Perioperative Nursing Flashcards
decisions are made here until wheeled back to the surgical suite. Can be days before when labs/xrays may be completed.
Preoperative
beginning when the client is wheeled back to surgery and until the client is in post-op.
intraoperative
–, after time person comes out of surgery until theyre discharged, could be anything after surgery
this phase continues until the client is discharged from care of the surgeon.
postoperative
after surgery
– Determine the origin of the presenting symptoms and extent of a disease process
Diagnostic
– Repair or removal of diseased organ or restore normal physiological functioning
Curative
ie: Breast Biopsy
diagnostic
ie: amputation of GREAT toe or removal of gallbladder
curative
– Decrease the spread of the disease process to prolong life or to alleviate pain.
Palliative
ie: partial tumor removal
palliative
– Correct a disease process or improve cosmetic appearance after accident
Reconstructive
ie: rhinoplasty (hit in nose)
Reconstructive
– Improve cosmetic appearance ie: Face lifts, Breast Implants, Collagen Lips
Cosmetic
– Improve cosmetic appearance
Cosmetic
ie: Face lifts, Breast Implants, Collagen Lips
Cosmetic
– Remove disease tissue or organ and replace with functioning tissue ie: a few are kidney, heart, eyes, large bone
Transplant
– Remove disease tissue or organ and replace with functioning tissue
Transplant
ie: a few are kidney, heart, eyes, large bone
Transplant
Surgeries are categorized according to the degree of severity or _____
URGENCY
surgery requiring immediate intervention to sustain life.
emergent
Ie: gun shot, stabbing appendix
emergent
surgery dictates the necessity to maintain health situations that are not life threatening.
urgent
ie: bladder obstruction, intestinal obstruction
urgent
– is usually performed at a convenient time with the client
elective
ie: Carpal tunnel, breast biopsies.
elective
Client that has been in hospital prior to surgery, and begins recovery as _______ after surgery.
inpatient
Client enters hospital or free standing outpatient center has surgery and is discharged home after recovering and stable from Anesthesia and the surgical procedure.
outpatient
is usually brief, carries a low risk and results in few complications. *
minor or low risk
_____ surgeries are mostly elective
Minor
teeth extraction ex.
minor or low risk
removal of _____ organs- requires hospitalization and may require specialized care.
major surgery
Hospitals (Large & Small)
Ambulatory Care
Free-standing Surgical Centers
Doctors’ Offices
types of surgical centers
The primary goal of _____ nursing care is to place the client in the best possible condition for surgery through careful assessment and through preparation
preoperative
– provides pertinent information relative to factors that can increase the client’s risk or influence the expected surgical outcomes.
ie: medical HX, medications, allergies, age-related factors, social, cultural, spiritual concerns and psychological status.
patient history
Nurse conducts the ______ in a quiet room, free of background noise.
With the elderly – you may need to speak in a strong and clear voice.
interview
Pre-admission testing ____ before (tell about woman that was pregnant)
days
Usually clients come with another family member or friend – sometimes this is needed if the client having the surgery is having difficulty comprehending the surgical procedure. They may help interpret such
instructions
Why are you having surgery?
When did this problem start?
What do you think caused this problem?
Has this problem prevented you from working?
Are you able to take care of your own needs?
Are you experiencing any discomfort or pain?
What are you expecting from this surgery?
Is there anything that you do not understand regarding this surgery?
Are you worried about anything?
Will someone be available to assist you when you return home?
questions you need to ask before surgery
Patient will be given specific instructions based on dr/facility protocols. May include using _____to shower day before and day of surgery to decrease bacteria.
chlorhexidine
Talk to them, how are they handling coming in for the surgery.
coping
– is usually vague, uneasy feeling often nonspecific their worried of the “unknown”
Anxiety
- usually they have a family member with them
Support system
– is a feeling of dread related to an identifiable source that the client validates. Grandparent died from Anesthesia
Common fears
If they are diabetic their blood sugar may ______ during or shortly after surgery. After surgery, the stress may cause an ______ in blood sugar which can delay healing of wounds or cause complications. Also malnutrition needs to be corrected as well as dehydration, and electrolyte imbalances.
drop, increase,
Alcohol/Drug use: patient may have ______ withdrawal ( a life threatening event that usually occurs 48 to 72 hours after alcohol withdrawal) They seize..
alcohol
Should encourage them to stop smoking 4 to 8 weeks prior if able to reduce ______ ___ ______ complications. Do be aware that most won’t and you will need to watch them more closely after.
pulmonary and wound healing
______ should not be taken for 7-10 days prior if possible.
______ meds should be d’cd 2-3 weeks before surgery.
Aspirin, Herbal
What are some special preexisting factors that you need to assess for?
Diabetes
Alcohol/Drugs
Smoking
Previous Medication use
Purpose
Lab data
Radiographic assessment
Other diagnostic assessments
Factors which influence
risk
preop assessment continued
REMEMBER!!!! This is done a little differently depending where the surgery takes place.
preop assessment
Purpose is to determine the client’s present health status and ability to tolerate the surgical procedure and anesthesia.
Generally the more involved the surgery; the more involved diagnostic testing.
preop assessment
Also, more involved testing with the client’s that are elderly or those that multiple pre-existing health problems
Nursing advocacy to make sure the physician’s are aware of any significant abnormalities and follow-up is done.
preop assessment
client’s ability to tolerate blood loss involved with surgery,
- H&H
______ count assess the immune system and healing potential
White Blood
- normal range for proper heart an neuromuscular functioning
Fluid/Electrolytes Studies
– ability to clot normally post-surgery Prothrombin Time (PT) (evaluates the extrinsic system )& Partial Prothrombin Time (PTT) (assesses the intrinsic system )(which both id the clotting mechanism)
coagulation studies
cbc has?
H&H
WBC
______, gives basic info regarding the heart and lungs, determine whether the client’s cardiac and respiratory systems are healthy for those scheduled for surgery and general Anesthesia.
X-ray & Electrocardiogram
____: Urinalysis general screening for diseases such as renal problems or diabetes
Lab
______: done if blood transfusion is anticipated
Blood type & cross match
______ blood transfusion this is where the clients donates their own blood ahead a time.
AUTOLOGOUS
gas exchange issues- may be affected more by anesthesia
Kidney and liver issues possible- difficulty ridding body of anesthesia
More likely to have issues with orientation after surgery
risk factors in the elderly
Kidney/liver: Increased risk with prolonged effects of anesthesia.
Gas exchange: May have more trouble with keeping oxygen level up.
Orientation: If patient has trouble with orientation, they are at a higher risk of falls- reorient. Also check to see if the patient was oriented prior to surgery to determine if it is a new problem
increased risk factors in the elderly
Increased risk of respiratory issues after surgery
increased risks with tobacco use
_____ possible withdrawal seizures
Patient’s use of ______ may affect the way that a patient tolerates anesthesia and pain medication
alcohol
drugs
______ are responsible for obtaining informed consent. However, the ______ should verify that the consent was obtained before treatment begins.
Surgeons
nurse
The purpose of the consent – it states the extent of action documented. Ie: Amputation of right great toe
The nurse can ______ the patient signing it and may ask the patient if they understand but if information about the surgery, risks, etc haven’t been given by the dr or if the patient has more questions the patient should notify the dr.
witness
Consent should be signed before any _____
preop meds (are given).
If the surgeon proceeds without appropriate consent, nursing administration should be notified immediately. The nurse should make notations ______ the chart, This practice protects the nurse should this case go to court.
outside
If the client reverses a decision and decides against the surgery, the _____ is OBLIGATED to inform the surgeon in order to prevent unwanted TXT.
NURSE
Client’s routine medications
Specific Preparations ordered by
Physician
NPO Status
Preoperative Medication
common orders
Instructions on taking ______ ( Diabetic Meds, antihypertensives, anticoagulants)
routine meds
The ______ needs to inform client, or Dr, office needs to inform
Have client bring meds, or list of all meds.
Pre-admissions Nurse
Make sure you have a list of _____ including allergy to latex.
allergies
NPO STATUS – Nothing by mouth, decrease the likelihood of ____ and decrease the risk of ____
vomiting
aspiration
Often 6-8 hours depending when surgery is scheduled.
Keep in mind – client has an IV to keep fluid balanced , sometimes depending when the surgery is scheduled and the type of surgery
NPO status
Versed
Fentanyl
Tagamet
Reglan
Robinul
Ancef
Preoperative Medications - specific time given 1 hr. before going back.
You will also want to teach client about ____course. What will they expect when they wake up. Teach about pain relief, deep breathing, incentive spirometry, when they will get out of bed…
operative
Use the incentive spirometer in the ______
essential skills
Prescription anticoagulants
Oral diabetics (insulin dose may be changed.. May be different depending on dr)
Routine Meds (Held):
Aspirin (in many versions)
non-steroidal anti-inflammatory (NSAIDs) (in many versions)
Vitamin E
garlic
ginger
ginkgo biloba
Non prescription anticoagulants that are held
In general, blood pressure (heart) medications, anti-seizure medications
routine meds that are usually given
reduces anxiety, sedation, induces amnesic affect (push slowly) Monitor respiratory. depression, hypotension
Versed – Benzodiazepines
use to supplement general anesthesia, short-acting analgesic during perioperative periods. (ANALGESIC reduce pain) (push slowly)
Fentanyl – Narcotic/Opiate
Reduces gastric acid volume and concentration (hanging at a high port)
Tagamet – H2 recepter
Gastric empty
Reglan – Antiemetics
reduces respiratory secretions, decrease risk of aspiration, decreases vomiting ( used more in larger cases)
Robinul – Anticholinergics
used prophylaxis in clients having surgery assoc. with high risk for surgery.
Ancef - antiinfective, antibiotic
Client has ID band, and allergy bracelet
Informed Consent is signed and witnessed
Diagnostic tests results are at front of chart
H & P with Hgt & Wgt
Pre-Op intervention completed
Pre-Op meds administered
V/S taken right before exiting Pre-Op
Client voided (can you get client up to void)
Family members present say see you later. (try not to say good bye) ?????
Check policy & procedure regarding dentures, glasses, hearing aids ( give to spouse, friend)
Proper attire – jewelry off, nail polish, make-up (also according to policy & procedure)
preop checklist
Nurse signs off to the ______
Nurse places documentation on chart and includes
Anesthesia/Circulator
_____ prevention of wrong site, wrong procedure, wrong person surgery… These are ”never” events
Time out
A ______ is called by any member of the surgical team, but usually by a specifically designated person, e.g. the circulation nurse.
“time out”
Ideally, the patient should be ____ and participate in the verification process of patient identity, surgical site, and planned procedure (so-called “awake time out”).
awake
The “time out” must be repeated intraoperatively for every additional ______ performed on the same patient.
procedure
Control risks for fire
Control microbes
Surgical Asepsis:
Sterilized equipment
Scrub
Body covered with sterile drapes.
JCAHO’s national patient safety goals
______ must be trained in reduction of risk for fires. Control heat sources, manage fuels, and minimize oxygen concentration under drapes.
Surgery staff
Microbes: _________ zone: scrubs and caps
semirestricted
______ zone: scrubs, shoe covers, caps, and masks. Artificial nails are banned on OR personnel .
Restricted
RN leadership role. Protects the patients’ safety and health. Monitors actions of the team. Verifies consent, coordinates team. Monitors aseptic practices.
circulating nurse
: rn, lpn, or scrub assistant. Sets up sterile tables and assists during the procedure by handing instruments, counts all needles, sponges and instruments at end of surgery.
Scrub nurse
Given inhalation and intravenous
CNS depressed:
Risk for Cardiac and respiratory
problems
general anesthesia
What are the phases of general anesthesia?
induction
maintenance
emergence
______ – tracheal intubation for airway patency
_______ – positioned, surgery performed
______ – anesthesia reversed; extubation
Induction, Maintenance, Emergence
is a type of local, it’s done with a topical, cream or spray applied to the skin that blocks the nerve impulse.
regional anesthesia
lidocaine is used to depresses the nerve sensation ( breast Biopsy, skin BX)
local anesthesia
injected to produce a lack of sensation over a certain area, ( wrist surgery)
nerve block
injected in the epidural space this can be used during abdomen or extremity surgeries ie: Maternity
epidural block
local anesthetic is injected in the subarachnoid space – lower abdomen, perineum, and lower extremities ie: Hip fractures elderly with poor health problem
be aware of leakage of CSF Cerebrospinal Fld. Which will reduce CSF pressure and the client will have a post-op HA
Intervention : Bed rest, hydrate
spinal block anesthesia
Epidural goes into the epidural space rather than the subarachnoid space that the _____ goes in. Epidural therefore requires more medication because it doesn’t have direct contact with spinal cord or nerve roots.
spinal
Spinal anesthesia goes into ______ at L4-L5. Both produce anesthesia of the lower extremities, perineum, and lower abdomen.
subarachnoid space
If it goes too high it will paralyze the respiratory muscles and will required mechanical ventilation until it wears off.
Nausea, vomiting, and pain could occur in this surgery.
spinal anesthesia
Headache may be an after effect. ______common in the spinal than epidural due to leakage of CSF. If this occurs, then a blood patch may be performed.
More
Often the drug of choice for induction of anesthesia or for conscious sedation
Rapid induction, rapid return to consciousness, minimum residual effects
Lack of memory of the surgical procedure
Decreased nausea and vomiting postop
For moderate (conscious) sedation- administer slowly over 2 min.
●● Monitor carefully during and after moderate sedation or
anesthesia for respiratory arrest or hypotension.
●● Inject _______ into large vein to decrease pain at
injection site.
CLIENT EDUCATION: Arrange for a ride home following outpatient procedure.
propofol
Reduce anxiety preoperative
●Promote amnesia
●Produce mild sedation (unconsciousness) with little‑to ‑moderate respiratory depression with careful titration
midazolam [versed]
Lower doses of anesthetics are required in ______. Often experience an increase in duration of clinical effects of medications. Higher perioperative morbidity and mortality.
elderly
N/V
Anaphylaxis
Hypoxia
Hypothermia
Malignant hyperthermia
Disseminated Intravascular Coagulation
Possible Intraop complications
- they will be turned on their side, suction used to remove saliva and gastric contents.
Gagging
: may be immediate or delayed reaction to meds given in OR.
Anaphylaxis
In general anesthesia this will be done by anesthetist or CRNA. In conscious sedation, the nurse is the one giving the medication and monitoring pulse ox, vital signs etc.
Monitor oxygenation status
glucose metabolism is reduced and temp may fall causing metabolic acidosis. This is a core body temp below 98 degrees. May occur as a result of infusion of cold fluids, inhalation of cold gases, open body wounds, advanced age, and meds.
Interventions: warm IV fluids, dry . Should be done gradually not rapidly.
Hypothermia
Rare inherited muscle disorder chemically induced by anesthetics. ID of risk is imperative. Those at risk are those with strong bulky muscles, history of muscle cramps and weakness, unexplained temp elevations, and unexplained death of a family member during surgery that was accompanied by elevated temp.
s/s of mal. Hyperthermia: tachycardia (over 150) is often the first sign. Hypotension, oliguria, and later cardiac arrest. Rising temp is usually a late sign that occurs rapidly.
Malignant hyperthermia:
Increased prothrombin and platelets
Widespread formation of intravascular clots
Clotting factor expended
Severe generalized hemorrhaging
Life Threatening Complication
DIC
s/s bleeding from puncture sites, gums…
Treatment packed cells, fibrinogen, plasma, whole blood.
DIC
Gas exchange
Pain
Infection
Tissue integrity
common priority problems post op
Respiratory paralysis
elimination
GI
inform of procedure
observe for hypotension
no trauma to the extremities
thing you need to watch out for with anesthesia
after you want to monitor respirations frequently for residual effects of anesthesia and pain medication ( resp. rate and depth as well as pulse ox and skin color)
resp paralysis
both GI and GU may be affected. Often person may not be able to void right after surgery. You should encourage voiding if patient doesn’t have a catheter in. If unable to void within _______ (or when bladder palpable) you will have to get an order for catheterization.
7 or 8 hours
GI: patient GI system will “_____ during surgery. Therefore after surgery (general surgery) generally the client will not have anything to eat. They will move to clear liquids and advance diet.
stop”
Observe for ______ which could be a reaction to residual anesthesia or may be due to blood loss, position, or other medications.
hypotension
OR nurse and anesthesia give report to______ nurse she will monitor patency airway, vital signs, surgical site, coming off anesthesia, fluid status, pain control, other post operative orders ie: lab tests, IV fluids
PACU
When stable from _______ They go to 2nd stage PACU or to the floor to be monitored.
general Anesth.
Hemorrhage, Hypovolemic Shock
Deep Venous Thrombosis (DVT)
Pulmonary Embolism
cardiovascular complications
Client becomes restless or less responsive
Monitor postoperative H&H (?)
Hypotension, tachycardia
Pressure for obvious bleeding
Notify surgeon
cardiovascular complications
_______ may result from blood loss, hypoventilation, position changes, pooling of blood in extremities, or side effects of medication and anesthetics. Most common cause is blood loss.
Hypotension and shock
______ pallor, cool moist skin, rapid breathing, cyanosis, rapid weak thready pulse, narrowing pulse pressure, low blood pressure, concentrated urine.
Shock:
Client has pain, edema usually in one leg
Bed rest
Contact Physician immediately
After DXN; Placed on an Anticoagulant
Prevention: Ted hose
use intermittent devices ie: external pneumatic compression machine (SCDS or SCUDS)
Early ambulation
Adequate hydration
DVT) Thrombus in deep vein of leg
DVT _____, moves, and lodges in pulmonary circulation
Client has chest pain, dyspnea, tachycardia
bed rest, contact physician immediately,
Prevention includes adequately treating DVT
dislodges
what are these?
scuds
Atelectasis
Prevention
Aspiration
respiratory complications from surgery
_______ is the closure or collapse of alveoli. Occurs frequently postop due to a shallow breathing pattern caused by anesthetic, pain medications and not taking deep breaths due to fear of pain.
Atelectasis
cough sputum production and low grade fever
May be sever e and cause dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis.
Prevention - cough and deep breathe, instruct client to use incentive spirometry splinted cough
s/s atelectasis
what lung condition is associated with pneumonia?
atelectasis
Early in postop period PACU at risk for hypoxia due to hypoventilation and airway obstruction related to continued anesthetic effects. Their muscles are relaxed and the muscles of the pharynx are included. When the patient is on back the lower jaw and tongue may fall backward and the air passages become obstructed. Tile the head vback and push forward on the angle of the lower jaw. This pulls the tongue forward and opns air passage.
They may come back with a plastic airway. Resp. difficulty may be caused by excessive mucous or aspiration of vomit. Turn to side. Elevate HOB if not contraindicated..
hypoventilation
Prevention - Aspiration how do we tell client to lay if they are not rid of heavy secretions
left side laying
The collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression.
Causes include bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration.
Postoperative patients are at high risk for ________
atelectasis
Symptoms are insidious and include cough, sputum production, and a low-grade fever.
Respiratory distress, anxiety, and symptoms of hypoxia occur if large areas of the lung are affected.
s/s of atelectasis
What are nursing interventions associated with problems with anesthesia?
Urine Elimination
might need a one time cath
Bowel Elimination
encourage them to move around
Discharge from PACU Based on:
Respirations
Energy
Alertness
Circulation
Temperature
will discharge when theyre awake and alert, vitals are stable, and breathing alright.
when they get to med surge: check _________
breathing, check vitals, PULSE OX
Airway (patent?)
Breathing- Quality, pattern, rate, depth
Using accessory muscles?
Pulse ox?
0xygen? Rate and device?
CV status: BP, pulse within patient’s baseline?
Peripheral pulses?
Heart rate/rhythm
Mental status:
How does it compare to prior to surgery?
Respond to verbal stimuli?
Temperature-
Near preop range?
IV fluids-
What is infusing? How much is remaining? What is rate needed? What rate is it set on?
Any tubes-
If there are they draining appropriately and what does the draining look like?
Surgical incision site-
How is it dressed? How much drainage on dressing?
Check under patient for further bleeding or drainage
Drains present? If so are they set properly?
look under the patient to make sure theyre not bleeding out
Airway (patent?)
Breathing- Quality, pattern, rate, depth
Using accessory muscles?
Pulse ox?
0xygen? Rate and device?
CV status: BP, pulse within patient’s baseline?
Peripheral pulses?
Heart rate/rhythm
Mental status:
How does it compare to prior to surgery?
Respond to verbal stimuli?
Temperature-
Near preop range?
IV fluids-
What is infusing? How much is remaining? What is rate needed? What rate is it set on?
Any tubes-
If there are they draining appropriately and what does the draining look like?
Surgical incision site-
How is it dressed? How much drainage on dressing?
Check under patient for further bleeding or drainage
Drains present? If so are they set properly?
look under the patient to make sure theyre not bleeding out
Upon arrival to med surg
________:
the single most significant measure to prevent complications
AMBULATION
When caring for post op patient think of the 4 Ws
Wind: prevent respiratory complications
Wound: prevent infection
Water: monitor I & O
Walk: prevent thrombophlebitis [i think she meant thrombosis or thromboembolism]
Effects of increased ADH & increased Aldosterone after Surgery
water and sodium retention(first 24 hours)
After 24 hours, post-op diuresis
can be sweaty and will urinate more and putting off a lot of fluid
water and sodium retention(first 24 hours)
After 24 hours, post-op diuresis
can be sweaty and will urinate more and putting off a lot of fluid
Effects of increased ADH & increased Aldosterone after Surgery
unable to void 8-10 hour post op
palpable bladder
frequent small amount of voiding
pain in suprapubic area
urinary retention which is a possible post op complication
What systems are usually affected if a post op complication occurs?
Urinary system
Respiratory system
GI system
Wound -skin/musculoskeletal system
circulatory system
s/s of pneumonia
s/s of atelectasis
What are respiratory complications that can occur post op?
pneumonia
atelectasis
What are GI complications that can occur post op?
gastric dilation paralytic ileus
nausea & vomiting
abdomen distention
s/s gastric dilation
decreased bowel sounds
no stool or flatus
nausea
vomiting
abdomen distention/tenderness
s/s paralytic ileus
What are complications that can occur with the wound/skin/musculoskeletal systems?
Infection
Dehiscence
evisceration
evidence of bowel through incision
increased pain
s/s of evisceration
separation of incision
dehiscence
redness
purulent drainage
fever
tachycardia
leukocytosis
s/s of infection
what are possible post op complications associated with the circulatory system?
pulmonary emolism
hypovolemic shock
decreased urine
decreased bp
weak pulse
cool clammy
restless
increased bleeding
increased thirst
decreased CVP
s/s of hypovolemic shock
chest pain
dyspnea
increased resp rate
tachycardia
increased anxiety
diaphoresis
decreased orientation
decreased bp
blood gas changes
s/s of pulmonary embolism
What are post op complications associated with the urinary system?
urinary retention
unable to void 8-10 hours post op
palpable bladder
frequent, small amount of voiding
pain in the suprapubic area
s/s of urinary retention
Home care preparation
Health teaching
Psychosocial preparation
Health care resources
factors associated with discharge
is inserted to maintain patency of the duct and to promote bile passage, this is after a cholecystectomy
T-tube
______________________________________immediately after surgery nurses may have to empty every 15-60 minutes, with time every 2-4 hrs.
Jackson-Pratt (small Oval ) & Hemo-vac (accordion)
Document amount, color, consistency, and odor from the drain.
If there is large amount notify the ______
physician
JP drain. Works by vacuum. Need to drain and then re-collapse before closing. Need to pin to gown so that they don’t pull.
hemovac
surgical wound pulled shut with sutures
incision edges are well-approximated
Primary Intention:
- wound is gaping, irregular granulation tissue fills in , some scaring. DO we need to worry about infection?
Secondary Intention
– not sutured, tissue heals by granulation process usually a large scar.
Tertiary Intention
– clear or slightly yellow (serum plasma of blood) drainage
Serous
– thick reddish, contains red blood cells and serum drainage
Sanguineous
drainage – result of infection, contains white blood cell, tissue debris, bacteria, thick, color varies with causative organisms
Purulent
thin pink or light red drainage
Serosainguinous:
– separation of layers of incision wound
Dehiscence
– protrusion of body organs through area where incision cam apart( with the abdomen the intestines may protrude)
Evisceration
what is the protocol for wound evisceration?
An intervention would be to cover with sterile dressing soaked in sterile saline then call Dr. for surgical closure.
dehiscence
Evisceration
This of course is emergent. An intervention would be to cover with sterile dressing soaked in sterile saline then call Dr. for surgical closure.
Adequate pain control Allows the client to participate in recovery and avoid ______
complications
Use a pain scale administer and evaluate med effectiveness
Obtain alternate meds or routes if pain is ineffective
Teach client how to splint incision with movement
Ways to changing position that lessen pull on incision
pain control measures
Discharge Instructions
Follow-up plans
Home Care
Wound Care
Prescriptions
Contact Person
Follow-up Appointment
promotion of recovery post op
Also look at chart 20- 4 in your text about patient education on wound care
Look at Chart 19 2 Homecare checklist for discharge and
19 3 for interventions immediately post surgery
