lect 3 perioperative management

Perioperative Phases

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Surgical classifications

1. Diagnostic ( biopsy)2. Curative ( excision of tumor)3. Reparative (multiple wound repair)4. Reconstructive or cosmetic ( mamoplasty)5. Palliative (relief pain or correct a problem)

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According to degree of urgency

Emergent: require immediate attention without delay.

Urgent: require prompt attention within 24-30 hours.

Required: requires operation, plan hospital admission within a few wks or months.

Elective: should be operated on, failure to have surgery isn’t catastrophic.

Optional: the decision rests with the pt, depend on personal preference

preoperative phase

reduce patient’s anxiety, aid

recovery and allow the patient

express concerns and fears

nurses establish a rapport, and

develop a plan of care

Invasive procedures, such as a surgical incision, a biopsy

Procedures requiring sedation and/or anesthesia

A nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient

Procedures involving radiation

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Criteria for valid Informed consent: Voluntary consent Incompetent pt ( mentally retarded, mentally ill, or

comatose) Informed subject Explanation Description of risks and benefits Answer questions about procedure Instructions Information written in understandable language.

Preoperative Assessment

1.Providing Patient Teaching 2. Providing Psychosocial

Intervention 3. Maintaining Patient Safety 4. Managing Nutrition and Fluids 5. Preparing the Bowel 6. Preparing the Skin

1. Providing Patient Teaching Deep

Breathing, Coughing, and Incentive Spirometry

Mobility and Active Body Movement

Pain Management

• A pain assessment

• Postoperatively, medications are administered to relieve pain and maintain comfort without suppressing respiratory function

Cognitive Coping Strategies

Imagery: The patient concentrates on a

pleasant experience or restful scene.

Distraction: The patient thinks of an enjoyable

story or recites a favorite poem or song

1.Providing Patient Teaching 2. Providing Psychosocial

Intervention 3. Maintaining Patient Safety 4. Managing Nutrition and Fluids 5. Preparing the Bowel 6. Preparing the Skin

2. Providing Psychosocial Interventions

Reducing Anxiety and Decreasing

Fear

Respecting Cultural, Spiritual, and

Religious Beliefs

2. Maintaining Patient Safety

3. Managing Nutrition and Fluids (fluid and food were restricted preoperatively overnight and often longer)

4. Preparing the Bowel

5. Preparing the Skin

hospital gown remove hairpins, and cover the head

completely dentures or plates are removed Jewelry is not worn

•Administering Preanesthetic Medication

•Maintaining the Preoperative Record

•Transporting the Patient to the Presurgical Area

Intraoperative Nursing Management

The surgical team

the anesthesiologist or anesthetist,

the surgeon, nurses, and the surgical

technologists (or assistants).

The Circulating Nurse

verifying consent; coordinating the team; and ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, and the

availability of supplies and materials. The circulating nurse monitors aseptic

practices to avoid breaks in technique

The Scrub Role performing a surgical hand scrub setting up the sterile tables preparing sutures, ligatures, and special

equipment (eg, laparoscope) assisting the surgeon and the surgical

assistants during the procedure.  count all needles, sponges, and instruments  Tissue specimens obtained during surgery are

labeled by the person.

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General :Sterility of surface or articles Personnel: Scrubbed personnel remain in

the area of the operation . Only a small part of the scrubbed person’s body is considered sterile: from front waist to the shoulder area, forearm and gloves.

Drapping Delivery of sterile supplies Fluids

Types of Anesthesia and Sedation

General Anesthesia  Regional Anesthesia (Epidural Anesthesia,

Spinal Anesthesia Moderate Sedation Local Anesthesia

Anesthesia is a state of narcosis (severe central nervous system depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss.

General Anesthesia

Inhaled anesthetic agents include volatile liquid agents(e.g Halothane) and gases(e.g Nitrous oxide , o2).

Regional Anesthesia

In regional anesthesia, an anesthetic agent is

injected around nerves so that the region

supplied by these nerves is anesthetized.

Epidural anesthesia

Spinal anesthesia

is an extensive conduction nerve

block that is produced when a local

anesthetic agent is introduced into

the subarachnoid space at the

lumbar level, usually between L4 and

L5

Moderate sedation

is a form of anesthesia that involves the IV

administration of sedatives or analgesic

medications to reduce patient anxiety and

control pain during diagnostic or therapeutic

procedures.

Local anesthesia

into the tissues at the planned incision site.

• It is simple, and nonexplosive.• Equipment needed is minimal. • Postoperative recovery is brief. •Undesirable effects of general

anesthesia are avoided. • It is ideal for short and minor surgical

procedures

postoperative period

The postanesthesia care unit (PACU), also

called the recovery room or postanesthesia

recovery room, is located adjacent to the

operating rooms suite.

Nursing Management in the PACU Assessing the Patient Maintaining a Patent Airway Maintaining Cardiovascular Stability

(Hypotension and Shock , Hemorrhage , Hypertension and Dysrhythmias)

Relieving Pain and Anxiety Controlling Nausea and Vomiting DeterminingReadinessforDischargeFr

omthePACU

Nursing Management After Surgery Preventing Respiratory Complications Relieving Pain Promoting Cardiac Output Encouraging Activity Caring for Wounds Maintaining Normal Body Temperature Managing Gastrointestinal Function and

Resuming Nutrition

Promoting Bowel Function Managing Voiding Maintaining a Safe Environment Providing Emotional Support to the

Patient and Family Managing Potential Complications Promoting Home and Community-

Based Care