Chapter 016

471 views
382 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
471
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Kendall SCD machine, sleeves, and TED stockings.Venodyne pneumatic compression system.Flowtron DVT calf garments.
  • Chapter 016

    1. 1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chapter 16Care of Preoperative Patients
    2. 2. 2Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Period Begins when patient is scheduled for surgery;ends at time of transfer to surgical suite Nurse functions as educator, advocate,promoter of health and safety
    3. 3. 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient & Family Teaching Tubes Drains Vascular access
    4. 4. 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Nasogastric Tube
    5. 5. 5Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Prevention of RespiratoryComplications Breathing exercises Incentive spirometry Coughing and splinting
    6. 6. 6Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Changes of Agingas Surgical Risk Factors Decreased: Cardiac output, peripheral circulation Vital capacity, blood oxygenation Blood flow to kidneys, glomerular filtration rate Increased: Blood pressure Risk for skin damage, infection Sensory deficits Deformities related to osteoporosis/arthritis
    7. 7. 7Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Considerations forPreoperative Care Chronic illness Malnutrition Impaired self-care ability Allergies Inadequate support systems
    8. 8. 8Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Considerations forPreoperative Care (cont’d) Stress from surgery/anesthesia Cardiopulmonary complications after surgery Mental status changes Risk for falls
    9. 9. 9Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Reasons for Surgery Diagnostic – determines origin and cause ofdisorder Curative – resolves health problem byrepairing or removing cause Restorative – improves patient’s functionalability Palliative – relieves symptoms of diseaseprocess, but does not cure Cosmetic – alters/enhances personalappearance
    10. 10. 10Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Urgency and Degree of Risk ofSurgery Urgency: Elective Urgent Emergent Degree of Risk: Minor Major
    11. 11. 11Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Extent of Surgery Simple Radical Minimally invasive (MIS)
    12. 12. 12Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Anxiety Interventions Preoperative teaching Encourage communication Promote rest Use distraction Teach family members
    13. 13. 13Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Skin Preparation Break in the skin increases risk for infection Patient may be asked to shower usingantiseptic solution Hair removal by electric clippers, depilatories Shaving of hair creates risk for infection!
    14. 14. 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Drugs Reduce anxiety Promote relaxation Reduce nasal and oral secretions
    15. 15. 15Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Drugs (cont’d) Prevent laryngospasm Reduce vagal-induced bradycardia Inhibit gastric secretion Decrease amount of anesthetic needed forinduction and maintenance of anesthesia
    16. 16. 16Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Collaborative Management:Assessment History and data collection: Age Drugs, substance use Medical history (including cardiac and pulmonary) Complementary/alternative practices Previous surgical procedures, anesthesia Blood donations Discharge planning
    17. 17. 17Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Physical Assessment/ClinicalManifestations Obtain baseline vital signs Focus on problem areas identified in history;all body systems affected by surgicalprocedure Report abnormal assessment findings tosurgeon/anesthesiology personnel
    18. 18. 18Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.System Assessment Cardiovascular CAD, MI within 6 months beforesurgery, angina, hypertension, dysrhythmias Respiratory Chronic respiratory problems Smoking increases carboxyhemoglobin bloodlevel, deceases oxygen delivery Renal/Urinary Kidney impairment inhibits drugs/anesthetic agentexcretion
    19. 19. 19Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.System Assessment (cont’d) Neurologic Determine baseline Assess LOC, ability to follow commands Musculoskeletal Nutritional status Malnutrition and obesity increase surgical risk Psychosocial
    20. 20. 20Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Prevention of CardiovascularComplications Be aware of patients at greater risk for DVT Antiembolism stockings Pneumatic compression devices Leg exercises Mobility
    21. 21. 21Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Laboratory Assessment Urinalysis Blood type and crossmatch CBC or hemoglobin level and hematocrit Clotting studies (PT, INR, aPTT)
    22. 22. 22Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Laboratory Assessment (cont’d) Electrolyte levels Serum creatinine level Pregnancy test Chest x-ray ECG
    23. 23. 23Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Insufficient Information Interventions Preoperative teaching Informed consent: Surgeon obtains signed consent before sedationand/or surgery Nurse clarifies facts and dispels myths aboutsurgery Nurse not responsible for providing detailedinformation about procedure!
    24. 24. 24Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Informed Consent Patients may sign with “X” In emergency, telephone authorization isacceptable Special permits required for some procedures
    25. 25. 25Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.NPSGs and Informed Consent Ensure correct site is selected and wrong siteis avoided Licensed independent practitioner markssite, involving patient if possible “Time out” procedure adopted by mostfacilities
    26. 26. 26Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Implementing Dietary Restrictions NPO: Patient not to ingest anything by mouthfor 6 to 8 hours before surgery: Decreases risk for aspiration Give patients written/oral directions to stressadherence Surgery can be canceled if instructions notfollowed
    27. 27. 27Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Administering Regularly ScheduledMedications Consult with physician and anesthesiaprovider for instructions Drugs for certain conditions often allowedwith a sip of water: Cardiac disease Respiratory disease Seizures Hypertension
    28. 28. 28Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Intestinal Preparation Performed to prevent injury to colon; reducenumber of intestinal bacteria Enema or laxative
    29. 29. 29Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient Using Incentive Spirometer
    30. 30. 30Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patients at Risk for VTE Obese patients Age 40 or older History of cancer Decreased mobility or immobile Spinal cord injury
    31. 31. 31Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patients at Risk for VTE (cont’d) History of VTE, PE, varicose veins, edema Oral contraceptives Smoking History of decreased cardiac output Hip fracture, total hip/knee surgery
    32. 32. 32Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.External Pneumatic CompressionDevices
    33. 33. 33Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Chart Review Ensure all documentation, preoperativeprocedures, orders are complete Check surgical consent form and others forcompleteness Inform patient that area will be marked beforeprocedure begins Document allergies, height, and weight
    34. 34. 34Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Chart Review (cont’d) Ensure all laboratory and diagnostic testresults are in chart Document/report any abnormal results Report special needs and concerns
    35. 35. 35Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Patient Preparation Remove most clothing; provide gown Leave valuables with family member or lockup Tape rings in place if cannot be removed Ensure patient is wearing ID band
    36. 36. 36Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Patient Preparation(cont’d) Remove: Dentures Prosthetic devices Hearing aids Contact lenses Fingernail polish Artificial nails Pierced jewelry

    ×