Surgery 6th year, Tutorial (Dr. AbdulWahid)
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Surgery 6th year, Tutorial (Dr. AbdulWahid)

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Nov. 2nd, 2011

Nov. 2nd, 2011

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Surgery 6th year, Tutorial (Dr. AbdulWahid) Surgery 6th year, Tutorial (Dr. AbdulWahid) Presentation Transcript

  • Preoperative phase
  • Intraoperative phase
  • Postoperative phase
  • EMERGENT –Severe bleeding
  • URGENT 24-30
  • ELECTIVE
  • OPTIONAL
  • MAJOR
  • MINOR
  • CLASSIFICATIONS OF SURGERY
    • Accdg. To Purpose :
    • DIAGNOSTIC
    • EXPLORATORY
    • CURATIVE
    • ABLATIVE
    • PALLIATIVE
    • RECONSTRUCTIVE
    • Accdg. To Location :
    • INTERNAL –
    • EXTERNAL –
  • FOUR BASIC PATHOLOGIC CONDITIONS THAT REQUIRE SURGERY:
    • OBSTRUCTION
    • PERFORATION
    • EROSION
    • TUMORS
  • SURGICAL RISK PATIENTS
    • Extremes of age ( very young & very old )
    • Extremes of weight (emaciation, obesity)
    • Dehydrated pts.
    • Nutritional deficits
    • Pts. with severe trauma or injury, infection/sepsis
    • Pts. with cardiovascular disease
    • Endocrine dysfunction (diabetes mellitus)
    • Hypertensive & hypotensive pts.
    • Hepatic disease
    • Preexisting mental or physical disability
  • PHASES OF O.R. NURSING :
    • PREOPERATIVE PHASE
    • PREPARATION FOR SURGERY
  • Day of surgery :
    • History.
    • Head-to-toe assessment
    • Informed consent
    • Pt.’S identity & surgical site verified
    • Ivf started.
    • Necessary tests.
  • Psychological Support :
    • Fears, anxieties,
    • Trusting relationship with client.
    • Explain pre- ,operative & post-op procedures
    • Allow client to ask questions.
    • Demonstrate confidence in surgeon & staff.
    • Provide for spiritual care.
  • PREOPERATIVE TEACHING
    • Preoperative medication
    • Breathing exercises, coughing, incentive spirometer
    • Leg exercises
    • Position changes and movement
    • Pain management
  • Diaphragmatic Breathing and Splinting When Coughing
  • Leg Exercises and Foot Exercises
  • Ensure the diagnostic
    • CBC
    • Electrolytes
    • PT/PTT (Prothrombin Time;Partial thromboplastin time)
    • Urinalysis
    • ECG
    • Blood typing & crossmatch
    • NPO-
    • Bowel prep
    • skin prep
  • Immediate preoperative preparation
      • Complete checklist and chart
      • Hospital gown, voiding, removal of dentures, jewelry,
      • Preoperative medication
    • Transporting
  •  
    • Adult client (over 18 y/o) signs own permit unless unconcious or mentally incompetent.
    • If unable to sign, relative (spouse or next of kin) or guardian will sign.
    • In an emergency, permission via telephone or telegram is acceptable; have a 2 nd listener on phone when telephone permission is given
  •  
    • Consents are not needed for emergency care if all 4 of the ff. criteria are met:
    • There is an immediate threat to life.
    • Experts agree that it is an emergency.
    • Client is unable to consent.
    • A legally authorized person cannot be reached.
  • PREOPERATIVE MEDICATIONS
    • PURPOSES:
    • sedative.
    • narcotics.
    • anticholinergics.
    • antiemetics and H2-blockers.
  •  
    • REVIEW MEDICAL RECORD AND PHYSICIAN’S ORDER: INITIALS
    • 1. History and Physical completed and in chart
    • 2. Laboratory studies/Reports in chart 3. EKG report in chart
    • 4. Chest X-ray report in chart
    • 5. Operative Permit completed, signed, & witnessed in chart
    • 6. Anesthesia Permit completed, signed, & witnessed in chart
    • 7. Consent for blood transfusion completed, signed, & witnessed in chart
    • 8. Medication Reconciliation Form Completed & Signed
    • PREOPERATIVE PREPARATION : INITIALS
    • 1 . Identification bracelet accurate and affixed to wrist or ankle prior to transport
    • 2 . Allergies checked, allergies bracelet on and allergy sticker on chart
    • 3 . Isolation label on chart
    • 4 . Jewelry, hairpieces, hairpins, contact lenses, glasses, prosthesis, underwear, money removed ..
    • 5 . Vital signs taken and recorded ................................................................................................ 5 . ____
    • Time taken_________ BP_________ Temp_______ HR_______ Resp_______
    • 6 . Dentures : Full : Upper Lower Partial : Upper Lower
    • Removed : Sent Home Left at bedside
    • Left in place as requested by : Anesthesiologist Patient
    • 7. Patient NPO yes since ________
    • If no: O.R. notified (Time) _______
    • 8. Medication sheets on chart..
    • 9. Most recent nursing assessment attached
    • 10. Report called to____________ at________________(time)