Transcript preparing for the patient in surgery - A

PREPARING FOR THE
PATIENT IN SURGERY
WEEK 6
Why Me?
Thoughts that run thru the pt’s mind
 Pt’s
often question why them?
 Component that make up the individual:
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Physical Need: any need or activity related to genetics,
physiology, or anatomy.
Psychological Need: Any need or activity related to the
ID and understanding of one’s self.
Social Need: Any need or activity related to one’s ID or
interaction with another person or group.
Spiritual Need: Any need or activity related to one’s ID
and understanding place in the universe.
Why Me?
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All of these needs exist
as a group, not
individually.
However, each individual
is unique as each
handles each situation
differently.
Family members must be
considered as well with
consideration of their
physical, psychological,
social, and spiritual
issues (maintain
communication prn)
Reasons for Surgery
deformity – Cleft Lip
 Trauma – MVA
 Nonmalignant tumor – Uterine Fibroid
 Malignant tumors – Colon cancer
 Disease - HIV
 Condition – Kidney Stone
 Psychological state – Facelift (Rhytidectomy)
 Genetic
Preparing for the Patient in Surgery
Requires Knowledge of:
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HOLISTIC APPROACH
Recognizing our patients as a person, not the case in OR
#4 or the radical mastectomy in OR #4
 Maslow’s “Hierarchy of Needs”, a view of human
development
 “Life Tasks Approach” to psychosocial needs pg 61
 Cultural and Religious Influences
 The “Nursing Process” as applicable to the ST
Maslow’s Hierarchy of Needs
Physiological Needs
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Most basic biological
or survival needs of
the patient
Oxygen
Water
Food
Temperature
regulation
Safety Needs
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Patient’s perception of
placing trust that their
environment is safe
Trust in surgeon
Trust in staff/institution
Warmth provided
Protected from infection
by asepsis
Positioned comfortably
Injury prevented
Love and Belonging Needs
(Social)
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Recognized and
cared for as an
individual
 Caring for others
 Interacting with
others: family,
friends, church
members, and coworkers
Esteem Needs
 Positive
regard for one’s self and others
 To be respected and respect others
Self-Actualization
 To
fulfill what one views as their potential
or purpose in life
Application of Maslow in
Surgery
 Prioritization
of care in surgery
 Trauma for example: biological issues
take precedence (oxygen, blood loss
control, pain relief, and infection control)
 Can also recognize patient’s rights
 Provide competent care
 Provide safety, privacy, and respect
Development and Change
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Life Tasks Approach
(Table 4-2, pg. 61)
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The Life Tasks
Approach gives us a
way to understand a
surgical patient’s
needs and fears
Development and Change
 Open
to page 61 - discuss
Death and Dying
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3 accepted definitions of death:
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Cardiac death: complete
absence of heartbeat and
respiration.
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Higher Brain Death:
irreversible loss of higher
brain function. PT still has
respiration, BP, and heart
beat w/o the aid of a
respirator.
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Whole-Brain Death:
irreversible loss of all brain
function. Includes flat
EEG, lack of pupil reflexes,
and hypothermia.
Cultural Considerations
 Gives
us a perspective of the surgical
patient’s thoughts and feelings about
health care needs
 Language can be a huge barrier
 Cultural considerations can help us for
when we can’t communicate, as well as
when we can
Asian Americans
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Chinese:
silence is valued
touch is limited
fear invasive procedures
distrustful of doctors and health care workers
who perform painful procedures
both parents involved in decisions regarding
their children
Asian Americans continued
 Japanese:
touch is limited
 feel direct eye contact disrespectful
 stoic
 family needs come first
 eldest child cares for elderly
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Asian Americans continued
 Vietnamese:
 eye
contact disrespectful
 father is decision maker
 use titles when addressing
 do not ask direct questions
Asian Americans continued
 Filipinos:
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avoid eye contact
value nonverbal communication
family needs come first
Hispanic Americans
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Father needs to be there when speaking to male
children
Familial and personal privacy valued/very
modest
Father decision maker and provider for family
Women tend to the ill
Fearful of hospitals/may see as a “place to die”
American Indians
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Avoid prolonged direct eye contact
Family members are responsible for each other
Takes time for them to form opinions about
health care providers
Elders assume leadership roles
With amputated limbs, may require them to go to
the family or stay with patient
Middle Eastern
 No
touching outside family or spouse
 Male dominated culture, therefore is
decision maker
 Males are only to be alone with their wife,
not other females (May require male
health care workers)
 Females can only be touched by female
health care providers
Appalachian
 Direct
eye contact disrespectful
 Kindness valued
 Judge health care workers by how they
relate to them not by competence
 Fearful of hospitals, considered a “place to
die”
 Care of the ill is provided by family
including extended family members
Religious Considerations
 ST
needs a basic understanding of
different religions and their relationship to
health care
 Religion can raise ethical and legal issues
for patients and health care providers
 Religion can conflict with modern medical
technology
American Indian
 Abortion
not allowed
 Organ transplantation discouraged
 Medical treatment views vary
Islam
 Privacy
important
 Medical treatment is encouraged
Roman Catholic
 Abortion
not allowed
Jehovah’s Witness
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No food containing
blood
 No blood transfusion
 Abortion not allowed
 Organ transplantation
allowed provided
organ is stripped of all
blood
Special Populations
 Pediatric
patients
 Geriatric patients
 HIV, Trauma, Organ Donor or Recipient
Pediatric Patients
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Specialty area
Anatomy and physiology
differ from adult
Response to anesthesia
and other medications
differ from adults
Psychologically,
communication with child
dramatically different
Descriptions of pain and
pain locations may not be
precise like an adult
Pediatric Patient continued
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Surgical team will
naturally feel more
protective towards
children
Communication with
infant to two year olds
will be limited to
reassurances and
snuggling
Explanations should be
short and appropriate
for the three year old to
twelve year old
Surgical Team Role with
Pediatric Patient
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Obtain good anesthesia
Finish surgical procedure
effectively, efficiently, and
safely
Get the child back to their
family as soon as
possible
Will be more sensitive to
cold room temperatures
due to decreased body
surface area, so room will
be kept very warm
Geriatric Patients
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May or may not have
diminished mental
status/Do not assume
all elderly are “senile”
as most are not
 Pay special attention
to physical changes in
the body that do
affect all elderly and
directly influence our
care of them
Physical Changes of the
Geriatric Patient
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Skin loses elasticity causing it to easily bruise or tear
Care must be taken when moving and positioning patient
to avoid shearing or bruising of the skin
Care must be taken when applying and removing tape
and or other sticking drape materials to avoid thin areas
of skin and ripping skin off the body
Sensitive to prolonged pressure over bony
prominences/Pad these areas well to avoid ulceration
Physical Changes of the
Geriatric Patient
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Loss of subcutaneous
layer or fatty/protective
layer of skin
 Causes sensitivity to cold
and can result in
hypothermia
 Use warm blankets and
warm fluids
 Keep as much of the
body insulated as
possible
 With Bair Huggers always
attach/Never leave hose
free to just blow onto
body as can cause major
burns
Physical Changes of the
Geriatric Patient
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Loss of bone, joint
mobility, and muscle
mass
 Loss of flexibility
 More prone to
fracturing of the
bones
 Extreme care with
positioning and
padding
Physical Changes of the
Geriatric Patient
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Loss of urinary bladder
and bowel control
Don’t be surprised by
SURPRISES
Maintain patient integrity
and privacy and assist
with cleaning at the end
of the procedure before
transport
SURPRISES that have
prolonged contact with
the skin can cause
breakdown of the skin
HIV, Trauma, Organ Donors or
Recipients
 Maintain
caring environment
 Maintain asepsis
 Maintain same high level of care to
surgeon and patient
 Protect the patient from injury from
environmental hazards
ST Responsibilities
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Ethically and legally responsible to provide
service to our surgeon and patient despite how
we feel about the culture or religious beliefs of
our surgeons or patients
Must provide a caring environment
Must provide surgical asepsis
Must protect the patient from injury
THE PATIENT COMES FIRST
Maintaining the Surgical
Environment Continued
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Speak in a calm, clear, unhurried tone
 Move patients with care paying attention to proper body
alignment and any IV lines or other lines that could get
snagged during movement from stretcher to OR bed and
back
 Maintain safety precautions for everything in the OR
room that could cause the patient harm or injury
 Perform tasks in an efficient and effective manner
 BE EXTRA EYES AND EARS FOR THE PATIENT’S
NEEDS AND SAFETY
Helping to Maintain the Surgical
Environment as the ST
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Can introduce self professionally
Maintain communication with the RN circulator
throughout the surgical procedure
Aid with reports on where you are in the procedure and
status of the patient so the RN circulator can keep the
family informed
If assisting the circulator, a touch or squeeze of the
patient’s hand can calm a fearful patient
Explain everything you are going to do when the patient
is awake (regional anesthesia)
Use appropriate language that can be understood not
medical terms
Military Time
Military Time
 You
will often see military time in the OR,
on the chart and used between staff.
 It is used to avoid confusion between a.m.
and p.m. since we are a 27/7 service.
 The main difference between regular and
military time is how hours are expressed.
Regular time uses numbers 1 to 12 to
identify each of the 24 hours in a day. In
military time, the hours are numbered from
00 to 23. Under this system, midnight is
00, 1 a.m. is 01, 1 p.m. is 13, and so on.
Military Time
Morning
After Noon (just add 12)
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Midnight = 0000
1:00 a.m. = 0100
3:00 a.m. = 0300
6:00 a.m. = 0600
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Noon =
1200
1:00 p.m. = 1300
3:00 p.m. = 1500
6:00 p.m. = 1800
Summary
 Reasons
for surgery
 Recognizing patient as a person:
physical
psychological
social
spiritual
Summary continued
 Maslow’s
Hierarchy of Needs
 Life Tasks Approach to development and
change
 ST role in maintaining surgical
environment
 Cultural considerations
 Religious considerations
Summary continued
 Special
populations:
Pediatric
Geriatric
HIV, Trauma, Organ donor or recipient
 ST responsibilities