definition of surgery perioperative nursing care definition of surgery surgery is any procedure...

Perioperative Nursing Care Definition of SurgeryDefinition of Surgery

Surgery is any procedure performed on Surgery is any procedure performed on the human body that uses instruments to the human body that uses instruments to alter tissue or organ integrityalter tissue or organ integrity.

Perioperative Nursing Care

Perioperative NursingPerioperative Nursing- connotes the delivery of patient care in the preoperative,intraoperative, and postoperativepostoperative 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 diagnosis;identifies desired patient outcomes;develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient.

Perioperative Nursing Care Type of Surgery

Seriousness: Degree of riskSeriousness: Degree of riskMajorMajor- Involves extensive - Involves extensive

reconstruction or alteration in body reconstruction or alteration in body parts;poses great risks.parts;poses great risks. MinorMinor- - Involves minimal alteration in body Involves minimal alteration in body parts;often designed to correct parts;often designed to correct deformities;involves minimal risk compared deformities;involves minimal risk compared with major procedures.with major procedures.

Perioperative Nursing Care Types of Surgery

Urgency: reason for procedure:Elective-Performed on the basis of client’s choice; not

essential and may not necessary for health.Urgent- Necessary for client’ health,may prevent

additional problem from developing (e.g. tissue destruction);not necessarily emergency. Emergent- Must be done immediately to save life or preserve function of body part.

Required- Has to performed at some point;can be pre-scheduled.

Perioperative Nursing Types of SurgeryTypes of Surgery

DiagnosticDiagnostic-Allows to confirm diagnosis.

CorrectiveCorrective- Excision or removal of diseased body part.

ReconstructiveReconstructive-Restore function or appearance to traumatized or malfunctioning tissues.


Procurement for transplantProcurement for transplant- Removal of organs and/or tissues from a person pronounced brain death for transplantation into another person.

ConstructiveConstructive- Restores function lost or reduced as result of congenital anomalies.

CosmeticCosmetic- Performed to improve personal appearance.


Extent of surgery Extent of surgery :SimpleSimple- Only the most overtly

affected areas involved in the surgery.RadicalRadical- Extensive

surgery beyond the area obviously involved; is directed at finding a root cause.LocationLocation: Based on the area of the body on which the surgery occurs (e.g abdominal, heart surgery).

Perioperative Nursing Care Surgical settingsSurgical settings

Surgical suitesSurgical suites

Ambulatory care settingAmbulatory care setting

ClinicsClinics

Physician officesPhysician offices

Community settingCommunity setting

HomesHomes

Perioperative Nursing Care Surgical settingsSurgical settings

DisadvantagesDisadvantagesLess time for rapportLess time to assess, evaluation, teachRisk of potential complication post D/C.

Advantages of outpatientAdvantages of outpatient:Low costLow risk of infectionLess interruption of routineLess than from workLess stress

Perioperative Nursing CareMethod of teachingMethod of teaching

TimingTiming-most useful when started the week before admission and reinforced before surgery and the client is less anxious.Content:Content:

Surgical ProcedureSurgical ProcedurePreoperative routinesPreoperative routinesIntraoperative routinesIntraoperative routines

Postoperative routinesPostoperative routinesSensory preparationSensory preparationPain reliefPain relief

Perioperative Nursing Care PhasesPhases

PreoperativePreoperative-begins with the decision for surgical intervention and ends with transfer to the OR.

Nursing Interventions

Baseline assessment during interview at clinic,office or over the phone.

Assessment in the pre-admission unit, client room, holding area or induction room

Perioperative Nursing Care Preoperative Surgical PhasePreoperative Surgical Phase

AssessmentAssessment:Nursing HistoryNursing History-key elements that pertains to the surgical client’s risks and needs. Information concerning about advance directives. Ask if the patient has a durable power of attorney for health care and a living will.Medical HistoryMedical History- includes past illnesses and the primary reason for seeking medical care.


Assessment continue…..Assessment continue…..Previous surgeriesPrevious surgeries- - past experience with past experience with

surgery can reveal potential physical and surgery can reveal potential physical and psychological responses to procedure and alert psychological responses to procedure and alert you to special needs and risk factors. you to special needs and risk factors. Complications such as anaphylaxis or malignant Complications such as anaphylaxis or malignant hyperthermia.hyperthermia.

Medication HistoryMedication History- - any medications that any medications that might predispose to surgical complicationsmight predispose to surgical complications ..


AllergiesAllergies- to medications, topical agents used to prepare the skin for surgery, and latex can create significant risks.Smoking HabitsSmoking Habits – greater risks for complications.Alcohol and Controlled Substance UseAlcohol and Controlled Substance Use and abuseand abuse- to be prepared for adverse reactions, such as withdrawal, that may occur during surgery.

Client ExpectationsClient Expectations- to identify the client’s and family perceptions and expectations regarding surgery and health care providers.


Family SupportFamily Support- determine the extent of the client’s support from family members or friends.

OccupationOccupation- surgery may result in physical alterations that hinder or prevent a person from returning from work.

FeelingFeeling- surgery causes anxiety and a feeling of loss of control for most clients.

Cultural and Spiritual FactorsCultural and Spiritual Factors- cultural differences in the use of both verbal and nonverbal communication require you to validate interpretation of cues with the client and family.


Coping ResourcesCoping Resources- assessment of a client’s feeling and self-concept helps to reveal whether the client has the ability to cope with the stress of surgery.

Body imageBody image-surgical removal of a diseased tissue often leaves permanent disfigurement or alteration in body function.

Perioperative Nursing CareSelected factors that in increase surgical riskSelected factors that in increase surgical risk..

AgeAge- Very young and older clients.

NutritionNutrition- a malnourished client is prone to poor tolerance of anesthesia, infection, poor wound healing and the potential for multiple organ failure after surgery.

ObesityObesity- often have difficulty in resuming normal activity after surgery.

Perioperative Nursing CarePhysical assessment/clinical manifestationsPhysical assessment/clinical manifestations

General surveyGeneral survey- gestures and body movements may reflect decreased energy or weakness caused by illness.Cardiovascular systemCardiovascular system- alterations in cardiac status are responsible for as many as 30% of perioperative death.Respiratory systemRespiratory system- a decline in ventilatory function, assessed through breathing pattern and chest excursion, may indicate a client’s risk for respiratory complications.


Renal systemRenal system-abnormal renal function can altered fluid and electrolyte balance and decrease the excretion of preoperative medications and anesthetic agents.

Neurologic systemNeurologic system- a client’s LOC will change as a result of general anesthesia but should return to the preoperative LOC after surgery.


MusculoskeletalMusculoskeletal 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 systemGastrointestinal system- alteration in function after surgery may result in decreased or absent bowel sound and distention.

Head and NeckHead and Neck- the condition of oral mucous membranes reveals the level of hydration.

Perioperative Nursing CareGerontological Considerations

CardiovascularCardiovascularCoronary flow decreases

Heart rate decreasesResponse to stress

decreases Peripheral vascular decreases Cardiac output decreases Cardiac reserve decreases


Respiratory SystemStatic lung volumes decreasesPulmonary static recoil decreasesSensitivity of the airway receptors decreases

Nervous systemIncreased incidence of post.op. confusionIncreased incidence of deliriumIncreased sensitivity to anesthetic agents


Renal SystemRenal blood flow declines 1.5% per

year Renal clearance reduced

GastrointestinalDecreased intestinal motility

Decreased liver blood flowDelayed gastric emptying


MusculoskeletalDecreased mass, tone, strengthDecreased bone density

IntegumentaryDecreased elasticityDecreased lean body massDecreased subcutaneous fat

Perioperative Nursing CareLaboratory and diagnostic studiesLaboratory 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.

Blood typeBlood type and screenscreen, urinalysisurinalysis, 1212 lead EKGlead EKG and chest X-raychest X-ray are ordered to screen for pre-existing abnormalities.

Perioperative Nursing CareCommon nursing diagnosisCommon nursing diagnosis

Knowledge deficitKnowledge deficit

AnxietyAnxiety

Risk for ineffective airway clearanceRisk for ineffective airway clearance

Risk for ineffective peripheral tissue Risk for ineffective peripheral tissue perfusionperfusion

Perioperative Nursing CarePerioperative Nursing CarePreop. teachingPreop. 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 patient’s familiarity with procedural events. This includes surgical experience (procedural), what the pt. may experience (sensory) and what actions may help decrease anxiety (behavioral).

Perioperative Nursing CarePerioperative Nursing CareAnxietyAnxiety

The nurse must consider the pt’s 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.

Perioperative Nursing CarePreanesthesia Management Physical Status Categories

ASA 1: Healthy patient with no diseaseASA 11: Mild systemic ds without fx limitationsASA 111:Severe systemic ds associated with definite fx limitationsASA 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

Perioperative Nursing CarePerioperative Nursing CareFinal Preparation for surgeryFinal Preparation for surgery

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

Perioperative Nursing CarePerioperative Nursing CarePre-op. medicationsPre-op. medications

Prior to administering – check permitsPrior to administering – check permits

Purpose: Allay anxietyPurpose: Allay anxietyDecrease pharyngeal secretions- Decrease pharyngeal secretions-

decrease gastric secretions.decrease gastric secretions.Decrease side effects of anesthesiaDecrease side effects of anesthesia

Induce amnesiaInduce amnesia

Perioperative Nursing CarePerioperative Nursing CareMedicationsMedications

Sedatives/hypnotics- Nembutal

Tranquilizers-Ativan, versed, valium

Opiate analgesics- Demerol, morphine

Anticholinergics-Atropine sulfate,atarax

H2o blockers.- Tagamet, Zantac

Antiemetic- Reglan, Phenergan

Perioperative Nursing Care PhasesPhases

IntraoperativeIntraoperative- - Transferred to OR-ends with the transfer Transferred to OR-ends with the transfer to the recovery area.to the recovery area.

Nursing InterventionsNursing Interventions

Communicating plan of care

Identifying nursing activities

Establishing priorities

Coordinate care with team members

Coordinate supplies and equipment

Control environment

Document plan of care

Perioperative Nursing Care Intraoperative RolesIntraoperative Roles

Surgeon

Anesthesiologist

Scrub Nurse

Circulating Nurse

OR techs

Perioperative Nursing CarePerioperative Nursing CareIntraoperative Phase- Surgical teamIntraoperative Phase- Surgical team

SurgeonSurgeon-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 patient’s care.Scrub nurse-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.

Perioperative Nursing CarePerioperative Nursing CareSurgical teamSurgical team

Circulating NurseCirculating 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.

Perioperative Nursing CarePerioperative Nursing CareSurgical teamSurgical team

Anesthesiologist and anesthetist-Anesthesiologist and anesthetist- anesthetizing the pt. providing appropriate levels of pain relief, monitoring the pt’s physiologic status and providing the best operative conditions for the surgeons.

Other personnel- pathologist, radiologist, perfusionist, EVS personnel.

Perioperative Nursing Care Surgical teamSurgical team

Nursing Roles:Nursing Roles:Staff educationStaff educationClient/family teachingClient/family teachingSupport and reassuranceSupport and reassuranceAdvocacyAdvocacyControl of the environmentControl of the environmentProvision of resourcesProvision of resourcesMaintenance of asepsisMaintenance of asepsisMonitoring of physiologic and psychological Monitoring of physiologic and psychological

statusstatus

Perioperative Nursing CareSurgical asepsis

Ensure sterility

Alert for breaks

Perioperative Nursing Care Types of AnesthesiaTypes of Anesthesia

RegionalLocal

Nerve blockEpidural

Spinal

General

Spinal Anesthesia

Indications -surgical procedures below the diaphragm

-patients with cardiac or respiratory diseaseAdvantages -mental status monitoring -shorter recoveryDisadvantages -necessary extra expertise -possible patient painContraindications -coagulopathy -uncorrected hypovolemia

Spinal Anesthesia

Involved medications-lidocaine-bupivacaine-tetracaine

Patient assessment-continuous heart rate, rhythm, and

pulse oximetry monitoring-level of anesthesia

-motor function and sensation return monitoring

Spinal Anesthesia

Complications-hypotension

-bradycardia-urine

retention -postural puncture headache

-back pain

Spinal analgesia

Indications -postoperative pain from major surgeryInvolved medications -lipid-soluble drugs -preservative-free morphineMonitoring recovery -respiratory depression -urine depression -pruritus -nausea and vomiting

Perioperative Nursing CarePerioperative Nursing Care PhasesPhases

PostoperativePostoperative- - Begins with transfer to PACU and Begins with transfer to PACU and ends with the discharge of the patients from the ends with the discharge of the patients from the surgical facility or the hospital.surgical facility or the hospital.

Nursing InterventionsNursing Interventions

Communicating pertinent information about surgery Communicating pertinent information about surgery to the PACU staff.to the PACU staff.

Postoperative evaluation in clinic or home.Postoperative evaluation in clinic or home.

Perioperative Nursing CarePerioperative Nursing CareNursing assessment in the PACUNursing assessment in the PACU

Vital signs- presence of artificial airway, o2 sat,BP,pulse, temperature.LOC- ability to follow command, pupillary responseUrinary outputSkin integrityPainCondition of surgical woundPresence of IV linesPosition of patient

Perioperative Nursing CarePerioperative Nursing CareNursing DiagnosisNursing Diagnosis

Ineffective airway clearance- increased secretions 2 to anesthesia, ineffective cough, painIneffective breathing pattern- anesthetic and drug effects, incisional painAcute painUrinary retentionRisk for infection

Perioperative Nursing Care Postoperative ManagementPostoperative Management

Maintain a patent airway

Stabilize vital signs

Ensure patient safety

Provide pain

Recognize & manage complications

Perioperative Nursing CareWhen caring for post-surgical patient, When caring for post-surgical patient, think of the “4 W’sthink of the “4 W’s””

Wind: prevent respiratory complications

Wound: prevent infection

Water: monitor I & O

Walk: prevent thrombophlebitis

Perioperative Nursing CarePerioperative Nursing CareComplicationsComplications

Respiratory- atelectasis, pulm. EmbolusCardiovascular- venous thrombosisGastrointestinal-Hiccoughs, N/V,abd. Distention, paralytic ileus, stress ulcer.GU- urinary retentionHemorrhage-slipping of a ligature(suture)Wound infection-Wound dehiscence and evisceration-

Perioperative Nursing CarePerioperative Nursing CareGerontologic considerationsGerontologic 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.

definition of surgery perioperative nursing care definition of surgery surgery is any procedure...

Documents

heart surgery

radical extensive surgery

organ integrity surgery

nursing process

plan of care

delivery of patient

stress slide

function of body