Preoperative nursing

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Preoperative nursing

  1. 1. PERIOPERATIVE NURSING MANAGEMENT CHRISTIAN B. ALCANTARA
  2. 2. WORDS TO PONDER.ü  ambulatory surgery: may include outpatient - (or same-day) surgery that does not require an overnight hospital stay or short stay, with admission to an inpatient.  informed consent: the patient’s autonomous decision about whether to undergo a surgical procedure; based on the nature of the condition, the treatment options, and the risks and benefits involved.
  3. 3. WORDS TO PONDER.ü  intraoperative phase: period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU)  perioperative phase: period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care
  4. 4. WORDS TO PONDER.ü  postoperative phase: period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home  preadmission testing (PAT): diagnostic testing performed before admission to the hospital
  5. 5. WORDS TO PONDER.ü  preoperative phase: period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table
  6. 6. Perioperative and Perianesthesia Nursing  The special field known as perioperative and perianesthesia nursing includes a wide variety of nursing functions associated with the patient’s surgical experience during the perioperative period. Perioperative and perianesthesia nursing addresses the nursing roles relevant to the three phases of the surgical experience: preoperative, intraoperative, and postoperative.
  7. 7. Preoperative phase  begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room table.  establishing a baseline evaluation of the patient before the day of surgery by carrying out a preoperative interview
  8. 8. Preoperative phase  ensuring that necessary tests havebeen or will be performed (preadmission testing)  arranging appropriate consultative services  providing preparatory education about recovery from anesthesia and postoperative care
  9. 9. Intraoperative Phase  begins when the patient is transferredonto the operating room table and ends when he or she is admitted to the postanesthesia care unit (PACU)  providing for the patient’s safety  maintaining an aseptic environment
  10. 10. Intraoperative Phase  ensuring proper function of equipment  providing the surgeon with specific instruments and supplies for the surgical field, and completing appropriate documentation
  11. 11. Intraoperative Phase  providing emotionals upport by holding the patient’s hand during general anesthesia induction  assisting in positioning the patient on the operating room table using basic principles of body alignment
  12. 12. Postoperative Phase  begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or at home  maintaining the patient’s airway  monitoring vital signs
  13. 13. Postoperative Phase  assessing the effects of the anesthetic agents  assessing the patient for complications  providing comfort and pain relief
  14. 14. Postoperative Phase  nursing activities then focus on promoting the patient’s recovery  initiating the teaching  follow-up
  15. 15. GENETICS IN NURSING PRACTICE—Perioperative Nursing  Nurses who are caring for patients undergoing surgery need to take various genetic considerations into account when assessing patients throughout the perioperative experience. For example, surgical outcomes may be altered by genetic conditions that may cause complications with anesthesia, including the following:  Malignant hyperthermia  Central core disease (CCD)  Duchenne muscular dystrophy  Hyperkalemic periodic paralysis  King-Denborough
  16. 16. Preparation for Surgery  INFORMED CONSENT – The nurse may ask the patient to sign the form and may witness the patient’s signature. It is the physician’s responsibility to provide appropriate information.  protects the patient from unsanctioned surgery  protects the surgeon from claims of an unauthorized operation
  17. 17. Criteria for Valid Informed Consent  Voluntary Consent - valid consent must be freely given, without coercion.  Incompetent Patient - legal definition: individual who is not autonomous and cannot give or withhold consent (eg, individuals who are mentally retarded, mentally ill, or comatose)
  18. 18. Criteria for Valid Informed Consent  Informed Subject - Informed consent should be in writing. It should contain the following:  Explanation of procedure and its risks  Description of benefits and alternatives  An offer to answer questions about procedure  Instructions that the patient may withdraw consent  A statement informing the patient if the protocol differs from customary procedure
  19. 19. Criteria for Valid Informed Consent  Patient Able to Comprehend - Information must be written and delivered in language understandable to the patient. Questions must be answered to facilitate comprehension if material is confusing.
  20. 20. Categories of Surgery Based on Urgency  I. Emergent—  Patient requires immediate attention; disorder may be life-threatening  Without delay  Severe bleeding  Bladder or intestinal obstruction  Fractured skull  Gunshot or stab wounds  Extensive burns
  21. 21. Categories of Surgery Based on Urgency  II. Urgent—  Patient requiresprompt attention  Within 24–30 h  Acute gallbladder infection  Kidney or ureteral stones
  22. 22. Categories of Surgery Based on Urgency  III. Required—  Patient needs to have surgery  Plan within a few weeks or months  Prostatic hyperplasia without bladder obstruction  Thyroid disorders  Cataracts
  23. 23. Categories of Surgery Based on Urgency  IV. Elective—  Patient should have surgery  Failure to have surgery not catastrophic  Repair of scars  Simple hernia  Vaginal repair
  24. 24. Categories of Surgery Based on Urgency  V. Optional—  Decision rests with patient  Personal preference  Cosmetic surgery
  25. 25. Nutrients Important for Wound Healing  Protein  To replace the lean body mass lost during the catabolic phase after stress  To restore blood volume and plasma proteins lost through exudates, bleeding from the wound, and possible hemorrhage  To replace losses resulting from immobility (increased excretion)  To meet the increased needs for tissue repair and resistance to infection
  26. 26. Nutrients Important for Wound Healing  Calories  To replace losses related to lack of oral intake and hypermetabolism during catabolic phase after stress  To spare protein  To restore normal weight
  27. 27. Nutrients Important for Wound Healing  Water  To replace fluid lost through vomiting, hemorrhage, exudates, fever, drainage, diuresis  To maintain homeostasis
  28. 28. Nutrients Important for Wound Healing  Vitamin C  Important for capillary formation, tissue synthesis, and wound healing through collagen formation  Needed for antibody formation
  29. 29. Nutrients Important for Wound Healing  Thiamine, niacin, riboflavin, Folic acid, vitamin B12  Requirements increase with increased metabolic rate  Needed for cell proliferation and therefore tissue synthesis  Important for maturation of red blood cells  Impaired folic acid synthesis associated with the use of some antibiotics; impaired vitamin B12 absorption associated with the use of some antibiotics
  30. 30. Nutrients Important for Wound Healing  Vitamin A  Important for tissue synthesis, wound healing, and immune function  Enhances resistance to infection
  31. 31. Nutrients Important for Wound Healing  Iron  To replace iron lost through blood loss
  32. 32. Nutrients Important for Wound Healing  Zinc  Needed for protein synthesis and wound healing  Needed for normal lymphocyte and phagocyte response
  33. 33. Risk Factors for Surgical Complications  Hypovolemia  Dehydration or electrolyte imbalance  Nutritional deficits  Extremes of age (very young, very old)  Extremes of weight (emaciation, obesity)  Infection and sepsis  Toxic conditions  Immunologic abnormalities
  34. 34. Risk Factors for Surgical Complications  Pulmonary disease  Obstructive disease  Restrictive disorder  Respiratory infection  Renal or urinary tract disease  Decreased renal function  Urinary tract infection  Obstruction
  35. 35. Risk Factors for Surgical Complications  Pregnancy  Diminished maternal physiologic reserve  Cardiovascular disease  Coronary artery disease or previous myocardial infarction  Cardiac failure  Dysrhythmias  Hypertension  Prosthetic heart valve  Thromboembolism  Hemorrhagic disorders  Cerebrovascular disease
  36. 36. Risk Factors for Surgical Complications  Endocrine dysfunction  Diabetes mellitus  Adrenal disorders  Thyroid malfunction  Hepatic disease  Cirrhosis  Hepatitis  Preexisting mental or physical disability

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