More Related Content
What's hot
What's hot (20)
Similar to 1. surgical nursing intruduction
Similar to 1. surgical nursing intruduction (20)
Recently uploaded
Recently uploaded (20)
1. surgical nursing intruduction
- 1. Surgical Nursing Shalith Athurupana RN,BScN(Hons),MN(Reading) Intensive Care Nursing Officer, Neuro Trauma Centre, National Hospital of Sri Lanka Vice Secretary, Sri Lanka Nurses Association. 4/5/2022 AMRAK Certified 1
- 2. End of this module • Describe the cause, symptoms, treatment and prevention of Surgical Diseases. • Demonstrate skills in carrying out nursing techniques and procedures with the application of scientific principles. • Discuss nursing process and provide nursing care to clients with surgery. 2 AMRAK Certified 4/5/2022
- 4. Introduction • Surgery is the branch of medicine that is concerned with the treatment of injuries, diseases, and other disorders by manual and instrumental. • Surgery involves the management of acute injuries and illnesses as differentiated from chronic, slowly progressing diseases, except when patients with the latter type of disease must be operated upon. 4 AMRAK Certified 4/5/2022
- 5. History • Surgery is as old as humanity, for anyone who has ever stanched a wound has acted as a surgeon. • In some ancient civilizations surgery reached a rather high level of development, as in India, China, Egypt, and Hellenistic Greece. • In Europe during the Middle Ages, the practice of surgery was not taught in most universities, and ignorant barbers instead wielded the knife, either on their own responsibility or upon being called into cases by physicians. 5 AMRAK Certified 4/5/2022
- 6. Cont. History • The organization of the United Company of Barber Surgeons of London in 1540 marked the beginning of some control of the qualifications of those who performed operations. • This guild was the precursor of the Royal College of Surgeons of England. • In the 18th century, with increasing knowledge of anatomy, such operative procedures as amputations of the extremities, excision of tumors on the surface of the body, and removal of stones from the urinary bladder had helped to firmly establish surgery. 6 AMRAK Certified 4/5/2022
- 7. Cont. History • Accurate anatomical knowledge enabled surgeons to operate more rapidly. • patients were sedated with opium or made drunk with alcohol, tied down, and a leg amputation. • The pain involved in such procedures, however, continued to limit expansion of the field until the introduction of ether anesthesia in 1846. • The number of operations thereafter increased markedly • only to accentuate the frequency and severity of “surgical infections.” 7 AMRAK Certified 4/5/2022
- 9. Cont. History • In the mid-19th century the French microbiologist Louis Pasteur developed an understanding of the relationship of bacteria to infectious diseases. • The application of this theory to wound sepsis by the British surgeon Joseph Lister from 1867 resulted in the technique of antisepsis, which brought about a remarkable reduction in the mortality rate from wound infections after operations. • The twin emergence of anesthesia and antisepsis marked the beginning of modern surgery. 9 AMRAK Certified 4/5/2022
- 11. WilhelmConradRontgen. Wilhelm Conrad Rontgen’s discovery of X-rays at the turn of the 20th century added an important diagnostic tool to surgery. 11 AMRAK Certified 4/5/2022
- 12. Cont. History • The discovery of blood types in 1901 by Austrian biologist Karl Landsteiner made transfusions safer. • New techniques of anesthesia involving not only new agents for inhalation but also regional anesthesia accomplished by nerve blocking (spinal and local anesthesia) were also introduced. • The use of positive pressure and controlled respiration techniques (to prevent the lung from collapsing when the pleural cavity was opened) made chest surgery practical and relatively safe for the first time. 12 AMRAK Certified 4/5/2022
- 13. Cont. History • The intravenous administration (injection into the veins) of anesthetic agents was also adopted. • In the period from the 1930s to the 1960s, the replenishment of body fluids by intravenous infusion. • The introduction of chemicals and antibiotics to fight infection and to treat the metabolically disturbed body. • The development of heart-lung machines helped bring surgery to a state in which every body cavity, system, organ, and area could safely be operated on. 13 AMRAK Certified 4/5/2022
- 14. Present-day surgery • Contemporary surgical therapy is greatly helped by monitoring devices that are used during surgery and during the postoperative period. • Other items monitored are The heart contractions as indicated by electrocardiograms Tracings of brain waves recorded by electroencephalograms reflect changes in brain function Oxygen level in arteries and veins Carbon dioxide partial pressure in the circulating blood Respiratory volume and exchange. 14 AMRAK Certified 4/5/2022
- 15. Present-day surgery • Intensive monitoring of the patient usually continues into the critical postoperative stage. 15 AMRAK Certified 4/5/2022
- 16. Types of surgery Based on timing • Elective surgeries done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. • Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity. • A semi-elective surgeries one that must be done to avoid permanent disability or death, but can be postponed for a short time. 16 AMRAK Certified 4/5/2022
- 17. Types of surgery Based on purpose Exploratory surgeries performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. 17 AMRAK Certified 4/5/2022
- 18. Types of surgery By type of procedure Amputation involves cutting off a body part, usually a limb or digit. Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Cosmetic surgery is done to improve the appearance of an otherwise normal structure. Excision is the cutting out or removal of an organ, tissue, or other body part from the patient. 18 AMRAK Certified 4/5/2022
- 19. Types of surgery By type of procedure Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery. 19 AMRAK Certified 4/5/2022
- 20. Types of surgery By body part When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones and/or muscles) 20 AMRAK Certified 4/5/2022
- 21. Types of surgery By degree of invasiveness Minimally invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure or laparotomy requires a large incision to access the area of interest. 21 AMRAK Certified 4/5/2022
- 22. Surgical Scrub, Gowning, and Gloving • https://www.youtube.com/watch?v=wXJRBD_7Xvo 22 AMRAK Certified 4/5/2022
- 23. Surgical team • Surgeon and surgical assistant(s) • Anesthesia provider • Surgical assistant • Scrub nurse • Theatre technician • Circulating nurse 23 AMRAK Certified 4/5/2022
- 24. Surgical Positions The five basic positions used for surgery These are supine, lithotomy, sitting, prone, and lateral. 24 AMRAK Certified 4/5/2022
- 28. Surgical Positions Lateral position ( left, right) 28 AMRAK Certified 4/5/2022
- 29. Anesthesia • Complete or partial loss of sensation • Types of anesthesia include • Local anesthesia induce the absence of sensation in a specific area. E.g. Dental procedures • Regional anesthesia affecting only a large part of the body. E.g. limb or the lower half of the body. (Spinal and Epidural) 29 AMRAK Certified 4/5/2022
- 30. Anesthesia • General anesthesia medically induced coma and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents. • Topical (surface) Anesthesia applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. 30 AMRAK Certified 4/5/2022
- 31. Nursing Care for ClientWho is ReceivingAnesthesia • Check for allergies • Abnormal Lab. Results • Extreme apprehension post induction • Keep client flat until worn off • Monitor urine output • Observe sign of resp. distress 31 AMRAK Certified 4/5/2022
- 32. What is Medical-Surgical Nursing • Medical-surgical nursing is the foundation of all nursing practice. • Once upon a time and not so very long ago, all nurses practiced the art and science of nursing on wards, everyone was a medical or surgical nurse - that is where all nursing started. • Today many nurses choose to work in the specialty of medical-surgical nursing. • Medical-surgical nursing has evolved from an entry-level position to an adult health specialty. (Academy of Medical-Surgical Nursing, 2011) 32 AMRAK Certified 4/5/2022
- 33. What is Medical-Surgical Nursing • Medical-Surgical Nursing is no longer viewed as stepping- stone but is solid rock and the backbone of every institution. • It is the largest group of practicing professionals. • Medical-surgical nurses care for adult patients in many settings, such as in patient care unit, clinics, home health care, long-term care, skilled nursing homes, urgent care centers, surgical centers, and universities, just to name a few. (Academy of Medical-Surgical Nursing, 2011) 33 AMRAK Certified 4/5/2022
- 34. Surgical Nurse surgical nurse, also referred to as a theatre nurse or scrub nurse, specializes in perioperative care, providing care to patients before, during and after surgery. During the surgery, they assist the anesthetist and surgeons when they are needed. 34 AMRAK Certified 4/5/2022
- 35. Principles of Surgical Nursing • Assessment, planning, implementing and evaluating care using a nursing model or framework. • Managing fluid and electrolyte balance. • Managing nutrition. • Managing pain. • Managing infection control. • Managing wounds and wound care. • Managing stress and anxiety. • Managing possible altered body image. 35 AMRAK Certified 4/5/2022
- 36. Surgical Nurse Responsibilities • Giving preoperative instructions. • Preparing patients for surgery. • Assisting the Anesthetist and Surgeons when needed. • Sterilizing and marking incision sites. • Intervening when there are complications. • Administering medication. • Preparing the operating room. 36 AMRAK Certified 4/5/2022
- 37. What skills do surgical nurses need • Ability to work as a team. • Excellent communication skills. • Highly organized. • Attention to detail. • Problem solving and critical thinking. 37 AMRAK Certified 4/5/2022
- 38. PERIOPERATIVE NURSING • The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery and recovery. (total surgical experience of the patient) • Can be divided into three phases 1. Preoperative 2. Intraoperative 3. Postoperative 38 AMRAK Certified 4/5/2022
- 39. 01. Preoperative Phase The period of time from when decision for surgical intervention is made to when the patient is transferred to the operating room table. 39 AMRAK Certified 4/5/2022
- 40. 02. 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 post anesthesia care unit. 40 AMRAK Certified 4/5/2022
- 41. 03. Postoperative Phase Period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow-up evaluation in the clinical setting or home. 41 AMRAK Certified 4/5/2022
- 42. Perioperative Management of Care • Schedule the diagnostic tests. • Verify that all the necessary documents are on the client’s medical record. • Report abnormal diagnostic results to the surgeon. • Prepare and teach the client. • Obtain informed consent 42 AMRAK Certified 4/5/2022
- 43. Preoperative Management of Care Assessment Nursing history • Medical history • Medications • Allergies • Age-related considerations • Social and cultural considerations • Spiritual considerations • Psychosocial status 43 AMRAK Certified 4/5/2022
- 44. Preoperative Management of Care Assessment Physical assessment • General survey • Head and neck • Upper extremities • Anterior and posterior chest and abdomen • Lower extremities 44 AMRAK Certified 4/5/2022
- 45. Preoperative Management of Care Nursing diagnosis Common nursing diagnoses for the preoperative client are Deficient Knowledge related to surgery, and Anxiety and Fear. Outcome identification and planning • The overall goal is to protect the client from injury related to anesthesia and surgery. 45 AMRAK Certified 4/5/2022
- 46. Preoperative Management of Care Cont. Outcome identification and planning • Discharge planning considerations include Psychosocial and spiritual support systems and community resources Financial aspects of the illness Degree of illness or disability Rehabilitation Preventive care Client teaching needs 46 AMRAK Certified 4/5/2022
- 47. Preoperative Management of Care Implementation • Surgical consent form • Preoperative checklist • Client teaching about interventions to prevent postoperative complications Postoperative exercises Incentive spirometer Antiembolism stockings Transcutaneous electrical nerve stimulation 47 AMRAK Certified 4/5/2022
- 48. Preoperative Management of Care Physical preparation Skin preparation Nutrition Gastrointestinal preparation Nasogastric tube Bowel preparation Urinary elimination Safety precautions Medications 48 AMRAK Certified 4/5/2022
- 49. Preoperative Management of Care Evaluation Preoperative evaluation focuses on the client’s ability to verbalize and demonstrate the exercises. The evaluation of a client’s preoperative preparation for surgery should include understanding of the procedure, verbalization and return demonstration of postoperative exercises, and postoperative expectations resulting from the surgery. Documentation of preoperative activities must be entered in the client’s record. 49 AMRAK Certified 4/5/2022
- 50. Intraoperative Management of Care Begins when patient is transferred to operating room table Provide for patient safety Maintain aseptic environment Provide surgeon with supplies and instruments Documentation 50 AMRAK Certified 4/5/2022
- 51. Intraoperative Management of Care Surgical environment Unrestricted zone Can enter in street clothes Receiving desk, locker rooms Semi restricted zone Surgical attire required Hallways, storage areas 51 AMRAK Certified 4/5/2022
- 52. Intraoperative Management of Care Surgical environment Restricted zone Controlled and germ-free Scrub attire required OR and rooms where sterile instruments are prepared 52 AMRAK Certified 4/5/2022
- 53. Intraoperative Management of Care Occupational hazards • There is a risk of exposure to harmful pathogens. • Latex allergies, needlesticks, eye splashes, back injuries, and indoor pollution are of particular concern. • Precautions should be in place that are in compliance to particular authority. 53 AMRAK Certified 4/5/2022
- 54. Intraoperative Management of Care Assessment • Check the client’s identification band and confirm the surgical site. • Check for client alterations that can affect positioning during the procedure. • Make sure the OR bed is prepared to receive the client and that accessories are available for a specific position. 54 AMRAK Certified 4/5/2022
- 55. Intraoperative Management of Care Nursing diagnosis • Common intraoperative nursing diagnoses promote client comfort, safety, and support during the surgical procedure. • Risk for perioperative positioning injury, Risk for injury, Risk for infection, Hypothermia. 55 AMRAK Certified 4/5/2022
- 56. Intraoperative Management of Care Planning • Specific nursing care is planned to encompass the surgeon’s specifications for positioning and to alleviate or prevent any individual client problem. • Determine the appropriate mode of client transfer, equipment and positioning aids, as well as the need for ancillary personnel to accomplish positioning . 56 AMRAK Certified 4/5/2022
- 57. Intraoperative Management of Care Interventions Surgical asepsis Skin preparation Positioning and draping Electrical hazards Heat loss Monitoring physiological functioning 57 AMRAK Certified 4/5/2022
- 58. Intraoperative Management of Care Evaluation • Before the client is transferred to the recovery room, the OR nurse evaluates and documents achievement of client outcomes. • The nurse documents the specific data on the OR record. 58 AMRAK Certified 4/5/2022
- 59. Postoperative Management of Care • Admission to ICU/HDU/WD • Maintain airway • Monitor vital signs • Assess effects of anesthesia • Assess for complications of surgery • Provide comfort and pain relief • Ends with follow-up evaluation in clinical setting or home 59 AMRAK Certified 4/5/2022
- 60. Postoperative Management of Care • The primary goal of nursing care during the immediate postoperative phase is to maintain the “A-B-Cs”: airway, breathing, and circulation. • Ongoing care is directed toward restoring the client to the preoperative health status. 60 AMRAK Certified 4/5/2022
- 61. Postoperative Management of Care Assessment • Following the initial assessment of the client’s respiratory status, the nurse performs a total assessment • Airway and respiratory status • Circulatory status • Neurologic status • Fluid and metabolic status • Level of discomfort or pain • Wound management 61 AMRAK Certified 4/5/2022
- 62. Postoperative Management of Care Nursing diagnoses • Ineffective airway clearance • Ineffective breathing pattern • Ineffective tissue perfusion • Deficient fluid volume • Imbalanced nutrition less than body requirements 62 AMRAK Certified 4/5/2022
- 63. Postoperative Management of Care Planning • Care planning is done in two parts 1. Immediate care rendered in the recovery area 2. Ongoing postoperative care. • Care is prioritized according to the type of anesthesia and surgical interventions. 63 AMRAK Certified 4/5/2022
- 64. Postoperative Management of Care Planning • After discharge, the nurse ensures that the client is knowledgeable about home care. • For clients who are hospitalized postoperatively, the nursing care plan encompasses both inpatient and discharge needs . 64 AMRAK Certified 4/5/2022
- 65. Postoperative Management of Care Interventions • Maintaining respiratory status • Maintaining circulatory status • Maintaining neurologic status • Maintaining fluid and metabolic status • Managing pain 65 AMRAK Certified 4/5/2022
- 66. Postoperative Management of Care Discharge from the Recovery area Specific client outcomes include • The client is conscious, oriented, and can move all extremities. • The client demonstrates full return of reflexes. • The client can clear the airway and cough effectively. • Vital signs have been stable or within baseline ranges for 30 minutes. 66 AMRAK Certified 4/5/2022
- 67. Postoperative Management of Care Cont. Discharge from the Recovery area Specific client outcomes include • Intake and urinary output are adequate to maintain the circulating blood volume. • The client is afebrile or a febrile condition has been treated accordingly. • Dressings are dry or have only minimal drainage. 67 AMRAK Certified 4/5/2022
- 68. Preoperative Nursing Management Patient Education Teaching deep breathing and coughing exercises. Encouraging mobility and active body movement. e.g. Turning(change position),foot and leg exercise. Explaining pain management. Teaching cognitive coping strategies. 68 AMRAK Certified 4/5/2022
- 69. Preoperative Nursing Management Managing nutrition and fluids. • The major purpose of withholding food and fluid before surgery is to prevent aspiration. • A fasting period of 8hours or more is recommended. Preparing the bowel for surgery. • Enema is not commonly ordered, unless the patient is undergoing abdomen or pelvic surgery. e.g. (cleansing enema, laxative). 69 AMRAK Certified 4/5/2022
- 70. Preoperative Nursing Management Preparing the skin. • The goal of preoperative skin preparation is to decrease bacteria without injuring the skin. (Shaving according to the site of surgery) 70 AMRAK Certified 4/5/2022
- 71. Preoperative Nursing Management Immediate preoperative nursing intervention • Administering preanesthetic medication. • Maintaining the preoperative record. e.g. Final checklist, consent form, identification. 71 AMRAK Certified 4/5/2022
- 72. Potential Intraoperativecomplication • Nausea and vomiting • Anaphylaxis • Hypoxia and other respiratory complication • Hypothermia 72 AMRAK Certified 4/5/2022
- 73. Nursing management in the post anesthesia care unit • Assessing the patient Frequent assessment of the patient oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness. • Maintaining a patent airway The primary objectives are to maintain pulmonary ventilation and prevent hypoxia and hypercapnia. The nurse applies oxygen, and assesses respiratory rate and depth, oxygen saturation. 73 AMRAK Certified 4/5/2022
- 74. Nursing management in the post anesthesia care unit • Maintaining cardiovascular stability The nurse assesses the patient’s mental status, vital signs, cardiac rhythm, skin temperature, color and urine output. Central venous pressure, arterial lines and pulmonary artery pressure. The primary cardiovascular complications include hypotension, shock, hemorrhage, hypertension and dysrhythmias. 74 AMRAK Certified 4/5/2022
- 75. Nursing management in the post anesthesia care unit • Assessing and managing voluntary voiding Urine retention after surgery can occur for a verity of reasons. Opioids and anesthesia interfere with the perception of bladder fullness. Abdominal, pelvic ,hip may increase the likelihood of retention secondary to pain. • Encourage activity Most surgical patients are encouraged to be out of bed as soon as possible. Early ambulation reduces the incidence of post operative complication as, atelectasis, pneumonia, gastrointestinal discomfort and circulatory problem. 75 AMRAK Certified 4/5/2022
- 76. Post Operative Complication • Shock Is the response of the body to a decrease in the circulating volume of blood, tissue perfusion impaired, cellular hypoxia and death. • Hemorrhage Is the escape of blood from a blood vessel. 3- Deep vein thrombosis. (DVT). Occur in pelvic vein or in lower extremities, and it’s common after hip surgery. 76 AMRAK Certified 4/5/2022
- 77. Post Operative Complication • Pulmonary embolism. It’s the obstruction of one or more pulmonary arterioles by an embolus originating some where in the venous system or in the right side of heart. • Urinary Retention. • Intestinal obstruction. Result in partial or complete impairment to the forward flow of intestinal content. 77 AMRAK Certified 4/5/2022