Study Guide 15: Post-Perioperative Nursing Op/Pre-Op
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fulmerduckworth on December 11, 2010
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Terms | Definitions |
|---|---|
 Perioperative Nursing Overview | • A clinical specialty, referring to the role of the nurse during three stages of the client's surgical experience: • Preoperative (before surgery) • Intraoperative (during surgery) • Postoperative (after surgery) phases of the client's surgical experience. |
| Types of Surgery Categorization | • Purpose - Diagnostic, ablative, palliative, reconstructive, transplant • Degree of Urgency - urgency/necessity to preserve a client's life, body part or function • Degree of seriousness/risk - minor or major according to seriousness/risk to the client |
| Surgery Purpose - Diagnostic | • Confirm/establish a diagnosis |
| Surgery Purpose - Ablative | • Excise/remove a diseased body part |
| Surgery Purpose - Palliative | • Reduce pain or intensity of symptoms; it does not cure |
| Surgery Purpose - Reconstructive | • Restores appearance or function to traumatized or malfunctioning tissues |
| Surgery Purpose - Transplant | • Replaces malfunctioning structures or organs |
| 3 Degrees of Urgency | • Elective surgery is performed when surgery is the preferred treatment and may improve the client's life, but is not essential for the person's health • Urgent surgery is necessary for the client's health and may prevent complications from developing • Emergency surgery must be done immediately to save the client's life or preserve function of a body part |
| Degree of Seriousness-Risk | • Surgery is classified according to the degree of risk to the client • Usually determined by the client's age, nutritional status, general health, use of medications, and mental status • Major surgery involves a high degree of risk and or involves extensive reconstruction or alteration of body parts • Minor surgery involves minimal risk and minimal alteration of body parts |
| Preoperative Care Assessment - History | Should include: • Current health status • Allergies • Current medications • Medical history • Previous surgeries • Understanding and expectations of the surgery • Use of alcohol, caffeine, or other drugs • Family and social support • Occupation • Emotional health Status |
| Preoperative Care Assessment - Physical | • Is brief but complete, and focuses on systems that could affect the client's response to the surgery or to anesthesia. • Data from the physical exam provide an important baseline for comparison during and after surgery. • Vital signs • Head and Neck • Skin Turgor • Thorax and Lung • Heart and vascular • Abdomen • Neurological status |
| Preoperative Screening Tests | • Complete Blood Count (CBC) • Serum Electrolyte Analysis • Coagulation Study (Prothrombin Time, Partial Thromboplastin Time, Platelet Count) • Serum Creatinine Test And Blood Urea Nitrogen (BUN) • Urinalysis • Chest X-ray. • Electrocardiogram (ECG) • Blood Typing And Cross Matching • Fasting Blood Glucose |
| Physical Preparation for Surgery | • Adequate Nutrition and Hydration • Normal Elimination • Adequate Rest and Sleep • Clean • Medications • Antiembolism Stockings "Prevent DVT" • Personal "Valuables, General Description (example: White Gold Diamond Ring = clear stone ring, silver colored" • Prostheses • Special orders • Special skin preparation |
| Preoperative Teaching | • Preoperative teaching has been shown to decrease postoperative complications. • Timing of the teaching is important. • When done too far in advance or when the client is anxious, it is not as effective. • Surgical events and sensations "let them know what to expect" • Pain management - Transcutaneous Electrical Nerve Stimulation (TENS), Patient Controlled Analgesia (PCA) |
| Pre-operative Teaching | • Breathing and Coughing Exercises • Incentive Spirometry • Leg Exercises and Turning in Bed • Emotional Support • Inform Consent |
| Inform Consent | Be sure that: • Patient knows what to expect • Patient knows risks • Patient knows procedure • Patient knows recovery period |
| Pre-op: Nursing Diagnoses | • Anxiety/Fear r/t threat of loss of body part or unknown effects of surgery on usual functions and roles • Fear r/t anticipation of postoperative pain • Knowledge Deficit (preoperative and postoperative routines/care) r/t no prior experience • Sleep Pattern Disturbance r/t hospital routines, stress, and anxiety • Anticipatory Grieving r/t anticipated surgical loss of body part |
| Types of Anesthesia | • General Anesthesia (completely out) • Regional Anesthesia (RA) - Temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. • (RA) Topical anesthesia (applied to skin) • (RA) Local Anesthesia (infiltration) (injected at site) • (RA) Nerve block (spinal sac) (applied to plexus) • (RA) Infiltration block (used with IV and tourniquet) • (RA) Spinal anesthesia (spinal sac - subarachnoid space) • (RA) Epidural anesthesia (spinal sac - epidural space) |
| Postoperative Period | • The postoperative period begins with admission of the client to the postanesthesia recovery area and ends when healing is complete. • Consists of two stages: immediate care and ongoing postoperative care, which lasts from return to the unit until healing is complete. • Goals of nursing care are to: prevent complications, promote healing, facilitate coping with altered structure/function, perform teaching, and plan for home care. |
| Post-Anesthesia Care Unit (PACU) Discharged | • They are conscious and oriented. • They are able to maintain a clear airway and deep breathe and cough freely. • Vital signs have been stable or consistent with preoperative vital signs for at least 30 minutes. • Protective reflexes (e.g., gag, swallowing) are active. • They are able to move all extremities. • Intake and urinary output is adequate (at least 30 mL/hr). • They are afebrile or a febrile condition has been attended to. • Dressings are dry and intact; there is no overt drainage. |
| Potential Complications of Surgery and Anesthesia | • Respiratory: ABC (Airway, Breathing, Circulation) • Cardiovascular: ABC (Airway, Breathing, Circulation) • Central Nervous System • Fluid Status • Wound Status • Physical Safety |
| Steps If Bleeding | • Assess entire area of wound "do not remove dressing", make sure the is no blood running out under the dressing. • Circle the blood spot to determine if increasing. • If increasing apply another layer of dressing over the first layer • The doctor removes the first dressing |
| Therapeutic Nursing Interventions Immediate Postoperative Care | • Nursing care in the immediate postanesthetic phases focuses on preventing complications from anesthesia or the surgery. • Assessments are initially made every 10-15 minutes, and usually continue for about 2 hours, depending on the surgery and length of anesthesia. • The client is transferred from the recovery area when physical status and level of consciousness are stable. |
| Postoperative Nursing: Immediate Care | • Respiratory Status - airway patency, oxygen saturation, effectiveness of ventilation • Cardiovascular Status - BP, All pulses, Skin; color, temperature, edema • Decreased urine output • Central nervous system status - LOC orientated x 3, reflexes (gag, cough), ability to move extremities • Fluid Status - Intravenous fluid intake, wound drainage (amount, type, color) & dressing (dry, intact), urine output, skin turgor or edema, vital signs • Pain (type, location, intensity) • Nausea and Vomiting • Keep all lines patent • Assure that monitors and equipment are functioning • Positioning • Help arouse and orient the client • Facilitate oxygenation • Treat hypotension • Provide for safety • Provide for comfort |
| Postoperative Nursing: Ongoing Care | • Most hospitals have protocols for postoperative assessments. For example, when a client is returned to the unit after surgery, assessments may be made every 15 minutes for the first hour, every 30 minutes for the second hour, and then every 4 hours for the next 48 hours. • Assessments include: pain level, level of consciousness; vital signs; skin color and temperature; comfort; fluid balance; dressings and bed clothes; appearance of wound; and tubes and drains, etc. |
| Post-op Nursing Diagnosis | • Altered Urinary Elimination • Body Image Disturbance • Delayed Surgical Recovery • Impaired Gas Exchange • Impaired Verbal Communication • Impaired Skin Integrity • Impaired Physical Mobility • Ineffective Airway Clearance • Ineffective Breathing Pattern • Nausea • Pain • Risk for Fluid Volume • Deficit Risk for Infection • Risk for Injury • Urinary Retention |
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