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.
Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue. It is most commonly caused by S. pyogenes and S. aureus.5 Bacteria may gain access to the dermis via a break in the skin barrier in healthy adults, whereas the hematogenous route is more common in immunocompromised patients.
The affected skin is usually erythematous, swollen, painful, and warm to the touch. Severe cellulitis can be complicated by bullae, pustules, or necrotic tissue. Damage to lymphatic vessels can lead to recurrent episodes of cellulitis.6 In areas of the world endemic for lymphatic filariasis, it is important to rule out this disease in cases of recurrent bouts of lower-extremity cellulitis and lymphangitis.
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.
Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue. It is most commonly caused by S. pyogenes and S. aureus.5 Bacteria may gain access to the dermis via a break in the skin barrier in healthy adults, whereas the hematogenous route is more common in immunocompromised patients.
The affected skin is usually erythematous, swollen, painful, and warm to the touch. Severe cellulitis can be complicated by bullae, pustules, or necrotic tissue. Damage to lymphatic vessels can lead to recurrent episodes of cellulitis.6 In areas of the world endemic for lymphatic filariasis, it is important to rule out this disease in cases of recurrent bouts of lower-extremity cellulitis and lymphangitis.
Antibiotics for surgical prophylaxis.
Surgical site infections(SSIs) are a significant cause of morbidity and mortality.
Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20%undergoing intra-abdominal operations will develop an SSI.
SSIs have become the second most common cause of nosocomial infection and these data are likely underestimated.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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.
Bowman’s 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
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Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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, Ganong’s 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
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2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Definition
According to Centers for Disease Control and
Prevention (CDC), A surgical site infection is an
infection that occurs after surgery in the part of
the body where the surgery took place.
Surgical site infections can sometimes be
superficial infections involving the skin only. Other
surgical site infections are more serious and can
involve tissues under the skin, organs, or
implanted material
3. Epidemiology (World and India)
Globally SSIs estimation is 0.5%-15% and in
India it is in higher rates ranging from 23%-38%.
4. Types
According to CDC
Superficial incisional
Affects skin and
subcutaneous tissue
Deep incisional
Affects fascial and
muscle layers
Organ/ space infection
Affects any part of the
body other than incision
that is opened/
manipulated during the
surgical procedure
5. Classification of surgical
procedures based on risk of
infection
Clean
Atraumatic
No inflammation encountered
No break in technique
Gastro intestinal, genitourinary and respiratory
tracts not entered
Wound infection rate is 1.5-4.2%
Need for prophylaxis not usually required
Example: Inguinal hernia repair
6. Classification of surgical
procedures based on risk of
infection
Contaminated
Gastro intestinal tract/ respiratory tract entered
but without spillage
Minor break in technique
Wound infection rate is less than 10%
Prophylaxis is usually required
Example: Cholecystectomy
7. Classification of surgical
procedures based on risk of
infection
Clean- Contaminated
Acute inflammation
Infected bile or urine
Gross spillage from gastro intestinal tract
Major lapse in technique
Fresh traumatic wound (12-24h)
Wound infection rate is 10-20%
Prophylaxis is usually required
Example: Appendicectomy
8. Classification of surgical
procedures based on risk of
infection
Dirty and infected established infection
Transaction of clean tissue to enable collection of
pus
Traumatic wound with retained lifeless tissue
Faecal contamination
Delayed treatment
Wound infection rate is 20-40%
Prophylaxis is compulsorily required
Example: Sigmoid colectomy
10. Risk factors
Operative risk factors
Tissue ischemia
Lack of haemostasis
Tissue damage
Presence of necrotic tissue
Presence of foreign body including surgical
material
12. Pathogenesis
Any surgery
↓
Breaching of protective barrier of any organ (epithelial
tissue) and mucosa
↓
Entry of endogenous and exogenous micro organisms
to that organ
↓
Inflammation
↓
Surgical site infection
13. Clinical Presentation
Superficial incisional
Affects skin and subcutaneous tissue
Clinical presentation include redness, pain, heat/
swelling at site of incision and presence of pus
within 30 days
14. Clinical Presentation
Deep incisional
Affects fascial and muscle layers
Clinical presentation include presence of pus/ an
abscess, fever with tenderness of wound,
separation of the edges of the incision exposing
the deeper tissues within 30 days and 1 year if
implant is used
15. Clinical Presentation
Organ/ space infection
Affects any part of the body other than incision
that is opened/ manipulated during the surgical
procedure
Clinical presentation include loss of function of a
joint, abscess in an organ, localised peritonitis/
collection and ultrasound/ CT scan confirm
infection within 30 days and 1 year if implant is
used
17. Diagnosis
Based on clinical presentation
Culture test
Complete blood count
Erythrocyte sedimentation rate
C reactive protein
Procalcitonin
Neutrophil CD64
18. Non Pharmacological Treatment
Recommended steps to patients and care takers
during different phases of surgery:
Pre operative phase
Patient preparation- Pre operative washing, hair
removal, nasal MRSA decontamination, antimicrobial
prophylaxis guidance, staff preparation and theatre
movement
Intra operative phase
Operating team preparation, patient skin preparation,
maintaining patient homeostasis and wound
dressings
Post operative phase
Dressing and cleaning the wound, antimicrobial
treatment for SSI, debridement of SSI
19. Treatment Algorithm
1. Gastrointestinal surgery
a. Upper GIT
↓
Bowel flora/ Staphylococcus aureus/ Gram
negative bacilli
↓
Co amoxiclav/ Cefuroxime/ Gentamycin
20. Treatment Algorithm
1. Gastrointestinal surgery
b. Biliary surgery
↓
Staphylococcus aureus/ Gram negative bacilli
↓
Co amoxiclav/ Cefuroxime+ Metronidazole
Gentamycin+ Metronidazole
21. Treatment Algorithm
1. Gastrointestinal surgery
c. Colorectal surgery / Appendicectomy
↓
Staphylococcus aureus/ Gram negative
bacilli/ Anaerobes
↓
Co amoxiclav/ Cefuroxime+ Metronidazole
Gentamycin+ Metronidazole
29. Choice of antimicrobial agent
should consider following
Likely infecting organism
Local susceptibility of potential pathogens to
antimicrobials
Pharmacokinetics
Patient’s allergy status to antibiotics
Administration time
Drug cost
Carriage of resistant organisms
Prevalence of Clostridium defficile infection in
hospital
