surgical nurse: nursing management for surgical patient

1. Preoperative nursing management
By Dr Abdiasis Omar Mohamed
MBBS

2. Preoperative management
• The field of preoperative and perianesthesia nursing
includes a wide variety of nursing functions.
• The preoperative period consists of three phases that
begin and end at a particular point in the sequence of
events in the surgical experience.
• The preoperative phase begins when the decision to
proceed with surgical intervention is made and ends
with the transfer of the patient in to the operating
room (OR) table.

3. • The intraoperative phase begins when the patient is
transferred onto the OR table and ends with
admission to the PACU.
• Nursing duties involve acting as scrub nurse,
circulating nurse, or registered nurse first assistant
(RNFA).

4. • The postoperative phase begins with the admission of
the patient to the PACU and ends with a follow-up
evaluation in the clinical setting or home.

5. • The Preoperative Nursing Data Set (PNDS)
categorizes the practice of preoperative nursing
practice into four domains: safety, physiologic
responses, behavioral responses, and health care
systems.
• The first three domains reflect phenomena of
concern to preoperative nurses and are composed of
nursing diagnoses, interventions, and outcomes.

6. • The fourth domain, the health care system, consists of
structural data elements and focuses on clinical
processes and outcomes. The model is used to depict
the relationship of nursing process components to the
achievement of optimal patient outcomes.

7. Preadmission testing
• focuses on admission data such as patient
demographics, health history, and other information
pertinent to the surgical procedure (i.e., appropriate
consent forms, diagnostic and laboratory tests)

8. Surgical classification
• Surgery may be performed for various reasons.
• A surgical procedure may be diagnostic (eg, biopsy,
exploratory laparotomy), curative (eg, excision of a
tumor or an inflamed appendix), or reparative (eg,
multiple wound repair).

9. • It may be reconstructive or cosmetic (eg,
mammoplasty or a facelift) or palliative (eg, to relieve
pain or correct a problem—for instance, a
gastrostomy tube may be inserted to compensate for
the inability to swallow food).

10. CATEGORIES OF SURGERY BASED ON URGENCY
Classification Indications for Surgery Examples
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
II. Urgent-Patient requiers prompt
attention
Within 24–30 hours Acute gallbladder infection
Kidney or uretral stones
III. Required-Patient needs to have
surgery
Plan within a few weeks or months Prostatic hyperplasia without
bladder obstruction
Thyroid disorders
Cataracts
IV. Elective-Patient should have
surgery
Failure to have surgery not
catastrophic
Repair of scars
Simple hernia
Vaginal repair
V. Optional-Decision rests with
patient
Personal preference Cosmetic surgery

11. • Special Considerations During the preoperative
Period
1. Gerontologic Considerations
a) skillful preoperative assessment and treatment
b) skillful anesthesia and surgery,
c) meticulous and competent postoperative and
postanesthesia management.

12. 2. Patients Who Are Obese
3. Patients With Disabilities
4. Patients Undergoing Ambulatory Surgery
5. Patients Undergoing Emergency Surgery

13. Informed Consent
• Informed consent is the patient’s autonomous
decision about whether to undergo a surgical
procedure.
• Voluntary and written informed consent from the
patient is necessary before non emergent surgery can
be performed in order to protect the patient from
unsanctioned surgery and protect the surgeon from
claims of an unauthorized operation.

14. • Consent is a legal mandate, but it also helps the
patient to prepare psychologically, because it helps to
ensure that the patient understands the surgery to be
performed.

15. • Informed consent is necessary in the following
circumstances:
 Invasive procedures, such as a surgical incision, a
biopsy, a cystoscopy, or paracentesis
 Procedures requiring sedation and/or anesthesia
 nonsurgical procedure, such as an arteriography, that
carries more than a slight risk to the patient
 Procedures involving radiation

16. Preoperative Assessment
• History taking
• Physical examination
• Genetic consideration

17. • Factors to asses
• Nutritional and fluid status, Dentition, Alcohol and
drug, Respiratory status, Cardiovascular status,
Hepatic and renal function, Endocrine function,
Immune function, Previous medication use and
Psychosocial factors

18. 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

19. - Pulmonary disease
• Obstructive disease
• Restrictive disorder
• Respiratory infection
• Renal or urinary tract disease
• Decreased renal function
• Urinary tract infection
• Obstruction

20. • Cardiovascular disease
• Coronary artery disease or previous myocardial
infarction
• Cardiac failure
• Dysrhythmias
• Hypertension
• Prosthetic heart valve
• Thromboembolism
• Hemorrhagic disorders
• Cerebrovascular disease

21. • Endocrine dysfunction
• Diabetes mellitus
• Adrenal disorders
• Thyroid malfunction
• Hepatic disease
• Cirrhosis
• Hepatitis
• Preexisting mental or physical disability

22. General Preoperative Nursing Interventions
1. Providing Patient Teaching
• Deep Breathing, Coughing, and Incentive Spirometry
• Mobility and Active Body Movement
• Pain Management
• Cognitive Coping Strategies : Cognitive strategies
may be useful for relieving tension, overcoming
anxiety, decreasing fear, and achieving relaxation.
• Imagery, Distraction, Optimistic self-recitation and
Music therapy.

23. 2. Providing Psychosocial Interventions
• Reducing Anxiety and Decreasing Fear
• Respecting Cultural, Spiritual, and Religious Beliefs
3. Maintaining Patient Safety
4. Managing Nutrition and Fluids
5. Preparing the Bowel
6. Preparing the Skin

24. Immediate preoperative nursing
interventions
• Changing into a hospital gown that is left untied and
open in the back.
• The patient with long hair may braid it, remove
hairpins, and cover the head completely with a
disposable paper cap.
• The mouth is inspected, and dentures are removed. If
left in the mouth, these items could easily fall to the
back of the throat during induction of anesthesia and
cause respiratory obstruction.

25. 1. Administering Preanesthetic Medication
2. Maintaining the Preoperative Record
3. Transporting the Patient to the Presurgical Area
4. Attending to Family Needs

26. Expected Patient Outcomes
1. Relief of anxiety
2. Decreased fear
3. Understanding of the surgical intervention
4. No evidence of preoperative complications

27. Critical thinking exercises
• During your preoperative assessment of your patient,
a 42-year-old female who is alert and oriented reports
that she is having her right breast removed for cancer.
The OR schedule indicates that she is having a left
mastectomy (breast removal). What preoperative
assessments are indicated? What nursing
interventions are warranted? What should your initial
action be?

28. THE END