PERI-OP (MEDSURG 17) Flashcards by Angel Rhainne Custodio

Used to describe the nursing care provided in the total surgical experience of the patient.

PERIOPERATIVE NURSING

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3 parts of perioperative

Preoperative
Intraoperative
Postoperative

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Extends from the time the client is admitted in the surgical unit, to the time he/she is prepared for the surgical procedure, until he is transported into the operating room.

PREOPERATIVE

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Extends from the time the client is admitted to the OR, to the time of administration of
anesthesia, surgical procedure is done, until
he/she is transported to the RR/PACU.

INTRAOPERATIVE

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Extends from the time the client is admitted to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow-up care.

POSTOPERATIVE

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MAJOR TYPES OF PATHOLOGIC PROCESS
REQUIRING SURGICAL INTERVENTION (OPET)

Obstruction

Erosion

Perforation

Tumors

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impairment to the flow of vital
fluids (blood, urine, CSF,bile).
○ Example: Hydrocephalus,
intussusception, cholelithiasis

Obstruction

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wearing off of a surface or
membrane.
○ Example: Burn

Erosion

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rupture of an organ.
○ Ruptured aneurysm

Perforation

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abnormal new growths.
○ Benign prostatic hyperplasia (BPH)

Tumors

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CLASSIFICATION OF SURGICAL PROCEDURE
ACCORDING TO PURPOSE (DECAP)

Diagnostic

Exploratory

Curative

Palliative

Aesthetic

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To establish the presence of a disease
condition (e.g., excision and biopsy).
○ To confirm diagnosis.
○ Example: Pap Smear

Diagnostic

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Determine the extent of disease
condition (e.g., exploratory
laparoscopy).

Exploratory

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To treat the disease condition.

Curative

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3 types under curative

Ablative
Constructive
Reconstructive

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removal of an organ
“ectomy”
Example: Hysterectomy.
tonsillectomy, nephro
capsulectomy,

Ablative

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repair of congenitally
defective organ “plasty, orrhaphy,
pexy”
.Example: Repair of cleft palate,
osteoplasty, perineorrhaphy

Constructive

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repair of damaged
organ.
■ Example: Total joint
replacement

Reconstructive

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To relieve distressing signs and
symptoms, not primarily to cure
disease.

Palliative

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Surgical manipulation to enhance
physical appearance.

Aesthetic

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CLASSIFICATION OF SURGICAL PROCEDURE
ACCORDING TO URGENCY (EUREO)

Emergent

Urgent/Imperative

Required

Elective

Optional

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patient requires immediate
attention, life threatening condition.

Without delay.
○Example: Severe bleeding, gunshot,
stab wounds, fractured skull

Emergent

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patient requires prompt
attention.
○ Within 24 to 30 hours.
○ Example: Kidney/ureteral stones

Urgent/Imperative

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patient needs to have surgery.
○ Plan within a few weeks or months.
○ Example: Cataract, thyroid d/o

Required

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patient should have surgery. ○ Failure to have surgery is not catastrophic. ○ Example: Repair of scar, vaginal repair

Elective

patient's decision. ○ Personal preference. ○ Example: Cosmetic surgery

Optional

CLASSIFICATION OF SURGICAL PROCEDURE ACCORDING TO THE DEGREE OF RISK

Major surgery Minor surgery

High risk/greater risk for infection. ○ Extensive-prolonged. ○ Large amount of blood loss. ○ Vital organs may be handled or removed.

Major Surgery

Generally not prolonged. ○ Leads to few serious complication. ○ Involves less risk.

Minor Surgery

EXAMPLE OF AMBULATORY SURGERY

Teeth extraction Circumcision Vasectomy Cyst removal Tubal ligation

SURGICAL RISK

Obesity Poor Nutrition Fluid and Electrolyte Imbalances Age Presence of Disease (Cardiovascular disease, DM, respiratory disease) Concurrent or prior pharmacotherapy Nature of condition Location of condition Magnitude/urgency of the surgery Mental attitude of the patient Caliber of the health care team

Assessing and correcting physiologic and psychologic problems that may increase surgical risk. Giving the person and significant others complete learning/teaching guidelines regarding surgery. Instructing and demonstrating exercises that will benefit the person during the postoperative period. Planning for discharge and any projected changes in lifestyle due to surgery.

PRE-OPERATIVE NURSING

PHYSIOLOGIC ASSESSMENT OF THE CLIENT UNDERGOING SURGERY

Presence of Pain Nutritional and Fluid and Electrolyte Imbalance Cardiovascular/Pulmonary Function Renal Function Gastrointestinal/Liver Function Endocrine Function Neurologic Function Hematologic Function Use of Medication Presence of Trauma and Infection

ROUTINE PREOPERATIVE SCREENING TEST

CBC ABO Typing Serum Electrolyte PT/PTT FBS BUN ALT/AST/LDH and Bilirubin Serum albumin and total CHON Urinalysis Chest X Ray ECG (Electrocardiogram)

Collects RBC, WBC, hemoglobin, hematocrit, platelet.

CBC

Blood type.

ABO Typing

Calcium, sodium, potassium, etc.

Serum Electrolyte

Measures clotting time.

PT/PTT

Evaluates wound healing.

FBS (Fasting Blood Sugar

Kidney functions.

BUN (Blood Urea Nitrogen)/Creatinine

Liver functions.

ALT/AST/LDH and Bilirubin

Nutritional status of the patient.

Serum albumin and total CHON

Urine composition.

Urinalysis

Respiratory function, heart size.

Chest X Ray

Function of heart (rhythm)

ECG (Electrocardiogram)

PSYCHOSOCIAL ASSESSMENT AND CARE CAUSES OF FEARS OF THE PREOPERATIVE CLIENTS

>Fear of Unknown (Anxiety) Fear of Anesthesia Fear of Pain Fear of Death Fear of Disturbance on Body Image

loss of finance, employment, social and family roles

Worries

MANIFESTATION OF FEARS (TABASISFD)

Anxiousness Bewilderment Anger Tendency to exaggerate Sad, evasive, tearful, clinging Inability to concentrate Short attention span Failure to carry out simple directions Dazed

INFORMED CONSENT

Validity: 24 hours

best and legally accepted informed consent.

Written Permission

PRE-OPERATIVE CARE. PHYSICAL PREPARATION BEFORE SURGERY

Correct any dietary deficiencies. Reduce an obese person's weight. Correct fluid and electrolyte imbalances. Restore adequate blood volume with BT. Treat chronic disease. Halt or treat any infectious process. Treat an alcoholic person with vitamin supplementation, IVF or fluids if dehydrated.

How many times per hour to use incentive spirometer

10 to 12 times

Refers to a flattening of the dome of the diaphragm during inspiration, with resultant enlargement of the upper abdomen as air rushed in. During expiration, abdominal muscles contract.

Diaphragmatic Breathing

Promotes removal of chest secretions.

Coughing and Splinting

Prevents bedsores or decubitus ulcers. Done every 2 hours.

Turning

Moving legs improves circulation and muscle tone.

Foot and Leg Exercise

Prevents DVT (Deep Vein Thrombosis)

Early Ambulation

PREPARING THE PATIENT THE EVENING BEFORE SURGERY

Preparing the Skin Preparing the G.I. Preparing for Anesthesia Promoting Rest and Sleep

Clear Liquids

2 hrs

Breast Milk

4 hours

Nonhuman Milk

6 hours

Light Meal

6 hours

Regular/Heavy Meal

8 hours

Tranquilizers and Sedatives

Midazolam ○ Diazepam (Valium) ○ Lorazepam (Ativan) ○ Diphenhydramine

Can be used as pre bt meds

Diphenhydramine

Analgesics

Nalbuphine (Nubain)

Anticholinergics

Atropine Sulfate

Proton Pump Inhibitor

Omeprazole (Losec) Famotidine

acid secretion in the stomach.

Proton Pump Inhibitor