38613029 Perioperative Nursing CD

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Prepared by:

PERIOPERATIVE NURSING


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DEFINITION OF TERMS

SURGERY -It is the branch of medicineconcerned with diseases and conditionswhich require or are amenable to operativeprocedures. Surgery is the work done by a

surgeon.

-"Surgery can involve cutting,abrading, suturing, laser or otherwisephysically changing body tissues andorgans."


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SURGEON - A physician who treats disease,injury, or deformity by operative or manualmethods. A medical doctor specialized in theremoval of organs, masses and tumors and in

doing other procedures using a knife (scalpel)

STERILE - free from living germs ormicroorganisms; aseptic: sterile surgicalinstruments.


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ASEPSIS - The state of being free ofpathogenic microorganisms.

- The process of removingpathogenic microorganisms or protectingagainst infection by such organisms.

SEPSIS - a toxic condition resulting from thespread of bacteria or their toxic products froma focus of infection; especially: septicemia
http://www.m-w.com/dictionary/septicemiahttp://www.m-w.com/dictionary/septicemia


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SEPSIS- is a severe illness caused byoverwhelming infection of the bloodstream bytoxin-producing bacteria.

- is caused by bacterial infection thatcan originate anywhere in the body.

DISINFECTANT - any chemical agent usedchiefly on inanimate objects to destroy orinhibit the growth of harmful organisms.
http://www.healthline.com/galecontent/sepsishttp://www.healthline.com/galecontent/sepsis


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ANTISEPTICS- is a substance that prevents or

arrests the growth or action of microorganismseither by inhibiting their activity or by destroyingthem. The term is used especially forpreparations applied topically to living tissue

STERILIZATION-the destruction of all living microorganisms,

as pathogenic bacteria, vegetative forms, andspores.


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BACTERIOSTATIC -Capable of inhibiting thegrowth or reproduction of bacteria.

- An agent, such as a chemical or biologicalmaterial, that inhibits bacterial growth.

BACTERICIDAL - Capable of killing bacteria.

BACTERIOCIDES - is a substance that killsbacteria .Bactericides are either disinfectants,

antiseptics or antibiotics.
http://www.medterms.com/script/main/art.asp?ArticleKey=5315http://www.medterms.com/script/main/art.asp?ArticleKey=13954http://cancerweb.ncl.ac.uk/cgi-bin/omd?bacteriahttp://en.wikipedia.org/wiki/Bacteriumhttp://en.wikipedia.org/wiki/Disinfectanthttp://en.wikipedia.org/wiki/Antiseptichttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Antiseptichttp://en.wikipedia.org/wiki/Disinfectanthttp://en.wikipedia.org/wiki/Bacteriumhttp://cancerweb.ncl.ac.uk/cgi-bin/omd?bacteriahttp://www.medterms.com/script/main/art.asp?ArticleKey=13954http://www.medterms.com/script/main/art.asp?ArticleKey=5315


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PREFIXES & SUFFIXES

Prefixes & Suffixes can explain the type ofprocedure the client will undergo:

PREFIXES

Supra above ; beyond Ortho joint

Chole bile or gall

Cysto bladder

Encephalo- brain


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Entero intestine

Hystero uterus

Mast breast

Meningo membrane; meninges Myo muscle

Nephro kidney

Neuro nerve

Oophor - ovary


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Pneumo lungs

Pyelo kidney pelvis

Salphingo fallopian tube

Thoraco chest Viscero organ esp. abdomen


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SUFFIXES

Oma tumor ; swelling

Ectomy removal of an organ or gland

Rhapy suturing or stitching of a part oran organ

Scopy looking into

Ostomy making an opening or a stoma

Otomy cutting into


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Plasty to repair or restore

Cele tumor ; hernia ; swelling

Itis inflammation of


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PHASES OF O.R. NURSING :

I. PREOPERATIVE PHASE

The rendering of nursing care to thesurgical client as soon as he is admitted &the decision to undergo surgery is made.

It ends on the time the client is transferredto the O.R.


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NURSING ACTIVITIES :

Assessment of the client (baseline evaluation of

the pt. before the day of surgery-interview)

Identification of potential/actual health problems.

PREADMISSION TESTING- ensure necessary

tests have been performed

Pre-op teaching involving client & support

persons.


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Day of surgery :

pt. teaching reviewed

informed consent confirmed

pt.s identity & surgical site verified

IVF started.


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PREPARATION FOR SURGERY

Psychological Support :

a) Assess clients fears, anxieties, support

systems & patterns of coping.

b) Establish trusting relationship with client &significant others.

c) Explain routine procedures, encourageverbalization of fears & allow client to ask

questions.


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d) Demonstrate confidence in surgeon & staff.

e) Provide for spiritual care if appropriate.


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PREOPERATIVE TEACHING

Frequently done on an outpatient basis.

Assess clients level of understanding of

surgical procedure & its implications.

Answer questions, clarify & reinforceexplanations given by the surgeon.

Explain routine pre- & post-op procedures &any special equipment to be used.


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PREOPERATIVE TEACHING Preoperative experience

Preoperative medication

Breathing exercises, coughing, incentive spirometer

Leg exercises

Position changes and movement Pain management

Reducing anxiety and fear, support of coping

Special considerations related to outpatient surgery


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Preoperative Nursing

Interventions

PHYSICAL PREPARATIONS:

Patient safety is a primary concern.

Obtain history of past medical conditions,surgical procedures, dietary restrictions &medications.

Perform baseline head-to-toe assessment,including VS, height & weight.

Ensure that diagnostic procedures pertinentto surgery are performed as ordered:


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1. CBC2. Electrolytes

3. PT/PTT (Prothrombin Time;Partialthromboplastin time)

4. Urinalysis

5. ECG

6. Blood typing & crossmatch


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NPO- to prevent aspiration Bowel prep and skin prep

- cleansing enema or laxative before surgeryto allow satisfactory visualization of thesurgical site.

- goal of pre-op skin prep is to decreasebacteria without injuring the skin.


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Immediate preoperative preparation Complete checklist and chart

Hospital gown, voiding, removal of dentures,jewelry, contacts, etc.

Preoperative medication

Transporting the pt. to the Presurgical areaabout 30 to 60 minutes before anesthetics isto be given.

Attend to family needs


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LEGAL PREPARATION:

Surgeon obtains operative permit (informedconsent)

1. Surgical procedures, alternatives , possiblecomplications & disfigurements or removal of

body parts are explained.2. It is part of the nurses role as client advocate

to confirm that the client understandsinformation given.


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INFORMED CONSENT is necessary in the ff.Circumstances:

Invasive procedures, such as surgicalincisions, biopsy, cystoscopy or paracentesis.

Procedures requiring sedation or anesthesia

A non-surgical procedure, such asarteriography

Procedures involving radiation


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Adult client (over 18 y/o) signs own permitunless unconcious or mentally incompetent.

1. If unable to sign, relative (spouse or next ofkin) or guardian will sign.

2. In an emergency, permission via telephoneor telegram is acceptable; have a 2nd listeneron phone when telephone permission isgiven


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3. Consents are not needed for emergencycare if all 4 of the ff. criteria are met:

a. There is an immediate threat to life.

b. Experts agree that it is an emergency.

c. Client is unable to consent.

d. A legally authorized person cannot bereached.


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Minors (under 18 y/o) must have consentsigned by an adult (i.e. Parent or legalguardian)

Emancipated minor (married or independently

earning his or her own living)may sign his/ herown consent.


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Witness to informed consent may be a nurse,another M.D., clerk or any other authorizedperson.

The nurse witnessing informed consent,

specifies whether witnessing explanation ofsurgery or just signature of the client.


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PREOPERATIVE MEDICATIONS

PURPOSES:1. To relieve fear & anxiety.

2. To reduce dose needed for induction &maintenance of anesthesia.

3. To prevent reflex bradycardia that happensduring induction of anesthesia.

4. To minimize oral secretions.


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II. INTRAOPERATIVE PHASE Giving nursing care to client undergoing

surgery.

It starts from the time the pt. was admittedto the O.R. , during operation until it ends &transferred to the PACU.


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NURSING ACTIVITIES:

Activities providing for pts safety.

Maintenance of aseptic environment.

Ensuring proper function of equipments.

Providing surgeons with specific instruments &supplies for surgical field.

Completing documentation.

Positioning pts.

Acting as scrub/circulating nurse.


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Members of the Surgical Team

Patient

Anesthesiologist oranesthetist

Surgeon

Nurses (Scrub& Circulating)

Surgical

technologists
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SCRUB TEAM @ WORK


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PATIENT the most important member of thesurgical team. May feel relaxed & prepared, orfearful & highly stressed.

- is also subject to several risks.

OPERATING SURGEON pre-op dx & care.

- performance of operation.- post-op mgt & care

- assumes all responsibility for all medical actsof judgement & mgt.


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SURGEON & ASSISTANTS scrub & perform thesurgery.

REGISTERED NURSE 1ST ASST. practicesunder the direct supervision of the surgeon.(handling tissue, suturing, maintaininghemostasis)

ANESTHESIOLOGIST /

NURSE ANESTHETIST administers theanesthetic agent & monitors the pts physical

status throughout the surgery.


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SCRUB NURSE provides sterile instruments &supplies to the surgeon during the procedure.

- performs surgical hand scrub. CIRCULATING NURSE coordinates the care of

the pt. in the O.R.

- care provided includes assisting with pt.

positioning , skin prep, managing surgicalspecimens & documenting intraoperative events.


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SCRUB NURSE


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CIRCULATING

NURSE


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Prevention of Infection

The surgical environment stark appearance& cool temperature. Located central to allsupporting services.

Unrestricted zone where street clothes are

allowed. Semirestricted zone- where attire consists of

scrub clothes & caps.

Restricted zone- where scrub clothes, shoe

covers, caps & masks are worn.


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THE OPERATING ROOM


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SURGICAL ASEPTIC TECHNIQUE

BEFORE AN OPERATION, it is necessary tosterilize and keep sterile all instruments,materials, and supplies that come in contactwith the surgical site. Every item handled by

the surgeon and the surgeon's assistantsmust be sterile. The patient's skin and thehands of the members of the surgical teammust be thoroughly scrubbed, prepared, and

kept as aseptic as possible.


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DURING THE OPERATION, the surgeon,surgeon's assistants, and the scrub nurses must

wear sterile gowns and gloves and must nottouch anything that is not sterile.

Maintaining sterile technique is a cooperativeresponsibility of the entire surgical team.

Each member must develop a surgicalconscience, a willingness to supervise and besupervised by others regarding the adherence tostandards.

BASIC PRINCIPLES OF


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BASIC PRINCIPLES OF

SURGICAL ASEPSIS

All personnel assigned to the operating roommust practice good personal hygiene. Thisincludes daily bathing and clothing change.

Those personnel having colds, sore throats,

open sores, and/or other infections should notbe permitted in the operating room.


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Operating room attire (which includes scrubsuits, gowns, head coverings, and face masks)should not be worn outside the operating room

suite. If such occurs, change all attire before re-entering the clean area. (The operating room andadjacent supporting areas are classified as"clean areas.")

All members of the surgical team having directcontact with the surgical site must perform thesurgical hand scrub before the operation.


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All materials and instruments used in contactwith the site must be sterile.

The gowns worn by surgeons and scrubcorpsmen are considered sterile from shoulder

to waist (in the front only), including the gownsleeves.

If sterile surgical gloves are torn, punctured, orhave touched an unsterile surface or item, they

are considered contaminated.


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The safest, most practical method of sterilizationfor most articles is steam under pressure.

Label all prepared, packaged, and sterilizeditems with an expiration date.

Use articles packaged and sterilized in cottonmuslin wrappers within 28 calendar days.

Use articles sterilized in cotton muslin wrappersand sealed in plastic within 180 calendar days


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Unsterile articles must not come in contactwith sterile articles.

Make sure the patient's skin is as clean aspossible before a surgical procedure.

Take every precaution to preventcontamination of sterile areas or supplies byairborne organisms.


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HANDLING STERILE ARTICLES

When you are changing a dressing, removingsutures, or preparing the patient for a surgicalprocedure, it will be necessary to establish asterile field from which to work. The field

should be established on a stable, clean, flat,dry surface.

An article is either sterile or unsterile; there isno in-between. If there is doubt about the

sterility of an item, consider it unsterile


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Any time the sterility of a field has beencompromised, replace the contaminated fieldand setup.

Do not open sterile articles until they are

ready for use. Do not leave sterile articles unattended once

they are opened and placed on a sterile field.


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Do not return sterile articles to a container once

they have been removed from the container. Never reach over a sterile field.

When pouring sterile solutions into sterilecontainers or basins, do not touch the sterilecontainer with the solution bottle. Once openedand first poured, use bottles of liquid entirely. Ifany liquid is left in the bottle, discard it.


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Never use an outdated article. Unwrap it,inspect it, and, if reusable, rewrap it in a newwrapper for sterilization.


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Intraoperative Complications

Nausea and vomitingAnaphylaxis

Hypoxia and respiratory complications

Hypothermia

Malignant hyperthermia

Disseminated intravascular coagulation (DIC)

Potential Adverse Effects of


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Potential Adverse Effects of

Surgery and Anesthesia

Allergic reactions and drug toxicity or reactions Cardiac dysrhythmias

CNS changes and oversedation or undersedation

Trauma: laryngeal, oral, nerve, and skin, including

burns

Hypotension

Thrombosis

Nursing Goals for the Patient in


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Nursing Goals for the Patient in

the Intraoperative Period

Reducing anxiety Preventing positioning injuries

Maintaining patient safety

Maintaining the patient's dignity

Avoiding complications


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Protecting the Patient from Injury

Patient identification Correct informed consent

Verification of records of health history and exam

Results of diagnostic tests

Allergies (include latex allergy)

Monitoring and modifying the physical

environment


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Safety measures such as grounding ofequipment, restraints, and not leaving a sedated

patient

Verification and accessibility of blood


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III. POSTOPERATIVE PHASE Begins with the admission of the client to

PACU & ends with discharge of client fromhospital or facility providing continuity of

care.


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Nursing Management in the


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Nursing Management in the

PACU

Provide care for the patient until he/she hasrecovered from the effects of anesthesia.

Patient has resumption of motor and sensory

function, is oriented, has stable VS, and shows

no evidence of hemorrhage or othercomplications of surgery.

Frequent skilled assessment of the patient is vital

Responsibilities of the PACU


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Responsibilities of the PACU

Nurse

Review pertinent information and baselineassessment upon admission to the unit.

Assessments include airway and respirations,cardiovascular function, surgical site, function ofthe central nervous system; also assess IVs and

all tubes and equipment. Reassess VS and patient status every 15 minutes

or more frequently as needed.

Provide report and transfer the patient to anotherunit or discharge the patient to home.

Outpatient Surgery/Direct


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Discharge

Discharge planning and discharge assessment

Provide written andverbalinstructionsregarding follow-up care, complications, wound

care, activity, medications, and diet.

Give prescriptions and phone numbers. Discuss

actions to take if complications occur.



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Discharge

Give instructions to the patient and a responsibleadult who will accompany the patient.

Patients are not to drive home or be discharged

to home alone. Sedation and anesthesia maycloud memory and judgment and affect ability.

38613029 Perioperative Nursing CD

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