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Peri-Operative Care

Peri-Operative Care. NURS 2016. Stages of the Peri-Operative Period. Pre-Operative From time of decision to have surgery until admitted into the OR theatre. Stages of the Peri-Operative Period. Intra-Operative

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Peri-Operative Care

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  1. Peri-Operative Care NURS 2016

  2. Stages of the Peri-Operative Period Pre-Operative • From time of decision to have surgery until admitted into the OR theatre.

  3. Stages of the Peri-Operative Period Intra-Operative • Time from entering the OR theatre to entering the Recovering Room or Post Anesthetic Care Unit (PACU)

  4. Stages of the Peri-Operative Period Post-Operative • Time from leaving the RR or PACU until time of follow-up evaluation (often as opt-patient)

  5. Ectomy Otomy Oscopy Pathy Rhage Oma Itis Logy Megaly Rhea Lysis Megaly Some Suffixes

  6. Chole Lap Dys Cyst Lith Carcin Neo Ortho Trans Some Prefixes

  7. Reduction Resection Bypass Excision I & D Aspiration DVT Dehiscence Evisceration Paralytic Ileus A Few Terms

  8. Classifications of Surgery • I Emergency: immediately • II Urgent: 24-30 hours • III Required: need surgery in upcoming weeks • IV Elective: Should have • V Optional: Not necessary – a choice

  9. Pre-Operative Period • Nursing Assessment • Nutritional and Fluid Status • Drug and Alcohol use • Respiratory Status • CV Status • Other system (renal, hepatic, immune • Medications • Psychosocial, spiritual and cultural beliefs

  10. Pre-Operative Period • Nursing Interventions • Teaching • Physical Prep • Surgical Site • Nutrition and Fluids • Preanesthetic Medication • Psychosocial Support • Reducing anxiety and addressing fears

  11. Pre-Operative Period • Teaching • Pain management • Deep Breathing and Coughing • Movement and Ambulation

  12. Pre-Operative Period • Pre-Op Checklist (figure 18.3, page 413) • Proper documentation complete • Physical and chemical work-up complete • Patient physically prepared • Current condition

  13. Intra-Operative Period • Nursing Roles: Patient Advocate • Scrub nurse • Responsible for ‘sterile’ work • Monitor sterile integrity of procedure • Monitors equipment (instruments, sutures, etc) • Circulating nurse • Protects patient safety • Monitors operating room conditions • Monitors surgical team activities

  14. Intra-Operative Period Stages of Anesthesia I: Beginning II: Excitement III: Surgical anesthesia IV: Medullary Depression

  15. Inhalation Halothane and methoxyflurane Administered via mask or endotracheal tube Inducation and recovery quite rapid Intravenous Tranq/Sedatives Opioids Neuroleptanalgesics Dissociative Agents Barbiturates Nonbarbiturates Intra-Operative Period:Achieving Anesthesia

  16. Intra-Operative Period Anesthesia is not always General • Regional • Blocks • Local infiltration

  17. Intra-Operative Period Complications • Nausea and vomiting • Anaphylaxis • Hypoxia • Hypothermia • Malignant Hyperthermia • DIC

  18. Post-Operative Period • Immediate Post-Op • PACU • Assist and monitor patient in post-anesthetic stage • Airway, circulation, hemorrhage, nausea/vomiting • Recovery • Clinical Unit • Discharge home

  19. Post-Operative Period: Clinical Unit Primary focus • Neurological status • Pain management • Respiratory function • Circulatory function • Wound care • Fluid Balance • Nutritional status

  20. Post-Operative Period Immediate Assessment • Level of consciousness • Vital Signs (q15 x 2, q30, . . .) • Wound • Fluid Balance • Pain

  21. Preventing Respiratory Complications Relieving Pain Promoting Cardiac Function Encouraging Activity Promoting Wound Healing Maintaining Body Temp Monitoring GI Function Managing Voiding Providing Support Post-Operative Period: Recovery:Day 1 to Discharge

  22. Post-Operative Period: Complications • Deep Vein Thrombosis • Hematoma • Infection • Wound Dehiscence

  23. Post-Operative Period • Consider the list of Nursing Diagnosis provided • What nursing interventions would be appropriate

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