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Chapter 016 Chapter 016 Presentation Transcript

  • Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chapter 16Care of Preoperative Patients
  • 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
  • 3Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient & Family Teaching Tubes Drains Vascular access
  • 4Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Nasogastric Tube
  • 5Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Prevention of RespiratoryComplications Breathing exercises Incentive spirometry Coughing and splinting
  • 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
  • 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
  • 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
  • 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
  • 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
  • 11Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Extent of Surgery Simple Radical Minimally invasive (MIS)
  • 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
  • 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!
  • 14Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Drugs Reduce anxiety Promote relaxation Reduce nasal and oral secretions
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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)
  • 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
  • 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!
  • 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
  • 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
  • 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
  • 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
  • 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
  • 29Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient Using Incentive Spirometer
  • 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
  • 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
  • 32Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.External Pneumatic CompressionDevices
  • 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
  • 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
  • 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
  • 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