Transcript Peri-Operative Care

Peri-Operative Care
NURS 2016
Stages of the Peri-Operative Period
Pre-Operative
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From time of decision
to have surgery until
admitted into the OR
theatre.
Stages of the Peri-Operative Period
Intra-Operative
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Time from entering the
OR theatre to entering
the Recovering Room
or Post Anesthetic Care
Unit (PACU)
Stages of the Peri-Operative Period
Post-Operative
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Time from leaving the
RR or PACU until time
of follow-up evaluation
(often as opt-patient)
Some Suffixes
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Ectomy
Otomy
Oscopy
Pathy
Rhage
Oma
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Itis
Logy
Megaly
Rhea
Lysis
Megaly
Some Prefixes
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Chole
Lap
Dys
Cyst
Lith
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Carcin
Neo
Ortho
Trans
A Few Terms
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Reduction
Resection
Bypass
Excision
I&D
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Aspiration
DVT
Dehiscence
Evisceration
Paralytic Ileus
Classifications of Surgery
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I
II
III
IV
V
Emergency: immediately
Urgent: 24-30 hours
Required: need surgery in upcoming
weeks
Elective: Should have
Optional: Not necessary – a choice
Pre-Operative Period
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Nursing Assessment
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Nutritional and Fluid Status
Drug and Alcohol use
Respiratory Status
CV Status
Other system (renal, hepatic, immune
Medications
Psychosocial, spiritual and cultural beliefs
Pre-Operative Period
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Nursing Interventions
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Teaching
Physical Prep
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Surgical Site
Nutrition and Fluids
Preanesthetic Medication
Psychosocial Support
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Reducing anxiety and addressing fears
Pre-Operative Period
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Teaching
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Pain management
Deep Breathing and Coughing
Movement and Ambulation
Pre-Operative Period
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Pre-Op Checklist (figure 18.3, page 413)
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Proper documentation complete
Physical and chemical work-up complete
Patient physically prepared
Current condition
Intra-Operative Period
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Nursing Roles: Patient Advocate
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Scrub nurse
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Responsible for ‘sterile’ work
Monitor sterile integrity of procedure
Monitors equipment (instruments, sutures, etc)
Circulating nurse
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Protects patient safety
Monitors operating room conditions
Monitors surgical team activities
Intra-Operative Period
Stages of Anesthesia
I: Beginning
II: Excitement
III: Surgical anesthesia
IV: Medullary Depression
Intra-Operative Period:
Achieving Anesthesia
Inhalation
 Halothane and
methoxyflurane
 Administered via mask
or endotracheal tube
 Inducation and
recovery quite rapid
Intravenous
 Tranq/Sedatives
 Opioids
 Neuroleptanalgesics
 Dissociative Agents
 Barbiturates
 Nonbarbiturates
Intra-Operative Period
Anesthesia is not always
General
 Regional
 Blocks
 Local infiltration
Intra-Operative Period
Complications
 Nausea and vomiting
 Anaphylaxis
 Hypoxia
 Hypothermia
 Malignant Hyperthermia
 DIC
Post-Operative Period
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Immediate Post-Op
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PACU
Assist and monitor patient in post-anesthetic
stage
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Airway, circulation, hemorrhage, nausea/vomiting
Recovery
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Clinical Unit
Discharge home
Post-Operative Period: Clinical Unit
Primary focus
 Neurological status
 Pain management
 Respiratory function
 Circulatory function
 Wound care
 Fluid Balance
 Nutritional status
Post-Operative Period
Immediate Assessment
 Level of consciousness
 Vital Signs (q15 x 2,
q30, . . .)
 Wound
 Fluid Balance
 Pain
Post-Operative Period:
Recovery: Day 1 to Discharge
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Preventing Respiratory
Complications
Relieving Pain
Promoting Cardiac
Function
Encouraging Activity
Promoting Wound
Healing
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Maintaining Body
Temp
Monitoring GI
Function
Managing Voiding
Providing Support
Post-Operative Period: Complications
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Deep Vein Thrombosis
Hematoma
Infection
Wound Dehiscence
Post-Operative Period
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Consider the list of Nursing Diagnosis
provided
What nursing interventions would be
appropriate