Nursing Management of Clients with Peri-Operative Stressors - PowerPoint PPT Presentation

Loading...

PPT – Nursing Management of Clients with Peri-Operative Stressors PowerPoint presentation | free to download - id: 3c408e-YzExY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Nursing Management of Clients with Peri-Operative Stressors

Description:

Nursing Management of Clients with Peri-Operative Stressors NUR133 Lecture #2 & #3 K. Burger, MSEd, MSN, RN, CNE What is Medical-Surgical Nursing? Blend of technical ... – PowerPoint PPT presentation

Number of Views:313
Avg rating:3.0/5.0
Slides: 55
Provided by: www2Sunys
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Nursing Management of Clients with Peri-Operative Stressors


1
Nursing Management ofClients with
Peri-Operative Stressors
  • NUR133
  • Lecture 2 3
  • K. Burger, MSEd, MSN, RN, CNE

2
What is Medical-Surgical Nursing?
  • Blend of technical skills caring relationships
  • Specialty of nursing
  • Nursing care of adults 18yrs
  • Requires broad scope of knowledge
  • Encompasses many roles/competencies
  • Academy of Medical-Surgical Nurses (AMSN)
    specialty organization

3
Take some time to
  • Review the Academy of Medical Surgical Nurses
    (AMSN) website _at_http//www.medsurgnurse.org
  • Click on and readLearn more about Medical
    Surgical Nursing
  • What are your opinions about the role of the
    medical surgical nurse as outlined in this AMSN
    statement?

4
Peri-Operative Nursing
  • SURGERYDEFINITION A planned alteration of
    physiologic processes within the body in an
    attempt to arrest or eliminate disease or illness
  • PHASES Pre-operativeIntra-operativePost-opera
    tive

5
Goal of Peri-Operative Nursing
  • To prepare the client mentally and physically for
    surgery and to assist in full recovery in the
    shortest time possible with the least discomfort.

6
Classifications of Surgery
  • PURPOSE
  • Diagnostic
  • Curative-Ablative-Restorative
  • -Reconstructive
  • Palliative
  • Cosmetic
  • Transplant
  • URGENCY
  • Elective
  • Urgent
  • Emergency

SERIOUSNESS Minor Major
7
Variables Affecting Surgical Outcome
  • Age
  • Nutrition
  • Fluid Balance
  • Life-style Habits
  • Medical Conditions
  • Medication History
  • Family History
  • Prior Surgical Experiences
  • Spiritual and/or Cultural Beliefs
  • Anxiety and Coping Mechanisms

8
Pre-Operative Phase
  • Begins when a decision is made to perform a
    surgical procedure and ends when the client
    enters the operating room
  • Nursing goals Assessing for risk
    factorsEmotional support of client Client
    teachingPhysical preparation of client

9
Pre-operative Nursing Assessment
  • HISTORY
  • Age
  • Medication
  • Medical history
  • Allergies
  • Prior surgeries and outcomes
  • Anesthesia history / personal familial
  • Lifestyle habits alcohol / smoking/ exercise

10
Pre-operative Nursing Assessment
  • PHYSICAL
  • VS
  • Head Neck
  • Skin Turgor
  • Thorax Lungs
  • Heart Vascular System
  • Abdomen
  • Neurological Status

11
Pre-Operative Nursing Assessment
  • LABS
  • Complete Blood Count (CBC)
  • Basic Metabolic Panel (BMP)
  • Coagulation Studies PT/PTT
  • Urinalysis
  • Blood typing / screening
  • Additional tests as indicated
  • DIAGNOSTICS
  • Chest X-Ray(CXR)
  • Electrocardiogram(ECG)
  • Additional tests as indicated

12
LABORATORY NORMALS
  • Students should research/fill-in/memorize the
    following lab values ( See pg 302-303 Iggy)
  • K
  • Na
  • Cl
  • FBS
  • BUN
  • Cr
  • WBC
  • Hgb
  • Hct

13
Pre-operative Nursing Assessment
  • Knowledge
  • Informed Consent
  • Anxiety
  • Coping mechanisms
  • Availability of support

14
Common Pre-operativeNursing Diagnosis
  • Anxiety r/t situational crisis, change in health
    status, fear of unknown, fear of pain and/or
    disfigurement
  • Knowledge deficit r/t pre/post operative
    procedures
  • Disturbed Sleep r/t anxiety about upcoming surgery

15
Pre-operative Nursing InterventionsEmotional
Support
  • Utilize positive communication techniquestouch
    eye contact validating statements
  • Active listening
  • Encourage verbalization of fears/anxieties
  • Avoid negative communication techniquesfalse-reas
    surancejudgmental statements

16
Pre-Operative Nursing InterventionsClient
Teaching
  • Peri-operative progression sensations
  • Description of Pre and Post operative events
  • Description of events in OR and PACU
  • Pain management
  • Coughing Deep Breathing Exercises
  • Incentive Spirometry
  • Turning Positioning
  • Leg Exercises Ambulation

17
Client TeachingPain Management
  • Pre-operative assessment of individual pain
    perception on 1-10 scale
  • Reassurance that pain reports WILL bebelieved
    and acted upon
  • Use of PCA
  • Benefits of ATC versus PRN
  • Allaying of fears regarding addiction
  • Potential side-effects of narcotics
  • How pain management promotes recovery

18
Client TeachingPulmonary Exercises
  • Method for diaphragmatic breathingHands on
    ribs, inhale thru nose allowing abdomen to
    expand, hold 3-5 sec, exhale thru pursed lips,
    10X /hr while awake
  • Method for controlled coughingDeep breath X2 ,
    then inhale,hold breath 2-3 sec,
    coughforcefully 2-3X consecutively
  • Method for splinting

19
Client TeachingPulmonary Exercises
  • Instruction on use of Incentive SpirometerTake
    2-3 normal breathes, close lips on mouthpiece,
    inhale to reach set goal, hold 3-5 sec, release
    mouthpiece exhale, 10X/hr while awake.

20
Client TeachingActivity
  • LEG EXERCISESDorsi/Plantar flexion, ankle
    rotation, knee/hip flexion, 5X each leg/hr w.a.
  • AMBULATIONDiscuss importance of early ambulation
    and method for getting out of bed
  • TURNING AND POSITIONINGUse of side rails
  • External pneumatic compression devices
    (Sequentials, SCDs, Flowtron)

21
Pre-operative Nursing InterventionsPhysical
Preparation of Client
  • Implementing dietary restrictions
  • Initiation of surgical preps
  • Insertion of tubes/drains/vascular access
  • Completion of pre-operative checklist
  • Administration of pre-operative medication

22
Pre-operative Nursing ResponsibilitiesMedical
Record Review
  • Informed Consent
  • History and Physical
  • Medical Clearance
  • Advance Directives
  • Allergies / Previous anesthesia reactions
  • Presence of autologous blood bank
  • Labs and Diagnostics

23
Intra-Operative Phase
  • Begins when client arrives in surgical area and
    lasts until they are in the PACU
  • Nursing Goals Prevention of injury to
    clientMaintenance/Promotion of oxygenation,
    cardiac output, balanced I O

24
The Intra-operative Team
  • Surgeon
  • Surgical Assistants MD, PA, ST
  • Anesthesiologist and/or Nurse Anesthetist
  • Registered Nurses Circulating, Scrub

25
Anesthesia
  • Anesthesia is defined as the absence of normal
    sensation. This also includes loss of protective
    reflexes!
  • Anesthesia providesamnesia analgesia
    muscular relaxation
  • Stages I-IV of Anesthesia ( Guedels Signs)
  • TypesGeneralLocalConscious Sedation

26
General Anesthesia
  • Inhalation
  • Intravenous
  • Balanced use of both
  • Mechanical Ventilation presence of ET tube
  • Use of adjuvant medications such asHypnotics
    VersedOpioids FentanylNeuromuscular Blocking
    Agents Pavulon
    Anectine

27
Important Factors in theCare of the Anesthetized
Client
  • Use protective positioning techniques
  • Handle gently
  • Change positions slowly
  • Keep client warm

28
Potential Complications ofGeneral Anesthesia
  • Overdose
  • Unrecognized hypoventilation
  • Complications of intubation
  • Anaphylaxis
  • Hypothermia
  • Injury r/t positioning, burns
  • Malignant hyperthermia

29
Malignant Hyperthermia
  • Rare but extreme emergency
  • Occurs most often with inhalants
  • Genetic predisposition
  • Uncontrolled acceleration of muscle metabolism
    and increased BMR
  • Life threatening elevated temperature,
    hyperkalemia, acidosis

30
Emergency Treatment of Malignant Hyperthermia
  • Stop surgical procedure/anesthesia if possible
  • Hyperventilate with 100 oxygen
  • Administer DANTROLENE intravenously
  • Undertake body cooling measuresIced NS
    intravenouslyCooling blanket

31
Local Anesthesia
  • Advantages
  • Client remains conscious
  • Cost effective
  • Minimal recovery time
  • Vasoconstrictive agents decrease bleeding
  • Disadvantages
  • Client remains conscious
  • Potential for local tissue irritation
  • Potential for sudden systemic reaction such as
    hypotension

32
Regional AnesthesiaTypes
  • Field BlockInjected around the operative field
  • Nerve BlockInto or around a nerve or nerve group
  • SpinalInto subarachnoid space
  • Epidural Into epidural space

33
Regional Anesthesia
  • Advantages
  • Patient remains conscious
  • No respiratory depression or irritation
  • Enhanced pain management post-operatively
  • Disadvantages
  • Patient remains conscious
  • Circulatory depression/stasis
  • Potential trauma/infection _at_ site of injection
  • Edema - potential for spinal headache

34
Conscious Sedation
  • IV administered hypnotic, opioid, or sedative
  • Reduces LOC but does not produce unconsciousness
  • Airway maintained
  • Client can respond to simple commands
  • Provides short amnesia action
  • Commonly used for scopes, caths etc.

35
Intra-operative Nursing Diagnosis
  • Risk for positioning Injury
  • Risk for Fluid Volume Imbalance
  • Risk for Hyperthermia
  • Potential for Hypoventilation
  • Risk for Aspiration
  • Risk for Impaired Skin Integrity(see EBP page
    335 Iggy)Pressure ulcers do occur in surgery

36
Post-Operative Phase
  • Begins upon admission to the PACU and continues
    through entire recovery phase
  • Nursing Goals Promoting physiological recovery
    of all body systems, prevention of complications,
    pain management, client teaching and emotional
    support

37
Focused Assessment in PACU
  • Respiratory patent airway, O2 status
    (Most common PACU complication)
  • CNS monitor gradual return of function
  • Surgical Incision site bldg? drainage?
  • Vital Signs cardiac function
    hypothalmus depression
  • GI- nausea/vomiting common, aspiration risks
  • GU- strict Intake and Output, check for retention
  • Comfort administer analgesia IV per MD orders

38
Discharge CriteriaPACU(Modified Aldrete Score)
  • Consciousness2 Fully awake1 Responds to
    name0 No response
  • Activity on command2 Moves all extremities1
    Moves two extremities0 No movement
  • Respiration2 Free deep breathing1 Dyspneic,
    hyperventilating, obstructed breathing0 Apneic
  • Circulation2 Blood pressure within 20 of
    pre-op level1 Blood pressure within 5020 of
    pre-op level0 Blood pressure 50, or less, of
    pre-op level
  • Oxygen saturation2 SpO2 gt92 on room air1
    Supplemental O2 required to maintain SpO2 gt920
    SpO 2 lt92 with O2 supplementation
  • Total Score10 Score 9 needed to leave PACU

39
Focused Assessmentfor Post-Operative ClientUpon
arrival on Nursing Unit
  • VS compare against PACU data, take frequently
    until stable
  • Respiratory status auscultate, pulse ox
  • Cardiac status HR peripheral pulses
  • LOC
  • Skin surgical site and other areas
  • Abdomen listen for return of bowel sounds
    check for distention ( flatus vs
    urine)
  • Tubes IV, NG, Drains, Foley
  • Comfort Administer analgesics check PACU record

40
Nursing DiagnosisPost-Operative Clients
  • Acute Pain
  • Risk for Ineffective Tissue Perfusion r/t
    hypovolemia, circulatory stasis
  • Risk for Ineffective Breathing Pattern r/t pain,
    effects of anesthesia/narcotics
  • Risk for Infection r/t invasive procedure,
    respiratory stasis
  • Risk for Deficient Fluid Volume r/t fluid losses
    during surgery

41
Post-Operative Nursing Interventions
  • Prevention of complications
  • Respiratory-Assess for s/s pneumonia,
    atelectasis, pulmonary embolus-Encourage C DB
    and Incentive Spiro-Position with HOB
    elevated-Encourage ambulation

42
Post-Operative Nursing Interventions
  • Prevention of complications
  • Cardiovascular-Assess for s/s hemorrhage,
    shock, thrombophlebitis-Utilize sequential TEDs
    -Encourage leg exercises and/or
    ambulation-Position to promote venous return

43
Post-operative Nursing Interventions
  • Preventions of complications
  • Elimination-Assess for s/s of constipation,
    urinary retention, ileus, UTI-Encourage
    ambulation -Maintain IV and/or PO fluid
    intake-Provide privacy, proper positioning and
    other strategies to promote elimination

44
Post-Operative Nursing Interventions
  • Prevention of Complications
  • Wound-Assess for s/s of infection, dehiscence,
    evisceration-Promote wound healing through
    careful aseptic handling-Encourage balanced diet
    w/ sufficient protein, Vit C, Iron, Zinc-
    Administer prescribed antibiotics

45
Antibiotic Medications
  • Students should research the following classes
    of antibiotics for important nursing implications
    of each (Chapter 37 38 Lilley)Penicillens
    Ex UnasynCephalosporins Ex
    RocephinSulfonamides Ex BactrimTetracycline
    Ex VibramycinAminoglycosides Ex
    GentamicinQuinolines Ex LevaquinMacrolides
    Ex Erythromycin
  • Carbapenems Ex ImipenemMiscellaneous Ex
    Vancomycin

46
Post-operative Nursing Interventions
  • Comfort and Rest
  • Pain management
  • Keep linens clean and dry
  • Provide for personal hygiene needs
  • Keep environment quiet

47
Post-operative Nursing Interventions
  • Fluids and Nutrition
  • Monitor I O
  • Provide good oral hygiene
  • Ice chips / water sips
  • Assess for return of peristalsis
  • Assess for gag reflex
  • Gradual diet progression clear, full, soft

48
Post-Operative Nursing Interventions
  • Emotional support-Encourage expression of
    feelings-Utilize positive communication
    techniques
  • Knowledge deficit-teach wound care, s/s
    infection, dietary recommendations, activity
    restrictions, medication regime

49
Transfusion Therapy
  • Pretransfusion responsibilities
  • Verify prescription and other concommitant orders
  • Test donors and recipients blood for
    compatibility
  • ABO and Rh TYPE CROSSMATCH
  • Obtain consent and apply blood braceletper
    hospital policy
  • Determine patency of IV AND angiocath
    lumen(20gauge minimum)
  • Collect supplies 250 mL bag Normal
    Saline Y-set blood tubing with filter

50
Pre-Tranfusion Responsibilities
  • Obtain blood product from lab per protocol
  • With another nurse confirm - physician order-
    client identification
  • - blood bag label, attached tag, and requisition
    slip for ABO and Rh compatability
  • - client blood bracelet matches blood bank
    number on unit of blood to be administered
  • -expiration date
  • Inspect blood for discoloration, gas bubbles, or
    cloudiness.

51
Transfusion Responsibilities
  • Assess vital signs.
  • Prime Y-tubing with NSGently agitate blood
    bagSpike and attach blood bag
  • Begin transfusion slowly and stay with client
    first 15 minutes. Take VS Q 5 minutes.
  • Ask client to report unusual sensations such as
    chills, shortness of breath, hives, or itching.
  • After 15 minutes without reaction increase flow
    rate to administer blood product per agency
    protocol.(usually 11/2 hr 2 hrs for PC)
  • Continue to monitor client closely with VS q
    15-q30m
  • Flush line with NS after infusion is complete

52
Types of Transfusions
  • Packed red blood cells
  • Platelets
  • Plasma transfusions fresh frozen plasma
  • Cryoprecipitate
  • Granulocyte (white cell) transfusions

53
Transfusion Reactions
  • Clients can develop any of the following
    transfusion reactions
  • Hemolytic
  • Allergic
  • Febrile
  • Bacterial
  • Circulatory overload
  • Iron overload
  • Hypocalcemia
  • Hyperkalemia
  • NURSING INTERVENTIONS
  • STOP TRANSFUSION
  • CHANGE IV TUBING
  • KEEP IV PATENT WITH NS
  • NOTIFY MD

54
Autologous Blood Transfusion
  • Collection and infusion of clients own blood
  • Eliminates compatibility problems reduces risk
    for transmission of bloodborne disease
  • Preoperative autologous blood donation
  • Intraoperative autologous transfusion
  • Postoperative blood salvage
About PowerShow.com