Chapter 12: nursing care of patients having surgery Flashcards
surgery urgency levels
- emergency
- urgent
- elective
- optional
purposes of surgery
- aesthetic
- diagnostic
- exploratory
- preventive
- curative
- reconstructive
- palliative
types of surgery
- open incision
- minimally invasive surgery: endoscopic, scope, robotic, laser
preoperative
decision for surgery until transfer to surgery
intraoperative
transfer to surgery until transfer to perianesthesia care unit
postop phase
pacu through recovery
LPN role in preoperative phase
- assist in data collection
- reinforce explanations/instructions
- provide emotional/psychological support
- provide family care: comfort, answer questions
factors influencing surgical outcomes
- age
- chronic disease
- emotional responses
- nutrition
- smoking, and alcohol and/or drug abuse
- avoid smoking: 24 hours before surgery, 3-4 weeks w/ lung disorders
emotional response: fear
- dying
- anesthesia fear
- pain
- body image
anesthesia fear
- accidental awareness under general anesthesia
- brain damage
- loss of control
- not waking up after surgery
emotional response: fear - interventions
- assist patient w/ coping
- discuss anxiety and fears
- use music and guided imagery
- report extreme fears to surgeon
- encourage patient/anesthesia professional discussion
- patient may request surgery while awake: local anesthesia, involvement in experience provides comfort
preadmission surgical patient assessment
- health history
- risk factors
- education
- discharge planning
- referrals
- diagnostic testing: pregnancy test
- advance directives
preoperative routines
- date and time of surgery
- admission time
- length of stay
- items to bring and wear
- recovery after surgery
- family information
- discharge criteria: responsible adult for outpatient surgery discharge
preoperative instructions
- preps: nasal culture, skin, bowel
- medications
- NPO times
- pain control
- postop exercises
postoperative exercises
- deep breathing and coughing
- incentive spirometry
- leg exercises
preoperative patient: assessment
- health history
- medications, herbs, and supplements
- physical assessment
preoperative nursing diagnoses
- anxiety
- fear
- deficient knowledge
preperative consent
patient gives legal permission for surgery
- informed consent surgeon’s responsibility
- no analgesia or sedation before signing
- voluntary
- can withdraw at any time
- valid for 30 days
LPN role: witnessing consent
- ensure patient has been informed
- direct patient questions to surgeon
- signature indicates observed voluntary signing of consent
preparation for surgery
- preoperative preparation checklist
- preoperative medications
holding area
- verifications: patient data, surgical site - patient initials/marks operative site
- time out
- IV insertion
- IV antibiotic
- Prewarming
arrival in surgery: explain what to expect
- position
- safety
- tubes placed after anesthesia induction
- skin prep
LPN role in intraoperative phase
- scrub nurse
- sterile instrument field
- assist surgeon
anesthesia
- general
- local (regional)
- adjunct agents
- procedural sedation and analgesia (formerly conscious sedation)
general anesthesia
- loss of sensation, consciousness, reflexes
- IV or inhalation route
- endotrachial intubation
- complication: malignant hyperthermia
local (regional) anesthesia
- loss of sensation to body region
- injection of a local agent
malignant hyperthermia
- rare hereditary muscle disease
- triggered by some general anesthesia agents/succinylcholine
- potentially fatal
- surgery stopped, anesthesia discontinued
- 100% oxygen give
- cooled w/ ice, iced iv solutions
- dantrolene sodium, IV muscle relaxer given
PACU nursing diagnoses
- ineffective airway clearance
- ineffectivev breathing pattern
- risk for aspiration
- deficient fluid volume
- acute pain
family visitation
- keep informed
- maintain confidentiality (HIPPA)
PACU discharge criteria
- stable vital signs
- oxygen saturation Sa02 > 90%
- awake, baseline LOC
- respirations not depressed
- bleeding controlled
safety after transfer
- place bed in lowest position with side rails up
- place call button within patient’s reach
- instruct to call for assistance w/ ambulation
- assist w/ ambulation
- have pt sit on side of bed before standing
nursing diagnoses for postop patients
- ineffective breathing pattern
- ineffective airway clearance
- acute pain
- risk for surgical site infection
- deficient fluid volume
- ineffective peripheral tissue perfusion
- urinary retention
- risk for infection
- impaired skin integrity
- imbalanced nutrition
- constipation
- impaired physical mobility
wound evisceration interventions
- position in low Fowler position w/ knees flexed
- cover wound w/ sterile dressings or clean towels moistened w/ warm sterile normal saline
- notify surgeon immediately
- monitor vital signs for evidence of shock
- infuse IV fluids as ordered
- prepare for immediate surgery
ambulatory surgery discharge criteria
- stable vital signs
- no bleeding
- no nausea/vomitig
- controlled pain
- voided as ordered
- no dizziness when upright
- discharged to a responsible adult
ambulatory surgery discharge instructions: teaching
- wound care, medications, complications
- rest 24-48 hours
- no driving, operating machinery
- follow up surgeon’s visit
- written instructions signed by patient
- prescriptions
inpatient discharge instructions
- teaching: wound care, medications, complications, equipment, follow up surgeon’s visit
- written instructions/signed
- prescriptions
