The person undergoing surgery


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  • Preparation may include: *providing information *teaching activities- deep breathing & coughing exercises, leg exercises, moving & changing position *physical examination *laboratory tests & diagnostic studies *informed consent *psychological preparation *physical preparation- GIT, skin, administration of medications *preparation immediately before operation: wt, vital signs, voided, urinalysis, removal of makeup, nail polish, removal of jewellery, hairpins, prosthetic devices, spectacles, contact lenses, hearing aids. Dentures, crowns.Theatre gown/cap. Identification bands, allergies noted. Consent signed. Premedication. Pre-op check list completed. Previous pt. notes, x-rays, diagnostic results.
  • p. 669 tabners
  • Classification of surgery p.1539 Potter & Perry
  • p.401 Lewis
  • The person undergoing surgery

    1. 1. The person undergoing surgery1 DK/CIII/surgical pt
    2. 2. The person undergoing surgery  If you work in a hospital, you may have contact with a person before and after surgery. In nursing facilities, many residents are recovering from surgery. Many post operative patients need home care. Your role in caring for surgical patients depends on certain factors:  The employer’s policies  Whether the surgery was major or minor  The person’s condition before surgery  The person’s condition after surgery2 DK/CIII/surgical pt
    3. 3. Preoperative Care  The preoperative phase begins when surgical intervention is first considered and ends when the patient is admitted to the operating theatre  Preparations for surgery depend on diagnosis & type of surgery3 DK/CIII/surgical pt
    4. 4. Pre operative preparation including client communication/teaching  An important part of modern surgery is day surgery, also know as ambulatory surgery. Advance surgical techniques and better client preparation have allowed for clients to be admitted, operated on and discharged in the same day. All types of anaesthesia can be used.  Surgery is treating diseases, injuries and deformities by operation. As part of the client’s preparation you may need to discuss various terms used to describe surgery.4 DK/CIII/surgical pt
    5. 5. Types of surgery  Elective surgery is done for the person’s well-being. It is not life saving and may not be necessary for the person’s health. The surgery is scheduled well ahead of time, allowing the person to be well prepared psychologically and emotionally and leaving time for any pre testing to be done.  Urgent surgery is necessary for the person’s health. It must be done soon to prevent damage or disease.  Emergency surgery is done immediately It is life saving and the need is sudden and unexpected.5 DK/CIII/surgical pt
    6. 6. Surgical intervention May be directed towards:  a tumour (excess of tissue)  A defect (deficiency of tissue)  A deformity (displacement of structures)  Or the removal of foreign bodies (non-living material)6 DK/CIII/surgical pt
    7. 7. Methods of performing surgical procedures:  open surgery e.g. mastectomy – external surgical wound  closed surgery e.g. T.U.R.P. – wound is internal  minimal access e.g. laparoscopic – minimal external wounds and faster recovery time7 DK/CIII/surgical pt
    8. 8. Preparation  Providing information  Teaching activities  Examining/assessing the individual  Performing laboratory tests and diagnostic studies  Gaining the individual’s informed consent  Preparing the individual psychologically and physically8 DK/CIII/surgical pt
    9. 9. The person needs to be prepared for what happens before after and during surgery.  Physical and psychological preparation is necessary.  Often the person who needs to have surgery experiences many fears, - fear of loss of an organ, - who will care for the children, - how will they cope with the pain, - will they survive?9 DK/CIII/surgical pt
    10. 10. Purpose of surgery  diagnostic surgical exploration to aid diagnosis e.g. biopsy to determine presence and/or extent of pathology  Constructive restores function lost or reduced (congenital anomalies) e.g. congenital defects  transplant due to organ damage  reconstructive restores function or appearance to traumatised or malfunctioning tissues e.g. fractures  palliative relieve or reduce intensity of disease symptoms e.g. colostomy to bypass inoperable bowel obstruction from cancer  Cosmetic to improve appearance e.g. rhinoplasty, repairing burns scars.10 DK/CIII/surgical pt
    11. 11. Common Fears and Concerns of Surgical Patients •The fear of cancer •The fear of prolonged recovery •The fear of body disfigurement and scarring •The fear of more surgery and treatments •The fear of disability •The fear of being separated from family and friends •The fear of pain •The fear of tubes, needles and other equipment •The fear of dying •Concerns •The fear of anaesthesia and it’s effects •Who will look after the partner •The fear of going to sleep and not waking up •Who will take care of the pets •The fear of exposure •Who will pay the bills •The fear of complications •Who will take care of the unit11 DK/CIII/surgical pt
    12. 12. Nursing Assistant responsibilities in caring for the person who has fears and concerns:  Listen to the person who voices fears or concerns about surgery  Refer any questions about the surgery or it’s results to the nurse  Explain any procedures you do  Perform your tasks in a competent and confident manner12 DK/CIII/surgical pt
    13. 13. The Pre-operative Period  The doctor or registered nurse will do any pre- operative teaching. Once the doctor explains what is going to be done the person may sign a consent form should they wish to proceed. The registered nurse does the pre-operative teaching and tells the person what to expect after surgery.  It is not your role to educate the patient, but you should be aware of what is happening so you can give efficient basic care.13 DK/CIII/surgical pt
    14. 14. Pre operative preparation elective:  pre-admission clinics/tests  early intervention programs  patient education/assessment  referral emergency  day only/short stay/long stay:  transit lounge/pre-op prep areas14 DK/CIII/surgical pt
    15. 15. Anaesthesia Factors influencing the choice of anaesthetic include : 1. Nature of the surgery (length & complexity of of operation). 2. Client’s status (pre-existing medical conditions). 3. Anatomical & physiological conditions. 4. Client preference.15 DK/CIII/surgical pt
    16. 16. Anaesthesia  Anesthesia blocks the perception of pain.  Anesthesia is classified according to the CNS effects: i) local – the loss of sensation without the loss of consciousness ii) regional – the loss of sensation to a region of the body without loss of consciousness when a specific nerve or group of nerves is blocked with the administration of a local anaesthetic iii) general – the loss of sensation with loss of consciousness,+/- skeletal muscle relaxation, analgesia and elimination of the somatic, autonomic and endocrine responses16 DK/CIII/surgical pt
    17. 17. awareness of patient teaching  deep breathing and coughing exercises  pain management (including PCA)  moving and changing position  wounds, drains, intravenous infusions, indwelling catheters, nasogastric tubes  specialised surgical procedures17 DK/CIII/surgical pt
    18. 18. 18 DK/CIII/surgical pt
    19. 19. anti-embolic stockings  support blood vessels  prevent stasis  prevent thrombus formation19 DK/CIII/surgical pt
    20. 20. pre-op  base line data collection (including weight)  skin preparation ( you may be involved with this), according to policy  clipping  showering  total body wash  gastrointestinal preparation, e.g. bowel preparation  fasting regimes ( NBM 6-8 hours before) there should be a sign above the person’s bed and the water jug should be removed.20 DK/CIII/surgical pt
    21. 21. Pre-Operative Checklist Item Time Rationale 1. Operative area shaved 1 day pre- op or Hairs – harbour micro-organisms - in OT obscure op site 2. Special skin 1-2 days pre-op Decreases risk of infection. preparation morning of op 3. Weight 1 day pre-op Calculation of drug dosage Baseline for comparison 4. Consent Pre-op Legal purposes – written consent necessary for operative procedures 5. Bowel preparation Night before Prevents incontinence during anaesthesia. Decreases risk of post-op discomfort and abdominal distension.21 DK/CIII/surgical pt
    22. 22. Pre-Operative Checklist Item Time Rationale 6. Premedication given As ordered Promotes relaxation. Reduces apprehension. Dries up oral secretions. Decreases risk of inhalation. 7. Natural teeth Prior to transfer to OT May be dislodged during Dentures – in situ anaesthesia. Removed 8. Make up; nail polish, Day of surgery Nail polish – easier to observe the individual for jewellery, cyanosis. Prosthesis – may hairpins, contact lenses cause injury. Jewellery – may removed come in contact with metal and burn individual if diathermy used.22 DK/CIII/surgical pt
    23. 23. Pre-Operative Checklist Item Time Rationale 9. Temp: On admission and Abnormality may mean postponement of Chart on day of surgery operation Pulse: Resp: B.P.: 10. NBM: - Morning op -Usually 12mn Present of food/fluid causes vomiting night before and risk of inhalation. -- afternoon op - 6 hrs prior 11. Intragastric As ordered Aspiration of stomach contents and tube in situ decompression of stomach.23 DK/CIII/surgical pt
    24. 24. Pre-Operative Checklist Item Time Rationale 12. Stomach aspirated If emergency op and patient has Time: had food during the past 6 hours. Amount: 13. Voided/Catheterised 1 hr pre-op To prevent incontinence and Time: prevent injury to bladder. Amount: Morning of op Detect renal dysfunction. Urinalysis: 14. X rays with patient To accompany For referral by surgeon. (eg patient to OT For referral by anaesthetist. Orthopaedic, Gallbladder) E.C.G.24 DK/CIII/surgical pt
    25. 25. Pre-Operative Checklist Item Time Rationale 15. Outpatient clinic notes To accompany patient to For referral by OT anaesthetist and surgeon. 16. All current and To accompany patient to For referral by previous history notes OT anaesthetist and surgeon. 17. Blood cross matched Day before Possible need for and typed transfusion.25 DK/CIII/surgical pt
    26. 26. Pre-Operative Checklist Item Time Rationale 18. No. of blood bottles in Day of op Easy access if transfusion necessary O.T. fridge 19. Night sedation Night before To relax, decrease anxiety.26 DK/CIII/surgical pt
    27. 27. Recovery room27 DK/CIII/surgical pt
    28. 28. Post-op - preparing the patient’s room (surgical bed, placing equipment and supplies in the room, as directed by the nurse) - observations: You may be assigned to measure vital signs and observe the patient’s condition. - Other observations: time and amount of first voiding, FBC. - care of drips/drains ( If the drip is not dripping, do not touch the drip(IV), inform the RN) Inform the registered nurse of the appearance of bright red blood from the drainage tubes or suction tubes.28 DK/CIII/surgical pt
    29. 29. Post-op assessment  Vital signs  Colour  Level of consciousness (LOC)  Wound dressing  Drainage from urinary catheter  Presence of discomfort or pain29 DK/CIII/surgical pt
    30. 30. Post op  An IV (intravenous catheter) in your hand or arm to provide fluids and medicines until you are able to drink fluids well.  A face mask or tube under your nose to supply oxygen.  A tube to drain urine from your bladder. You may feel the urge to urinate even though your bladder is empty.  An NG (nasogastric) tube through your nose into your stomach to help prevent nausea and vomiting.  Wound drains to help your incision heal.  Leg wraps that inflate and deflate and/or elastic stockings to help circulation in your legs while you are less active. 30 DK/CIII/surgical pt
    31. 31. Post op  Remember: The post-op person is NBM until they have been given permission by the doctor to progress to a different diet. The registered nurse will tell you when to change the signs above the patient’s bed.31 DK/CIII/surgical pt
    32. 32. Subsequent post-op care  Assessing respiratory and circulatory needs  Comfort needs  Nutritional and fluid needs  Elimination needs  Movement and exercise needs  Hygiene needs  Psychological needs  Protection and safety needs  Wound care needs (including drainage tubes, sutures and clips)  Observe for complications  Preparation for discharge32 DK/CIII/surgical pt
    33. 33. Complications  Pain  Haemorrhage  Shock (hypovolaemic) respiratory complications (pneumonia, atelectasis)  Thrombophlebitis  Pulmonary embolism  Nausea and vomiting (N&V)  Abdominal distension  Paralytic ileus  Urinary retention  Wound infection/dehiscence/evisceration33 DK/CIII/surgical pt
    34. 34. Operative procedures Some examples include:  Prostatectomy  Hysterectomy  Cholecystectomy  Appendicectomy  Tonsillectomy  (Breast) lumpectomy  Hip replacement  Knee replacement34 DK/CIII/surgical pt
    35. 35. Operating room35 DK/CIII/surgical pt
    36. 36. 36 DK/CIII/surgical pt
    37. 37. 37 DK/CIII/surgical pt