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Perioperative Nursing Peg 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 and related nursing diagnoses.
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Meet the Patient • The experience of surgery is a routine event for everyone involved EXCEPT for the patient!
Postoperative Phase:Plan of Care System Assessments and related nursing diagnoses
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 “Okay, Williams, we’ll vote… how many here say the heart has four chambers?” • Cardiac assessment data • Leg exercises • Avoiding venous statsis • ICD/hose
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”
Age Hemorrhage Hypovolemia Local Factors Nutritional Deficits Oxygen deficit Drainage Medications Systemic Disorders Wound Stressors Factors Affecting Wound Healing
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 "Dr. Trueman, can I be excused? My brain is full."