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Perioperative Nursing Definition of Surgery

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Perioperative Nursing Definition of Surgery Surgery is any procedure performed on the human body that uses instruments to alter tissue or organ integrity. – PowerPoint PPT presentation

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Title: Perioperative Nursing Definition of Surgery


1
Perioperative Nursing Definition
of Surgery
  • Surgery is any procedure performed on the human
    body that uses instruments to alter tissue or
    organ integrity.

2
Perioperative Nursing
  • Perioperative Nursing- connotes the delivery of
    patient care in the preoperative,intraoperative,
    and postoperative periods of the patients
    surgical experience through the framework of the
    nursing process. The nurse assesses the patient-
    collecting,organizing, and prioritizing patient
    data establishing nursing diagnosisidentifies
    desired patient outcomesdevelop and implements a
    plan of care and evaluates that care in terms of
    outcomes achieved by the patient.

3
Perioperative Nursing Phases
  • Preoperative phase begins when the decision to
    have surgery is made and ends when the client is
    transferred to the OR table.
  • Intraoperative phase begins when the client is
    transferred to the OR table and ends when the
    client is admitted to the PACU.
  • Postoperative phase - begins with the admission
    of the client to the PACU and ends when the
    healing is complete.

4
Perioperative Nursing Types of
Surgery
  • Purpose/reasons -
  • Degree of urgency necessity to preserve the
    clients life, body part, or body function.
  • Degree of risk involved in surgical procedure
    is affected by the clients age, general health,
    nutritional status, use of medications, and
    mental status.
  • Extent of surgery Simple and radical

5
Perioperative Nursing Type of
Surgery (Purpose)
  • Diagnostic-Allows to confirm or establishes
    diagnosis.
  • Corrective- Excision or removal of diseased body
    part.
  • Reconstructive-Restore function or appearance to
    traumatized or malfunctioning tissues.
  • Ablative Removes a diseased body parts
  • Palliative Relieves or reduces pain or symptoms
    of a disease it does not cure
  • Transplant Replaces malfunctioning structures
  • Cosmetic- Performed to improve personal
    appearance.

6
Perioperative Nursing Types of Surgery
(Urgency)
  • Emergency- performed immediately to preserve
    function or the life of the client.
  • Elective is performed when surgical
    intervention is the preferred treatment for a
    condition that is not imminently life threatening
    or to improve the clients life.
  • Urgent Necessary for client health to prevent
    additional problem from developing not
    necessarily an emergency.
  • Required has to be performed at some point can
    be pre-scheduled.

7
Perioperative NursingType of Surgery
(Degree of Risk)
  • Major involves a high degree of risk.
  • Minor normally involves little risk.
  • Age very young and elder clients are greater
    surgical risks than children and adult.
  • General health- surgery is least risky when the
    clients general health is good.
  • Nutritional Status required for normal tissue
    repair.
  • Medications regular use of certain medications
    can increase surgical risk.
  • Mental status disorder that affect cognitive
    function

8
Perioperative Nursing Surgical
settings
  • Surgical suites
  • Ambulatory care setting
  • Clinics
  • Physician offices
  • Community setting
  • Homes

9
Perioperative Nursing Surgical
settings
  • Disadvantages Less time for
    rapport Less time to assess, evaluation,
    teach Risk of potential complication post D/C.
  • Advantages of outpatient Low cost Low
    risk of infection Less interruption of
    routine Less than from work Less stress

10
Preoperative Nursing
Consent
  • Nature and intention of the surgery
  • Name and qualifications of the person performing
    the surgery.
  • Risks, including tissue damage, disfigurement, or
    even death
  • Chances of success
  • Possible alternative measures
  • The right of the client to refuse consent or
    later withdraw consent.

11
Preoperative Nursing Assessment
(Nursing History)
  • Current health status-
  • Allergies
  • Medications- list all current medications
  • Previous surgeries
  • Understanding of the surgical procedure and
    anesthesia
  • Smoking
  • Alcohol and other-altering substances
  • Coping
  • Social resources
  • Cultural considerations

12
Preoperative Nursing Care Physical
assessment
  • Cardiovascular system
  • Respiratory system
  • Renal system
  • Neurological system
  • Musculoskeletal system
  • Nutritional status
  • Gerontological considerations

13
Perioperative Nursing CarePhysical
assessment/clinical manifestations
  • General survey- gestures and body movements may
    reflect decreased energy or weakness caused by
    illness.
  • Cardiovascular system- alterations in cardiac
    status are responsible for as many as 30 of
    perioperative death.
  • Respiratory system- a decline in ventilatory
    function, assessed through breathing pattern and
    chest excursion, may indicate a clients risk for
    respiratory complications.

14
Perioperative Nursing CarePhysical
assessment/clinical manifestations
  • Renal system-abnormal renal function can altered
    fluid and electrolyte balance and decrease the
    excretion of preoperative medications and
    anesthetic agents.
  • Neurologic system- a clients LOC will change as
    a result of general anesthesia but should return
    to the preoperative LOC after surgery.

15
Perioperative Nursing CarePhysical
assessment/clinical manifestations
  • Musculoskeletal system- Deformities may interfere
    with intraoperative and postoperative
    positioning. Avoid positioning over an area where
    the the skin shows signs of pressure over bony
    prominences.
  • Gastrointestinal system- alteration in function
    after surgery may result in decreased or absent
    bowel sound and distention.
  • Head and Neck- the condition of oral mucous
    membranes reveals the level of hydration.

16
Preoperative Nursing Care
Gerontological Considerations
  • Cardiovascular Coronary flow
    decreases Heart rate decreases Response to
    stress decreases Peripheral vascular
    decreases Cardiac output decreases Cardiac
    reserve decreases

17
Preoperative Nursing Care Gerontological
Considerations
  • Respiratory System
  • Static lung volumes decreases
  • Pulmonary static recoil decreases
  • Sensitivity of the airway receptors decreases
  • Nervous system
  • Increased incidence of post.op. confusion.
  • Increased incidence of delirium
  • Increased sensitivity to anesthetic agents

18
Preoperative Nursing Care Gerontological
Considerations
  • Renal System Renal blood flow declines 1.5
    per year. Renal clearance reduced
  • Gastrointestinal Decreased intestinal
    motility
  • Decreased liver blood flow Delayed gastric
    emptying

19
Preoperative Nursing Care Gerontological
Considerations
  • Musculoskeletal Decreased mass, tone,
    strength Decreased bone density
  • Integumentary Decreased elasticity Decreas
    ed lean body mass Decreased subcutaneous fat

20
Preoperative Nursing Care Psychosocial
considerations
  • Level of anxiety
  • Coping ability
  • Support systems

21
Preoperative Nursing Care Laboratory
and diagnostic studies
  • Screening tests depend on the condition of the
    client and the nature of the surgery. If test
    reveals severe problems the surgery may be cancel
    until the condition is stabilized.
  • Routine screening test-CBC,Blood grouping and
    X-match, Lytes, fasting blood sugar, BUN
    Creatinine, ALT,AST, and bilirubin,Serum albumin,
    and Total protein, Urinalysis, Chest X-ray,ECG

22
Preoperative Nursing Care Common nursing
diagnosis
  • Knowledge deficit
  • Anxiety
  • Risk for ineffective airway clearance
  • Fear related to
  • Disturbed sleep pattern
  • Anticipatory grieving related to

23
Preoperative Nursing Care
Preop. teaching
  • The education plan should begin with assessment,
    including baseline knowledge of the patient and
    family, readiness to learn,barriers to learning,
    patient and family concern and learning styles
    and preferences.
  • The content focuses on information that will
    increase patients familiarity with procedural
    events. This includes surgical experience
    (procedural), what the pt. may experience
    (sensory) and what actions may help decrease
    anxiety (behavioral).

24
Preoperative Nursing Care Anxiety
  • The nurse must consider the pts family and
    friends when planning psychological support.
  • Empowering their sense of control. Activities
    that decreasing anxiety are deep breathing,
    relaxation exercises, music therapy, massage and
    animal-assisted therapy.
  • Use of medication to relieve anxiety.

25
Preoperative Nursing CarePreanesthesia
Management Physical Status Categories
  • ASA 1 Healthy patient with no disease
  • ASA 11 Mild systemic ds without fx limitations
  • ASA 111Severe systemic ds associated with
    definite fx limitations
  • ASA 1V Severe systemic ds that is a constant
    threat to life.
  • ASA V Moribund pt. Who is not expected to
    survive without the operation.
  • ASA V1 A declared brain-death whose organ are
    being recovered for donor.
  • E Emergency

26
Preoperative Nursing CareFinal Preparation for
surgery
  • All personal belongings are identified and
    secured.
  • Jewelry is usually removed.
  • Dentures are removed, labeled and placed in a
    denture cup.
  • Pt. to verbally confirm the surgical procedures
    and the surgical site. This verification process
    is documented in the medical record on the preop.
    checklist.

27
Preoperative Nursing Care Pre-op.
medications
  • Prior to administering check permits
  • Purpose Allay anxiety Decrease pharyngeal
    secretions- Decrease gastric
    secretion.
  • Decrease side effects of anesthesia.
  • Induce amnesia

28
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29
Preoperative Nursing Care Medications
  • Sedatives/hypnotics- Nembutal
  • Tranquilizers-Ativan, versed, valium
  • Opiate analgesics- Demerol, morphine
  • Anticholinergics-Atropine sulfate,atarax
  • H2o blockers.- Tagamet, Zantac
  • Antiemetic- Reglan, Phenergan

30
Intraoperative Phase Surgical
Team
  • Surgeon
  • Anesthesiologist
  • Scrub Nurse
  • Circulating Nurse
  • OR techs

31
Intraoperative Nursing Care Roles of
team members
  • Surgeon-responsible for determining the
    preoperative diagnosis, the choice and execution
    of the surgical procedure, the explanation of the
    risks and benefits, obtaining inform consent and
    the postoperative management of the patients
    care.
  • Scrub nurse- (RN or Scrub tech)- preparation of
    supplies and equipment on the sterile field
    maintenance of pt.s safety and integrity
    observation of the scrubbed team for breaks in
    the sterile fields provision of appropriate
    sterile instrumentation, sutures, and supplies
    sharps count.

32
Perioperative Nursing CareSurgical team
  • Circulating Nurse - responsible for creating a
    safe environment, managing the activities outside
    the sterile field, providing nursing care to the
    patient. Documenting intraoperative nursing care
    and ensuring surgical specimens are identified
    and place in the right media. In charge of the
    instrument and sharps count and communicating
    relevant information to individual outside of the
    OR, such as family members.

33
Perioperative Nursing CareSurgical team
  • Anesthesiologist and anesthetist- anesthetizing
    the pt. providing appropriate levels of pain
    relief, monitoring the pts physiologic status
    and providing the best operative conditions for
    the surgeons.
  • Other personnel- pathologist, radiologist,
    perfusionist, EVS personnel.

34
Perioperative Nursing Care Surgical team
  • Nursing Roles
  • Staff education
  • Client/family teaching
  • Support and reassurance
  • Advocacy
  • Control of the environment
  • Provision of resources
  • Maintenance of asepsis
  • Monitoring of physiologic and psychological status

35
Intraoperative Nursing Care Surgical
asepsis
  • Ensure sterility
  • Alert for breaks

36
Intraoperative Phase Anesthesia
  • Greek word- anesthesis, meaning negative
    sensation. Artificially induced state of partial
    or total loss of sensation, occurring with or
    without consciousness.
  • Blocks transmission of nerve impulses
  • Suppress reflexes
  • Promotes muscle relaxation
  • Controlled level of unconsciousness

37
Intraoperative Phase
Anesthesia
  • Factors influencing dosage and type
  • Type and duration of the procedure
  • Area of the body being operated on
  • Whether the procedure is an emergency
  • Options of management of post. Op. pain
  • How long it has been since the client ate, had
    any liquids, or any medications
  • Client position for the surgical procedures

38
Intraoperative Phase Types of
Anesthesia
  • General- method use when the surgery requires
    that the patient be unconscious and/or paralyzed.
  • A general anesthetic acts by blocking awareness
    centers in the brain so that amnesia (loss of
    memory), analgesia (insensibility to pain),
    hypnosis (artificial sleep), and relaxation
    (rendering a part of the body less tense) occur.

39
Intraoperative Phase Stages of
General Anesthesia
  • Stage 1- Analgesia and sedation, relaxation
  • Stage 2- Excitement, delirium
  • Stage 3- Operative anesthesia, surgical
    anesthesia
  • Stage 4- Danger

40
Intraoperative Phase
  • Complications of General Anesthesia
  • Overdose
  • Hypoventilation
  • Related to anesthetic agents
  • Malignant hyperthermia
  • Related to intubation

41
Intraoperative Phase
  • Local or Regional Anesthesia
  • Temporarily interrupts the transmission of
    sensory nerve impulses from a specific area or
    region.
  • Motor function may or may not be affected
  • Client does not lose consciousness
  • Gag reflex remains intact
  • Supplemented with sedatives, opioids, or
    hypnotics

42
Types of Regional Anesthesia
  • Topical (surface)
  • Local
  • Nerve Block
  • Intravenous (Bier Block)
  • Spinal
  • Epidural (peridural)

43
Intraoperative Phase
  • Complications of Local/Regional Anesthesia
  • Anaphylaxis
  • Administration technique
  • Systemic absorption
  • Overdosage

44
Spinal Anesthesia
  • Indications -surgical procedures below the
    diaphragm
  • -patients with cardiac or respiratory disease
  • Advantages -mental status
    monitoring -shorter recovery
  • Disadvantages -necessary extra
    expertise -possible patient pain
  • Contraindications -coagulopathy -uncor
    rected hypovolemia

45
Spinal Anesthesia
  • Involved medications -lidocaine -bupivac
    aine -tetracaine
  • Patient assessment -continuous heart rate,
    rhythm, and pulse oximetry monitoring -leve
    l of anesthesia -motor function and sensation
    return monitoring

46
Spinal Anesthesia
  • Complications -hypotension -bradycardia
    -urine retention -postural puncture
    headache -back pain

47
Spinal analgesia
  • Indications -postoperative pain from major
    surgery
  • Involved medications -lipid-soluble
    drugs -preservative-free morphine
  • Monitoring recovery -respiratory
    depression -urine depression -pruritus
    -nausea and vomiting

48
Examples of location for Spinal and Epidural
Anesthesia.
49
Nerve Block Sites
50
Intraoperative Phase
  • Conscious Sedation
  • Administration of IV sedative, hypnotic, and
    opioid medications.
  • Produces a depressed level of consciousness
  • Retains ability to maintain a patent airway
  • Able to respond to verbal commands or physical
    stimulation
  • Used for relatively short procedures

51
Postoperative Nursing CareNursing assessment in
the PACU
  • Vital signs- presence of artificial airway, 02
    sat,BP,pulse, temperature.
  • LOC- ability to follow command, pupillary
    response
  • Urinary output
  • Skin integrity
  • Pain
  • Condition of surgical wound
  • Presence of IV lines
  • Position of patient

52
Postoperative Nursing CareNursing Diagnosis
  • Ineffective airway clearance- increased
    secretions 2 to anesthesia, ineffective cough,
    pain
  • Ineffective breathing pattern- anesthetic and
    drug effects, incisional pain
  • Acute pain
  • Urinary retention
  • Risk for infection

53
Postoperative Phase
  • Assessment of the Postanesthesia Client
  • Airway
  • Vital signs
  • Cardiac monitoring
  • Peripheral vascular assessment
  • Level of consciousness (LOC)
  • Fluid and electrolytes
  • GI system
  • Integumentary system
  • Discomfort/pain

54
Perioperative Nursing Care Postoperative
Management
  • Maintain a patent airway
  • Stabilize vital signs
  • Ensure patient safety
  • Provide pain
  • Recognize manage complications

55
Postoperative Nursing CareWhen caring for
post-surgical patient, think of the 4 Ws
  • Wind prevent respiratory complications
  • Wound prevent infection
  • Water monitor I O
  • Walk prevent thrombophlebitis

56
Postoperative Phase
Complications
  • Respiratory- atelectasis, pulm. Embolus
  • Cardiovascular- venous thrombosis
  • Gastrointestinal-Hiccoughs, N/V,abd. Distention,
    paralytic ileus, stress ulcer.
  • GU- urinary retention
  • Hemorrhage-slipping of a ligature(suture)
  • Wound infection-
  • Wound dehiscence and evisceration-

57
Dehiscence
  • Partial or complete separation of the outer layer
    of the wound.
  • Possible causes
  • Poor suturing technique
  • Distention
  • Excessive vomiting
  • Excessive coughing
  • Dehydration
  • Infection

58
Evisceration
  • Total separation of the layers protrusion of
    internal organs or viscera through the open
    wound.
  • Causes same as dehiscence
  • Treatment
  • Call for help
  • Cover with sterile NS soaked gauze/towels
  • Keep moist
  • DO NOT ATTEMPTS TO REINSERT ORGANS.
  • Keep in supine position with knees/hips bent
  • Assessment/VS q 5 min. until MD arrive
  • Prepare for surgery.

59
Postoperative Phase
60
Postoperative Phase
61
Postoperative Nursing CareGerontologic
considerations
  • Mental status- attributed to medications, pain,
    anxiety, depression.
  • Delirium- infection, malignancy, trauma, MI, CHF,
    opioid use.
  • Dementia-sundowning-sleep disturbances, lack of
    structure in the afternoon or early morning,
    sleep apnea.
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