Pre and intra operative phase

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Pre and intra operative phase

  1. 1. Prepared by: Marisel Indon LunaPrepared by: Marisel Indon Luna PERIOPERATIVE NURSINGPERIOPERATIVE NURSING CARECARE 11
  2. 2. OBJECTIVESOBJECTIVES At the end of the presentation the participants willAt the end of the presentation the participants will be able to:be able to: 1.1. Recognize the different phase of perioperativeRecognize the different phase of perioperative nursing care.nursing care. 2.2. Identify the goal of care in each phasesIdentify the goal of care in each phases 3.3. Identify the different nursing role andIdentify the different nursing role and responsibility.responsibility. 4.4. Effectively apply it in actual nursing practice forEffectively apply it in actual nursing practice for care and safety of the patientcare and safety of the patient 22
  3. 3. Operating RoomOperating Room Surgery a branch of medicine that treat injuries, deformities or diseases by operation or manipulation 33
  4. 4. IntroductionIntroduction PERIOPERATIVE NURSING is thePERIOPERATIVE NURSING is the nursing care rendered to the totalnursing care rendered to the total surgical experience of the patientsurgical experience of the patient 33PhasesPhases 11..Preoperative phasePreoperative phase 22..Intra operative phaseIntra operative phase 33..Post operative phasePost operative phase 44
  5. 5. Pre-operative Phase Pre-operative Phase 55
  6. 6. Pre operative CarePre operative Care Care rendered to the patientCare rendered to the patient from the time the decision isfrom the time the decision is made for surgicalmade for surgical intervention to the time theintervention to the time the patient is transfer to thepatient is transfer to the operating roomoperating room.. 66
  7. 7. GOAL OF CAREGOAL OF CARE To prepare the patientTo prepare the patient physically, psychologicallyphysically, psychologically spiritually and legallyspiritually and legally.. 77
  8. 8. PHYSICAL PREPARATIONPHYSICAL PREPARATION 1. Develop nursing history1. Develop nursing history 2. Physical assessment ( P.E, V/S, Lab.2. Physical assessment ( P.E, V/S, Lab. Examination)Examination) 3. Assessment for risk factors3. Assessment for risk factors 4. Preparation of the operative site4. Preparation of the operative site Skin preparation:Skin preparation: a. scrubbing or taking a batha. scrubbing or taking a bath b. shaving or hair removalb. shaving or hair removal Gastro intestinal tract preparation:Gastro intestinal tract preparation: a. NPO ( Nothing per Orem )a. NPO ( Nothing per Orem ) b. Bowel clearanceb. Bowel clearance Genitourinary tract preparation-Genitourinary tract preparation- 5. Some patients may benefit from a sleeping5. Some patients may benefit from a sleeping 88
  9. 9. Psychological and spiritualPsychological and spiritual preparationpreparation Patients are often fearful or anxious about havingPatients are often fearful or anxious about having surgery.surgery. 1.1. It is often helpful for the patient to express theirIt is often helpful for the patient to express their concernsconcerns 2.2. Family needs to be included in psychologicalFamily needs to be included in psychological preoperative carepreoperative care 3.3. Pastoral care or religious affair assistancePastoral care or religious affair assistance Children may be especially fearful.Children may be especially fearful. 1.1. They should be allowed to have a parent with themThey should be allowed to have a parent with them as much as possibleas much as possible 2.2. Encouraged to bring a favorite toy or blanket to theEncouraged to bring a favorite toy or blanket to the hospital on the day of surgery.hospital on the day of surgery. 99
  10. 10. Legal preparationLegal preparation Informed consent or operative permit - is theInformed consent or operative permit - is the process of informing the patient about theprocess of informing the patient about the surgical procedure and its benefits thesurgical procedure and its benefits the risk, and possible complication therisk, and possible complication the anesthesia, and other treatment optionanesthesia, and other treatment option.. 1010
  11. 11. Purpose of informed consentPurpose of informed consent 1.1. To ensure that the patient understands theTo ensure that the patient understands the nature of the treatment.nature of the treatment. 2.2. To indicate that the patient’s decision was madeTo indicate that the patient’s decision was made without pressure.without pressure. 3.3. To protect the patient against unauthorizedTo protect the patient against unauthorized procedure.procedure. 4.4. To ensure that the procedure is performed onTo ensure that the procedure is performed on the correct body part.the correct body part. 5.5. To protect the surgeon and hospital against legalTo protect the surgeon and hospital against legal action by a patient who claims that anaction by a patient who claims that an authorized procedure was performed.authorized procedure was performed. 1111
  12. 12. Obtaining a consentObtaining a consent 1.1. Adult patient with sounds mind sign consentAdult patient with sounds mind sign consent 2.2. Patient should be properly informed.Patient should be properly informed. Signature isSignature is obtained with the patient’s complete understanding.obtained with the patient’s complete understanding. 3.3. The surgeon is responsible for obtaining the consent.The surgeon is responsible for obtaining the consent. 4.4. Older client and minors , mentally ill, need a legalOlder client and minors , mentally ill, need a legal guardian to sign the consent form.guardian to sign the consent form. 5.5. The nurse may witness the clients signing of the consentThe nurse may witness the clients signing of the consent 6.6. If patient is unable to write, thumb mark is acceptable ifIf patient is unable to write, thumb mark is acceptable if there is a witness to his mark.there is a witness to his mark. 7.7. Emancipated minors.Emancipated minors. 1212
  13. 13. Validity of a consentValidity of a consent 1.1. Written permission is required by lawWritten permission is required by law 2.2. Adult mentally healthy are competent to sign there consentAdult mentally healthy are competent to sign there consent 3.3. Minors – (18 and below) parents or legal guardian signedMinors – (18 and below) parents or legal guardian signed 4.4. Mentally ill- parents or legal guardian, appointed by the courtMentally ill- parents or legal guardian, appointed by the court 5.5. Emergency- ( if patient is unconscious or no legal guardian,Emergency- ( if patient is unconscious or no legal guardian, the medical practitioner is expected to act in the patient's bestthe medical practitioner is expected to act in the patient's best interests until family can be found.interests until family can be found. 6.6. A witness to the patient’s signature is required.A witness to the patient’s signature is required. 7.7. If the patient is unable to write a thumb mark is acceptable ifIf the patient is unable to write a thumb mark is acceptable if there is a witness to his mark.there is a witness to his mark. ““Validity may vary depend on the jurisdiction”Validity may vary depend on the jurisdiction” 1313
  14. 14. Some recent cases:  In April 2011 an ophthalmologist in Portland, operated on the wrong eye of a 4-year-old boy.  In December 2010, Beth Israel Deaconess Medical Center in Boston reported that neurosurgeons had performed three wrong-site spinal surgeries in a two-month period.  And after five wrong-site operations in less than three years, state officials in 2009 ordered that video cameras be installed in the operating rooms of Rhode Island Hospital in Providence, which was fined $150,000.
  15. 15. THE WASHINGTON POST The Pain of Wrong Site Surgery By Sandra G. Boodman, June 20, 2011 Based on state data, Joint Commission officials estimate that wrong-site surgery occurs 40 times a week in U.S. hospitals and clinics. Last 2010, 93 cases were reported to the accrediting organization, compared with 49 in 2004.
  16. 16. Patient educationPatient education 1.1. A vital component of the surgical experience.A vital component of the surgical experience. 2.2. Designed to help the patient understand theDesigned to help the patient understand the surgical experience to minimize anxiety andsurgical experience to minimize anxiety and promote full recovery from surgery andpromote full recovery from surgery and anaesthesia.anaesthesia. 3.3. Preoperative patient education maybe offeredPreoperative patient education maybe offered through conversation, discussion, audiovisualthrough conversation, discussion, audiovisual aids or videos & demonstrations.aids or videos & demonstrations. 1616
  17. 17. Post-operative exercisesPost-operative exercises Incentive spirometry (10-12 times per hour)Incentive spirometry (10-12 times per hour) Coughing – promotes removal of chest secretionsCoughing – promotes removal of chest secretions Deep breathing- decrease or lessen the painDeep breathing- decrease or lessen the pain Turning – stimulates circulation and relievesTurning – stimulates circulation and relieves pressure areaspressure areas Foot and leg exercise – improves circulation andFoot and leg exercise – improves circulation and muscle tonemuscle tone *SHOULD be taught to patient prior to Operation **SHOULD be taught to patient prior to Operation * 1717
  18. 18. Pre-operative medicationPre-operative medication To aid in the administration of anTo aid in the administration of an anesthetic,anesthetic, minimize respiratory tract secretionsminimize respiratory tract secretions and changes in heart rateand changes in heart rate to relax the patient and reduce anxietyto relax the patient and reduce anxiety 1818
  19. 19. Types of PreoperativeTypes of Preoperative medicationmedication 1.1. Opiates – such as morphine and demerolOpiates – such as morphine and demerol 2.2. Anticholinergic – such as atrophineAnticholinergic – such as atrophine 3.3. Barbiturates/Tranquilizers – pentobarbitalBarbiturates/Tranquilizers – pentobarbital 4.4. Prophylactic antibiotics – to be effectiveProphylactic antibiotics – to be effective when bacterial contamination is expectedwhen bacterial contamination is expected.. 1919
  20. 20. Admitting the patient toAdmitting the patient to surgerysurgery:: 1.1. Final Checklist/ PreoperativeFinal Checklist/ Preoperative checklistchecklist 2.2. Identification and verificationIdentification and verification 3.3. Review of patient recordReview of patient record 4.4. Consent formConsent form 5.5. Patient preparednessPatient preparedness 6.6. Transporting the patient to the ORTransporting the patient to the OR 2020
  21. 21. Intra-operative careIntra-operative care The intra-operative phase extend from theThe intra-operative phase extend from the time the client is admitted to the operatingtime the client is admitted to the operating room, to the time of anesthesiaroom, to the time of anesthesia administration, performance of the surgicaladministration, performance of the surgical procedure and until the client isprocedure and until the client is transported to the recovery room ortransported to the recovery room or postanethesia care unit (PACUpostanethesia care unit (PACU(.(. 2121
  22. 22. Surgical TeamSurgical Team Scrub team orScrub team or sterile teamsterile team 1.1. SurgeonSurgeon 2.2. AssistantAssistant surgeonsurgeon 3.3. Scrub nurseScrub nurse Non sterile noneNon sterile none scrub teamscrub team 1.1. AnesthesiologiAnesthesiologi st andst and technicianstechnicians 2.2. CirculatingCirculating nursenurse 2222
  23. 23. Throughout the surgical experienceThroughout the surgical experience the nurse functions as the patient’sthe nurse functions as the patient’s advocateadvocate Goals of care:Goals of care: 1.1. Safe administration of anesthesia, right patient,Safe administration of anesthesia, right patient, right procedure, correct siteright procedure, correct site 2.2. HomeostasisHomeostasis 3.3. Promote the principle of asepsisPromote the principle of asepsis 4.4. HemostasisHemostasis 2323
  24. 24. Anesthesia classificationAnesthesia classification:: A.A. General anesthesia-General anesthesia- is the loss of allis the loss of all sensation and consciousness.sensation and consciousness. B.B. Regional / Local Anesthesia-Regional / Local Anesthesia- TheThe client loss sensation in an area of theclient loss sensation in an area of the body but remains conscious.body but remains conscious. :: 2424
  25. 25. Anesthesia ClassificationAnesthesia Classification General anesthesiaGeneral anesthesia administered by :administered by : 1.1. Intravenous infusionIntravenous infusion 2.2. Inhalation of gasesInhalation of gases through a mask orthrough a mask or 3.3. through an endo-through an endo- tracheal tubetracheal tube inserted into theinserted into the trachea.trachea. Regional / LocalRegional / Local anesthesiaanesthesia 1.1. TopicalTopical 2.2. Local/infiltrationLocal/infiltration 3.3. Nerve blockNerve block 4.4. Intravenous blockIntravenous block 5.5. SpinalSpinal 6.6. EpiduralEpidural 2525
  26. 26. 44Stages of anesthesiaStages of anesthesia 1.1. Stage I begins with the induction of anesthesia andStage I begins with the induction of anesthesia and ends with the patient's loss of consciousness.ends with the patient's loss of consciousness. 2.2. Stage II, or REM stage,. From Loss ofStage II, or REM stage,. From Loss of consciousness to loss of lid reflex.consciousness to loss of lid reflex. 3.3. Stage III, or surgical anesthesia, Loss of lid reflex toStage III, or surgical anesthesia, Loss of lid reflex to loss of most reflexloss of most reflex 4.4. Stage IV, or medullary stage, or overdose- it isStage IV, or medullary stage, or overdose- it is marked by hypotension or circulatory failure.marked by hypotension or circulatory failure. Note: Being aware of the different stages will help us toNote: Being aware of the different stages will help us to better predict the course of event and actbetter predict the course of event and act accordingly in emergency situation.accordingly in emergency situation. 2626
  27. 27. Intra operative complicationsIntra operative complications:: 1.1. HypoventilationHypoventilation 2.2. Oral traumaOral trauma 3.3. HypotensionHypotension 4.4. Cardiac dysrhythmiaCardiac dysrhythmia 5.5. HypothermiaHypothermia 6.6. Peripheral nerve damagePeripheral nerve damage 7.7. Malignant hyperthermiaMalignant hyperthermia 2727
  28. 28. Principle of Aseptic techniquePrinciple of Aseptic technique 1. All items used within the sterile field must1. All items used within the sterile field must be sterile.be sterile. 2. A sterile barrier that has been permeated2. A sterile barrier that has been permeated must be considered contaminated.must be considered contaminated. 3. The edges of a sterile wrapper or container3. The edges of a sterile wrapper or container are considered unsterile once the package isare considered unsterile once the package is opened.opened. 4. Gowns are considered sterile from chest to4. Gowns are considered sterile from chest to the level of the sterile field, and the sleevesthe level of the sterile field, and the sleeves to 2inches above the elbows.to 2inches above the elbows. 2828
  29. 29. Cont. principlesCont. principles 5. Tables are sterile at table level only.‡5. Tables are sterile at table level only.‡ 6. Sterile persons and items touch only6. Sterile persons and items touch only sterile areas; unsterile persons andsterile areas; unsterile persons and items touch only unsterile areas.‡items touch only unsterile areas.‡ 7.Movement around the sterile field must7.Movement around the sterile field must not contaminate the field.not contaminate the field. 8. ‡All items and areas of doubtful8. ‡All items and areas of doubtful sterility are considered contaminated.sterility are considered contaminated. 2929
  30. 30. WHO Safe Surgery Saves Lives Checklist.flv 3030
  31. 31. ReferencesReferences  Lippincott Manual of nursing Practice 8Lippincott Manual of nursing Practice 8thth EditionEdition  MSD Gen Surgery F02AMSD Gen Surgery F02A  American Nurses Association. Role of registeredAmerican Nurses Association. Role of registered nurse in the management of patient receivingnurse in the management of patient receiving conscious sedation for short term therapeutic,conscious sedation for short term therapeutic, diagnostic or surgical procedure.diagnostic or surgical procedure.  Association of Perioperative Registered Nurses (2004)Association of Perioperative Registered Nurses (2004) AORN standards and recommended practices forAORN standards and recommended practices for perioperative nursing.perioperative nursing.  http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Chttp://www.surgeryencyclopedia.com/Pa-St/Preoperative-C  http://nursingcrib.com/http://nursingcrib.com/
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