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Perioperative care


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Perioperative care

  1. 1. PERIOPERATIVE CARE NUR 105 ADULT HEALTH IShelton State Community College J. WILLIAMS
  2. 2. Perioperative Care Learning Objectivess Define key terms.s Define the three phases of perioperative care.s Describe the methods of classifying a surgical procedure and give an example of each one.s Describe the different types of anesthesia.
  3. 3. Perioperative Care Learning Objectives-continueds Utilize the nursing process in the care of a surgical patient.s Describe the nursing intervention for each of the three phases.s Identify factors and health conditions that may influence or alter the well- being of an surgical patient.
  4. 4. Perioperative Care (contd)s Describe the nurses’ legal responsibilities in the preparing the patient for surgery.s Identify the appropriate nursing care in assessing and monitoring for complications.s Utilize effective communication techniques in teaching client and family about surgery.
  5. 5. Perioperative CareCase Studys Lula White keeps her appointment with the surgeon. She has experienced abdominal pain/ cramping and a heavy menstrual flow for over 2 years, resulting in weakness and chronic anemia. Ms. White has talked it over with her husband and they both agreed on her undergoing a total hysterectomy. Ms. White is 48 years, married for 21 years with 4 children. The oldest child graduated from high school this year and the youngest is in the 6th grade.s At today’s office visit, the surgeon arranges for Ms. Hudson to have lab work drawn through the Outpatient Dept. Laboratory.s 1. What lab work would be ordered pre-op and the purpose for the lab work? What other tests may be required prior to surgery?s 2. Describe what information would you obtain in present and past health history.
  6. 6. Perioperative CareCase Study - continueds 3. What kind of information should the doctor discuss with Ms. White prior to the surgical procedure?s 4. How would you classify this type of surgery?s Ms. White is mildly overweight. In the past history, she reports smoking for years but stopped 10 years ago. She denies drugs or other tobacco products. Ms. White took oral contraceptives about five years ago until she developed hypertension and blood clots in her lower leg. She remains on diazide and took coumadin 3-4 years ago in treatment of blood clot. What risk factors might you be concerned with?
  7. 7. Perioperative Care Three Phases s Preoperative s Intraoperative s Postoperative
  8. 8. Perioperative Care Categories and Purposess Reason/Purpose – Diagnostic, curative, restorative, palliative, cosmetics Degree of Urgency – urgent, elective, optionals Degree of Risk – major, minors Anatomic locations Extent of surgery- minimal, open, simple and radical
  9. 9. Perioperative CarePreoperative Phase- Assessment s Risk Factors age, nutritional, health status, fluid and lytes imbalances, radiation, cardiopulmonary, chemotherapy, meds, family history, prior surgical experiences (positive/negative), type of surgery, location site
  10. 10. Perioperative Care Preoperative Phase- Assessments Nursing History – past & present, meds, diet, allergies (latex), personal habits, occupation, finances, family support, knowledge of surgery, attitudes Physical Exams Diagnostic Tests – CBC, electrolytes, creatinine, urinalysis, x-ray exams, EKG, Blood Type, PTT, PT, Platelet – Blood donationss Radiographics Bloodless Surgery/Discharge
  11. 11. Perioperative Care Preoperative Cares Psychological Responses Informed Consent - Nurse witnesss Mentally competents If minor, a guardian, parent, or court order will sign permit; state will dictate age.s Sociologicals DNR
  12. 12. Nursing Process – Preoperative Cares Assessment – History, Physical Exam, Lab/Radiology, Health Status, Risk Factors, Medss Nursing Diagnosiss Planning – Goal statement – EOC (expected outcome criteria)
  13. 13. Perioperative Care Preoperative -Implementations Informed Consent s Vital Signss Nutrition/fluids - IV ; s Height/ Weight NPO after MN s Special orders -s Elimination (insert tubes, -enemas, foley medications)s Hygiene - skin s Promote Comfort - scrub; remove nail Anti-anxiety meds polish, hair pins, s Skin preparation hospital gown
  14. 14. Perioperative Care Preoperative Care - Nursing Cares Pre-op Teaching - – leg and deep breathing exercises; ROM exercises – Moving patient ; coughing and splintings Monitor - – pt and diagnostic tests. – TEDS, Elastic Wraps, Pneumatic Compression devices, early ambulation
  15. 15. Perioperative Care Preoperative - Implementations Day of Surgery - complete pre-op checklist sheet in medical record, VS, skin prep removal of prosthetics, hair pins, dentures, bowel and bladder prep, TEDS, IV, NG Tube, ID band, and pre- op medications.
  16. 16. Perioperative Care Pharmocologys Purpose - facilitate effective anesthetics, minimize respiratory tract secretions and relax, reduce anxiety.s Types - Opiates, Anticholinergics, Barbiturates, Prophylactic antibiotics
  17. 17. Perioperative Care Pharmocology s Hazardous to Surgerys Certain antibioticss Anti-depressantss Phenothiaziness Diureticss Steriodss Anticoagulants
  18. 18. Perioperative Care Preoperative - Evaluations Evaluate goals and outcome criteria
  19. 19. Perioperative Care Intraoperative Cares From the holding room to the operating room and then to recovery room.s Implementation of anesthesia for analgesic, sedative, and muscle relaxant purposes as well as control Autonomic Nervous System.
  20. 20. Perioperative Care Intraoperative Cares Holding area - enter prior to OR; nurse continues to prepare patient(insert foley or start IV)s Nurse assist in transfer to and from OR, maintain proper body alignment.
  21. 21. Intraoperative Care Staffs Surgeon, surgical assistant – Surgical scrub, gowning, surgical asepsiss Anesthesia – Anesthesiologist, CRNA
  22. 22. Periopereative Nursing Staffs Holding Area Nurses Circulating Nurses Scrub Nurse/Surgical Technologist (ORT’s)s Specialist Nurse
  23. 23. Perioperative Care Preoperative -Anesthesia s Types– General– Regional– Local
  24. 24. Perioperative Care Intraoperative Care s Common General Anestheticss Inhaled General Anesthetics – Nitrous oxide, cyclopropanes Inhaled liquid – halothane, enflurane, isofluranes Intravenous Anesthetic – Pentothal (thiopental)
  25. 25. Perioperative CareNursing Concerns-Preops Patent Airways Therapeutic Response to Anesthesias Proper Positionings Maintain Surgical Asepsis
  26. 26. Perioperative CareIntraoperative Care-Complications Hypoventilation s Cardiac dysrhythmias Oral Trauma - s Hypothermia endotracheal intubation s Peripheral nerve damages Hypotension s Malignant hyperthermia
  27. 27. Perioperative CareIntraoperative - Complications 2s Malignant hyperthermia - due to abnormal and excessive intracellular collection of Ca+ resulting in hypermetabolism and increased muscle contraction.s Signs and Symptoms - high fever, tachycardia, muscle rigidity, heart failure, pseudotetany, and CNS damage.
  28. 28. Perioperative Care Adjunctive Anesthetic Agentss Opioid analgesic s Anticholinergic – Alfenta – Atropine, – Demerol and scopolamine Morphines Benzodiazepine s Sedative-hypnotic – Valium, Versed – Atarax, Vistaril, Seconal, Nembutal
  29. 29. Perioperative Care Intraoperative-Drug Interactions Antihypertensives- hypotensions Beta-Blockers- myocardium decreaseds Tetracycline--renal toxicitys Enflurane - liver disease lead to toxicity
  30. 30. Perioperative Care Anesthesias Local/Regional s Topical – Epidural – Dermoplast – Infltration (benzocaine) – Nerve Block – cocaine – Spinal – ethyl chloride – Topicals Anesthetic agents – Xylocaine, Novocain, carbocaine
  31. 31. Perioperative Care Anesthesias Geriatric concernss Address safety issues - sensory declines Hepatic, cardiac respiratory and renal declines Assess for preexisting problems such as cardiac, renal, hepatic, or respiratory.
  32. 32. Perioperative Care Intraoperative Cares Treatment of Malignant Hyperthermia – discontinue inhalent anesthetic, Give Dantrium, oxygen, dextrose 50%, diuretic, antiarrhythmics, sodium bicarbonate, and hypothermic measures-cooling blanket, iced IV saline or iced saline lavage of stomach, bladder, rectum.
  33. 33. Postoperative CareNur 105 Adult Health
  34. 34. Learning Objectives/Outcomess Define the time line for the postoperative period.s Describe nursing care during the PACU.s Describe nursing care during the post operative period.s Identify proper technique in care of surgical wounds.s State complications in wound healing.
  35. 35. Perioperative Care Immediate Anesthetic Care (PACU)s Respiratory Status - patent airways Cardiovascular - regular, strong heart rate and stable BP (VS); peripheral pulses; Homan’s Signs Neurological – level of consciousness; orientation, sensations Fluid and Electrolyte, Acid Base Balance
  36. 36. Post – op Drug Therapys Pain s Complementary and – Pain Assessment Alternativve – Opioids in IV small Therapies doses – Positioning, – Hypotension, Massage, relaxation respiratory and diversion, – GI motility guided imagery, biofeedback, music, – GI bleed (Motrin) etc. – Narcan/Romazicon
  37. 37. Post – Operative Care Nutrition sClear Liquids s Full Liquids s Soft s Regular
  38. 38. Nursing Care Post Op Physical Assessment (continued)s Renal Functions Gastrointestinals Dressingss Pains Thermoregulation
  39. 39. Perioperative Care Elderly Care in Postops Respiratory System s Hypothermia – diminished airway – less subcutaneous reflexes and cough tissue, muscle, slows Cardiovascular metabolic rate – myocardium s Pain weakness – more intense, confusion, impaired circulation and sensory
  40. 40. Perioperative Care Complications in Postops Hypotension s Immobility with skins Dysrhythmia integritys Venous Thrombosis s Urinary retentions Pulmonary s Urinary tract Embolism infections Hiccoughs s Wound infection,s Adbominal dehiscence, distention - paralytic hemorrhage evisceration, ileus
  41. 41. Perioperative Care Postop Cares Psychological – Anxiety – Altered body image – Finances, Family responsibility – Future changes
  42. 42. Perioperative Care Immediate Anesthetic Cares Airway/breathing ex. s Dressingss VS, Pulses s Drains/Tubess IV s I&O; renal functions ABG’s s Medicationss Pulse oximetry s Laboratory works Pupil Respond s Hemodynamicss Level of conscious s Position/ROMs Safety s Comfort
  43. 43. Perioperative Care Discharge Planss Patient/Family Education and Psychosocial Support is throughout. – Return MD Visit – Dressing Care and Comfort – Optimum respiratory,circulatory function, diet, meds(antibiotics, analgesic) – Adequate hydration and body temperature – Adequate renal function, safety in ADL
  44. 44. PERIOPERATIVE CARE Postoperative Cares Postoperative Care – Same care as immediate anesthetic care – Decrease frequency of vital signs to every 4 hours, IV’s will be discontinued in time, increase ADL, decrease in breathing exercises and breathing treatments, advance diet. – Recovery Period - 4 to 6 weeks
  45. 45. PERIOPERATIVE CARE Summarys Specific Nursing Duties for each phase: – Preoperative, Intraoperative, Postoperatives Throughout Perioperative Care, the nurse will always: – Monitor patient’s response to therapeutic regime, prevent complications, patient education and promote optimum well-being