Caring for perioperative clients
Contents Outline
Objectives.
Introduction.
Phases of perioperative care.
Types of surgery.
Categories of surgery based on urgency.
Preoperative assessment.
Surgical risk factors.
Preoperative preparation.
Nursing diagnosis and intervention in preoperative phase.
Postoperative care.
Nursing diagnosis and intervention in postoperative period.
Postoperative complications.
COLONOSCOPY- A PICTORIAL OVERVIEW
⢠Dear viewers,
⢠Greetings from âSurgical Educatorâ
⢠This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
⢠In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
⢠I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
⢠I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
⢠I hope it would be interesting and very useful to all my viewers.
⢠You can access this video in the following links:
⢠surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
⢠Thank you for watching the video.
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes, the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop. Hemorrhoids are also called piles.
Postoperative care is the care you receive after a surgical procedure. The type of postoperative care you need depends on the type of surgery you have, as well as your health history. It often includes pain management and wound care. Postoperative care begins immediately after surgery.
COLONOSCOPY- A PICTORIAL OVERVIEW
⢠Dear viewers,
⢠Greetings from âSurgical Educatorâ
⢠This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
⢠In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
⢠I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
⢠I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
⢠I hope it would be interesting and very useful to all my viewers.
⢠You can access this video in the following links:
⢠surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
⢠Thank you for watching the video.
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes, the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop. Hemorrhoids are also called piles.
Postoperative care is the care you receive after a surgical procedure. The type of postoperative care you need depends on the type of surgery you have, as well as your health history. It often includes pain management and wound care. Postoperative care begins immediately after surgery.
Peri operative nursing is a nursing specialty that works with patients who are having injuries, invasive procedures. Peri-operative nurses work closely with surgeons, anesthesiologists, nurse anesthetist, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, post operative care primarily in the operating theater. The nurse assesses the patient data; establishing nursing diagnosis; identifies desired patient outcome; develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient
All aspects of peri operative care is described.
-preoperative care
-postoperative care
Role of nurse in pre operative nursing:
1.Pre operative assessment.
2.Obtaining informed consent.
3.Pre operative teaching.
4.Physical preparation of patients.
5.Psychological preparation
6.Informed Consent
POST OPERATIVE CARE: Post operative phase begins when the client is admitted to the post operative unit and ends with the clientâs post operative evaluation in the physicianâs office.
GOAL:
ď§Restore homeostasis and prevent complication.
ď§Maintain adequate cardio vascular and tissue perfusion
ď§Maintain adequate respiratory function
ď§Maintain adequate nutrition and elimination
ď§Maintain adequate fluid electrolyte balance
ď§Maintain adequate renal function
ď§Promote adequate rest, comfort, and safety
ď§Promote adequate wound healing
ď§Promote and maintain activity and mobility
ď§Provide adequate psychological support.
TRANSFER FROM OPERATION ROOM:
ď§After sending the patient to operating room, prepare a bed to receive the patient undergone surgery.
ď§Receive the patient without disturbing the devices attached to the patient.
ď§Assessment A- Airway, B- Breathing, C- Circulation, C- Consciousness, S- Safety, D- Dressing, D- Drainage, D- Drugs , E- Elimination F- Foods, F- Fluids P- Pain.
ď§Ask the theater staff about any complications during surgery.
ď§Check vital signs.
ď§Check the operation site for bleeding, discharge, etc. if drainage tube are filled.
ď§Keep the patient well covered to prevent draught
ď§Never leave the patient alone to prevent injury from fall
ď§Observe the patient for swallowing reflexes
ď§Quickly observe the functioning of all devices and make sure that they are in its functioning order.
ď§Check the doctorâs order for other instruction and treatment.
POST OPERATIVE COMPLICATIONS:
ďˇHaematological: Hemorrhage
ďˇRespiratory: Atelectesis, Pneumonia, Pulmonary Embolism
ďˇCardiovascular: Hypertension, cardiac dysrhythmias, venous thrombosis
ďˇUrinary: Urinary retention
ďˇGastrointestinal: Constipation
ďˇNeurological: CVA/Stroke
ďˇImmunological: Infection
ďˇWound healing: infection
ďˇPsychological: Body image problrms
POST OPERATIVE NURSING CARE:
ď§Maintaining Respiratory function:
i.Encourage diaphragmatic breathing exercise at least every two hours while clients are awake
ii.Instruct to use incentive spirometers for maximum inspiration
iii.Encourage early ambulation
iv.Change position every one two hours.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganongâs Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowmanâs Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2â3 criteria; moderate AUD: 4â5 criteria; severe AUD: 6â11 criteria).
The four main behavioral effects of AUD are impaired control over
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of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganongâs Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendaçþes da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS â Objetivos do Desenvolvimento SustentĂĄvel e a EstratĂŠgia Global para a SaĂşde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pĂłs-natais devem expandir-se para alĂŠm da cobertura e da simples sobrevivĂŞncia, de modo a incluir cuidados de qualidade.
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Uma âexperiĂŞncia pĂłs-natal positivaâ ĂŠ um resultado importante para todas as mulheres que dĂŁo Ă luz e para os seus recĂŠm-nascidos, estabelecendo as bases para a melhoria da saĂşde e do bem-estar a curto e longo prazo. Uma experiĂŞncia pĂłs-natal positiva ĂŠ definida como aquela em que as mulheres, pessoas que gestam, os recĂŠm-nascidos, os casais, os pais, os cuidadores e as famĂlias recebem informação consistente, garantia e apoio de profissionais de saĂşde motivados; e onde um sistema de saĂşde flexĂvel e com recursos reconheça as necessidades das mulheres e dos bebĂŞs e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendaçþes novas e jĂĄ bem fundamentadas sobre cuidados pĂłs-natais de rotina para mulheres e neonatos que recebem cuidados no pĂłs-parto em unidades de saĂşde ou na comunidade, independentemente dos recursos disponĂveis.
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O estabelecimento da amamentação e o manejo das principais intercorrências Ê contemplada.
Recomendamos muito.
Vamos discutir essas recomendaçþes no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação sĂł estĂĄ disponĂvel em inglĂŞs atĂŠ o momento.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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3. Caring for perioperative clients
Contents Outline
1. Objectives.
2. Introduction.
3. Phases of perioperative care.
4. Types of surgery.
5. Categories of surgery based on urgency.
6. Preoperative assessment.
7. Surgical risk factors.
8. Preoperative preparation.
9. Nursing diagnosis and intervention in preoperative phase.
10. Postoperative care.
11. Nursing diagnosis and intervention in postoperative
period.
12. Postoperative complications.
4. Objectives:
At the end of this lecture, the student must be able to:
1. Differentiate the phases of perioperative care.
2. Define the types and categories of surgery.
3. Identify the preoperative assessments.
4. Develop a preoperative teaching plan.
5. Identify surgical risk factors.
6. Describe the preoperative preparation.
7. Discuss assessments needed in immediate and later postoperative
period.
8. Identify the postoperative complications.
Caring for perioperative clients
5. What is meant by
perioperative?
Perioperative is a term used to
describe the entire span of surgery,
including what occurs before,
during, and after the actual
operation.
6. Phases of perioperative care
Preoperative: begins with the decision to perform
surgery and continues until the client has reached the
operating area.
Intraoperative: includes the entire
duration of the surgical procedure, until
transfer of the client to the recovery area.
Postoperative: begins with admission to the recovery area and
continues until the client receives a follow up evaluation at home, or is
discharged to a rehabilitation unit.
7.
8. â˘Diagnostic â Removal and study of tissue to make a
diagnosis.(Pathology)
â˘Exploratory â Most extensive means to involve
exploration of a body cavity or use of
scopes inserted though small incision.
â˘Curative â Removal or replacement of defective tissue
to restore function.(Joint)
â˘Palliativeâ Relief of symptoms or enhancement of
function without cure. (Thiroidectomy)
â˘Cosmeticâ Correction of defects, improvement of
appearance, or change to a physical
feature.
Types of surgery
10. â˘Client assessment varies depending on the urgency of the surgery.
â˘Time for preoperative assessment, nursing diagnosis, and evaluation of the
nursing management may be limited when a client is admitted for ambulatory
surgery or admitted shortly before surgery.
â˘Recognition of the clientâs immediate preoperative needs is important.
â˘When the client is admitted, the nurse review preoperative instructions, such as
diet restriction, skin preparation, to ensure the client has followed them.
â˘The nurse immediately notifies the surgeon if the client has not carried out a
specific portion of the instruction.
Assessment
11. :
Preoperative Assessment
I. Review preoperative laboratory and
diagnostic studies
II. Review the clientâs health history and
preparation for surgery
III. Assess physical needs
IV. Assess psychological needs
V. Assess cultural needs
12. I. Review preoperative laboratory and diagnostic studies:
â˘Complete blood count.
â˘Blood type and cross match.
â˘Serum electrolytes.
â˘Urinalysis.
â˘Chest X-rays.
â˘Electrocardiogram.
â˘Other tests related to procedure or clientâs medical condition, such
as: prothrombin time, partial thromboplastin time, blood urea
nitrogen, creatinine, and other radiographic studies.
13. II. Review the clientâs health history and preparation for surgery:
â˘History of present illness and reason for surgery
â˘Past medical history
â˘Medical conditions (acute and chronic)
â˘Previous hospitalization and surgeries
â˘History of any past problem with anesthesia
â˘Allergies
â˘Present medications
â˘Substance use: alcohol, tobacco, street drugs
â˘Review of system
14. III. Assess physical needs:
â˘Ability to communicate
â˘Vital signs
â˘Level of consciousness
Confusion
Drowsiness
Unresponsiveness
â˘Weight and height
â˘Skin integrity
â˘Ability to move/ ambulate
â˘Level of exercise
â˘Prostheses
â˘Circulatory status
15. IV. Assess psychological needs:
â˘Emotional state
â˘Level of understanding of surgical procedure, preoperative and
postoperative instruction
â˘Coping strategies
â˘Support system
â˘Roles and responsibilities
V. Assess cultural needs:
â˘Language-need for interpreter
16. SURGICAL CONSENT
ď˘ Before surgery, the client must sign a surgical consent form or
operative permit.
ď˘ Clients must sign a consent form for any procedure that requires
anesthesia and has risks of complications.
ď˘ If an adult client is confused, unconscious, a family member or
guardian must sign the consent form.
ď˘ If the client is younger than 18 years of age, a parent or legal guardian
must sign the consent form.
ď˘ In an emergency, the surgeon may have to operate without consent,
health care personnel, however, makes every effort to obtain consent
by telephone, or fax.
ď˘ Each nurse must be familiar with agency policies and state laws
regarding surgical consent forms.
ď˘ Clients must sign the consent form before receiving any preoperative
sedatives.
ď˘ The nurse is responsible for ensuring that all necessary parties have
signed the consent form and that it is in the clientâs chart before the
client goes to the operating room (OR).
17. Teaching clients about their surgical procedure
and expectations before and after surgery is best
done during the preoperative period.
Clients are more alert and free of pain at this
time.
Clients and family members can better
participate in recovery if they know what to
expect.
The nurse adapts instructions and expectations
to the clientâs ability to understand.
Information in a preoperative teaching plan
varies with the type of surgery and the length of
the hospitalization.
18. Preoperative medication- when they are given
and their effects.
Post operative pain control.
Explanation and description of the post
anesthesia recovery room or post surgical area.
Discussion of the frequency of assessing vital
signs and use of monitoring equipment.
Explanation and demonstration deep breathing
and coughing exercises, use of incentive
spirometry, how to support the incision for
breathing exercises and moving, position
changes, and feet and leg exercises.
19. Information about intravenous (IV) fluids and
other lines and tubes such as nasogastric tubes.
Preoperative teaching time also gives the client
the chance to express any anxieties and fears
and for the nurse to provide explanations that
will help alleviate those fears.
When clients are admitted for emergency
surgery, time for explanation is unavailable;
explanations will be more complete during the
postoperative period.
20. Surgical Risk Factors:
ď¨ Age â Very young â Elderly
ď¨ Nutritional Status âMalnourished â Low
weight â Obese
ď¨ Medical Problems âAcute and chronic
respiratory problems â Hypertension â Liver
dysfunction â Renal failure â Diabetes
21.
22. Physical Preparation.
ď§ Skin preparation
ď§ Elimination
ď§ Food and fluids
ď§ Care of valuables
ď§ clothing/ grooming
ď§ Prostheses
Psychosocial Preparation.
ď§ Careful preoperative teaching can reduce fear and
anxiety of the clients.
23. Nursing Diagnosis
⢠Anxiety related to results of surgery and
postoperative pain.
⢠Knowledge deficit related to preoperative
procedures and postoperative expectations.
24.
25. Postoperative Care:
Immediate postoperative period.
Initial Assessment
Airway patency
Effectiveness of respiration
Presence of artificial airways
Mechanical ventilation, or supplemental oxygen
Circulatory status, vital signs
Wound condition, including dressings and drains
Fluid balance, including IV fluids, output from
catheters and drains and ability to void
Level of consciousness and pain
26. Postoperative Care:
Later postoperative period
Ongoing Assessment
Respiratory function
General condition
Vital signs
Cardiovascular function
Fluid status
Pain level
Bowel and urinary elimination
Dressings, tubes, drains, and IV lines
27. Nursing Diagnosis
⢠Risk for altered respiratory function related to
immobility, effects of anesthesia, analgesics and pain.
⢠Pain related to surgical incision and manipulation of
body structures.
⢠Altered Comfort (nausea and vomiting) related to
effects of anesthesia or side effects of narcotics.
⢠Risk for Infection related to break in skin integrity
(surgical incision, wound drainage devices).
⢠Activity Intolerance related to decreased mobility and
weakness secondary to anesthesia and surgery.
28. Nurseâs Responsibilities in Postoperative Phase
⢠Ensures a patent airway
⢠Helps maintain adequate circulation
⢠Prevents or assist with the treatment of shack
⢠Maintains proper position and function of
drain tubes and IV infusion
⢠Monitor for potential complications