Nursing management of the preoperative and intraoperative client Flashcards
perioperative phase
period of time from decision for surgery until patient is transferred into operating room
intraoperative phase
period of time from when patient transferred into operating room to admission to postanesthesia care unit (PACU)
postoperative phase
: period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home
different purposes of surgery
diagnostic curative palliative cosmetic functional
example of diagnostic surgical purpose
tumor that is growing or a growth that the doctors need to remove to be tested in a lab
example of curative surgical purpose
pt came in for an emergent type of surgery –> appendix rupture
example of palliative surgical purpose
removing pain condition rt tumor or another ailment causing a lot of distress for a pt
example of cosmetic surgical purpose
improve the looks of things – grfts or closures
example of functional surgical purpose
orthopedic elective procedures
ex: hip or knee surgeries
outpatient
Majority (est. 85%) of surgeries have moved to outpatient basis
inpatient
Reserved for complex surgical procedures and/or resource intensive recovery: Total joint procedures Neurological Major vascular/cardiac surgery Trauma
outpatient surgery
aka: same day, short stay, ambulatory, 23 hour
Can be performed in hospitals or surgi-centers
Set criteria must be met to qualify for this type of surgery
‘healthy’ patients
what criteria must a person meet for discharge (from outpatient)
Patient must meet certain criteria for discharge
drink
void
walk
will be admitted for overnight stay if complications develop
advantages of outpatient surgery
Decreased psychological stress
Decreased exposure to nosocomial infections
Economic benefit
Less separation anxiety, especially for kids
disadvantages/challenges to outpatient surgery
Difficult if live alone & can’t drive self home
Increased patient teaching needs d/t short amount of time
No skilled observations for complications
Pain control – oral meds and pain pumps
nursing activities during the preoperative period 5/6!!
Establish baseline assessment of patient via preop interview
** NEED TO KNOW IF THEY TOOK MEDS THAT DAY OR HELD THEM**
- need to know if any tests were done before sx (ex COVID test, needs to come back before procedure)
Includes physical and emotional assessment
Anesthesia history
Allergies or genetic problems
Latex allergy
Necessary testing ordered and performed
Preparatory education about recovery from anesthesia and post operative care
preadmission testing
Initial preoperative assessment
Teaching appropriate to patient’s needs
Involve family in interview
Complete preoperative diagnostic tests (ex bloodwork, CXR, EKGs, etc)
Verify understanding of surgeon-specific preop orders
Discuss, review advanced-directive document
Begin discharge planning by assessing patient postoperative transportation, care
preadmission testing for scheduled out-patients
Usually minimum amount of testing ordered (d/t ‘healthy’ patient status and type of surgery)
Most likely will be performed when patient arrives to hospital on day of surgery
preadmission testing for scheduled in patients
Usually performed several days to weeks prior to date of surgery
Urinalysis, blood work (CBC, lytes, H&H), Chest Xray, EKG > 40 years old, any other MD ordered test
Due to patient health status or type of surgery, these test results may need to be reviewed prior to proceeding with surgery
Nursing roles/responsibilities
Assessment Patient support Patient preparation and SAFETY (make sure everything is prepped and ready to go for surgeon) Patient education TEACHING-TEACHNG- TEACHING! Patient advocate
preoperative nursing assessment includes
Nutritional & fluid balance assessment Drug & alcohol usage Respiratory status Cardiovascular status Hepatic, renal function Endocrine status Previous medication use Psychosocial status Spiritual & cultural beliefs
preoperative assessment… prior to teaching, you should know…
Prior to teaching, you should know:
History of patient’s illness
Rationale for surgery
Nature of surgery (curative, palliative, disfiguring, ostomies, etc)
Patient readiness to learn
age, mental status, pre-existing knowledge about condition, family reaction to surgery
should know the nature of sx, may be disfiguring to pt with body image - such as before having an ostomy
preoperative teaching where does it start
Ideally starts in physician office and continues until patient arrives in operating room
Preoperative Teaching:
For planned inpatients - done during PAT visit.
For outpatients – via phone interviews or morning of surgery
different teaching methods
verbal
written information
return demonstration
combination
Preoperative teaching how does the nurse help
Nurse guides patient through experience & allows ample time for questions
Patient concerns; fears about anesthesia
Provide information to clear up misconceptions
Reinforce explanation of procedure (MD obtains informed consent)
how do nurses reinforce explanation of procedure
Explain preop procedures
remove jewelry, nail polish
Lab tests
Skin preparation – cleansing, possible shaving (sometimes with prosthesis - they want the pt to scrub with a hibiclens, which helps reduce postop infections)
Enemas or bowel preps before intestinal surgery (ostomy surgery - they need to be prepped before and make sure the bowel is cleaned out)
Rationale for withholding food and fluids
NPO status
Use of OTC supplements; stop using 2-3 weeks prior to surgery
what happens if a pt took their blood thinner the day of surgery
pt will not be having surgery that day
preoperative teaching
about postoperative procedures
TCDB
Incentive spirometer
Leg exercises
Moving in bed, splinting, getting out of bed
Equipment to expect post op (NG, catheter, drains, NPWT, dressings)
Importance of reporting pain/discomfort
what will be done to relieve pain (change positions/medication)
CRITERIA FOR INFORMED CONSENT
Voluntary Consent MUST include: Explanation of procedure and risks Description of benefits and alternatives An offer to answer questions Withdrawal statement Statement if protocol differs from usual
Competent vs incompetent pt
any sx voluntary except for emergent sx in some cases - the pt or the pts proxy must consent to the procedure
- save your life procedures must be done in some situations with or without consent - assume care
emancipated minor
can give informed consent for him or herself
Nurse responsibilities with informed consent
have consent signed before psychoactive meds are given
can reinforce info supplied by physician
WITNESS pts signature
special surgical populations
Geriatric Pediatric Obese Patients with physical or mental disability Patients with co-morbid conditions Patients with limited support systems
geri pop
psychosocial, cognititvely, do they need glasses? hearing aids? they have a lot of comorbidities
peds pop
dealing w pt and fam
parental involvement? age of pt? stages of our growth
obese pts
bias with society
pts w physical/ mental disability
need to make sure the pt understands the procedure and they have support
geriatric considerations
pain assessment
may fail to report symptoms
visual/hearing acuity changes
less physical reserve for recovery (cardiac conditions, dehydration, arthritis, skin integrity, endurance)
sensitivity to temp changes
confusion
clear communication
elderly have greater risks (skillful preop assessment and tx, skillfull anesthesia and sx techniques, meticulous and competent post anesthesia management)
pop is at greater risk for anesthesia problems
if they have comorbid conditions they are most likely to have post op management problems as well
peds considerations
provide age specific teaching
family oriented teaching, parents can reinforce teaching
sensitivity to temp changes (warm blankets, warm room, warming devices)
safety
size of equipment. instruments
be congizant of the age of the child as well as safety (make sure child has equipment and instruments)
bariatric pt
increased risk of sx complications (infection (dr anatomical folds), wound dehiscense, pulmonary)
size of equipment/instruments need to have larger support surface underneath them, as well as larger commode
safety supports - walkers that are larger for them so they can move adequately
diabilities
modifications in preop teaching
assistive devices (hearing aids, glasses, braces, prostheses)
use of interpreters for signing
mobility issues (may need extra personnel)
positioning devices
