Unit 29

1. Unit 29 The Surgical Patient

2. Objectives • Spell and define terms. • Describe the concerns of patients who are about to have surgery. • List the various types of anesthesia. • Shave the area to be operated on. • Prepare the patient’s unit for the patient’s return from the operating room.

3. Objectives • Give routine postoperative care when the patient returns to the room. • Assist the patient with deep breathing and coughing. • Apply elasticized stockings or bandages and pneumatic hosiery.

4. Introduction • Patients facing any surgical procedure tend to be fearful. • Remember that these patients require great emotional and physical support. • Such support should be given from the time each patient is admitted through the time the patient is discharged.

5. Hair Removal • Follow facility policies for preoperative hair removal: • A doctors’ order may be required to do a shave • Some people have coarse body hair that dulls the razor • Replace as often as needed

6. Hair Removal • Follow facility policies for preoperative hair removal: • Clippers and scissors may also be used for hair removal • Remove hair as close to the time of procedure as possible

7. Preoperative Responsibilities • Nursing assistant should do the following before a patient has surgery: • Remove patient’s dentures • Remove prostheses, including contact lenses, hearing aids, and glasses • Recheck vital signs • Inform RN if they are abnormal

8. Pain Perception • Before surgery • Patient is given medication to promote relaxation • Keep the side rails up • Do not allow the patient to get up unattended after medication has been given

9. Pain Perception • During surgery • Anesthetics are given to prevent pain • After surgery • Medications are given to reduce discomfort

10. Anesthesia • Given to prevent pain, to relax muscles, and to induce forgetfulness

11. Anesthesia • Anesthetic agent and method of administration • Determined by the location and type of surgery to be performed • Length of time needed for surgery • Patient’s physical condition

12. Anesthesia • Two main types of anesthetics: 1.General anesthetics induce the patient to become unconscious

13. Anesthesia • Two main types of anesthetics: 2. Local anestheticsinduce the loss of feeling in a specific area • Spinal anesthesiais given by inserting a long needle into the cerebrospinal fluid • If this anesthesia is given, keep the head of the bed flat postoperatively until instructed by the RN

14. Surgical Care • The care of the surgical patient can be divided into three parts: • Preoperative • Operative • Postoperative

15. Perioperative Hypothermia • Anesthesia and some sedatives • Disrupt internal ability to regulate temperature • Drugs • Promote heat loss by reducing shivering response • Prevent blood vessel constriction

16. Perioperative Hypothermia • Opening body cavities during surgical procedure • Further cools internal structures • Open body cavities combined with administration of blood and IV fluids • Further contribute to temperature loss

17. Perioperative Hypothermia • Some facilities: • Monitor patients’ temperatures throughout procedure, especially children • Body temperature • Cannot return to normal until anesthetic wears off • This allows normal temperature regulating responses to take over

18. Perioperative Hypothermia • Pain • Further decreases effectiveness of these responses • Return to normal temperature may take two to five hours • Depending on degree of hypothermia and age of patient

19. Antiembolism Hosiery • Physician may order antiembolism hosiery • Also called elastic hosiery or GPS compression hosiery

20. Antiembolism Hosiery • Never guess at hosiery size • Measure legs with a disposable tape measure • Compare measurements with size chart • Refer to Figure 29-16 • Follow policies for periodic hosiery removal and circulation checks

21. Antiembolism Hosiery