Perioperative NursingPeg Trueman RN MSN Ed.D. CNE

Meet the Patient

The experience of surgery is a routine event for everyone involved EXCEPT for the patient!

Nursing Management after Surgery

Postoperative Phase:Plan of Care

System Assessments

Respiratory Cardiovascular Fluid Status Nutrition Elimination Activity Wound Healing

Respiratory

Pulmonary assessment data

TCDB• C/I: CHI, eye sx

O2 therapy IPPB I.S.

The real reason dinosaurs became extinct.

Cardiovascular

Cardiac assessment data

Leg exercises Avoiding venous

statsis ICD/hose

“Okay, Williams, we’ll vote…how many here say the heart has four chambers?”

Fluid Status

Hydration status data

Drainage amts vital signs daily weights!

IV therapy Blood therapy

Nutrition

NPO status Progression of

diet check bowel

sounds

Feedings TPN

“The Nurse says a trip-o’-loomin’ cow-filler is feeding Grandma. It has three loops--one for breakfast, one for lunch, and one for dinner!”

Elimination

Urinary output• retention?!!• Dehydration• Catheter is the

last resort! Bowel activity

• bowel sounds• flatus

Ambulation!!!!

Activity

OOB ASAP!!• Usually within 24

hrs

Psychological impact

Needs encouragement!

Physiology of Wound Healing

Inflammatory Stage• “insult”

Proliferative Stage• reinforcemen/framework

Maturation Stage• “settling in”

Wound Healing:First Intention

Scar formation is minimal Properly closed Heal with little tissue reaction

Wound Healing:Second Intention

Wound is left open to granulate Resultant in scar formation “Healing by granulation”

Wound Healing:Third Intention

Two opposing granulation surfaces are brought together

Scar is deeper and wider “Delayed closure”

Factors Affecting Wound Healing

Age Hemorrhage Hypovolemia Local Factors Nutritional

Deficits

Oxygen deficit Drainage Medications Systemic

Disorders Wound Stressors

Wound Care

“Just a friendly suggestion…next time you do a dressing change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”

Post-op Pain Control

What is pain? Factors affecting pain Administration

• Preventative Approach• PRN vs ATC

• Routes of Administration• Intramuscular• Intravenous

• PCA pump/Epidural lines

Post-op Pain Control

Common Pain Medication• Demerol• Morphine• Dilaudid• Stadol• NSAIDs

Side Effects of Pain medication*

Managing Potential Complications

Shock/Hemorrhage Deep Vein Thrombosis (DVT) Pulmonary Embolism Respiratory Complications Urinary Retention Intestinal Obstruction Wound Complications

Surgery Specific Care

Postoperative Uniquities and “worries”

Remember Mr. P?

Case Study Review

Perioperative Nursing