Peri operative nursing


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Peri operative nursing

  1. 1. Peri-operative Nursing
  2. 2. Phases of Peri-operative periodPRE- operative phaseINTRA- operative phasePOST- operative phase
  3. 3. PRE-Operative PhaseBegins when the decision to havesurgery is made and ends whenthe client is transferred to theoperating table
  4. 4. INTRA-Operative PhaseBegins when the client istransferred to the operating tableand ends when the client isadmitted to the post-anesthesiaunit
  5. 5. Post-operative PhaseBegins with the admission of theclient to the PACU and ends whenhealing is complete
  6. 6. PERIOPERATIVE TEAM1. ANESTHESIOLOGIST or NURSE ANESTHESIST - makes preoperative assessment to plan type of anesthetic to be administered - to evaluate client’s physical status2. PROFESSIONAL O.R. NURSE - makes preop nursing assessments and documents intraoperative care plan
  7. 7. PERIOPERATIVE TEAM3. CIRCULATING NURSE - manages the OR - protects client’s safety and health needs by monitoring activities of members of the surgical team - monitors conditions in the OR
  8. 8. PERIOPERATIVE TEAM4. SCRUB NURSE - responsible for scrubbing before surgery - sets up sterile tables & equipment - assists surgeon and surgical assistants during the operation itself5. PACU NURSE - cares for the client until he/she recovers from the effects of anesthesia
  9. 9. PRINCIPLES OF SURGICAL ASEPSIS1. OR personnel must practice strict Standard Precautions2. All items used in the OR must be sterile3. All personnel must perform a surgical scrub
  10. 10. PRINCIPLES OF SURGICAL ASEPSIS4. All OR personnel are required to wear specific, clean attire – “shedding” the environment - must wear: a. sterile gown b. gloves c. special shoe covers d. hair cover – cap e. mask
  11. 11. PRINCIPLES OF SURGICAL ASEPSIS5. Any personnel harboring pathogenic microbes must report themselves unable to be in the OR6. Scrubbed personnel wearing sterile attire should touch only sterile items7. Sterile gown and drapes have defined borders of sterility.8. Unsterile personnel must stay at the periphery of the sterile operating area
  12. 12. PRINCIPLES OF SURGICAL ASEPSIS9. Sterile supplies are unwrapped and delivered by the circulating nurse10. The utmost caution & vigilance must be used when handling sterile fluids11. Anything that is used for one client must be discarded or, in some cases, resterilized
  13. 13. Activities in the Pre-opAssessing the clientsIdentifying potential or actual healthproblemsPlanning specific careProviding pre-operative teachingEnsure consent is signed
  14. 14. ConsentThe surgeon is responsible forobtaining the consent for surgeryNo sedation should be administeredbefore SIGNING the consentThe nurse may serve as witness
  15. 15. Activities during the Intra-opAssisting the surgeon as scrub nurseand circulating nurse
  16. 16. Activities in the POST-opAssessing responses to surgeryPerforming interventions to promotehealingPrevent complicationsPlanning for home-careAssist the client to achieve optimalrecovery
  17. 17. TYPES of SURGERYAccording to PURPOSEAccording to degree of URGENCYAccording to degree of RISK
  18. 18. According to PURPOSEDiagnostic Establishes a diagnosisPalliative Relieves or reduces pain or symptomsAblative Removes a diseased body partConstructive Restores function or appearanceTransplant Replaces malfunctioning structures
  19. 19. According to degree of urgencyEmergency Preserves function or lifesurgery Performs immediatelyElective Performed when conditionsurgery is not imminently life threatening
  20. 20. According to degree of RISKMajor Involves high degree of riskSurgery Complicated or prolongedMinor Involves low riskSurgery Produces few complications Performed as day surgery
  21. 21. Surgical RiskExtremes of ageMalnourishedObeseCo-morbid conditionsConcurrent medications
  22. 22. Pre-operative InterventionsEnsure signed consent formObtain nursing history, PE and lab examProvide pre-operative teaching as to thenature of surgery, what to expect andways to manage post-operativediscomfortsPerform physical preparations- shaving,hygiene, enema, NPO, medications
  23. 23. Pre-op nutritionAssess order for NPOSolid foods are withheld for about 8hours before general anesthesia
  24. 24. Pre-op eliminationLaxatives, enemas or both may beprescribed the night before surgeryHave the client void immediatelyBEFORE transferring them to the ORFoley catheter may be inserted asordered
  25. 25. Pre-op hygieneBath the night before surgery withantiseptic soapShaving of the skin is usually done inthe ORRemoval of jewelry and nail polish
  26. 26. Pre-op psychological preparationBe alert to the client’s anxiety levelAnswer questions or concernsAllow time for privacy
  27. 27. Pre-operative medicationsPre-op Drugs Example PurposeAnti-anxiety Diazepam To decrease nervousness Promote relaxationAnti- Atropine Decreases secretionscholinergic Prevent bradycardiaMuscle Succinylcholine To promote musclerelaxant relaxationAnti-emetic Promethazine To prevent nausea and vomitingAntibiotic Cephalosporin To prevent infection
  28. 28. Pre-operative medicationsPre-op Drugs Example PurposeAnalgesics Meperidine To decrease pain and decrease anesthetic doseAnti-histamine Diphenhydramine To decrease occurrence of allergyH-2 Cimetidine To decrease gastric fluidantagonist and acidity
  29. 29. Pre-operative screening testCBC Determine Hgb and Hct, infectionBlood type Determined in case of blood transfusionSerum Evaluates the fluid and electrolyteelectrolytes statusFBS Evaluates diabetes mellitusBUN, Creatinine Assess the renal functionALT, AST, Evaluates the liver functionBilirubinSerum albumin Evaluates nutritional statusCXR and ECG Respiratory and Cardiac status
  30. 30. Pre-operative teachingLeg exercises To stimulate blood circulation in the extremities to prevent thrombophlebitisDeep breathing To facilitate lung aeration andand Coughing secretion mobilization toExercises prevent atelectasis and hypostatic pneumonia Done every two to four hoursPositioning and To circulation, stimulate respiration,Ambulation decrease stasis of gas
  31. 31. Intra-operative phase interventionsDetermine the type of surgery andanesthesia usedPosition client appropriately forsurgeryAssist the surgeon as circulating orscrub nurseMaintain the sterility of the surgicalfieldMonitor for developing complications
  32. 32. AnesthesiaGeneral anesthesia Loss of all sensation and consciousnessRegional or Local anesthesia Loss of sensation in ONE area with consciousness present
  33. 33. GENERAL AnesthesiaProtective reflexes are lostAmnesia, analgesia and hypnosisoccurAdministered in two ways: Inhalational Intravenous
  34. 34. REGIONAL AnesthesiaTOPICAL Applied directly on the skinINFILTRATION Injected into a specific area of skinNERVE BLOCK Injected around a nerveSPINAL Low spinal anesthesiaSubarachnoidEPIDURAL Epidural space is injected with anesthesia
  35. 35. Patient PositioningProvides optimal visualizationProvides optimal access forassessing and maintaininganesthesia and functionProtects patient from harm
  36. 36. Position Patient during SurgeryAbdominal surgeries SupineBladder surgery Slightly trendelenburgPerineal surgery LithotomyBrain surgery Semi-fowler’sSpinal cord surgeries Prone mostlyLumbar puncture Side lying, flexed body
  37. 37. Functions of the nurse during OR procedureSCRUB NURSE Assists the surgeon Maintains sterility Handles instruments Drapes patient Counts sponges Wears sterile gown, glovesCIRCULATING Assists the Scrub nurseNURSE Positions the patient for surgery Positions any equipments
  38. 38. POST Operative InterventionsMaintain patent airwayMonitor vital signs and note for earlymanifestations of complicationsMonitor level of consciousnessMaintain on PROPER positionNPO until fully awake, with passageof flatus and (+) gag reflex
  39. 39. POST Operative InterventionsMonitor the patency of the drainageMaintain intake and outputmonitoringCare of the tubes, drains and woundEnsure safety by side rails upPain medication given as orderedMeasures to PREVENT post-opComplications
  40. 40. Post-operative interventionsPAIN MANAGEMENT Pain is usually greatest during the 12- 36 hours after surgery Narcotic analgesics and NSAIDS may be prescribed together for the early period of surgery Provide back rub, massage, diversional activities, position changes
  41. 41. Post operative interventionsPOSITIONING Clients who have spinal anesthesia is usually placed FLAT on bed for 8-12 hours Unconscious client is placed side lying to drain secretions Other positions are utilized BASED on the type of surgery
  42. 42. Post-operative InterventionsSome Examples of Position Post OpMastectomy Semi-fowlers’, affected arm elevatedThyroidectomy Semi fowlers’ , head midlineHemorrhoidectomy Semi-prone, side-lyingLaryngectomy Fowler’sPneumonectomy Lateral, affected sideLobectomy Lateral, unaffected side
  43. 43. Post-operative Interventions Some Examples of Position Post OpAneurysmal repair Fowler’s 45 degrees(abdomen)Amputation of lower Flat, with stumpextremities elevated with pillowCataract surgery Fowler’s 45 degreesSupratentorial Folwers’craniotomyInfratentorial Flat on bed, supinecraniotomySpina bifida repair Prone
  44. 44. Post-operative InterventionsDeep breathing and coughingexercises Q2-4 hours  to removesecretionsLeg exercises Q 2 hours  topromote circulationAmbulation ASAP preventsrespiratory, circulatory, urinaryand gastrointestinal complications
  45. 45. Post-operative InterventionsHydration after NPO to maintainfluid balanceSuction, either gastro orrespiratory to relieve distention,to remove respi secretionsDiet progressive, usually givenwhen bowel sounds and gag reflexreturn
  46. 46. Wound CareInspect dressing hourlyChange dressing dailyInspect for signs of infectionredness, swelling, purulentexudateMaintain wound drainage
  47. 47. DietNPO usually immediately after surgeryProgressive dietAssess the return of the bowel sounds
  48. 48. Liquid Diet Vs Soft dietClear liquid Full liquid Soft dietCoffee Clear liquid PLUS: All CL and FLTea Milk/Milk prod plus:Carbonated Vegetable juices Meatdrink Cream, butter VegetablesBouillon Yogurt FruitsClear fruit Puddings Breads andjuice cereals CustardPopsicle Pureed foods Ice cream andGelatin sherbetHard candy
  49. 49. Urinary EliminationOffer bedpansAllow patient to stand at the bedsidecommode if allowedReport to surgeon if NO URINE outputnoted within 8 hours post-op
  50. 50. CPTChest Physiotherapy Chest physiotherapy is based on the fact that mucus can be knocked or shaken form the walls of the airways and helped to drain from the lungs. The usual PVD SEQUENCE is as follows- POSITIONING, Percussion, Vibration, and removal of secretions by SUCTIONING or Coughing followed lastly by oral hygiene
  51. 51. Incentive SpirometryThis operates on the principle thatspontaneous sustained maximalinspiration is most beneficial to thelungs and has virtually no adverseeffects.The incentive spirometer measuresroughly the inspired volume andoffers the “incentive” of measuringprogress
  52. 52. Post operative complicationsAtelectasis Collapsed Assess breath alveoli due to sounds secretions Repositioning Deep breathing and coughingPneumonia Inflammation Chest physio of alveoli Suctioning AmbulationThrombophlebitis Inflammation Leg exercises of the veins Monitor for swelling Elevated extremities
  53. 53. Post-operative ComplicationsHypovolemic Loss of Shock positionShock circulatory Determine cause and fluid volume prevent bleeding O2, IVFUrinary Involuntary Encourage ambulationretention accumulation Provide privacy of urine Pour warm water CatheterizePulmonary Embolus Notify physicianembolism blocking the Administer O2w lung blood flow
  54. 54. Post-operative complicationsConstipation Infrequent High fiber diet passage of Increased fluid stool AmbulationParalytic ileus Absent bowel Encourage sound ambulation NPO until peristalsis returnsWound Occurs about Daily woundinfection 3 days after dressing surgery Antibiotics Maintain drain
  55. 55. Post-operative complicationsWound Separation of Cover the wounddehiscence wound edges at with sterile normal the suture line saline dressing Place in low- Fowler’s Notify MDWound Protrusion of Cover the woundevisceration the internal with saline pad organs and Place in low- tissues through fowler’s wound Notify MD
  56. 56. To emphasizeThe over-all goal of nursing care duringthe PRE-OPERATIVE phase is toprepare the patient mentally andphysically for the surgery
  57. 57. To emphasizeThe over-all goal of nursing care duringthe INTRA-OPERATIVE phase is tomaintain client safety
  58. 58. To emphasizeThe over-all goals of nursing careduring the POST-OPERATIVE phaseare to promote healing and comfort,restore the highest possible wellnessand prevent associated risk