Study Guide 15: Post-Perioperative Nursing Op/Pre-Op
|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
• Current medications
• Medical history
• Previous surgeries
• Understanding and expectations of the surgery
• Use of alcohol, caffeine, or other drugs
• Family and social support
• 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
• 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)
• 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
• Antiembolism Stockings "Prevent DVT"
• Personal "Valuables, General Description (example: White Gold Diamond Ring = clear stone ring, silver colored"
• 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
• 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
• Risk for Fluid Volume
• Deficit Risk for Infection
• Risk for Injury
• Urinary Retention