Chapter 1 Perioperative Concepts And Nursing Management

1. 1 Chapter 1 Perioperative Concepts And Nursing Management

2. 2 PERIOPERATIVE & PERIANESTHESIA NURSING Perioperative care is the nursing care provided to a client before, during, and after surgery. PREOPERATIVE PERIOD Begins when the decision for surgical intervention is made and ends with the transference of the patient to the operating room table. INPATIENT SURGERY-PROCEDURES ON A CLIENT WHO IS ADMITTED TO THE HOSPITAL. OUTPATIENT SURGERY-OPERATIVE PROCEDURES PERFORMED ON CLIENTS WHO RETURN HOME THE SAME DAY. LASER SURGERY-OUTPATIENT SURGICAL PROCEDURES WITH THE USE OF A LASER .

3. 3 INTRAOPERATIVE PERIOD Begins when the patient is transferred onto the operating room and ends with his admission to the postanesthesia recovery room (PARR) or postanesthesia care unit (PACU). POSTOPERATIVE PERIOD Begins with the admission of the patient to the PACU or PARR and ends with a follow �up evaluation in the clinical setting or at home. - The immediate postoperative period refers to the first 24 hours after surgery. - Nurses should monitor for complications.

4. 4 Surgical Classifications 1. Optional surgery: decision rests with patient (eg, cosmetic surgery). 2. Elective surgery refers to procedures that scheduled at the client's convenience (eg, cyst removal, repair of scars simple hernia or vaginal repair). 3. Required surgery: is warranted for conditions necessitating intervention within a few weeks (eg, cataract surgery, thyroid disorders). 4. Urgent surgery: is indicated for a problem requiring intervention within 24 to 48 hours (eg, some cancers, acute gallbladder infection and appendicitis, Kidney stones). 5. Emergency surgery: describes procedures that must be done immediately to sustain life or maintain function (eg, repair of a ruptured aortic aneurysm, gunshot, or knife wounds, extensive burns , fractures skull, intestinal obstruction)

5. 5 Informed Consent Information on the surgical procedure is provided by the physician Explanation includes permission a client gives after an explanation of the risks, benefits, and alternatives A signed form, witnessed by a nurse is evidence that consent has been obtained If the client is mentally confused, unconscious, or mentally incompetent, the client�s spouse, nearest blood relative, or someone with durable power of attorney for the client�s health care must sign the consent form.

6. 6 PREOPERATIVE NURSING CARE CONDUCT A NURSING ASSESSMENT PROVIDE PREOPERATIVE TEACHING PERFORM METHODS OF PHYSICAL PREPARATION ADMINISTER MEDICATIONS ASSIST WITH PSYCHOSOCIAL PREPARATION COMPLETE THE SURGICAL CHECKLIST

7. 7 SURGERY CHECKLIST

8. 8 RISK FACTORS THAT INCREASE PERIOPERATIVE COMPLICATIONS EXTREMES IN AGE DEHYDRATION MALNUTRITION OBESITY SMOKING DIABETES CARDIOPULMONARY DISEASE DRUG AND ALCOHOL ABUSE BLEEDING TENDENCIES LOW HEMOGLOBIN AND RED CELLS PREGNANCY

9. 9 PREOPERATIVE TEACHING PREOPERATIVE MEDICATIONS: WHEN THEY ARE GIVEN AND THEIR EFFECTS. POSTOPERATIVE PAIN CONTROL. EXPLANATION AND DESCRIPTION OF THE POSTANESTHESIA RECOVERY ROOM OR POSTSURGICAL AREA. DISCUSSION OF THE FREQUENCY OF ASSESSING VITAL SIGNS AND USE OF MONITORING EQUIPMENT.

10. 10 DEEP BREATHING, COUGHING, LEG EXERCISES Deep breathing is a form of controlled ventilation that opens and fills small air passages in the lungs to prevent atelectasis and pneumonia. Coughing is a natural method of clearing secretions from the airways. Leg exercises help promote circulation and reduce the risk of forming a thrombus in the veins. Antiembolism stockings help prevent thrombi and emboli by compressing superficial veins and capillaries redirecting blood to larger and deeper veins, where it flows more effectively toward the heart.

11. 11 DEEP BREATHING & COUGHING

12. 12 LEGS EXERCISES

13. 13 PREOPERATIVE MEDICATIONS ANTICHOLINERGICS: Glycopyrrolate (robinal) decreases respiratory secretions. ANTIANXIETY: Lorazepam (ativan) reduces anxiety. HISTAMINE-2 RECEPTOR ANTAGONIST: Cimetidine (tagamet) decreases gastric acidity and volume. NARCOTICS: Demerol (meperidine) decreases the amount of anesthesia needed to sedate the client. SEDATIVES: Midazolam (versed) promotes sleep or conscious sedation and decrease anxiety. ANTIBIOTICS: Kanamycin (Kantrex) destroy enteric microorganisms.

14. 14 PREOPERATIVE CHECKLIST History and physical examination. Name of procedure on surgical consent. Signed surgical consent. Laboratory results. Client is wearing an identification bracelet. Allergies have been identified. NPO. Skin preparation completed. Vital signs assessed.

15. 15 Jewelry removed. Dentures removed. Client is wearing a hospital gown and hair cover. Client has urinated. Location of IV site, type of intravenous solution, rate of infusion is identified. The prescribed preoperative medication has been given.

16. 16 Types of anesthesia 1. General Anesthesia (inhaled or intravenously) refers to drug � induced depression of the central nervous system that produces analgesia, amnesia and unconsciousness (affects whole body). 2. Regional anesthesia is a form of local anesthesia that suspends sensation and motion in body region or part; the client remains awake. Continuous monitoring is required in the event the block is not totally effective and the client experiences pain or reactions to blocking agents (e.g. nausea, cardiovascular collapse). Regional anesthesia differs in terms of location and size of the anatomic area anesthetized and the volume and type of anesthesia agent used.

17. 17 3. Spinal Anesthesia is local anesthesia injected into the subarachniod space at lumbar level to block nerves and suspend sensation and motion to the lower extremities, perineum, and lower abdomen. 4. Conduction Blocks suspend sensation and motion on various groups of nerves such as epidural block (i.e. anesthetic into space around the dura mater); Para vertebral block (i.e. produces anesthesia of the chest, abdominal wall and extremities) and Tran sacral (caudal) block (i.e. anesthesia of the perineum).

18. 18 SPINAL ANASTHESIA

19. 19 The perioperative team Surgeon performs the surgical procedure and heads the surgical team. An anesthesiologist or anesthetist makes a preoperative assessment to plan the type of anesthetic to be administered and to evaluate the client's physical status. Circulating nurse manages the operating room and protects the patient�s safety and health by monitoring the activities of the surgical team, checking the operating room conditions, and continually assessing the patient for signs of injury and implementing appropriate interventions. Verify consent, ensure cleanliness, proper temperature, humidity, and lightening; the safe functioning of equipments; and the availability of supplies and materials. Scrubbing nurse setting up the sterile tables; preparing sutures, and special equipments; and assisting the surgeon and the surgical assistants during the procedure by anticipating the instruments that will be required - Scrub nurse and circulator count all needles, sponges; and instruments used.

20. 20 OPERATION POSITIONS

21. 21 ENDOTRACHEAL INTUBATION

22. 22 INITIAL POSTOPERATIVE ASSESSMENTS Level of consciousness. Vital signs. Effectiveness of respirations. Presence or need for supplemental oxygen. Location of drains and drainage characteristics. Location, type, and rate of intravenous fluid. Level of pain and need for analgesia. Presence of a urinary catheter and urine volume.

23. 23 NURSING MANAGEMENT DURING RECOVERY FROM SURGERY Preventing respiratory complications. Relieving pain. Encouraging activity. Promoting wound healing. Maintaining normal body temperature. Managing GI function. Nutrition. Resumption of urinary function.

24. 24 POST OPERATIVE COMPLICATIONS

25. 25 TYPES OF INCISIONS

26. 26 CARE OF DRAIN

27. 27 DISCHARGE INSTRUCTIONS CARE OF THE INCISION. SIGNS OF COMPLICATIONS. DRUGS FOR PAIN MANAGEMENT. HOW TO SELF ADMINISTER PRESCRIBED MEDICATIONS. ACTIVITY LEVEL. AMOUNT OF WEIGHT THAT CAN BE LIFTED. DIET. RETURN FOR A MEDICAL APPOINTMENT.

28. 28 GERONTOLOGICAL CONSIDERATIONS Chronic medical problems increases risk of complications. Sensory deprivation interferes with communication in the operative period. Period of fluid restriction should be shortened before surgery to prevent dehydration. Older adults needed instructions on care and medications. Anticoagulant therapy increases the risk of bleeding. Carefully monitor cardiac status. A change in mental status is indicative of infection.