PREPARING FOR THE PATIENT IN SURGERY

1. PREPARING FOR THE PATIENT IN SURGERY WEEK 6

2. Why Me?Thoughts that run thru the pt’s mind • Pt’s often question why them? • Component that make up the individual: • Physical Need: any need or activity related to genetics, physiology, or anatomy. • Psychological Need: Any need or activity related to the ID and understanding of one’s self. • Social Need: Any need or activity related to one’s ID or interaction with another person or group. • Spiritual Need: Any need or activity related to one’s ID and understanding place in the universe.

3. Why Me? • All of these needs exist as a group, not individually. • However, each individual is unique as each handles each situation differently. • Family members must be considered as well with consideration of their physical, psychological, social, and spiritual issues (maintain communication prn)

4. Reasons for Surgery • Genetic deformity – Cleft Lip • Trauma – MVA • Nonmalignant tumor – Uterine Fibroid • Malignant tumors – Colon cancer • Disease - HIV • Condition – Kidney Stone • Psychological state – Facelift (Rhytidectomy)

5. Preparing for the Patient in Surgery Requires Knowledge of: • HOLISTIC APPROACH Recognizing our patients as a person, not the case in OR #4 or the radical mastectomy in OR #4 • Maslow’s “Hierarchy of Needs”, a view of human development • “Life Tasks Approach” to psychosocial needs pg 61 • Cultural and Religious Influences • The “Nursing Process” as applicable to the ST

6. Maslow’s Hierarchy of Needs

7. Physiological Needs • Most basic biological or survival needs of the patient • Oxygen • Water • Food • Temperature regulation

8. Safety Needs • Patient’s perception of placing trust that their environment is safe • Trust in surgeon • Trust in staff/institution • Warmth provided • Protected from infection by asepsis • Positioned comfortably • Injury prevented

9. Love and Belonging Needs(Social) • Recognized and cared for as an individual • Caring for others • Interacting with others: family, friends, church members, and co-workers

10. Esteem Needs • Positive regard for one’s self and others • To be respected and respect others

11. Self-Actualization • To fulfill what one views as their potential or purpose in life

12. Application of Maslow in Surgery • Prioritization of care in surgery • Trauma for example: biological issues take precedence (oxygen, blood loss control, pain relief, and infection control) • Can also recognize patient’s rights • Provide competent care • Provide safety, privacy, and respect

13. Development and Change • Life Tasks Approach (Table 4-2, pg. 61) • The Life Tasks Approach gives us a way to understand a surgical patient’s needs and fears

14. Development and Change • Open to page 61 - discuss

15. Death and Dying • 3 accepted definitions of death: • Cardiac death: complete absence of heartbeat and respiration. • Higher Brain Death: irreversible loss of higher brain function. PT still has respiration, BP, and heart beat w/o the aid of a respirator. • Whole-Brain Death: irreversible loss of all brain function. Includes flat EEG, lack of pupil reflexes, and hypothermia.

16. Cultural Considerations • Gives us a perspective of the surgical patient’s thoughts and feelings about health care needs • Language can be a huge barrier • Cultural considerations can help us for when we can’t communicate, as well as when we can

17. Asian Americans • Chinese: • silence is valued • touch is limited • fear invasive procedures • distrustful of doctors and health care workers who perform painful procedures • both parents involved in decisions regarding their children

18. Asian Americans continued • Japanese: • touch is limited • feel direct eye contact disrespectful • stoic • family needs come first • eldest child cares for elderly

19. Asian Americans continued • Vietnamese: • eye contact disrespectful • father is decision maker • use titles when addressing • do not ask direct questions

20. Asian Americans continued • Filipinos: • avoid eye contact • value nonverbal communication • family needs come first

21. Hispanic Americans • Father needs to be there when speaking to male children • Familial and personal privacy valued/very modest • Father decision maker and provider for family • Women tend to the ill • Fearful of hospitals/may see as a “place to die”

22. American Indians • Avoid prolonged direct eye contact • Family members are responsible for each other • Takes time for them to form opinions about health care providers • Elders assume leadership roles • With amputated limbs, may require them to go to the family or stay with patient

23. Middle Eastern • No touching outside family or spouse • Male dominated culture, therefore is decision maker • Males are only to be alone with their wife, not other females (May require male health care workers) • Females can only be touched by female health care providers

24. Appalachian • Direct eye contact disrespectful • Kindness valued • Judge health care workers by how they relate to them not by competence • Fearful of hospitals, considered a “place to die” • Care of the ill is provided by family including extended family members

25. Religious Considerations • ST needs a basic understanding of different religions and their relationship to health care • Religion can raise ethical and legal issues for patients and health care providers • Religion can conflict with modern medical technology

26. American Indian • Abortion not allowed • Organ transplantation discouraged • Medical treatment views vary

27. Islam • Privacy important • Medical treatment is encouraged

28. Roman Catholic • Abortion not allowed

29. Jehovah’s Witness • No food containing blood • No blood transfusion • Abortion not allowed • Organ transplantation allowed provided organ is stripped of all blood

30. Special Populations • Pediatric patients • Geriatric patients • HIV, Trauma, Organ Donor or Recipient

31. Pediatric Patients • Specialty area • Anatomy and physiology differ from adult • Response to anesthesia and other medications differ from adults • Psychologically, communication with child dramatically different • Descriptions of pain and pain locations may not be precise like an adult

32. Pediatric Patient continued • Surgical team will naturally feel more protective towards children • Communication with infant to two year olds will be limited to reassurances and snuggling • Explanations should be short and appropriate for the three year old to twelve year old

33. Surgical Team Role with Pediatric Patient • Obtain good anesthesia • Finish surgical procedure effectively, efficiently, and safely • Get the child back to their family as soon as possible • Will be more sensitive to cold room temperatures due to decreased body surface area, so room will be kept very warm

34. Geriatric Patients • May or may not have diminished mental status/Do not assume all elderly are “senile” as most are not • Pay special attention to physical changes in the body that do affect all elderly and directly influence our care of them

35. Physical Changes of the Geriatric Patient • Skin loses elasticity causing it to easily bruise or tear • Care must be taken when moving and positioning patient to avoid shearing or bruising of the skin • Care must be taken when applying and removing tape and or other sticking drape materials to avoid thin areas of skin and ripping skin off the body • Sensitive to prolonged pressure over bony prominences/Pad these areas well to avoid ulceration

36. Physical Changes of the Geriatric Patient • Loss of subcutaneous layer or fatty/protective layer of skin • Causes sensitivity to cold and can result in hypothermia • Use warm blankets and warm fluids • Keep as much of the body insulated as possible • With Bair Huggers always attach/Never leave hose free to just blow onto body as can cause major burns

37. Physical Changes of the Geriatric Patient • Loss of bone, joint mobility, and muscle mass • Loss of flexibility • More prone to fracturing of the bones • Extreme care with positioning and padding

38. Physical Changes of the Geriatric Patient • Loss of urinary bladder and bowel control • Don’t be surprised by SURPRISES • Maintain patient integrity and privacy and assist with cleaning at the end of the procedure before transport • SURPRISES that have prolonged contact with the skin can cause breakdown of the skin

39. HIV, Trauma, Organ Donors or Recipients • Maintain caring environment • Maintain asepsis • Maintain same high level of care to surgeon and patient • Protect the patient from injury from environmental hazards

40. ST Responsibilities • Ethically and legally responsible to provide service to our surgeon and patient despite how we feel about the culture or religious beliefs of our surgeons or patients • Must provide a caring environment • Must provide surgical asepsis • Must protect the patient from injury • THE PATIENT COMES FIRST

41. Maintaining the Surgical Environment Continued • Speak in a calm, clear, unhurried tone • Move patients with care paying attention to proper body alignment and any IV lines or other lines that could get snagged during movement from stretcher to OR bed and back • Maintain safety precautions for everything in the OR room that could cause the patient harm or injury • Perform tasks in an efficient and effective manner • BE EXTRA EYES AND EARS FOR THE PATIENT’S NEEDS AND SAFETY

42. Helping to Maintain the Surgical Environment as the ST • Can introduce self professionally • Maintain communication with the RN circulator throughout the surgical procedure • Aid with reports on where you are in the procedure and status of the patient so the RN circulator can keep the family informed • If assisting the circulator, a touch or squeeze of the patient’s hand can calm a fearful patient • Explain everything you are going to do when the patient is awake (regional anesthesia) • Use appropriate language that can be understood not medical terms

43. Military Time

44. Military Time • You will often see military time in the OR, on the chart and used between staff. • It is used to avoid confusion between a.m. and p.m. since we are a 27/7 service. • The main difference between regular and military time is how hours are expressed. Regular time uses numbers 1 to 12 to identify each of the 24 hours in a day. In military time, the hours are numbered from 00 to 23. Under this system, midnight is 00, 1 a.m. is 01, 1 p.m. is 13, and so on.

45. Military Time Morning After Noon (just add 12) Noon = 1200 1:00 p.m. = 1300 3:00 p.m. = 1500 6:00 p.m. = 1800 • Midnight = 0000 • 1:00 a.m. = 0100 • 3:00 a.m. = 0300 • 6:00 a.m. = 0600

46. Summary • Reasons for surgery • Recognizing patient as a person: physical psychological social spiritual

47. Summary continued • Maslow’s Hierarchy of Needs • Life Tasks Approach to development and change • ST role in maintaining surgical environment • Cultural considerations • Religious considerations

48. Summary continued • Special populations: Pediatric Geriatric HIV, Trauma, Organ donor or recipient • ST responsibilities