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Chapter 12
Nursing Care of Patients Having Surgery
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Surgery Urgency LevelsEmergencyUrgentElective Optional
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Purposes of SurgeryPreventiveDiagnostic Exploratory Curative Palliative Reconstructive
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Types of SurgeryOpen IncisionMinimally Invasive Surgery
“Keyhole,” “Endoscopic” Scope Robotic Laser
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Robotic Surgery – da VINCI
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Three Perioperative PhasesPreoperative
Decision for Surgery to Transfer to SurgeryIntraoperative Transfer to Surgery to PACU
Postoperative PACU to Recovery
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Preoperative PhaseLPN/LVN Role
Assist in Data CollectionReinforce Explanations/Instructions Provide Emotional/Psychological Support
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Factors Influencing Surgical Outcomes
Emotional ResponsesAgeHydration/NutritionSmoking and AlcoholDiseases
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Preadmission Surgical Patient Assessment
Health HistoryRisk FactorsEducation Discharge Planning Referrals Diagnostic Testing
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Preadmission Surgical Patient Assessment (cont’d)
Pregnancy Test Advance Directive
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Preoperative Teaching
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Preoperative RoutinesDate/Time of Admission/SurgeryAdmission ProceduresLength of Stay, Items to Bring and WearRecovery after SurgeryFamily InformationDischarge Criteria
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Preoperative InstructionsNPO Medications Bowel PrepPain Control
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Preoperative Instructions (cont’d)Postoperative Exercises
Deep Breathing and Coughing Incentive Spirometry Leg Exercises
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Incentive Spirometry
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Preoperative Patient: Assessment
Health HistoryMedicationsPhysical Assessment
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Preoperative Nursing Diagnoses
AnxietyFearDeficient Knowledge
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Preoperative ConsentGives Legal Permission for Surgery
Informed Consent Physician’s ResponsibilityNo Sedation When SigningVoluntaryCan Withdraw at Any TimeValid 30 Days
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LPN/LVN Role: Witnessing Consents
Ensure Patient Has Been Informed
Direct Questions to Physician
Signature Indicates Observed Voluntary Signing of Consent
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Preparation for SurgeryPreoperative Preparation ChecklistPreoperative Medications
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Preoperative Checklist
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Transfer to Surgery
Holding Area
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Holding AreaVerifications
Patient DataSurgical SiteTime Out
IV InsertionIV Antibiotic
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Intraoperative Phase Begins
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Arrival in SurgeryExplain What to ExpectPositionSafety Tubes Placed After AnesthesiaSkin Prep
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Intraoperative PhaseLPN/LVN Role
Scrub Nurse Sterile Instrument Field
Assists Physician
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AnesthesiaGeneral Anesthesia
Loss of Sensation, Consciousness, Reflexes IV or Inhalation Route
Local AnesthesiaLoss of Sensation to Body RegionInjection of a Local Agent
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Endotracheal Tube
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Malignant HyperthermiaRare Hereditary Muscle Disease Triggered by Some Types of General Anesthesia Agents
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Spinal Anesthesia
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AnesthesiaAdjunct Agents Conscious Sedation
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Surgery
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PACU
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Postoperative PhasePACU Nursing Diagnoses
Risk for AspirationIneffective Breathing Pattern
Ineffective Airway Clearance
Deficient Fluid Volume
Risk for Injury
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Postoperative Phase (cont’d)PACU Nursing Diagnoses (cont’d)
Disturbed Sensory Perception
Acute Pain
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Family Visitation Keep InformedMaintain Confidentiality (HIPAA)
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PACU Discharge CriteriaStable Vital SignsSao2 Greater Than 90%Awake, Baseline Level of ConsciousnessRespirations Not DepressedBleeding Controlled
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Nursing Diagnoses for Postoperative Patients
Ineffective Airway Clearance Ineffective Breathing Pattern Acute Pain Deficient Fluid Volume Ineffective Tissue Perfusion Impaired Urinary Elimination
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Nursing Diagnoses for Postoperative Patients (cont’d)
Urinary RetentionRisk for InfectionImpaired Skin IntegrityImbalanced NutritionConstipationImpaired Physical Mobility
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Complication Prevention
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Complication Prevention (cont’d)
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Stapled Incision
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Healing Phases
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Wound Dehiscence/Evisceration
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Ambulatory Surgery Discharge Criteria
Stable Vital SignsNo BleedingNo Nausea/Vomiting Controlled Pain Voided as Indicated No Dizziness When Upright
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Discharge InstructionsWritten Instructions/SignedTeaching
Wound Care Medications Complications Equipment
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Discharge Instructions (cont’d)Follow-up Physician’s VisitPrescriptions
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Discharge Teaching
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Home Health CareRN
Assessment, Complex Nursing Care, Teaching
LPN/LVN Basic Nursing Care
Assistants ADLs, Chores