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Adult Health--Perioperative Nursing
Terms in this set (33)
Perioperative Nursing Phase
Begins with client's decision to go into surgery, ends with client in the operating room
Prepares for surgery, during surgery, and after surgery
-AORN= American Operative RN
-Joint commission= Patient Safety Goals. Main occupation is to prevent infection. They make sure the health care team delivers the right treatment to prevent complications/infection
Costly errors that are preventable:
*Surgery on the wrong patient
*Surgery on the wrong part of the body
*Wrong surgery on the patient
*DVT or PE after hip replacement
*Foreign body left in the patient
*Surgical wound infection
Surgical Procedures Can Be Classified By:
* Purpose e.g. Palliation
* Degree of Urgency e.g. elective
* Degree of Risk
Surgical Purpose: Ablative
Removal of a diseased body part.
Ex: Amputation, Laser Surgery on Heart
Surgical Purpose: Diagnostic- Exploratory
Trying to rule out diseases.
Ex: Person gets hit by a car and has fluid floating around in the abdomen (Laparotomy)
Surgical Purpose: Palliative
To relieve symptoms; won't cure them
Surgical Purpose: Reconstructive
To restore surgery. Ex: Reconstruction of the mandible
Surgical Purpose: Cosmetic
Surgical Purpose: Transplant
Replace organ. Ex: Joint- Knee operation is considered a transplant.
Degree of Surgery
*Elective: Recommended, but not time sensitive
*Urgent: Usually between 24-48 hours you go to OR, to alleviate symptoms Ex: Nerve Damage. Repairing body part or restoring function
*Emergency: Need to go to OR right away. Ex: bleeding, hypotensive, hemorrhage of an organ
Degree of Risk
*Major: Usually involving general anesthesia. Associated with significant blood loss, involves vital organs, prolonged/complicated procedures, or associated with significant post-op procedures.
*Minor: O.P. basis. Usually for outpatient procedures.
Factors that Influence Risk
*Age- Extreme of age
*Type of Wound- huge incision: the more extensive the surgery, the higher risk of complication
*Preexisting Conditions: Ex: diabetes, heart failure, HIV, COPD, obesity--- all tend to lead to poor , slow healing. HTN leads to bleeding
*Mental Status: If you can't follow commands after surgery, the person will be prone to complications
*Medications: Anticoagulant Meds—risk of bleeding and Antihypertensive—increases risk of ischemia.
*Lifestyle Habits: Smoking and drinking, drug use
*Allergies: Anaphylactic reactions
Medications which Increases Risk
Antibiotics—increases anesthetic effects
*Antihypertensive— increases risk for ischemia
*Aspirin—Inhibits platelet function which increases risk for bleeding
*Corticosteroids—decreases immune response and makes them prone to infection
*Diuretics—can decrease volume. When you give anesthesia, it vasodilates
*Opioids—decrease blood pressure, can make patient hypotensive and groggy
*NSAIDS—can reduce inflammation
*Tranquilizers—can decrease BP and make it difficult to wake up patient
Preoperative Nursing Responsibilities
*Preoperative Nurse will take patient to pre-op nursing unit.
*Thorough health history is done. Make sure client demonstrates knowledge/understanding of the surgery—nurse can answer non-medical questions, can only give generalized answers.
*Physical assessment—focus on symptoms that indicate risk for surgery.
Preoperative Nursing Responsibilities- Screening Tests
*Preoperative Screening Tests: CBC—collect RBC, WBC, platelets, Hct, Hgb
Urinalysis—Check for infection
. Can show protein, increased white count
*ECG—Electrocardiogram for age of 50; to make sure that there is no underlying heart issue
Preoperative Nursing Responsibilities- Surgical Consent
*Pre-op NEEDS to confirm consent verification before going into OR room
*Confirm the patient understands and has no further questions
-We are witnessing that the patient is signing and are confirming that they understand what they are signing. It is the physician's job to explain what the consent sheet holds—the risks, benefits, alternatives...
-Emergency procedures—two physicians can give consent
-Complete preoperative teaching—Teach them what the patient will expect after surgery, BEFORE they go into surgery.
-Printed Materials: Procedure, Post-procedure process (home vs. hospitalization), turning, coughing and deep-breathing is necessary to expand lungs and get organs to function again
Preoperative Nursing Responsibilities- Preparing the Client Physically
*Surgical Scrub: Prepping the skin
*Bowel Preparation: Enemas
*Preoperative medications: To prevent intraoperative MI, use beta blockers before surgery
*Antiembolism stockings: Prevents clot
*Ensure a working IV
*Sterile Team: Surgeon, Surgical Assist
*First-Assist RN: Assist in surgery
Circulating nurse; in charge of the operating room. They are not sterile and are making sure that everything is running smoothly and that all the equipment is available and ready. Has idea about how much blood to have on board, temperature... everything! Good for personality type that are very analytical
*Anesthesia: Clean (not sterile). Keeping patients sedated/alive
*Skin Preparation: Pre-operatively; always clip hair (don't shave).
*Positioning the client: Circulating nurse has to prevent ulcers and prevent neurovascular damage.
Intraoperative Care: Client Safety
*"Time Out" - In the OR before you start surgery, there has to be a final verification. Circulating nurse has to direct it and verify that it is --- right patient, right procedure, right limb...
*Sterile field: Everything on sterile pile
*Monitor I and O: Any type of drainage; IV fluid replacements
*Sponge, Sharps, and Instrument Count: Always count...
Types of Anesthesia
*General Anesthesia: Rapid unconsciousness, completely out. Can sometimes be awake, though paralyzed!
*Conscious Sedation: Combination of sedation and analgesia. Not incubated, but can't remember anything. Given to patients who are having an outpatient procedure, bedside procedure, biopsy, endotrachial insertion...Not a paralytic
*Regional Anesthesia: Numbness to area or block the nerves. Usually for a patient who is even at risk for going to sleep.
*Spinal Anesthesia: injected into central nervous system. Numbs everything from below the block.
*Epidural Anesthesia: A little bit safer than spinal anesthesia but blocks sensation from the level below.
*Local Anesthesia: Numbs that particular spot.
Postoperative phase: The PACU
OR--> ICU--> Med-surg floor
*Recovery from anesthesia
*Monitor Urine Output—Kidneys will tell you early on if they're not getting enough cardiac output
Postoperative Care: Nursing Unit
-Frequent vital signs—every 15 mins, for 1st hour
-Sequential Compression Devices. Will squeeze/release pressure. Prevents DVT
-Incentive Spirometry—promotes coughing and deep breathing, but increases volume
*Hypothermia-- if they're cold, they can't clot
*Fluid and electrolyte imbalance
*Musculoskeletary injury secondary to positioning
*Risk for impaired body temperature
*Risk for imbalanced fluid volume
*Risk for Perioperative Positioning Injury
Potential Complications of Anesthesia
-Vasomotor Instability (and resultant hypotension and diminished peripheral perfusion)
-Respiratory Depression—anesthesia will knock out respiratory drive
Risks for Operative Patients
* Risk for imbalanced body temperature related to cool environment and cool IV fluids
*Risk for aspiration related to depressed respiration and reflex
*Risk for imbalanced fluid levels related to NPO status and blood loss
*Risk for perioperative positioning injury related to sensory perceptual disturbances secondary to anesthesia
*Patient will be free from injury
*Patient will remain physiologically stable
*Patient will experience optimal surgical outcome
*Patient will remain free from infection
*Patient will maintain body temperature within normal range
*Patient will have no skin, tissue, neuromuscular injury related to positioning or blood pressure cuff
In the Post Anesthesia Care Unit- recovery phase 1- patients are at risk for cardiovascular and respiratory compromise
-They are positioned on their side when they are unconscious to help maintain airway and drain saliva out of their mouths
-Phase II- Recovery from PACU and move to floor or discharge
Recovery from Anesthesia*
-Airway: Able to cough and deep breathe. Will help decide if patient gets moved from ICU and where to. Can they bring up secretions on their own - are they too weak?
-Mobility and Sensation return
-30 mL of urine is the minimal amount of output that should be seen
-If they're still bleeding perfusively after 2 hours after the OR, something's wrong
-Dressings and drains, clean,dry, and intact
Potential Surgical Complications
Nausea and Vomiting
Paralytic Ileus: Gut is the last one to wake up and may not want to be fed. There will be decreased bowel sounds and may be distended. May need NG tube to suction
Renal Failure- contrast injected- fluoronscopy- can lead to renal failure
Urinary Retention-patient is unable to urinate, usually because they're still anesthesized
Pain Management- Do not wait for patient to be in extreme pain
PCA- Patient can administer own pain meds (?)
SVT- antiembolism stockings
THIS SET IS OFTEN IN FOLDERS WITH...
PSON Adult Health 1 Exam 1
Adult Health Nursing Unit 1
Adult Health Nursing Exam 1
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