Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 16


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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 16

  1. 1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 16 NURSING CARE OF THE SURGICAL CLIENT
  2. 2. Surgery <ul><li>The treatment of injury, disease, or deformity through invasive operative methods. </li></ul><ul><li>Surgery is a unique experience, with no two clients responding alike to similar operations. </li></ul>
  3. 3. Surgery <ul><li>Minor: Presenting little risk to life. </li></ul><ul><li>Major: Possibly involving risk to life. </li></ul>
  4. 4. From a Client’s Vantage Point <ul><li>Surgery is a major stressor for all clients. </li></ul><ul><li>Anxiety and fear are normal. </li></ul><ul><li>Fear of the unknown is the most prevalent fear prior to surgery and is the fear that is the easiest for the nurse to help the client overcome. </li></ul>
  5. 5. Phases of Surgery <ul><li>Preoperative (before surgery) </li></ul><ul><li>Intraoperative (during surgery) </li></ul><ul><li>Postoperative (after surgery) </li></ul>
  6. 6. Perioperative Nursing <ul><li>Has one continuous goal: to provide a standard of excellence in the care of the client before, during, and after surgery. </li></ul><ul><li>Perioperative nursing is client oriented and must be geared to meet the client’s psychosocial needs as well as immediate physical needs. </li></ul>
  7. 7. Preoperative Phase: Common Anxieties <ul><li>Fear of the unknown. </li></ul><ul><li>Fear of pain and discomfort. </li></ul><ul><li>Fear of mutilation and disfigurement. </li></ul><ul><li>Fear of anesthesia. </li></ul><ul><li>Fear of disruption of life patterns (separation from family and significant others; impact on sexual and financial situation) </li></ul><ul><li>Fear of death/not waking up. </li></ul><ul><li>Fear of not being in control. </li></ul>
  8. 8. Preoperative Physiologic Assessment <ul><li>The outcome of surgical treatment is tremendously enhanced by accurate preoperative nursing assessment and careful preoperative preparation. </li></ul><ul><li>Information gathered through preoperative assessment and risk screening is later used for preparation of the surgical site, for surgical positioning, and as a comparative basis for postoperative assessments and complication screening. </li></ul>
  9. 9. Common Preoperative Laboratory Tests <ul><li>Hemoglobin and hematocrit (Hgb and Hct) </li></ul><ul><li>White blood cell count (WBC) </li></ul><ul><li>Blood typing and cross matching (screening) </li></ul><ul><li>Serum electrolytes </li></ul><ul><li>Prothrombin time (PT) and partial thromboplastin time (PTT) </li></ul><ul><li>Bilirubin </li></ul><ul><li>Liver enzymes </li></ul><ul><li>Urine analysis </li></ul><ul><li>Blood urea nitrogen (BUN) and creatinine </li></ul>
  10. 10. Variables Affecting Surgical Status <ul><li>Age </li></ul><ul><li>Nutritional status </li></ul><ul><li>Fluid and electrolyte status </li></ul><ul><li>Respiratory status </li></ul><ul><li>Medications </li></ul><ul><li>Cardiovascular status </li></ul><ul><li>Renal and hepatic status </li></ul><ul><li>Neurological, musculoskeletal, and integumentary status </li></ul><ul><li>Endocrine and immunological status </li></ul>
  11. 11. Client’s Psychological Condition <ul><li>The psychological condition of a client can have a stronger influence than does the physical condition. </li></ul><ul><li>Encourage clients to express their feelings and fears about receiving anesthetic and having surgery. </li></ul><ul><li>Observe the client for nonverbal clues indicative of anxiety. </li></ul><ul><li>To reduce client anxiety, explain to client what will be happening throughout the surgical experience. </li></ul>
  12. 12. Psychosocial Health Assessment <ul><li>Cultural beliefs can influence a person’s perception of surgery. </li></ul><ul><li>Clients should be provided the opportunity to express their spiritual values and beliefs. </li></ul>
  13. 13. Informed Consent <ul><li>A legal form signed by the client and witnessed by another person that grants permission to the client’s physician to perform the procedure described by the physician. </li></ul>
  14. 14. Informed Consent is Required <ul><li>WHEN: </li></ul><ul><li>Anesthesia is used. </li></ul><ul><li>Procedure is considered invasive. </li></ul><ul><li>Procedure is nonsurgical but has more than a slight risk of complications. </li></ul><ul><li>When radiation or cobalt therapy is used. </li></ul>
  15. 15. Purposes of Preoperative Teaching <ul><li>To answer questions and concerns about surgery. </li></ul><ul><li>To ascertain client’s present knowledge of the intended surgery. </li></ul><ul><li>To ascertain the need or desire for additional information. </li></ul><ul><li>To provide information in a manner most conducive to learning. </li></ul>
  16. 16. Physical Preparation <ul><li>Identifying the client and verifying the operative procedure. </li></ul><ul><li>Preparing operative site. </li></ul><ul><li>Checking client’s vital signs. </li></ul><ul><li>Assisting in putting on hospital gown, cap, and, if ordered, antiembolic hose. </li></ul><ul><li>Verifying allergies. </li></ul><ul><li>Verifying NPO (nothing by mouth) status. </li></ul><ul><li>Identifying any sensory deficits in the client. </li></ul>
  17. 17. Members of Sterile Surgical Team <ul><li>Surgeon. </li></ul><ul><li>First assistant (Physician or RN who assists surgeon in performing hemostasis, tissue retraction, and wound closure). </li></ul><ul><li>Scrub nurse (an LP/VN, RN, or surgical technologist who prepares and maintains integrity, safety, and efficiency of the sterile field throughout the operation). </li></ul>
  18. 18. Sterile Field <ul><li>The area surrounding the client and the surgical site that is free from all microorganisms. </li></ul>
  19. 19. Non-Sterile Members of the Surgical Team <ul><li>Anesthesia provider. </li></ul><ul><li>Circulating nurse (an RN responsible for management of personnel, equipment, supplies, environment, and communication throughout a surgical procedure). </li></ul>
  20. 20. Asepsis <ul><li>The absence of pathogenic microorganisms. </li></ul>
  21. 21. Elements of Aseptic Technique <ul><li>Sterile gowns and gloves. </li></ul><ul><li>Sterile drapes used to create sterile field. </li></ul><ul><li>Sterilization of items used in sterile field. </li></ul>
  22. 22. Sterile Conscience <ul><li>The practice of aseptic technique requires the development of sterile conscience, an individual’s personal honesty and integrity with regard to adherence to the principles of aseptic technique. </li></ul>
  23. 23. Intraoperative Nursing Care <ul><li>Risk of infection related to invasive procedure and exposure to pathogens. </li></ul><ul><li>Risk for injury related to positioning during surgery. </li></ul><ul><li>Risk of injury related to foreign objects inadvertently left in the wound. </li></ul><ul><li>Risk for injury related to chemical, physical, and electrical hazards. </li></ul><ul><li>Risk for impaired tissue integrity. </li></ul><ul><li>Risk for alteration in fluid and electrolyte balance related to abnormal blood loss and NPO status. </li></ul>Nurses are responsible for managing six areas of risk:
  24. 24. Postoperative Nursing Care <ul><li>Risk for ineffective airway clearance. </li></ul><ul><li>Risk for ineffective breathing pattern. </li></ul><ul><li>Risk for aspiration. </li></ul><ul><li>Risk for decreased cardiac output. </li></ul><ul><li>Risk for fluid volume deficit. </li></ul><ul><li>Risk for sensory/perceptual alterations. </li></ul><ul><li>Risk for injury and for altered thought processes. </li></ul>Nurses are responsible for managing seven areas of risk:
  25. 25. Aldrete Score: Defined as: <ul><li>A means of objectively assessing the physical status of clients recovering from anesthesia. Also known as the Post-Anesthetic Recovery Score. </li></ul>
  26. 26. Later Postoperative Nursing Care <ul><li>Risk for ineffective airway clearance caused by atelectasis and hypostatic pneumonia. </li></ul><ul><li>Risk for peripheral neurovascular dysfunction, fluid volume excess/deficit, and activity intolerance. </li></ul><ul><li>Risk for anxiety or ineffective individual coping. </li></ul><ul><li>Risk for altered nutrition--less than body requirements related to nausea and vomiting, abdominal distension, constipation and NPO status. </li></ul><ul><li>Risk for urinary retention. </li></ul><ul><li>Risk for sensory perceptual alterations. </li></ul><ul><li>Risk for impaired skin integrity and infection due to surgical incision. </li></ul>Nurses are responsible for managing these risks and complications:
  27. 27. Ambulatory Surgery <ul><li>Surgical care performed under general, regional, or local anesthesia and involving fewer than 24 hours of hospitalization. </li></ul><ul><li>Also known as same-day, one-day, outpatient, or short-stay surgery. </li></ul><ul><li>Cost containment, governmental changes, and technological advances have all promoted concept of ambulatory surgery. </li></ul>
  28. 28. Surgery and the Elderly <ul><li>Because of the physiologic changes and complex needs of the elderly client undergoing surgery, the nurse must be knowledgeable in promoting health and rehabilitation in the elderly surgical client. </li></ul>