Transcript PATIENT CARE CONCEPTS

PATIENT CARE CONCEPTS
Outline
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Physical health and its relationship to the ST and
the surgical patient
Post-operative complications
Equipment and immediate access
PACU criteria
Post-operative discharge instructions
Kübler-Ross Stages of Grief/Death and Dying
Alternative Healing Methodologies
Quality verses quantity of life
Organ procurement and transplantation
Physical Health
(Student Presentations)
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Relate the following health and wellness
concepts to the surgical patient and the
surgical technologist role:
Physical activity
Nutrition
Tobacco use
Alcohol use
Stress
Post-Operative Complications
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Complications are difficulties postoperatively that warrant immediate
treatment and may result in returning to
surgery.
Complications are accepted as risks of
having surgery, so are shared with the
patient pre-operatively before the surgical
consent is signed
Can result in prolonged hospitalization as
well as prolonging a patient’s recovery or
return to normal function
Types of Post-Operative
Complications
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Shock is inadequate blood flow, therefore
poor oxygenation to vital organs that can
result in irreversible damage to the organs
involved
Hemorrhage is heavy bleeding during,
shortly after, or some time after surgery
Pulmonary Embolus or PE occurs when a
blood clot forms, is dislodged, and is
carried to the heart’s pulmonary artery
Types of Post-Operative
Complications Continued
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Respiratory secretion impairment can
be from inadequate clearing of secretions
by the patient (coughing, turning, deep
breathing) or the accidental aspiration of
secretions. This can result in aspiration
pneumonia.
Gastro-intestinal/bowel obstruction is
most often seen after surgery involving the
abdomen. It can occur in 3 to 5 days postop or years down the road.
Types of Post-operative
Complications Continued
Post-op Psychoses is caused by
temporary lack of oxygen to the
brain. It can result in depression,
anxiety, mental confusion, and
hallucinations. This can also be a
result of the anesthetic or pain
medications.
 Retained foreign body
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Equipment/Immediate Access
Preparing for Complications
Keep set-up sterile as well as
yourself if able until the patient is
assuredly stable and ready for
transport
 Need to be prepared should you have
to go back in to a patient
 Oxygen
 Defibrillator
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Post-Anesthesia Care Unit
(PACU)
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Given there are no complications,
established criteria must be met by
the patient before they can be
discharged to the surgical floor of the
hospital or home in the case of outpatient surgery
PACU Criteria
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Uncomplicated breathing
Stable or a return to 20% of baseline VS
Temperature at 36°C or 96°F or better
Urine output not less than 30ml per hour
Nausea and vomiting controlled
Minimal pain complaints
Verbally responsive and oriented to person,
location , and events
Can move all four extremities
Outpatient PACU Criteria
The same criteria must be met with
the additional two criteria
 Can tolerate small amounts of clear
fluids without vomiting
 Have a responsible adult to drive the
patient home and stay with them the
remainder of the day
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Post-Operative/Discharge
Instructions
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May vary with type of operation
Activity will be encouraged/Limits will be on
lifting, pulling, and straining
Rest will be encouraged
Driving and operation of heavy machinery
may be discouraged for awhile
Resumption of sexual intercourse may have
a time frame
Resumption of showering and tub bathing
may have a time frame
Discharge or Post-Operative
Instructions Continued
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Alcoholic beverage consumption may have
a time frame
Smoking will be discouraged
Diet may be progressive
Instructions on dressing changes will be
given
Prescriptions will be given
Follow-up doctor appointment will be made
Discharge or Post-Operative
Instructions Continued
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The following will be reported to the
patient’s doctor by the patient immediately:
Fever
Prolonged nausea and vomiting
Swelling or excessive bleeding
Excessive pain
Inability to urinate or void
Inability to pass stool or defecate
Death and Dying
(The Grieving Process)
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Kübler-Ross Stages of Grief as
experienced by the patient and the family:
Denial-does not accept death as a reality.
Pretends it isn’t happening. This prolongs
communication of concerns.
Anger-Important not to take personally if
the health care provider. The person is
expressing their sense of helplessness and
outrage over their situation.
Kübler-Ross Stages of Grief
Continued
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Bargaining-involves a deal made with God,
the doctor, or nurse. For example “If I can
live until my grandson is born next month,
I’ll be ready to die.” When possible,
requests will be granted.
Depression-the previous methods are no
longer working. The person feels sad and
full of anguish. Death is a reality. Support
is important at this time.
Kübler-Ross Stages of Grief
Continued
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Acceptance-The person has accepted the
fact they are going to die and is at relative
peace with it. They will want loved ones
near. They may or may not want to reflect
on the past and consider the future without
them.
These stages do not always occur in order.
Patients and families may go back and
forth between stages and will likely each
be at different stages.
Alternative Healing
Methodologies
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Besides surgical and medical intervention,
patients may also seek help from
alternative healing methods
Alternative healing needs to be recognized
by the health care provider and every
attempt should be made to accommodate
these desires of the patient provided they
are harmless
The majority of alternative practices are
harmless whether they are effective or not
Types of Alternative Healing
Methodologies
Folk healers
 Voodoo
 Spiritual leaders/counsel/prayer
 Acupuncture
 Medicine man
 Herbalist
 Home remedies
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Quality verses Quantity of
Life
Terms Related to Quality
verse Quantity of Life
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Advance Directives Tells your family/caregivers and
physician what kind of care you would want if you
couldn’t speak for yourself
A. Living Will Written by you when you were well and
comes into effect when your are terminally/incurably ill
or in a persistent vegetative state. It details your
wishes given the previous circumstances.
B. HCPA (Health Care Power of Attorney) A document
more flexible than a living will. Allows designation of a
family member or friend to be your medical decision
maker should you become temporarily or permanently
unable to make your own decisions (only concerned
with health care decisions not personal/financial).
Without a will, we are at the mercy of our
family’s decisions or physician, who may or may
not do what is “right” or what we would want.
Organ Procurement and
Transplantation Myths
Wealthy and famous people get
priority
 The patient is too old and sick to be a
donor
 If I’m a donor, doctors won’t attempt
to save my life if I’m in an accident
 To be a donor, all I have to do is
check that box on my drivers license
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Organ Transplantation and
Procurement Facts
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Organ transplantation is one of the
twentieth century’s greatest breakthroughs
Nineteen people die every day waiting to
receive an organ transplant
Supply and demand gaps are growing
Organ procurement is based on patients
and families volunteering to donate their
organs
Cost is a factor (many insurances do not
cover expense/cost can range from
$35,000 to $200,000 the first year of a
transplant
Summary
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Physical health and its relationship to the ST and
the surgical patient
Post-operative complications
Equipment and immediate access
PACU criteria
Post-operative discharge instructions
Kübler-Ross Stages of Grief/Death and Dying
Alternative Healing Methodologies
Quality verses quantity of life
Organ procurement and transplantation