ward to deliver nursing care Classified as elective, urgent, or emergency
Copyright 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2

Surgery
Elective
Not necessary to preserve life and performed when patient chooses
Urgent
Required to keep additional health problems from occurring
Emergency
Performed immediately to save the individuals life or preserve function of a body part
Slide 3

Surgery for various purposes
Diagnostic study, reconstructive, transplant, constructive Ablation

Amputation or excision of any part of body or removal of a growth or harmful substance
Palliative
Therapy designed to relieve or reduce intensity of uncomfortable symptoms without cure
Surgical Terminology
See table 42-2, pg 1264

Slide 4

Common Variations of Surgical Settings (Box 42-1)
Inpatient:
Patient hospitalized for surgery
One-day (same-day surgery):

Patient is admitted the day surgery is scheduled and dismissed the same day
Outpatient:
Patient, not hospitalized, who is being treated; individual is admitted either to a short-stay unit or directly to the surgical suit
Slide 5

Common Variations of Surgical Settings (Box 42-1)
Short-stay surgical center (surgicenter):

Independently owned agency; surgery performed when overnight hospitalization is not required Also called ambulatory surgical center or one-day surgery center
Short-stay unit:
Department or floor where a patients stay does not exceed 24 hours Sometimes referred to as outpatient
Slide 6

Classification of surgical procedures
Seriousness
Major

Extensive reconstruction of or alteration in body parts Poses great risks to well-being o Examples: Coronary artery bypass, gastric resection Minimal alteration in body parts Designed to correct deformities Involves minimal risks o Examples: Cataracts, tooth extraction
Minor

Slide 7

Urgency
Elective
Patients choice
Example: Plastic surgery, bunionectomy
Urgent
Necessary for patients health
Examples: Excision of tumor, gallstones, coronary artery bypass
Emergency
Must be done immediately to save life or preserve function
Example: Control of hemorrhage, perforated appendix, repair of traumatic amputation

Slide 8

Purpose
Diagnostic
Confirm diagnosis; removal of tissue for more testing
Example: Exploratory laparotomy, breast mass biopsy
Ablation
Excision or removal of diseased body part or removal of a growth or harmful substance
Examples: Amputation, cholecystectomy
Palliative
Relieves or reduces intensity of disease symptoms Will not produce cure
Example: Colostomy, debridement of necrotic tissue

Slide 9

Purpose (continued)
Reconstructive
Restores function or appearance to traumatized or malfunctioning tissue
Example: Internal fixation of fractures, scar revision
Transplant
Replaces malfunctioning organs or structures
Examples: Kidney, cornea, joints, heart
Constructive
Restores function lost or reduced as result of congenital anomalies
Example: Repair of cleft palate, closure of atrial-septal defect

Slide 10
Perioperative Nursing
Entire operative process which includes:

Preoperative Before surgery Intraoperative

During surgery
Postoperative
Following surgery
Concept of perioperative nursing:
Stresses importance of providing continuity of care for surgical patient using nursing process
Slide 11
Perioperative nurses assess:
Patients health status preoperatively Identify specific patient needs Teach and counsel Attend to patients needs in OR Follow patients recovery
Safe, consistent, and effective nursing interventions during each phase of surgery
Nurses major responsibility:
Slide 12
Influencing factors
Age
Young and older patients metabolic needs such as temperature changes, cardiovascular shifts, respiratory needs, and renal function, may not respond to physiological changes quickly To assist to return to maximal level of health, nursing assessments and appropriate interventions should be ongoing
Physical condition
Healthy patients have smoother and faster recovery Coexisting health problems are slower to recover Assess each system to identify actual and potential problems
Slide 13
ABCDE Mnemonic Device to Ascertain Serious
Illness or Trauma in the Preoperative Patient
A:
allergy to medications, chemicals, environmental products like latex All allergies are reported to anesthesia and surgical personnel before beginning of surgery If allergies exist, an allergy band must be place on arm
B:
Bleeding tendencies or use of medications that deter clotting like aspirin, heparin and warfarin sodium Herbal medications increase bleeding times or mask potential blood-related problems
Slide 14
ABCDE Mnemonic Device to Ascertain Serious
Illness or Trauma in the Preoperative Patient

C:
Cortisone or steroid use
D:
Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but is also known to delay wound healing
E:
Emboli; previous embolic events (like lower leg blood clots) may recur because of prolonged immobility
Suppressed immune system are higher risk for development of

postop infection and have a dininished capacity to fight infection
Influencing factors
Nutritional factors
Body uses carbohydrates, proteins, fats to supply energy-producing glucose to its cells Carbohydrates and fats are primary energy producers Protein is essential to build and repair body tissue Stressful condition
Body need for energy and repair increases
Patient who maintain a sound, nutritional diet recover more quickly
Slide 16
Influencing factors
Nutritional factors
Influenced by: ethnic, cultural, religious, socioeconomic background, history highlights food preferences and dislikes Surgery alters appetite and metabolic functions, therefore must watch-out for malnutrition
Slide 17
Psychosocial needs
Fear of loss of control (anesthesia) Fear of the unknown (outcome, lack of knowledge) Fear of anesthesia (waking up) Fear of pain or inadequate post-operative analgesia (pain control) Fear of death (surgery, anesthesia) Fear of separation (support group) Fear of disruption of life patterns (ADLs, work) Fear of change in body image and mutilation Fear of detection of cancer
Socioeconomic and cultural needs

Patients are from different social, economic, religious, ethnic, cultural origin Geographic location affect the way individual responds Different cultures react to preoperative experience in different ways
Nursing from multicultural perspective assists nurses to have a frame of reference in approaching patients with respect to individually tailor care that promotes recovery
Slide 19
Medications
Review current medication regimen Multiple medications predisposes patients to adverse drug reactions and interactions with other medications in perioperative setting Pharmacologic categories used in patients
Anesthesia agents, antimicrobials, anticoagulants, hemostatic agents, oxytocics, steroids, diagnostic imaging dyes, cns agents Large number of medications increases the chance of interactions
Slide 20
Medications contd
Ask about herbal remedies/medications

See table 42-3, pg 1262
Assess for allergies to drugs that may be given during any phase of surgical experience Enquire about nondrug allergies:
Food, chemical, pollen, antiseptics, latex rubber products
Flag the front of patients chart to alert all health care provides to allergy status of patient
Slide 21
Education and experience
Tailor information to a patients educational level permits fear to be replace with accurate knowledge Encourage patient to repeat or summarize what has been presented Preoperative anxiety level influence
Amount of anesthesia required Amount of postoperative pain medication needed Speed of recovery from surgery
Slide 22
Education and experience contd
Unhurried and understanding nurse who listens to
patient, family, significant others invites confidence and helps to promote reduction of anxiety levels In addition to nursing and medical personnel, support can be provided to patients and their families by ministerial staff, social workers, patient advocates during this stressful time Figure: often, knowledge deficits occur when the patient is undergoing her first surgical experience
Slide 23
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8Ch 42-Perioperative Nursing

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Chapter 42

Care of the Surgical Patient

Introduction to the Surgical Patient

Introduction to the Surgical Patient

Introduction to the Surgical Patient

Diagnostic study, reconstructive, transplant, constructive Ablation

See table 42-2, pg 1264

Introduction to the Surgical Patient

One-day (same-day surgery):

Introduction to the Surgical Patient

Short-stay surgical center (surgicenter):

Introduction to the Surgical Patient

Introduction to the Surgical Patient

Example: Plastic surgery, bunionectomy

Examples: Excision of tumor, gallstones, coronary artery bypass

Example: Control of hemorrhage, perforated appendix, repair of traumatic amputation

Introduction to the Surgical Patient

Example: Exploratory laparotomy, breast mass biopsy

Examples: Amputation, cholecystectomy

Example: Colostomy, debridement of necrotic tissue

Introduction to the Surgical Patient

Example: Internal fixation of fractures, scar revision

Examples: Kidney, cornea, joints, heart

Example: Repair of cleft palate, closure of atrial-septal defect

Preoperative Before surgery Intraoperative

Concept of perioperative nursing:

Nurses major responsibility:

Suppressed immune system are higher risk for development of

Body need for energy and repair increases

Patient who maintain a sound, nutritional diet recover more quickly

Ask about herbal remedies/medications

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