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Alterations in the Surgical Patient NRS 121 Lisa M. Dunn

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Alterations in the Surgical Patient NRS 121 Lisa M. Dunn MSN/ED, RN, CCRN, CNE A surgical drain is a tube used to remove pus, blood or other fluids from a wound. – PowerPoint PPT presentation

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Title: Alterations in the Surgical Patient NRS 121 Lisa M. Dunn


1
Alterations in the Surgical Patient
  • NRS 121
  • Lisa M. Dunn MSN/ED, RN, CCRN, CNE

2
Understanding Terminology
  • Pre operative period
  • Intra operative period
  • Post operative period

3
Purpose of Surgery
  • Diagnostic
  • Curative
  • Restorative
  • Palliative surgery, which makes the patient
    more comfortable
  • Cosmetic surgery, which reconstructs the skin
    and underlying structures

4
Nursing ProcessSurgical Procedure Suffixes
  • -ectomy excision or removal of
  • appendectomy
  • -lysis destruction of
  • electrolysis
  • -orrhaphy repair or suture of
  • Herniorrhaphy
  • -oscopy looking into
  • endoscopy
  • -ostomy creation of opening into
  • Colostomy
  • -otomy cutting into or incision of
  • Tracheotomy
  • -plasty repair or reconstruction of
  • mammoplasty

5
Question
  • The nurse understands that the rationale for
    palliative surgery
  • is to
  • Resolve a health problem by repairing the cause
  • Improve functional ability
  • Enhance personal appearance
  • Relieve symptoms of a disease

6
Collaborative Management Assessment
  • History and data collection

-Age -Drug and substance use -Medical history,
including cardiac and pulmonary
histories -Previous surgery and anesthesia -Blood
donations -Discharge planning
7
Physical Assessment/ Clinical Manifestation
  • Obtain baseline vital signs
  • Focus on problem areas identified by the
    patients history on all body systems affected by
    the surgical procedure.
  • Report any abnormal assessment findings to the
    surgeon and the anesthesiology personnel.

8
System Assessment
  • Cardiovascular system
  • Respiratory system
  • Renal/urinary system
  • Neurological system
  • Musculoskeletal system
  • Nutritional status
  • Psychosocial assessment

9
Question
In assessing the client preoperatively, which of
the following statements by the client requires
further follow-up? A I usually skip breakfast,
so I will not be hungry before
surgery. B I started taking a multivitamin
last week. C I have been using several
different herbs for my health over the past
year. D I usually work out three times per
week.
10
Laboratory Assessment
  • Urinalysis
  • Blood type and crossmatch
  • Complete blood count or hemoglobin and hematocrit
  • Clotting studies
  • Electrolyte levels
  • Serum creatinine level
  • Pregnancy test
  • Chest x-ray
  • Electrocardiogram (EKG or ECG)

11
Question
  • The nurse reports which of the following
    electrolyte
  • laboratory results immediately to the
    anesthesiologist?
  • Potassium 3.9 mEq/L
  • Sodium 140 mEq/L
  • Fasting glucose 80 mg/dL
  • Creatinine 1.9 mg/dL

12
Knowledge Deficit Interventions
  • Preoperative teaching
  • Informed consent
  • The surgeon in responsible for obtaining signed
    consent before sedation is given and surgery is
    performed.
  • The nurses role is to clarify facts presented by
    the physician and dispel myths that the client or
    family may have about surgery.

13
Implementing Dietary Restrictions
  • The patient is given nothing by mouth (NPO) for 6
    to 8 hours before surgery.
  • NPO status decreases the risk for aspiration
  • Failure to adhere may result in cancellation of
    surgery or increase the risk of aspiration during
    or after surgery.

14
Administering Regularly Scheduled Medications
Notify the physician and anesthesia provider for
instructions about medications such as
  • Diabetes medications
  • Cardiac medications
  • Glaucoma medications
  • Anticoagulants
  • corticosteriods

15
Intestinal Preparation
  • Bowel and intestinal preparations are performed
    to prevent injury to the colon and to reduce the
    number of intestinal bacteria.
  • Enema and/ or laxative may be ordered.

16
Question
  • In preparing a client for gastrointestinal
    surgery, the nurse
  • explains the reason for the bowel prep is to
  • Eliminate any risk of infection
  • Reduce bacteria that is normally found in the
    bowel
  • Ensure the bowel is sterile
  • Decrease expected blood loss during surgery

17
Skin Preparation
  • Skin is the bodies first line of defense against
    infection.
  • A break in the barrier increases the risk of
    infection.
  • Shower using antiseptic solution.
  • Shaving as a procedure before surgery is viewed
    as controversial.

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20
Preoperative Education
  • Possible placement of drains, tubes and vascular
    access devices.
  • Teach patient about postoperative procedures and
    exercises.
  • Breathing exercises
  • Incentive spirometry
  • Coughing and splinting

21
Pre-Operative EducationDiaphragmatic Breathing
Exercises
22
Properative EducationDiaphragmatic Breathing
  • High or semi-fowlers position
  • Place hands lightly on the abdomen
  • Inspire deeply while allowing the abdomen to
    expand outward.
  • Hold breath for a count of 5
  • Exhale completed through pursed lips, allowing
    the cheeks and abdomen to deflate
  • On expiration, the abdomen contracts inward as
    air from the lungs is expelled
  • Repeat 5 times consecutively slowly
  • Perform q1-2 hours while awake

23
Splinting Abdomen
  • Coughing Exercises
  • Taught preop
  • Purpose to loosen, mobilize, and remove
    pulmonary secretions
  • Splinting the incision decreases the physical and
    psychologic discomfort associated with coughing
  • Diaphragmatic breathing
  • Splint the incision with interlocked hand or
    pillow
  • Three deep breaths and then cough forcefully
  • Repeat 5 x q2h while awake with rest periods

24
Pre-Operative EducationSplinting Abdomen while
Coughing
25
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26
Question
In teaching the client with planned surgery using
general anesthesia, it is a priority for the
nurse to include which statement in the
preoperative teaching? A. You many wake up with
a tube in your throat to help you
breath. B. Your surgery will last about 2
hours. C. Your family will be allowed to visit
you in the operating room. D. We will
not be able to give you pain medications until
you are fully awake.
27
Question
  • The nurse includes which of the following
    statements for a
  • client undergoing general anesthesia?
  • You will be able to talk with the surgeon during
    the
  • procedure.
  • You will have a breathing tube in your throat
    during the
  • procedure.
  • Your family will need to stay in the waiting
    room in order to
  • talk with the surgeon.
  • No information can be given to your family until
    you are
  • fully awake in the PACU.

28
Pre-Operative EducationPain Management Education
  • Pain Assessment 5th Vital Sign
  • Instruct in use of pain intensity rating scale
  • Initial postoperative period
  • Patient Controlled Analgesia
  • Patient Controlled Epidural Analgesia
  • Medication prescribed IV/IM at prescribed time
  • Other therapies Positioning, back rubs, ice,
    elevation
  • Progress to oral analgesic agents
  • 2nd or 3rd postop day or Ambulatory Surgery

29
Preoperative Education Continued
  • Leg procedures and exercises such as
  • - calf pumping
  • - antiembolism stocking
  • Sequential compression device
  • (SCD)
  • elastic wraps
  • Early ambulation
  • Range-of-motion exercises

30
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33
Anxiety Interventions
  • Preoperative teaching
  • Encouraging communication
  • Promoting rest
  • Using distraction
  • Teaching family and significant others
  • Cultural considerations
  • Pediatric considerations

34
Preoperative Chart Review
  • Ensure all documentation, preoperative
    procedures, and orders are complete.
  • Check the surgical consent form and others for
    completeness.
  • Document allergies
  • Document height and weight.

35
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36
Question
  • In completing the preoperative checklist on a
    client scheduled for general surgery, the nurse
    recognizes which of the following as
  • the greatest risk for the planned procedure?
  • Age 59
  • Ten pounds over ideal body weight
  • Diet Controlled diabetes mellitus
  • Brother had complications with general anesthesia

37
Question
  • The nurses role in informed consent includes
    which of the
  • following?
  • Taking the client on a tour of the operating room
  • Teaching the client about the planned procedure
  • Witnessing the operative consent
  • Ensuring the client talks with the primary
    surgeon before
  • the procedure.

38
Preoperative Chart Review Continued
  • All diagnostic test results and diagnostic tests
    are on the chart.
  • Document and report any abnormal results
  • Report special needs and concerns

39
Preop Patient Prep
  • Patients should remove clothing and only have on
    hospital gown.
  • Ensure adequate intravenous access
  • Valuables should be with a family member or
    locked up in hospital safe.
  • Tape rings in place if they cannot be removed.
  • Remove all pierced jewelry

40
Preop Patient Prep Continued
  • Client must be wearing an identification band
  • Notation of allergies noted on a wrist band
  • Dentures must be removed (note if patient has
    missing teeth or any loose teeth)
  • Remove hearing aids
  • Remove glasses
  • Remove nail polish
  • Remove hair pieces and any kind of hair pins or
    bands

41
Patient Gets a Time-Out!!!
Most facilities have some kind of check system in
place to make sure -Right patient -Right
procedure -Right surgical site
42
2010 Patient Safety Goals
The purpose of The Joint Commissions National
Patient Safety Goals (NPSGs) is to promote
specific improvements in patient safety. The
Requirements highlight problematic areas in
health care and describe evidence and
expert-based solutions to these problems. The
Requirements focus on system-wide solutions,
wherever possible.
43
Patient identification
Goal 1 Improve the accuracy of patient
identification
NPSG.01.01.01 Use at least two patient
identifiers when providing care, treatment and
services.
NPSG.01.02.01 Prior to the start of any surgical
or invasive procedure, individuals involved in
the procedure conduct a final verification
process, such as a time-out, to confirm the
correct patient, procedure and site using active,
not passive, communication techniques.
44
Health Care Associated Infections
Goal 7 Reduce the risk of health care
associated infections
NPSG.07.05.01 Implement best practices for
preventing surgical site infections.
45
Preoperative Medication
  • Reduce anxiety
  • Promote relaxation
  • Reduce pharyngeal secretions
  • Prevent laryngospasm
  • Inhibit gastric secretions
  • Decrease amount of anesthetic needed for
    induction and maintenance of anesthesia.
  • Administer antibiotics if ordered

46
Pre-Operative PeriodPreoperative Medications
  • Frequently used preoperative medications
  • Benzodiazepines They reduce anxiety, induce
    sedation and induce amnesia by slowing down the
    central nervous system.
  • midazolam (Versed)
  • diazepam (Valium)
  • lorazepam (Ativan)

47
Question (pick all that apply)
  • The nurse assumes the role of client advocate in
    the preoperative period.
  • A. notifying the physician of abnormal lab
    results
  • B. verifying that informed consent has been
    obtained
  • C. cosigning the operative consent form
  • D. reviewing preoperative teaching
  • E. providing support to family members

48
Alterations in the Surgical Patient
The Intra operative Period
49
Members of the Surgical Team
  • Surgeon
  • Surgical assistant
  • Anesthesiologist
  • Certified registered nurse anesthetist
  • Holding area nurse
  • Circulating nurse
  • Scrub nurse
  • Surgical technician/ Operating room technician

50
Environment of the Operating Room
  • Preparation of the surgical suite and team safety
  • Layout
  • Health and hygiene of the surgical team
  • Surgical attire
  • Surgical scrub

51
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54
Surgical Scrub, Gowning, and Gloving
55
Anesthesia
  • Induced state of partial or total loss of
    sensation, occurring with or without loss of
    consciousness.
  • Used to block nerve impulse transmissions,
    suppress reflexes, promote muscle relaxation,
    and, in some instances, achieve a controlled
    level of unconsciousness.

56
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57
General Anesthesia
  • Reversible loss of consciousness is induced by
    inhibiting neuronal impulses in several areas of
    the CNS.
  • State can be achieved by a single agent or a
    combination of agents.
  • CNS is depressed, resulting in analgesia,
    amnesia, and unconsciousness, with the loss of
    muscle tone and reflexes.

58
Stages of General Anesthesia
Stage 1 analgesia Stage 2 excitement Stage 3
operative Stage 4 danger
59
Administration of General
Anesthesia
  • Inhalation intake and excretion of anesthetic
    gas or vapor to the lungs through a mask
  • Intravenous injection barbiturates, ketamine,
    and propofol through the blood stream
  • Adjuncts to general anesthesia agents hypnotics,
    opioid analgesics, neuromuscular blocking agents

60
Balanced Anesthesia
  • Combination of intravenous drugs and inhalation
    agents used to obtain specific effects
  • Combination used to provide hypnosis, amnesia,
    analgesia, muscle relaxation, and reduced
    reflexes with minimal disturbance of physiologic
    function.

61
Balance Anesthesia Continued
  • Example
  • -thiopental for induction
  • -nitrous oxide for amnesia
  • -morphine for analgesia
  • -pancuronium for muscle relaxation

62
Complications from General Anesthesia
  • Malignant hyperthermia possible treatment with
    dantrolene
  • Overdose
  • Unrecognized hypoventilation
  • Complications of specific anesthetic agents
  • Complications of intubation

63
Question
  • In treating the client with malignant
    hyperthermia, the most important intervention is
  • Initiation of cooling measures
  • Administration of skeletal muscle relaxant
  • Reversal of anesthesia
  • Increasing rate of intravenous fluids

64
Local or Regional Anesthesia
  • Sensory nerve impulse transmission from a
    specific body area of region is briefly disrupted
  • Motor function may be affected
  • Patient remains conscious and able to follow
    instructions
  • Gag and cough reflexes remain intact
  • Sedatives, opioid analgesics, or hypnotics are
    often used as supplements to reduce anxiety.

65
Local Anesthesia
  • Topical anesthesia
  • Local infiltration
  • Regional anesthesia
  • -field block
  • -nerve block
  • -spinal anesthesia
  • -epidural anesthesia

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69
Question
  • In reviewing preoperative teaching for a client
    scheduled to have regional anesthesia, which
    statement by the client indicates that additional
    teaching is needed?
  • My legs may be numb for a while.
  • I hope I dont get too nervous being awake.
  • It will be difficult to move my legs immediately
    after surgery.
  • I am relieved that I will be asleep during this
    procedure.

70
Complications of Local or Regional Anesthesia
  • Anaphylaxis
  • Incorrect delivery technique
  • Systemic absorption
  • Overdosage

71
Complications of Local or Regional Anesthesia
continued.
  • Assess for CNS stimulation
  • Assess for CNS and cardiac depression
  • Assess for restlessness, excitement
  • Assess for incoherent speech
  • Assess for headache, blurred vision
  • Assess for nausea/vomiting, metallic taste
  • Assess for tremors and/or seizures
  • Assess vital signs against base line vital signs

72
Surgical Fires
Goal 11 Reduce the risk of surgical fires
NPSG.11.01.01 The organization educates staff,
including licensed independent practitioners who
are involved with surgical procedures and
anesthesia providers, on how to control heat
sources, how to manage fuels while maintaining
enough time for patient preparation, and
establish guidelines to minimize oxygen
concentration under drapes.
73
Thyroid Surgery. Patient had 12 reconstruction
surgeries.
Growing use of electrosurgical devices and paper
hospital drapes have contributed to fires in the
operating room.
74
affecting between 550 and 650 patients a year,
including 20 to 30 who suffer serious,
disfiguring burns. Every year, one or two people
die this way (MSNBC, 2006).
75
Question
  • An operating room nurse is positioning a client
    on the operating room table to prevent the
    clients extremities from dangling over the sides
    of the table. A nursing student who is observing
    for the day asks the nurse why this is so
    important. The nurse responds that this is done
    primarily to prevent
  • An increase in pulse rate
  • A drop in blood pressure
  • Nerve and muscle damage
  • Muscle fatigue in the extremities

76
Question
  • A nurse is preparing a preoperative client for
    transfer to the operating room. The nurse should
    take which action in the care of this client at
    this time?
  • Ensure that the client has voided
  • Administer all the daily medications
  • Practice postoperative breathing exercises
  • Verify that the client has not eaten for the last
    24 hours

77
Treatment of Complications
  • Establish an open airway
  • Give oxygen
  • Notify the surgeon
  • Fast-acting barbiturate is usual treatment
  • If toxic reaction is untreated, unconsciousness,
    hypotension, apnea, cardiac arrest, and death may
    result.

78
Conscious Sedation
  • IV delivery of sedative, hypnotic, and opioid
    drugs reduce the level of consciousness but
    allows the patient to maintain a patent airway
    and to respond to verbal commands.
  • Diazepam, midazolam, meperidine, fentanyl,
    alfentanil, and morphine sulfate are the most
    commonly used drugs.

79
Conscious Sedation Continued
Nursing Assessment Includes -Airway -Oxygen
saturation -Level of consciousness -Electrocardi
ographic status -vital signs monitor every 15 to
30 minutes
80
Collaborative Management
  • Assessment
  • Medical record review
  • Allergies and previous reactions to anesthesia or
    transfusions
  • Autologous blood transfusion
  • Laboratory and diagnostic test results
  • Medical history and physical examination findings

81
Question
  • A nurse is conducting preoperative teaching with
    a client about the use of an incentive
    spirometer. The nurse should include which piece
    of information in discussions with the client?
  • Inhale as rapidly as possible.
  • Keep a loose seal between the lips and the
    mouthpiece.
  • After maximum inspiration, hold your breath for
    15 seconds and exhale.
  • The best results are achieved when sitting up or
    with the head of the bed elevated 45 to 90
    degrees.

82
Risk for Perioperative Positioning Injury
  • Interventions include
  • Proper body position
  • Risk for pressure ulcer formation
  • Prevention of obstruction of circulation,
    respiration, and nerve conduction

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84
Alterations in the Surgical patient.
Impaired Skin Integrity
Interventions include -plastic adhesive
drape -skin closures include sutures (absorbable
and nonabsorbable), staples, and dermabond,
-- -retention sutures -insertion of
drains -applications of dressings -transfer of
a patient from the operating room table to the
stretcher or bed
85
Special Drains
  • Remove pus
  • Remove blood
  • Remove other body fluids from wound
  • Does not result in faster wound healing or
    prevent infection.

86
Penrose Drain
87
Jackson Pratt or JP
88
Hemovac
89
Dressings
Dry or moist Gauze Hydrocolloid Protects the
wound from surface contamination Hydrogel Maintain
s a moist surface to support healing Wound
V.A.C. Uses negative pressure to support healing
90
Dressings continued.
Changing Know type of dressing, placement of
drains, and equipment needed. Securing Tape,
ties, or binders Comfort measures Carefully
remove tape. Gently cleanse the wound. Administer
analgesics before dressing change.
91
Montgomery Straps
92
Ace wraps
  • To reduce the swelling of an injured area of the
    body
  • To hold wound bandages in place
  • To wrap around a arm or leg splint during healing
  • To improve blood flow to a limb like an arm or
    leg
  • To hold cold or hot packs in place on a body part

93
Ice pack
  • A general rule of thumb is to ice an injury over
    a period of 24 to 72 hours.
  • Apply cold packs for periods of up to 20 minutes
    every two to four hours.
  • When your skin starts to feel numb, it's time to
    give your body a break from a cold pack.

94
Question
  • Which of the nursing interventions would the
    nurse implement for the older client to minimize
    skin breakdown related to surgical positioning?
  • Padding bony prominences
  • Taping joints in anatomic position
  • Monitoring for excessive blood loss
  • Applying elastic stockings to lower extremities

95
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96
Question
A postoperative client asks a nurse why it is so
important to deep-breathe and cough after
surgery. In formulating a response, the nurse
incorporates the understanding that retained
pulmonary secretions in a postoperative client
can lead to A. pneumonia B. fluid imbalance C.
pulmonary edema D. Carbon dioxide retention
97
Question
  • A client with a perforated gastric ulcer is
    scheduled for surgery. The client cannot sign
    the operative consent form because of sedation
    from opioid analgesics that have been
    administered. The nurse should take which
    appropriate action in the care of this client?
  • Obtain a court order for the surgery
  • Send the client to surgery without the consent
    form being signed.
  • Have the hospital chaplain sign the informed
    consent immediately.
  • Obtain a telephone consent from a family member,
    following hospital policy.

98
Alterations in the surgical patient. The
postoperative Period
99
PACU/ RECOVERY ROOM
  • Purpose
  • Location
  • The PACU nurse

100
Collaborative Management
  • Assessment
  • - Assess respiration
  • - Examine surgical area for
    bleeding
  • - Monitor vital signs
  • - Assess for readiness to be
  • discharged once criteria have
    been met.

101
Respiratory Assessment
  • Airway assessment
  • Breath sounds
  • Additional respiratory assessments

102
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103
Cardiovascular Assessment
  • Vital signs
  • Cardiac monitoring
  • Peripheral vascular assessment

104
Question
  • To prevent thromboembolism in the post-op client
    the nurse should include which of the following
    in the plan of care?
  • Place the pillow under the knees and restrict
    fluids.
  • Use strict aseptic technique including
    handwashing and sterile dressing technique.
  • Assess bowel sounds in all four quadrants on
    every shift and avoid early ambulation.
  • Assess for Homans sign on every shift, encourage
    early ambulation, and maintain adequate hydration.

105
Neurological Assessment
  • Cerebral functioning
  • Motor and sensory assessment

106
Fluid, Electrolyte and Acid base Balance
  • Check fluid and electrolyte balance.
  • Make hydration assessment.
  • Intravenous fluid intake should be recorded.
  • Assess acid-base balance

107
Renal/Urinary System
  • The effects of drugs, anesthetic agents, or
    manipulation during surgery can cause urine
    retention.
  • Assess for bladder distention.
  • Consider other sources of output such as sweat,
    vomitus, or diarrhea stools.
  • Report a urine output of lt 30 mL/hr.

108
Question
  • It is 1000 P.M. and the nurse notes that an
    adult male who returned from the PACU at 200
    P.M. has not voided. The client has an out of
    bed order, but has not been up yet. The best
    action for the nurse to take is
  • Insert a foley catheter into the client
  • Straight-catheterize the client
  • Assist the client to stand at the side of his bed
    and attempt to void into a urinal
  • Encourage the client to lie on his side in bed
    and attempt to void into a urinal

109
Gastrointestinal Assessment
  • Nausea and vomiting are common reactions after
    surgery.
  • Peristalsis may be delayed because of long
    anesthesia time, the amount of bowel handling
    during surgery, and opioid analgesic use.
  • Clients who have abdominal surgery often have
    decreased peristalsis for at least 24 hours.

110
Nasogastric tube Drainage
  • Assess for presence of NGT/OGT
  • - decompress stomach
  • - drain stomach
  • - promote gastrointestinal rest
  • - allow gastrointestinal tract to
    heal
  • - enteral feeding
  • - monitor any gastric bleeding
  • Do not move or irrigate after gastric surgery
    without surgeon order.

111
Question
  • When assessing a post-op client, the nurse notes
    a nasogastric tube to low constant suction, the
    absence of a bowel movement since surgery, and no
    bowel sounds. The most appropriate plan of care
    based on these findings is to
  • Increase the clients mobility and ensure he is
    receiving adequate pain relief.
  • Increase coughing, turning, and deep breathing
    exercises.
  • Discontinue the nasograstric tube as the client
    does not need it any more.
  • Assess for bladder pain and distention

112
Skin Assessment
  • Normal wound healing
  • Ineffective wound healing can be seen most often
    between the 5th and 10th days after surgery
  • Dehiscence a partial or complete separation of
    the outer wound layers, sometimes described as a
    splitting open of the wound.

113
Skin Assessment Continued
  • -Evisceration a total separation of all wound
    layers and protrusion of internal organs through
    the open wound.
  • Dressings and drains, including casts and
    plastic bandages, must be assessed for bleeding
    or other drainage on admission to the PACU and
    hourly thereafter.

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115
Discomfort/Pain Assessment
  • Client almost always has pain or discomfort after
    surgery.
  • Pain assessment is started by the postanesthesia
    care unit nurse.
  • Pain usually reaches its peak the second day
    after surgery, when the client is more awake,
    more active, and the anesthetic agents and drugs
    given during surgery have been excreted.

116
Impaired Gas Exchange
  • Interventions include
  • Airway maintenance
  • Positioning the client in a side-lying position
    or turning his or her head to the side to prevent
    aspiration
  • Encouraging breathing exercises
  • Encouraging mobilization as soon as possible to
    help remove secretions and promote lung expansion

117
Impaired Skin Integrity
  • Interventions include
  • Nursing assessment of the surgical area
  • Dressings first dressing change usually
    performed by surgeon
  • Drains provide an exit route for air, blood, and
    bile as well as help prevent deep infections and
    abscess formation during healing

118
Acute Pain
  • Interventions include
  • Drug therapy
  • Complementary and alternative therapies such as
  • Positioning
  • Massage
  • Relaxation and diversion techniques

119
Potential for Hypoxia
  • Interventions include
  • Maintenance of airway patency and breathing
    pattern
  • Prevention of hypothermia
  • Maintenance of oxygen therapy as prescribed

120
Health Teaching
  • Prevention of infection
  • Dressing care
  • Nutrition
  • Pain medication management
  • Progressive increase in activity level
  • Use of proper body mechanics

121
References
Bray, A. (2006). Preoperative nursing assessment
of the surgical patient. Nursing Clinics
of North America, 41(2), 135-150. Dudek,
S.G. (2006). Nutrition essentials for nursing
practice (5th ed.) Philadelphia Lippincott
Williams and Wilkins. Ignatavicius, D.,
Workman, M.L. (Ed.). (2010).
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