PERI-OPERATIVE NURSING
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Transcript of PERI-OPERATIVE NURSING
PERI-OPERATIVE PERI-OPERATIVE NURSINGNURSING
THREE PHASESTHREE PHASES
PRE-OPERATIVEPRE-OPERATIVEINTRA-OPERATIVEINTRA-OPERATIVEPOST-0PERATIVEPOST-0PERATIVE
GENERAL GENERAL INFORMATIONINFORMATION
1.1. Pre-operative begins when the decisions for Pre-operative begins when the decisions for surgical intervention is made and ends when surgical intervention is made and ends when the patient is transferred to the operating roomthe patient is transferred to the operating room
2.2. Intra-operative begins when the patient Intra-operative begins when the patient is transferred to the surgery & ends is transferred to the surgery & ends when transferred to the recovery roomwhen transferred to the recovery room
3.3. Post-operative begins when the patient Post-operative begins when the patient is admitted to the recovery room & ends is admitted to the recovery room & ends with follow up evaluation in the clinical with follow up evaluation in the clinical setting or homesetting or home
PRE-OPERATIVE PRE-OPERATIVE SURGERYSURGERY
Carolyn Frye-ShegogCarolyn Frye-Shegog
GENERAL GENERAL INFORMATIONINFORMATION
• PURPOSE OF SURGERYPURPOSE OF SURGERY
• SURGERY SETTINGSSURGERY SETTINGS
• INFORMED CONSENTINFORMED CONSENT
CLASSIFICATION OF CLASSIFICATION OF SURGERYSURGERY
ACCORDING TO PURPOSE:ACCORDING TO PURPOSE: DIAGNOSTICDIAGNOSTICCURATIVECURATIVEPALLIATIVEPALLIATIVERECONSTRUCTIVERECONSTRUCTIVEPREVENTIVEPREVENTIVEEXPLORATORYEXPLORATORYCOSMETICCOSMETIC
MAJOR AND MINOR MAJOR AND MINOR SURGERYSURGERY
TERMINOLOGYTERMINOLOGY ECTOMY: REMOVAL OF AN ORGANECTOMY: REMOVAL OF AN ORGAN
RRHAPHY: SUTURE OF A PARTRRHAPHY: SUTURE OF A PART
SCOPY: LOOKING INTOSCOPY: LOOKING INTO
OSTOMY : MAKING AN OPININGOSTOMY : MAKING AN OPINING
PLASTY :REPAIR OR RESTOREPLASTY :REPAIR OR RESTORE
OTOMY: CUTTING INTO OTOMY: CUTTING INTO
AMBULATORY SURGERYAMBULATORY SURGERY• ADVANTAGES:ADVANTAGES:
• Less psychological distress associated with Less psychological distress associated with hospitalizationhospitalization
• Decreased exposure to hospital infectionsDecreased exposure to hospital infections• Economic savingsEconomic savings• Consumer satisfactionConsumer satisfaction
FACTORS AFFECTING FACTORS AFFECTING ADAPTATION TO SURGERYADAPTATION TO SURGERY• AGE:AGE:• NEUROENDOCRINE RESPONSE:NEUROENDOCRINE RESPONSE:• SURGICAL PROCEDURE:SURGICAL PROCEDURE:• PREVIOUS HOSPITALIZATIONS PREVIOUS HOSPITALIZATIONS
AND SURGERIES:AND SURGERIES:• SPIRITUAL BELIEFS:SPIRITUAL BELIEFS:• TYPE OF ADMISSIONTYPE OF ADMISSION
PSYCHOSOCIAL PSYCHOSOCIAL REACTIONS TO SURGERY:REACTIONS TO SURGERY:
EMOTIONAL RESPONSES TO SURGERY:EMOTIONAL RESPONSES TO SURGERY:
FEAR OF THE UNKNOWNFEAR OF THE UNKNOWN FEAR OF ANESTHESIA;FEAR OF ANESTHESIA; FEAR OF PAIN: UNIVERSAL –FEAR OF FEAR OF PAIN: UNIVERSAL –FEAR OF
MUTILATIONS OR ALTERED BODY IMAGEMUTILATIONS OR ALTERED BODY IMAGE FEAR OF DEATHFEAR OF DEATH FEAR OF SEPARATION AND ROLE FEAR OF SEPARATION AND ROLE
CHANGECHANGE
NON VERBAL NON VERBAL COMMUNICATION OF COMMUNICATION OF
FEARS AND ANXIETIESFEARS AND ANXIETIESRAPID SPEECHRAPID SPEECHJOKING JOKING MAKING LIGHT OF SITUATIONMAKING LIGHT OF SITUATIONWITHDRAWALWITHDRAWAL
NURSES ROLE NURSES ROLE • RECOGNIZING AND RECOGNIZING AND
UNDERSTANDING PSYCHOSOCIAL UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:REACTIONS TO SURGERY:
PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING ASSESSMENTASSESSMENT
PSYCHOLOGICAL ASSESSMENT:PSYCHOLOGICAL ASSESSMENT:
• Social History: smoking, alcohol Social History: smoking, alcohol consumption, occupation etc.consumption, occupation etc.
• Family health history Family health history
• Past health history & home Past health history & home medication: medication:
MEDICATIONS MEDICATIONS CON’TCON’T
• STEROIDS-should not be stopped abruptlySTEROIDS-should not be stopped abruptly• Antidepressants can increase hypotensive Antidepressants can increase hypotensive
effects of anesthesiaeffects of anesthesia• Antibiotics such as neomycin, kanamycin can Antibiotics such as neomycin, kanamycin can
combine with certain anesthetics & lead to combine with certain anesthetics & lead to respiratory paralysisrespiratory paralysis
• Insulin dosage may need to be adjusted-check Insulin dosage may need to be adjusted-check with the physicianwith the physician
• ASA thins blood so may increase post-op ASA thins blood so may increase post-op bleedingbleeding
• Antihypertensives & cardiac drugs can’t be Antihypertensives & cardiac drugs can’t be stopped abruptlystopped abruptly
• Check for the use of OTC drugs for glaucomaCheck for the use of OTC drugs for glaucoma
PHYSIOLOGICAL PHYSIOLOGICAL ASSESSMENTASSESSMENT
RespiratoryRespiratory
HX of dyspnea, coughing, hemoptysisHX of dyspnea, coughing, hemoptysisCOPD, or URICOPD, or URISmoker?Smoker?Record baseline breath soundsRecord baseline breath soundsDiagnostic tests;; ABG’S CXR, FPT’SDiagnostic tests;; ABG’S CXR, FPT’S
CARDIOVASCULARCARDIOVASCULAR• HX OF CARDIO OR CEREBRAL HX OF CARDIO OR CEREBRAL
VASCULAR DISEASEVASCULAR DISEASE• PACEMAKERPACEMAKER• ARTIFICIAL VALVESARTIFICIAL VALVES• ANTICOAGULANT THERAPYANTICOAGULANT THERAPY
CNS: (ENTRAL NERVOUS CNS: (ENTRAL NERVOUS SYSTEM)SYSTEM)
• HX of stroke, TIA’S,HX of stroke, TIA’S,• NEUROMUSCULAR DISORDERS NEUROMUSCULAR DISORDERS
SUCH AS MYASTHENIA GRAVI,SUCH AS MYASTHENIA GRAVI,• ESPECIALLY IMPORTANT TO ESPECIALLY IMPORTANT TO
ASSESS MENTAL STATUSASSESS MENTAL STATUS• LOCLOC
PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING CARECARE
• PRE – OPERATIVE TEACHINGPRE – OPERATIVE TEACHINGo THE NURSE IS RESPONSIBLE TO:THE NURSE IS RESPONSIBLE TO:
o FIND OUT WHAT PT. KNOWSFIND OUT WHAT PT. KNOWSo INCLUDE FAMILYINCLUDE FAMILYo USE SIMPLE TERMSUSE SIMPLE TERMSo EVALUATE PT. UNDERSTANDINGEVALUATE PT. UNDERSTANDINGo USE AUDIOVISUAL AIDSUSE AUDIOVISUAL AIDSo ASK FOR RETURN DEMONSTRATIONASK FOR RETURN DEMONSTRATION
PRE-OPERATIVE PRE-OPERATIVE TEACHINGTEACHING
USUAL TOPICS COVEREDUSUAL TOPICS COVEREDPreoperative testsPreoperative testsPreoperative routinesPreoperative routinesScheduleSchedulePACUPACUFAMILY DIRECTIONSFAMILY DIRECTIONSPOSTOP THERAPIESPOSTOP THERAPIESPAIN MANAGEMENTPAIN MANAGEMENTDIETDIET
PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING ASSESSMENTASSESSMENT
• PSYCHOLOGICAL ASSESSMENTPSYCHOLOGICAL ASSESSMENT• SOCIAL HISTORYSOCIAL HISTORY
• FAMILY HEALTH HISTORYFAMILY HEALTH HISTORY
• PAST HEALTH HISTORY PAST HEALTH HISTORY
• PHYSIOLOGICAL HISTORYPHYSIOLOGICAL HISTORY
PREOPERATIVE PHYSICAL PREOPERATIVE PHYSICAL PREPARATIONPREPARATION
PRE-OP PHYSICAL PREPARATIONPRE-OP PHYSICAL PREPARATIONNUTRITIONAL NUTRITIONAL NIGHT BEFORE SURGERY, LIGHT NIGHT BEFORE SURGERY, LIGHT
MEAL OR LIQUID DIETMEAL OR LIQUID DIETSPECIFIC IV FLUIDSSPECIFIC IV FLUIDSNPO AFTER MIDNIGHTNPO AFTER MIDNIGHTPOSSIBILITY OF LIGHT BREAKFAST POSSIBILITY OF LIGHT BREAKFAST
ON DAY OFON DAY OF
PRE-OP PHYSICAL PREPPRE-OP PHYSICAL PREP• IntestinalIntestinal
NPONPO
Enemas until clearEnemas until clear
LaxativesLaxatives
Antibiotics to decrease intestinal floraAntibiotics to decrease intestinal flora
PRE-OP PHYSICAL PREPPRE-OP PHYSICAL PREP• Skin prepSkin prep
• Bathe before surgeryBathe before surgery
• Shaving operative siteShaving operative site
• Scrub with betadine/other antisepticScrub with betadine/other antiseptic
Three important Three important components of consent components of consent
formform
1.1. Adequate disclosureAdequate disclosure
2.2. Sufficient comprehensionSufficient comprehension
3.3. Voluntary consentVoluntary consent