Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE
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Transcript of Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE
Perioperative NursingPeg Trueman RN MSN Ed.D. CNE
Meet the Patient
The experience of surgery is a routine event for everyone involved EXCEPT for the patient!
Nursing Management after Surgery
Postoperative Phase:Plan of Care
System Assessments
Respiratory Cardiovascular Fluid Status Nutrition Elimination Activity Wound Healing
Respiratory
Pulmonary assessment data
TCDB• C/I: CHI, eye sx
O2 therapy IPPB I.S.
The real reason dinosaurs became extinct.
Cardiovascular
Cardiac assessment data
Leg exercises Avoiding venous
statsis ICD/hose
“Okay, Williams, we’ll vote…how many here say the heart has four chambers?”
Fluid Status
Hydration status data
Drainage amts vital signs daily weights!
IV therapy Blood therapy
Nutrition
NPO status Progression of
diet check bowel
sounds
Feedings TPN
“The Nurse says a trip-o’-loomin’ cow-filler is feeding Grandma. It has three loops--one for breakfast, one for lunch, and one for dinner!”
Elimination
Urinary output• retention?!!• Dehydration• Catheter is the
last resort! Bowel activity
• bowel sounds• flatus
Ambulation!!!!
Activity
OOB ASAP!!• Usually within 24
hrs
Psychological impact
Needs encouragement!
Physiology of Wound Healing
Inflammatory Stage• “insult”
Proliferative Stage• reinforcemen/framework
Maturation Stage• “settling in”
Wound Healing:First Intention
Scar formation is minimal Properly closed Heal with little tissue reaction
Wound Healing:Second Intention
Wound is left open to granulate Resultant in scar formation “Healing by granulation”
Wound Healing:Third Intention
Two opposing granulation surfaces are brought together
Scar is deeper and wider “Delayed closure”
Factors Affecting Wound Healing
Age Hemorrhage Hypovolemia Local Factors Nutritional
Deficits
Oxygen deficit Drainage Medications Systemic
Disorders Wound Stressors
Wound Care
“Just a friendly suggestion…next time you do a dressing change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”
Post-op Pain Control
What is pain? Factors affecting pain Administration
• Preventative Approach• PRN vs ATC
• Routes of Administration• Intramuscular• Intravenous
• PCA pump/Epidural lines
Post-op Pain Control
Common Pain Medication• Demerol• Morphine• Dilaudid• Stadol• NSAIDs
Side Effects of Pain medication*
Managing Potential Complications
Shock/Hemorrhage Deep Vein Thrombosis (DVT) Pulmonary Embolism Respiratory Complications Urinary Retention Intestinal Obstruction Wound Complications
Surgery Specific Care
Postoperative Uniquities and “worries”
Remember Mr. P?
Case Study Review
Perioperative Nursing