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PERI-OPERATIVE NURSING

PERI-OPERATIVE NURSING. THREE PHASES PRE-OPERATIVE INTRA-OPERATIVE POST-0PERATIVE. GENERAL INFORMATION. Pre-operative begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room

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PERI-OPERATIVE NURSING

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  1. PERI-OPERATIVE NURSING THREE PHASES PRE-OPERATIVE INTRA-OPERATIVE POST-0PERATIVE

  2. GENERAL INFORMATION • Pre-operative begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room • Intra-operative begins when the patient is transferred to the surgery & ends when transferred to the recovery room • Post-operative begins when the patient is admitted to the recovery room & ends with follow up evaluation in the clinical setting or home

  3. PRE-OPERATIVE SURGERY Carolyn Frye-Shegog

  4. GENERAL INFORMATION • PURPOSE OF SURGERY • SURGERY SETTINGS • INFORMED CONSENT

  5. CLASSIFICATION OF SURGERY ACCORDING TO PURPOSE: • DIAGNOSTIC • CURATIVE • PALLIATIVE • RECONSTRUCTIVE • PREVENTIVE • EXPLORATORY • COSMETIC

  6. MAJOR AND MINOR SURGERY

  7. TERMINOLOGY • ECTOMY: REMOVAL OF AN ORGAN • RRHAPHY: SUTURE OF A PART • SCOPY: LOOKING INTO • OSTOMY : MAKING AN OPINING • PLASTY :REPAIR OR RESTORE • OTOMY: CUTTING INTO

  8. AMBULATORY SURGERY • ADVANTAGES: • Less psychological distress associated with hospitalization • Decreased exposure to hospital infections • Economic savings • Consumer satisfaction

  9. FACTORS AFFECTING ADAPTATION TO SURGERY • AGE: • NEUROENDOCRINE RESPONSE: • SURGICAL PROCEDURE: • PREVIOUS HOSPITALIZATIONS AND SURGERIES: • SPIRITUAL BELIEFS: • TYPE OF ADMISSION

  10. PSYCHOSOCIAL REACTIONS TO SURGERY: EMOTIONAL RESPONSES TO SURGERY: • FEAR OF THE UNKNOWN • FEAR OF ANESTHESIA; • FEAR OF PAIN: UNIVERSAL –FEAR OF MUTILATIONS OR ALTERED BODY IMAGE • FEAR OF DEATH • FEAR OF SEPARATION AND ROLE CHANGE

  11. NON VERBAL COMMUNICATION OF FEARS AND ANXIETIES • RAPID SPEECH • JOKING • MAKING LIGHT OF SITUATION • WITHDRAWAL

  12. NURSES ROLE • RECOGNIZING AND UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:

  13. PRE-OPERATIVE NURSING ASSESSMENT • PSYCHOLOGICAL ASSESSMENT: • Social History: smoking, alcohol consumption, occupation etc. • Family health history • Past health history & home medication:

  14. MEDICATIONS CON’T • STEROIDS-should not be stopped abruptly • Antidepressants can increase hypotensive effects of anesthesia • Antibiotics such as neomycin, kanamycin can combine with certain anesthetics & lead to respiratory paralysis • Insulin dosage may need to be adjusted-check with the physician • ASA thins blood so may increase post-op bleeding • Antihypertensives & cardiac drugs can’t be stopped abruptly • Check for the use of OTC drugs for glaucoma

  15. PHYSIOLOGICAL ASSESSMENT • Respiratory • HX of dyspnea, coughing, hemoptysis • COPD, or URI • Smoker? • Record baseline breath sounds • Diagnostic tests;; ABG’S CXR, FPT’S

  16. CARDIOVASCULAR • HX OF CARDIO OR CEREBRAL VASCULAR DISEASE • PACEMAKER • ARTIFICIAL VALVES • ANTICOAGULANT THERAPY

  17. CNS: (ENTRAL NERVOUS SYSTEM) • HX of stroke, TIA’S, • NEUROMUSCULAR DISORDERS SUCH AS MYASTHENIA GRAVI, • ESPECIALLY IMPORTANT TO ASSESS MENTAL STATUS • LOC

  18. PRE-OPERATIVE NURSING CARE • PRE – OPERATIVE TEACHING • THE NURSE IS RESPONSIBLE TO: • FIND OUT WHAT PT. KNOWS • INCLUDE FAMILY • USE SIMPLE TERMS • EVALUATE PT. UNDERSTANDING • USE AUDIOVISUAL AIDS • ASK FOR RETURN DEMONSTRATION

  19. PRE-OPERATIVE TEACHING • USUAL TOPICS COVERED • Preoperative tests • Preoperative routines • Schedule • PACU • FAMILY DIRECTIONS • POSTOP THERAPIES • PAIN MANAGEMENT • DIET

  20. PRE-OPERATIVE NURSING ASSESSMENT • PSYCHOLOGICAL ASSESSMENT • SOCIAL HISTORY • FAMILY HEALTH HISTORY • PAST HEALTH HISTORY • PHYSIOLOGICAL HISTORY

  21. PREOPERATIVE PHYSICAL PREPARATION • PRE-OP PHYSICAL PREPARATION • NUTRITIONAL • NIGHT BEFORE SURGERY, LIGHT MEAL OR LIQUID DIET • SPECIFIC IV FLUIDS • NPO AFTER MIDNIGHT • POSSIBILITY OF LIGHT BREAKFAST ON DAY OF

  22. PRE-OP PHYSICAL PREP • Intestinal • NPO • Enemas until clear • Laxatives • Antibiotics to decrease intestinal flora

  23. PRE-OP PHYSICAL PREP • Skin prep • Bathe before surgery • Shaving operative site • Scrub with betadine/other antiseptic

  24. Three important components of consent form • Adequate disclosure • Sufficient comprehension • Voluntary consent

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