Nur 105 Adult Health 2006 Perioperative Care

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PERIOPERATIVE CARE

NUR 105 ADULT HEALTH I

Shelton State Community CollegeJ. WILLIAMS


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Perioperative Care

Learning Objectivess Define key terms.

s Define the three phases of perioperative

care.s Describe the methods of classifying a

surgical procedure and give an example

of each one.s Describe the different types of

anesthesia.


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Perioperative Care

Learning Objectives-continueds Utilize the nursing process in the care of

a surgical patient.

s Describe the nursing intervention foreach of the three phases.

s Identify factors and health conditions

that may influence or alter the well-being of an surgical patient.


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Perioperative Care (contd)

s Describe the nurses legal

responsibilities in the preparing the

patient for surgery.

s Identify the appropriate nursing care in

assessing and monitoring for

complications.

s Utilize effective communication

techniques in teaching client and family

about surgery.


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Perioperative Care

Case Study

s Lula White keeps her appointment with the surgeon. She has

experienced abdominal pain/ cramping and a heavy menstrual

flow for over 2 years, resulting in weakness and chronic anemia.

Ms. White has talked it over with her husband and they both

agreed on her undergoing a total hysterectomy. Ms. White is 48years, married for 21 years with 4 children. The oldest child

graduated from high school this year and the youngest is in the

6th grade.

s At todays office visit, the surgeon arranges for Ms. Hudson to

have lab work drawn through the Outpatient Dept. Laboratory.

s 1. What lab work would be ordered pre-op and the purpose for

the lab work? What other tests may be required prior to

surgery?

s 2. Describe what information would you obtain in present andpast health history.


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Perioperative Care

Case Study - continued

s 3. What kind of information should the doctor discuss

with Ms. White prior to the surgical procedure?

s 4. How would you classify this type of surgery?

s Ms. White is mildly overweight. In the past history, she

reports smoking for years but stopped 10 years ago.

She denies drugs or other tobacco products. Ms.

White took oral contraceptives about five years ago

until she developed hypertension and blood clots in

her lower leg. She remains on diazide and took

coumadin 3-4 years ago in treatment of blood clot.

What risk factors might you be concerned with?


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Perioperative Care

Three Phases

s Preoperative

s Intraoperative

s Postoperative


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Perioperative Care

Categories and Purposess Reason/Purpose

Diagnostic, curative, restorative, palliative, cosmetic

s Degree of Urgency urgent, elective, optional

s Degree of Risk major, minor

s Anatomic locations Extent of surgery- minimal, open, simple and

radical


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Perioperative Care

Preoperative Phase- Assessments Risk Factors

age, nutritional, health status, fluid

and lytes imbalances, radiation,cardiopulmonary, chemotherapy,

meds, family history, prior surgical

experiences (positive/negative), typeof surgery, location site


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Perioperative Care

Preoperative Phase- Assessments Nursing History

past & present, meds, diet, allergies (latex),personal habits, occupation, finances, family

support, knowledge of surgery, attitudes Physical Exams Diagnostic Tests

CBC, electrolytes, creatinine, urinalysis, x-ray

exams, EKG, Blood Type, PTT, PT, Platelet Blood donations

s Radiographics Bloodless Surgery/Discharge


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Perioperative Care

Preoperative Cares Psychological Response

s Informed Consent - Nurse witness

s Mentally competent

s If minor, a guardian, parent, or court

order will sign permit; state will dictate

age.

s Sociological

s DNR


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Nursing Process Preoperative Care

sAssessment

History, Physical Exam, Lab/Radiology,

Health Status, Risk Factors, Medss Nursing Diagnosis

s Planning

Goal statement

EOC (expected outcome criteria)


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Perioperative Care

Preoperative -Implementations Informed Consent

s Nutrition/fluids - IV ;

NPO after MNs Elimination

-enemas, foley

s

Hygiene - skinscrub; remove nail

polish, hair pins,

hospital gown

s Vital Signs

s Height/ Weight

s Special orders -(insert tubes,

medications)

s

Promote Comfort -Anti-anxiety meds

s Skin preparation


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Perioperative Care

Preoperative Care - Nursing Cares Pre-op Teaching -

leg and deep breathing exercises; ROM

exercises

Moving patient ; coughing and splinting

s Monitor -

pt and diagnostic tests.

TEDS, Elastic Wraps, Pneumatic

Compression devices, early ambulation


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Perioperative Care

Preoperative - Implementations Day of Surgery - complete pre-op

checklist sheet in medical record, VS,

skin prep removal of prosthetics, hairpins, dentures, bowel and bladder prep,

TEDS, IV, NG Tube, ID band, and pre-

op medications.


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Perioperative Care

Pharmocologys Purpose - facilitate effective

anesthetics, minimize respiratory tract

secretions and relax, reduce anxiety.

s Types - Opiates, Anticholinergics,

Barbiturates, Prophylactic antibiotics


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Perioperative Care

Pharmocologys Hazardous to Surgery

s Certain antibiotics

sAnti-depressants

s Phenothiazines

s

Diureticss Steroids

sAnticoagulants


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Perioperative Care

Preoperative - Evaluation

s Evaluate goals and outcome criteria


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Perioperative Care

Intraoperative Cares From the holding room to the operating

room and then to recovery room.

s Implementation of anesthesia for

analgesic, sedative, and muscle

relaxant purposes as well as controlAutonomic Nervous System.


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Perioperative Care

Intraoperative Cares Holding area - enter prior to OR; nurse

continues to prepare patient(insert foley

or start IV)s Nurse assist in transfer to and from OR,

maintain proper body alignment.


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Intraoperative Care

Staff

s Surgeon, surgical assistant

Surgical scrub, gowning, surgical asepsis

sAnesthesia

Anesthesiologist, CRNA


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Periopereative Nursing Staff

s Holding Area Nurse

s Circulating Nurse

s Scrub Nurse/Surgical Technologist

(ORTs)

s Specialist Nurse


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Perioperative Care

Preoperative -Anesthesias Types

General

Regional

Local


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Perioperative Care

Intraoperative Cares Common General Anesthetics

s Inhaled General Anesthetics

Nitrous oxide, cyclopropane

s Inhaled liquid

halothane, enflurane, isoflurane

s Intravenous Anesthetic

Pentothal (thiopental)


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Perioperative Care

Nursing Concerns-Preop

s Patent Airway

s Therapeutic Response to Anesthesias Proper Positioning

s Maintain Surgical Asepsis


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Perioperative Care

Intraoperative Care-Complications Hypoventilation

s Oral Trauma -endotracheal

intubation

s Hypotension

s Cardiac dysrhythmia

s Hypothermia

s Peripheral nerve

damage

s Malignant

hyperthermia


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Perioperative Care

Intraoperative - Complications 2s Malignant hyperthermia - due toabnormal and excessive intracellular

collection of Ca+ resulting in

hypermetabolism and increased muscle

contraction.

s Signs and Symptoms - high fever,

tachycardia, muscle rigidity, heartfailure, pseudotetany, and CNS

damage.


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Perioperative Care

Adjunctive Anesthetic Agentss Opioid analgesic

Alfenta

Demerol andMorphine

s Benzodiazepine

Valium, Versed

s Anticholinergic

Atropine,

scopolamine

s Sedative-hypnotic

Atarax, Vistaril,

Seconal, Nembutal


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Perioperative Care

Intraoperative-Drug InteractionsAntihypertensives- hypotension

s Beta-Blockers- myocardium decreased

s

Tetracycline--renal toxicity

s Enflurane - liver disease lead to toxicity


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Perioperative Care

Anesthesias Local/Regional

Epidural

Infltration Nerve Block

Spinal

Topical

s Anesthetic agents Xylocaine, Novocain,

carbocaine

s Topical

Dermoplast

(benzocaine)

cocaine

ethyl chloride


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Perioperative Care

Anesthesias Geriatric concerns

sAddress safety issues - sensory decline

s Hepatic, cardiac respiratory and renal

decline

sAssess for preexisting problems such

as cardiac, renal, hepatic, or

respiratory.


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Perioperative Care

Intraoperative Cares Treatment of Malignant Hyperthermia

discontinue inhalent anesthetic, Give

Dantrium, oxygen, dextrose 50%, diuretic,

antiarrhythmics, sodium bicarbonate, and

hypothermic measures-cooling blanket,iced IV saline or iced saline lavage of

stomach, bladder, rectum.


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Postoperative Care

Nur 105 Adult Health


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Learning Objectives/Outcomes

s Define the time line for thepostoperative period.

s Describe nursing care during the PACU.s Describe nursing care during the post

operative period.s

Identify proper technique in care ofsurgical wounds.s State complications in wound healing.

Perioperative Care


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Perioperative Care

Immediate Anesthetic Care

(PACU)s Respiratory Status - patent airways Cardiovascular - regular, strong heart

rate and stable BP (VS); peripheralpulses; Homans Sign

s Neurological level of consciousness;orientation, sensation

s Fluid and Electrolyte, Acid BaseBalance


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Post op

Drug Therapy

s Pain

Pain Assessment

Opioids in IV smalldoses

Hypotension,

respiratory

GI motility GI bleed (Motrin)

Narcan/Romazicon

s Complementary and

Alternativve

Therapies Positioning,Massage, relaxation

and diversion, guided

imagery,

biofeedback, music,

etc.


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Post Operative Care

Nutrition

s

Clear Liquidss Full Liquids

s Soft

s Regular


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Nursing Care Post Op

Physical Assessment (continued)

s Renal Function

s Gastrointestinal

s Dressings

s Pain

s Thermoregulation


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Perioperative Care

Elderly Care in Postops Respiratory System

diminished airway

reflexes and cough

s Cardiovascular

myocardium

weakness

s Hypothermia

less subcutaneous

tissue, muscle, slow

metabolic rate

s Pain

more intense,

confusion, impairedcirculation and

sensory


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Perioperative Care

Complications in Postops Hypotension

s Dysrhythmia

s Venous Thrombosiss Pulmonary

Embolism

s

Hiccoughss Adbominal

distention - paralytic

ileus

s Immobility with skin

integrity

s

Urinary retentions Urinary tract

infection

s Wound infection,

dehiscence,

hemorrhage

evisceration,


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Perioperative Care

Postop Cares Psychological

Anxiety

Altered body image Finances, Family responsibility

Future changes


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Perioperative Care

Immediate Anesthetic Cares Airway/breathing ex.

s VS, Pulses

s IVs ABGs

s Pulse oximetry

s

Pupil Responds Level of conscious

s Safety

s Dressings

s Drains/Tubes

s I&O; renal functions Medications

s Laboratory work

s

Hemodynamicss Position/ROM

s Comfort


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PERIOPERATIVE CARE

Postoperative Cares Postoperative Care

Same care as immediate anesthetic care

Decrease frequency of vital signs to every4 hours, IVs will be discontinued in time,

increase ADL, decrease in breathing

exercises and breathing treatments,

advance diet.

Recovery Period - 4 to 6 weeks


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PERIOPERATIVE CARE

Summarys Specific Nursing Duties for each phase:

Preoperative, Intraoperative, Postoperative

s Throughout Perioperative Care, the

nurse will always:

Monitor patients response to therapeuticregime, prevent complications, patient

education and promote optimum well-being

Documents

Nur 105 Adult Health 2006 Perioperative Care