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VN 235 PERIOPERATIVE NURSING

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Preoperative Phase. Nursing Goal: Identify /implement actions to ... To ascertain serious illness or trauma in preoperative client ... Preoperative Consent ... – PowerPoint PPT presentation

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Title: VN 235 PERIOPERATIVE NURSING


1
VN 235PERIOPERATIVE NURSING
  • Helen Barnes MSN, RN

2
PERIOPERATIVE PHASES
  • Preoperative
  • Intraoperative
  • Postoperative

3
Perioperative Phases
  • Preoperative
  • Begins with decision
  • ends with transfer to O.R.
  • Intraoperative
  • Begins with transfer to OR
  • ends with admission to PACU.
  • Postoperative
  • Begins with admission to PACU
  • ends when recovery is complete.

4
Types of Surgery
  • Emergent - immediate
  • Urgent- needed within 24 - 30 hours
  • Elective planned no time requirements
  • Aesthetic- for improvement
  • Diagnostic- tissue samples or oscopy
  • Exploratory- confirmation of extent of condition

5
Types of Surgery
  • Preventive- removal before it causes a problem
  • Curative- removal of diseased tissue
  • Reconstructive- correction of body parts
  • Palliative- alleviation of symptoms without
    curing disease

6
Preoperative Phase
  • Nursing Goal Identify /implement actions to
    decrease surgical risk factors.
  • Emotional Responses
  • Age
  • Hydration/Nutrition
  • Smoking/Alcohol
  • Diseases

7
Preoperative Assessment
  • Health history
  • Identify risk factors
  • Client and family teaching
  • Referrals to social work, support groups,
    education programs
  • Lab test, ECG, chest x-ray
  • Copy of advance directives

8
Preoperative Assessment
  • Subjective Data - Health history questions
  • Demographic
  • Health history
  • Surgical history
  • Tobacco use
  • Alcohol use
  • Coping techniques
  • Family history
  • Female patients

9
Preoperative Assessment
  • Objective Data - Body System Review
  • Vital signs, oxygen saturation
  • Height/weight
  • Emotional status
  • Neurological
  • Skin
  • Respiratory/Cardiovascular
  • Gastrointestinal
  • Musculoskeletal

10
ABCDE Mnemonic Device
  • To ascertain serious illness or trauma in
    preoperative client
  • A Allergy to medications, chemicals, latex
  • B - Bleeding tendencies or use of
    anticoagulants, including herbal remedies
  • C Cortisone
  • D Diabetes mellitus
  • E Emboli previous history/prolonged
    immobility.

11
Nursing Process
  • Nursing Diagnosis
  • Anxiety R/T potential change in body image,
    hospitalization, pain, loss of
  • control, uncertainties about surgery
  • Planning/Goals
  • Decrease anxiety
  • Increase knowledge of surgical routines and
    procedures

12
Nursing Interventions
  • Inform client about procedures and routine.
  • Allow to express concerns.
  • Notify doctor if the client expresses extreme
    anxiety or fear.
  • If fear is excessive, the doctor may reschedule
    the surgery until client can cope.

13
Hydration and Nutrition
  • Maintain normal fluid and electrolyte balance
  • Increase levels of protein ( tissue repair), Vit.
    C (collagen formation), and zinc (tissue growth,
    skin integrity, and cell-mediated immunity)
  • Obese /underweight may not heal well. May have
    complications

14
Medications
  • Anticoagulants - stop prior to surgery
  • Diabetic medications- hold or take 1/2 dose as
    ordered
  • Steroids - may cause circulatory collapse if
    stopped abruptly. Can be given IV if NPO
  • Cocaine, marijuana, opiods can interact with the
    anesthesia.

15
Geriatric Consideration
  • Preoperatively
  • Reassure client/family
  • Pad bony prominences
  • Teach what to expect before, during, after
    surgery
  • Complete preop screening lab work, radiographic,
    nutritional assessment, PFT, ECG

16
Geriatric Consideration
  • Intraoperatively
  • Assess for hypothermia/hypoxia/ hemorrhage/output
  • Postoperatively
  • Pain control
  • Respiratory function
  • Mobility
  • Bowel and urinary function
  • Delirium

17
Preoperative Consent
  • Legal permission for surgery, invasive
    procedures, anesthesia, blood administration,
    radiation or cobalt therapy
  • Protects patient from unauthorized procedures
  • Protects physicians, anesthesiologist, hospital
    employees from claims of performing unauthorized
    procedures

18
Informed Consent
  • Criteria
  • Physician must tell client in understandable
    terms about diagnosis, proposed treatment, who
    will perform it, risks, alternative treatments
    prognosis.
  • Must be signed before analgesics or sedation.
  • Must be voluntary
  • In medical emergency, next of kin by phone, or
    court order. Physician documents need of
    treatment to save life.

19
Preop Nursing Interventions
  • NPO after MN. If surgery in the afternoon, may
    have clear liquids in early morning.
  • May brush teeth, but not swallow water.
  • Medications may be taken with small amount of
    water.
  • Enemas if needed for bowel surgery.
  • Teach on active participation in postop care to
    improve recovery.

20
Preop Nursing Interventions
  • Preop checklist
  • ID, VS, signed consent form
  • Remove make-up, hair pins, wigs, jewelry,
    underwear.
  • Remove label dentures, prostheses, glasses,
    hearing aids.
  • Check test results, H P
  • Valuables- give to family member/security
  • Ted hose if ordered. Void prior to preop
    medication. Side rails up.

21
Preop Medications
  • Narcotics - analgesia
  • Antianxiety- decrease anxiety
  • Anticholinergic- decrease secretions
  • Antiemetic- control nausea/vomiting
  • Histamine (H2) antagonist- decrease gastric acid
    secretions
  • Alkalinizing agent- prevent asthma-like attack
  • Antibiotic - prevent infection

22
Preop Family Instructions
  • Information on where to wait during surgery and
    who communicates clients status to them.
  • Same day surgery clients must have a driver
    waiting.

23
Postop Exercises
  • Deep breathing and coughing every hour while
    awake
  • Incentive spirometer every hour while awake
  • Arm and leg exercises
  • Turn every two hours
  • Sit up, dangle and ambulate

24
The End
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