Chapter 27 Perioperative Care

1. Chapter 27 Perioperative Care

2. Is the following statement true or false? Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart. Question

3. True. Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart. Answer

4. Introduction to OperativeCare Perioperative care is care that clients receive before, during, and after surgery Nurses assume general responsibilities when caring for clients during the preoperative, intraoperative, and postoperative periods of perioperative care

5. Preoperative Period Starts when client, or his family in an emergency situation, learn that surgery is necessary Ends when client istransported to the operating room

6. Types of Surgery According to Urgency

7. Preoperative Period (cont’d) Inpatient surgery Term used for procedures performed on a client who is admitted to the hospital, expected to remain at least overnight, and needs nursing care for more than 1 day after surgery Clients who have inpatient surgery undergo prior laboratory and diagnostic tests

8. Preoperative Period (cont’d) Inpatient surgery (cont’d) Anesthesiologist: physician who administers chemical agents that temporarily eliminate sensation and pain Anesthetist: nurse specialist who administers anesthesia under the direction of a physician

9. Question Removal of a cataract falls under which type of surgery? a. Required b. Emergency c. Urgent d. Elective

10. Answer a. Required The type of surgery conducted for the removal of a cataract is called “required surgery.” Surgery for relieving an intestinal perforation is an example of an “emergency surgery.” Removal of a malignant tumor is an example of an “urgent surgery.” Removal of a superficial cyst is known as an “elective surgery.”

11. Preoperative Period (cont’d) Outpatient surgery Term used for operative procedures performed on clients who return home the same day

12. Advantages and Disadvantages of Outpatient Surgery

13. Preoperative Period (cont’d) Outpatient surgery (cont’d) Clients remain in the outpatient surgical suite for a brief time and get discharged by midafternoon or early evening when: The client is awake and alert Vital signs are stable Oral fluids are retained

14. Preoperative Period (cont’d) Laser surgery Used as an alternative to many previously conventional surgical techniques such as reattaching the retina, removing skin tattoos, and revascularizing ischemic heart muscle

15. Preoperative Period (cont’d) Laser surgery (cont’d) Advantages Cost effectiveness Reduced need for general anesthesia Minimal blood loss Less time recuperating

16. Laser surgery (cont’d) Laser technology requires unique safety precautions such as eye, fire, heat, and vapor protection Various safety measures are taken during laser surgery Preoperative Period (cont’d)

17. Preoperative Period (cont’d) Informed consent Permission for a procedure thata client gives after an explanation of the risks, benefits, and alternatives

18. Surgical Consent Form

19. Preoperative blood donation Autologous transfusion: self-donated blood Directed donors: blood donors chosen from among the client’s relatives and friends If directed donation not used, it is available for use by other clients Preoperative Period (cont’d)

20. Question Which of the following types of surgeries is used for removal or replacement of defective tissues to restore function? a. Palliative b. Exploratory c. Curative d. Diagnostic

21. Answer c. Curative Curative surgery is used for the purpose of removal or replacement of defective tissues to restore function. Relief of symptoms or enhancement of function without cure is called palliative surgery. Exploratory surgery is a more extensive means to diagnose a problem. Removal and study of tissues to make a diagnosis is called diagnostic surgery.

22. Immediate preoperative care Nursing assessment Surgical risk factors Low hemoglobin and red cells Cardiopulmonary disease Malnutrition Dehydration Preoperative Period (cont’d)

23. Immediate preoperative care (cont’d) Preoperative teaching Deep breathing Coughing Leg exercises Postoperative pain management Preoperative Period (cont’d)

24. Immediate preoperative care (cont’d) Physical preparation Skin preparation Elimination Food and fluid restrictions Preoperative Period (cont’d)

25. Preoperative Period (cont’d) Immediate preoperative care (cont’d) Physical preparation (cont’d) Care of valuables Surgical attire Disposition of dentures and prostheses

26. Immediate preoperative care (cont’d) Preoperative medications Psychosocial preparation Preoperative checklist Preoperative Period (cont’d)

27. Preoperative Checklist

28. Receiving room Operating room Surgical waiting area Intraoperative Period

29. Intraoperative Period (cont’d) Anesthesia General: central nervous system Regional: specific area of the body Local Spinal, epidural, peripheral nerve blocks Conscious sedation: clients are sedated, a state of relaxation and emotional comfort but not unconsciousness; client can respond verbally and physically

30. Question Which of the following postoperative complications is a protrusion of abdominal organs through separated wounds? a. Wound infection b. Adynamic ileus c. Dehiscence d. Evisceration

31. Answer d. Evisceration A postoperative complication in which abdominal organs protrude through separated wounds is called evisceration. A wound infection indicates proliferation of pathogens at or beneath the incision. An adynamic ileus signifies lack of bowel activity, and dehiscence indicates separation of incisional edges.

32. Postoperative Period Immediate postoperative care Initial postoperative assessments Preparing the room Monitoring for complications Continuing postoperative care Food and oral fluid intake

33. Postoperative Period (cont’d) Continuing postoperative care (cont’d) Promoting venous circulation Pneumatic compression device Antiembolism hose Wound management Elimination

34. Pneumatic Compression Device

35. Postoperative Period (cont’d) Continuing postoperative care (cont’d) Discharge instructions How to care for the incision site Signs of complications to report Which foods to consume or avoid When and where to return for a medical appointment

36. Nursing Implications Applicable nursing diagnoses Deficient knowledge, fear, acute pain Risk for ineffective therapeutic regimen management, infection, impaired gas exchange, deficient fluid volume Ineffective breathing pattern, airway clearance Impaired skin integrity, disturbed body image

37. General Gerontologic Considerations Chronic health concerns in older clients may increase preoperative/postoperative periods Muscle atrophy occurs in older adults who have been on bed rest as little as 1 or 2 days; range-of-motion exercises can maintain mobility Important to assess client’s support system for care at home; client may need home rehabilitation services or extended care admission

38. General Gerontologic Considerations (cont’d) Wound healing may occur more slowly due to impaired circulation and oxygenation; poor hydration and nutrition Postoperative signs and symptoms may be more subtle or delayed; change in mental status may be early indicator of infection Cardiac status of older adults is monitored carefully after surgery