Transcript Surgical Client

Surgical Client
Part 1
Dr. Belal Hijji, RN, PhD
April 08, 2012
Learning Outcomes
After this lecture, students will be able to:
– Define the term perioperative nursing care
– Discuss surgical risk factors
– Describe a pre-operative nursing care plan of a surgical
client
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Perioperative Nursing Care and Surgical Settings
• Perioperative nursing care refers to nursing care given before
(preoperative), during (intraoperative), and after
(postoperative) surgery.
• Surgery is performed in hospitals, clinics, physicians’ offices,
and mobile unit. Minor surgeries are performed on an
outpatient basis.
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Surgical Risk Factors
• Age: {ery young and older clients are at greater surgical risk as
a result of an immature or a declining physiological status. An
infant has less subcutaneous fat than an adult placing him at
risk for wide temperature variations. General anesthesia can
inhibit shivering, a protective reflex to maintain body
temperature, and can cause vasodilation, which results in heat
loss. With advanced age, the client’s physical capacity to adapt
to the stress of surgery is hampered because of deterioration of
body function.
• Nutrition: Normal tissue repair and resistance to infection
depend on adequate nutrition. Surgery intensifies the need for
nutrients. After surgery, additional proteins, carbohydrates,
zinc, and vitamins A, B, C, and K are needed for proper
wound healing. A malnourished client is prone to poor
tolerance of anesthesia and can develop multiple organ failure 4
after surgery.
• Obesity: An obese client usually has reduced ventilatory
capacity because of the pressure exerted against the diaphragm
by an enlarged abdomen. The recumbent and supine positions
required on the operating table may further limit the obese
patient’s ventilation. Cardiovascular function is also
compromised because of the increased workload of the heart
and atherosclerotic blood vessels.
• Immunocompetence: A client with cancer may often undergo
radiotherapy before surgery to reduce the size of the tumor.
Radiation causes fibrosis and vascular scarring in the radiated
area, and tissues become fragile and poorly oxygenated.
Ideally, surgery is delayed 4 to 6 weeks after completing
radiotherapy to avoid wound healing problems.
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• Fluid and electrolyte balance: The body responds to surgery as
a form of trauma. As a result of adrenocortical stress response,
hormonal reactions cause sodium and water retention and
potassium loss after surgery. The more extensive the surgery,
the more severe the physiological stress. A client who is
dehydrated from vomiting preoperatively, is at greater risk for
hypovolemia
• Pregnancy: Surgery is only considered for urgent or emergent
reasons such as appendicitis or trauma. Anaesthesia and
medications may cause fetal abnormalities during the first
trimester. Pregnancy makes monitoring the client more
difficult. For example, high level of progesterone relaxes the
lower oesophageal sphincter and decrease GIT motility, which
slows gastric emptying, resulting in an increased risk for
aspiration of stomach contents.
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A Pre-Operative Nursing Care Plan of a Client
• Assessment: Mr. John enters a pre-admission centre for his
testing. He is for cholecystectomy in a hospital. He states that
he knows very little about his surgery. His doctor told him
that the operation is safe, but John knows few specifics. John
asks whether he will have an IV line, and if he will be
awake during the surgery. The nursing staff report that
John’s daughters have been calling and asking many
questions about intraoperative and postoperative events.
• Nursing Diagnosis: Deficient knowledge regarding
implications of surgery related to first surgical experience and
inadequate preparation.
• Planning
– Goal: Client will understand intraoperative and
postoperative events before the day of surgery
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• Expected outcomes
– The client and his daughters will describe events that
commonly occur in the holding area and operating room
on the day before surgery
– The client and his daughters will describe routine
postoperative nursing procedures on the day of
admission
– The client and his daughters will describe ways to
participate in postoperative care on the admission.
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• Implementation
– Give John the teaching booklet Your Surgical Experience.
Arrange a time to call at home and answer any questions about
the booklet’s content.
– Provide a planned teaching session to John and his daughters
answer after pre-admission testing. Explain events that will
occur in the holding area (IV access line insertion, vital signs
recording), and in operating room (positioning, anaesthesia). Use
visual aids to assist the client understanding of the procedure.
– Provide planned teaching session on day of admission with John
and his daughters to explain common events that will occur after
surgery and demonstrate postoperative exercises included in the
booklet
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• Evaluation: Ask John and daughters to
– identify the basic purpose of the surgery and changes to expects
afterward.
– identify routine types of postoperative monitoring and treatment
– state the most frightening aspect of surgery to him
– perform postoperative exercises (diaphragmatic breathing,
incentive spirometry, controlled coughing, turning, and leg
exercise).
• Post-operative exercises will be presented next week.
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