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Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE

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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Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE

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  1. Perioperative NursingPeg Trueman RN MSN Ed.D. CNE

  2. Meet the Patient • The experience of surgery is a routine event for everyone involved EXCEPT for the patient!

  3. Nursing Management after Surgery

  4. Postoperative Phase:Plan of Care System Assessments and related nursing diagnoses

  5. System Assessments • Respiratory • Cardiovascular • Fluid Status • Nutrition • Elimination • Activity • Wound Healing

  6. Respiratory • Pulmonary assessment data • TCDB • C/I: CHI, eye sx • O2 therapy • IPPB • I.S. The real reason dinosaurs became extinct.

  7. 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

  8. Fluid Status • Hydration status data • Drainage amts • vital signs • daily weights! • IV therapy • Blood therapy

  9. 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!”

  10. Elimination • Urinary output • retention?!! • Dehydration • Catheter is the last resort! • Bowel activity • bowel sounds • flatus • Ambulation!!!!

  11. Activity • OOB ASAP!! • Usually within 24 hrs • Psychological impact • Needs encouragement!

  12. Physiology of Wound Healing • Inflammatory Stage • “insult” • Proliferative Stage • reinforcemen/framework • Maturation Stage • “settling in”

  13. Wound Healing:First Intention • Scar formation is minimal • Properly closed • Heal with little tissue reaction

  14. Wound Healing:Second Intention • Wound is left open to granulate • Resultant in scar formation • “Healing by granulation”

  15. Wound Healing:Third Intention • Two opposing granulation surfaces are brought together • Scar is deeper and wider • “Delayed closure”

  16. Age Hemorrhage Hypovolemia Local Factors Nutritional Deficits Oxygen deficit Drainage Medications Systemic Disorders Wound Stressors Factors Affecting Wound Healing

  17. Wound Care “Just a friendly suggestion…next time you do a dressing change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”

  18. 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

  19. Post-op Pain Control • Common Pain Medication • Demerol • Morphine • Dilaudid • Stadol • NSAIDs • Side Effects of Pain medication*

  20. Managing Potential Complications • Shock/Hemorrhage • Deep Vein Thrombosis (DVT) • Pulmonary Embolism • Respiratory Complications • Urinary Retention • Intestinal Obstruction • Wound Complications

  21. Surgery Specific Care • Postoperative Uniquities and “worries”

  22. Remember Mr. P? • Case Study Review

  23. Perioperative Nursing "Dr. Trueman, can I be excused? My brain is full."

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