Transcript PERIOPERATIVE PERIOD

Preoperative Period
NUR 112
Lisa M. Dunn RN, MSN/ED
Purpose of Surgery
 Diagnostic
 Curative
 Restorative
 Palliative surgery, which makes the patient more
comfortable
 Cosmetic surgery, which reconstructs the skin and
underlying structures
Nursing Process
Pre-Operative Period
Surgical Procedure Suffixes
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-ectomy: excision or removal of
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-lysis: destruction of
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Colostomy
-otomy: cutting into or incision of
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endoscopy
-ostomy: creation of opening into
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Herniorrhaphy
-oscopy: looking into
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electrolysis
-orrhaphy: repair or suture of
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appendectomy
Tracheotomy
-plasty: repair or reconstruction of
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mammoplasty
Question
The nurse understands that the rationale for palliative surgery
is to:
A.
B.
C.
D.
Resolve a health problem by repairing the cause
Improve functional ability
Enhance personal appearance
Relieve symptoms of a disease
Collaborative Management
Assessment
 History and data collection
-Age
-Drug and substance use
-Medical history, including cardiac and
pulmonary histories
-Previous surgery and anesthesia
-Blood donations
-Discharge planning
Physical Assessment/ Clinical
Manifestation
Obtain baseline vital signs
Focus on problem areas identified by the
patient’s history on all body systems
affected by the surgical procedure.
Report any abnormal assessment findings
to the surgeon and the anesthesiology
personnel.
System Assessment
 Cardiovascular system
 Respiratory system
 Renal/urinary system
 Neurological system
 Musculoskeletal system
 Nutritional status
 Psychosocial assessment
Question
In assessing the client preoperatively, which of the
following statements by the client requires further
follow-up?
A “I usually skip breakfast, so I will not be hungry before
surgery.”
B “I started taking a multivitamin last week.”
C “I have been using several different herbs for my health
over the past year.”
D “I usually work out three times per week.”
Laboratory Assessment
Urinalysis
Blood type and crossmatch
Complete blood count or hemoglobin and hematocrit
Clotting studies
Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray
Electrocardiogram (EKG or ECG)
Question
The nurse reports which of the following electrolyte
laboratory results immediately to the anesthesiologist?
A.
B.
C.
D.
Potassium 3.9 mEq/L
Sodium 140 mEq/L
Fasting glucose 80 mg/dL
Creatinine 1.9 mg/dL
Knowledge Deficit
Interventions
Preoperative teaching
Informed consent
-The surgeon in responsible for obtaining
signed consent before sedation is given and
surgery is performed.
-The nurse’s role is to clarify facts
presented by the physician and dispel myths
that the client or family may have about
surgery.
Implementing Dietary
Restrictions
The patient is given nothing by mouth
(NPO) for 6 to 8 hours before surgery.
NPO status decreases the risk for
aspiration
Failure to adhere may result in
cancellation of surgery or increase the risk
of aspiration during or after surgery.
Administering Regularly
Scheduled Medications
Notify the physician and anesthesia provider for
instructions about medications such as:
Diabetes medications
Cardiac medications
Glaucoma medications
Anticoagulants
corticosteriods
Intestinal Preparation
Bowel and intestinal preparations are
performed to prevent injury to the
colon and to reduce the number of
intestinal bacteria.
Enema and/ or laxative may be
ordered.
Question
In preparing a client for gastrointestinal surgery, the nurse
explains the reason for the bowel prep is to:
A.
B.
C.
D.
Eliminate any risk of infection
Reduce bacteria that is normally found in the bowel
Ensure the bowel is sterile
Decrease expected blood loss during surgery
Skin Preparation
Skin is the bodies first line of defense
against infection.
A break in the barrier increases the risk
of infection.
Shower using antiseptic solution.
Shaving as a procedure before surgery
is viewed as controversial.
Preoperative Education
 Possible placement of drains, tubes and
vascular access devices.
 Teach patient about postoperative procedures
and exercises.
•Breathing exercises
•Incentive spirometry
•Coughing and splinting
Pre-Operative Education
Diaphragmatic Breathing Exercises
Properative Education
Diaphragmatic Breathing
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High or semi-fowler’s position
Place hands lightly on the abdomen
Inspire deeply while allowing the abdomen to
expand outward.
Hold breath for a count of 5
Exhale completed through pursed lips, allowing the
cheeks and abdomen to deflate
On expiration, the abdomen contracts inward as air
from the lungs is expelled
Repeat 5 times consecutively – slowly
Perform q1-2 hours while awake
Splinting Abdomen
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Coughing Exercises
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Taught preop
Purpose: to loosen, mobilize, and remove
pulmonary secretions
Splinting the incision decreases the physical and
psychologic discomfort associated with coughing
 Diaphragmatic breathing
 Splint the incision with interlocked hand or
pillow
 Three deep breaths and then cough forcefully
 Repeat 5 x q2h while awake with rest periods
Pre-Operative Education
Splinting Abdomen while Coughing
Question
In teaching the client with planned surgery using general
anesthesia, it is a priority for the nurse to include which
statement in the preoperative teaching?
A. “You many wake up with a tube in your throat to help you
breath.”
B. “Your surgery will last about 2 hours.”
C. “Your family will be allowed to visit you in the operating
room.”
D. “We will not be able to give you pain medications until you
are fully awake.”
Question
The nurse includes which of the following statements for a
client undergoing general anesthesia?
A. “You will be able to talk with the surgeon during the
procedure.”
B. “You will have a breathing tube in your throat during the
procedure.”
C. “Your family will need to stay in the waiting room in order to
talk with the surgeon.”
D. “No information can be given to your family until you are
fully awake in the PACU.”
Pre-Operative Education
Pain Management Education
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Pain Assessment – 5th Vital Sign
Instruct in use of pain intensity rating
scale
Initial postoperative period
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Patient Controlled Analgesia
Patient Controlled Epidural Analgesia
Medication prescribed IV/IM at prescribed time
Other therapies: Positioning, back rubs, ice,
elevation
Progress to oral analgesic agents
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2nd or 3rd postop day or Ambulatory Surgery
Preoperative Education
Continued…
Leg procedures and exercises such as:
- calf pumping
- antiembolism stocking
Sequential compression device
(SCD)
-elastic wraps
-Early ambulation
-Range-of-motion exercises
Anxiety Interventions
Preoperative teaching
Encouraging communication
Promoting rest
Using distraction
Teaching family and significant others
Preoperative Chart Review
Ensure all documentation, preoperative
procedures, and orders are complete.
Check the surgical consent form and
others for completeness.
Document allergies
Document height and weight.
Question
In completing the preoperative checklist on a client scheduled for
general surgery, the nurse recognizes which of the following as
the greatest risk for the planned procedure?
A.
B.
C.
D.
Age 59
Ten pounds over ideal body weight
Diet Controlled diabetes mellitus
Brother had complications with general anesthesia
Question
The nurse’s role in informed consent includes which of the
following?
A.
B.
C.
D.
Taking the client on a tour of the operating room
Teaching the client about the planned procedure
Witnessing the operative consent
Ensuring the client talks with the primary surgeon before
the procedure.
Preoperative Chart Review
Continued…
All diagnostic test results and diagnostic
tests are on the chart.
Document and report any abnormal results
Report special needs and concerns
Preop Patient Prep
Patient’s should remove clothing and only
have on hospital gown.
Ensure adequate intravenous access
Valuables should be with a family
member or locked up in hospital safe.
Tape rings in place if they cannot be
removed.
Remove all pierced jewelry
Preop Patient Prep Continued
Client must be wearing an identification band
Notation of allergies noted on a wrist band
Dentures must be removed (note if patient has missing
teeth or any loose teeth)
Remove hearing aids
Remove glasses
Remove nail polish
Remove hair pieces and any kind of hair pins or bands
Patient Gets a Time-Out!!!
Most facilities have some kind of check system in
place to make sure:
-Right patient
-Right procedure
-Right surgical site
2009 Patient Safety Goals
The purpose of The Joint Commission’s National
Patient Safety Goals (NPSGs) is to promote specific
improvements in patient safety.
The Requirements highlight problematic areas in
health care and describe evidence and expertbased solutions to these problems.
The Requirements focus on system-wide solutions,
wherever possible.
Patient identification
Goal 1:
Improve the accuracy of patient identification
NPSG.01.01.01: Use at least two patient identifiers
when providing care, treatment and services.
NPSG.01.02.01: Prior to the start of any surgical or
invasive procedure, individuals involved in the procedure
conduct a final verification process, such as a time-out, to
confirm the correct patient, procedure and site using
active, not passive, communication techniques.
Health Care Associated
Infections
Goal 7:
Reduce the risk of health care associated
infections
NPSG.07.05.01: Implement best practices for
preventing surgical site infections.
Preoperative Medication
Reduce anxiety
Promote relaxation
Reduce pharyngeal secretions
Prevent laryngospasm
Inhibit gastric secretions
Decrease amount of anesthetic needed for
induction and maintenance of anesthesia.
Administer antibiotics if ordered
Pre-Operative Period
Preoperative Medications
Frequently used preoperative
medications
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Benzodiazepines – They reduce anxiety,
induce sedation and induce amnesia by
slowing down the central nervous system.
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midazolam (Versed)
diazepam (Valium)
lorazepam (Ativan)
Question (pick all that apply)
The nurse assumes the role of client
advocate in the preoperative period.
A. notifying the physician of abnormal lab
results
B. verifying that informed consent has been
obtained
C. cosigning the operative consent form
D. reviewing preoperative teaching
E. providing support to family members
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