Transcript 4 L. Interventions for Preoperative Clients Care

Interventions for
Preoperative Clients Care
Perioperative Care
 Three
Phases
 Preoperative
 Intraoperative
 Postoperative
Surgical Classifications
1. Optional surgery: decision rests with patient (eg, cosmetic surgery).
2. Elective surgery refers to procedures that scheduled at the client's
convenience (eg, cyst removal, repair of scars simple hernia or
vaginal repair).
3. Required surgery: is warranted for conditions necessitating
intervention within a few weeks (eg, cataract surgery, thyroid
disorders).
4. Urgent surgery: is indicated for a problem requiring intervention
within 24 to 48 hours (eg, some cancers, acute gallbladder infection
and appendicitis, Kidney stones).
5. Emergency surgery: describes procedures that must be done
immediately to sustain life or maintain function (eg, repair of a
ruptured aortic aneurysm, gunshot, or knife wounds, extensive burns
, fractures skull, intestinal obstruction)
Informed Consent
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Information on the surgical procedure is provided by
the physician
Explanation includes permission a client gives after
an explanation of the risks, benefits, and alternatives
A signed form, witnessed by a nurse is evidence that
consent has been obtained
If the client is mentally confused, unconscious, or
mentally incompetent, the client’s spouse, nearest
blood relative, or someone with durable power of
attorney for the client’s health care must sign the
consent form.
PREOPERATIVE NURSING
CARE
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CONDUCT A NURSING ASSESSMENT
PROVIDE PREOPERATIVE TEACHING
PERFORM METHODS OF PHYSICAL
PREPARATION
ADMINISTER MEDICATIONS
ASSIST WITH PSYCHOSOCIAL
PREPARATION
COMPLETE THE SURGICAL CHECKLIST
SURGERY CHECKLIST
Purposes of Surgery
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Diagnostic
Curative
Restorative
Palliative surgery, which makes the
client more comfortable
Cosmetic surgery, which reconstructs
the skin and underlying structures
Collaborative Management
Assessment
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History and data collection
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Age
Drugs and substance use
Medical history, including cardiac and
pulmonary histories
Previous surgery and anesthesia
Blood donations
Discharge planning
Physical Assessment/Clinical
Manifestations
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Obtain baseline vital signs.
Focus on problem areas identified by
the client’s history on all body
systems affected by the surgical
procedure.
Report any abnormal assessment
findings to the surgeon and to
anesthesiology personnel.
System Assessment
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Cardiovascular system
Respiratory system
Renal/urinary system
Neurologic system
Musculoskeletal system
Nutritional status
Psychosocial assessment
Laboratory Assessment
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Urinalysis
Blood type and crossmatch
Complete blood count or hemoglobin
level and hematocrit
Clotting studies
Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray examination
Electrocardiogram
Deficient Knowledge
Interventions
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Preoperative teaching
Informed consent
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The surgeon is 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
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Client is given nothing by mouth
(NPO) for 6 to 8 hours before
surgery.
NPO status decreases the risk for
aspiration.
Failure to adhere can result in
cancellation of surgery or increase
the risk for aspiration during or after
surgery.
Administering Regularly
Scheduled Medications
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Consult the medical physician and
anesthesia provider for instructions
about drugs, such as those taken for
diabetes, cardiac disease, glaucoma,
regularly scheduled anticonvulsants,
antihypertensives, anticoagulants,
antidepressants, or corticosteroids.
Intestinal Preparation
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Bowel or intestinal preparations are
performed to prevent injury to the
colon and to reduce the number of
intestinal bacteria.
Enema or laxative may be ordered by
the physician.
Skin Preparation
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The skin is the body’s first line of
defense against infection; a break in
the barrier increases the risk for
infection.
Shower using antiseptic solution.
Shaving as a procedure before
surgery is viewed as controversial.
Preparing the Client
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Possible placement of tubes, drains,
and vascular access devices
Teaching about postoperative
procedures and exercises:
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Breathing exercises, incentive
spirometry, coughing and splinting
(Continued)
Preparing the Client (Continued)
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Leg procedures and exercises,
antiembolism stockings and elastic
wraps, early ambulation, and range-ofmotion exercises
DEEP BREATHING, COUGHING,
LEG EXERCISES
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Deep breathing is a form of controlled
ventilation that opens and fills small air
passages in the lungs to prevent atelectasis and
pneumonia.
Coughing is a natural method of clearing
secretions from the airways.
Leg exercises help promote circulation and
reduce the risk of forming a thrombus in the
veins.
Antiembolism stockings help prevent thrombi
and emboli by compressing superficial veins
and capillaries redirecting blood to larger and
deeper veins, where it flows more effectively
DEEP BREATHING &
COUGHING
LEGS EXERCISES
Anxiety Interventions
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Preoperative teaching
Encouraging communication
Promoting rest
Using distraction
Teaching family and significant
others
Preoperative Chart Review
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Ensure all documentation,
preoperative procedures, and orders
are complete.
Check the surgical consent form and
others for completeness.
Document allergies.
Document height and weight.
(Continued)
Preoperative Chart Review
(Continued)
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Ensure results of all laboratory and
diagnostic tests are on the chart.
Document and report any abnormal
results.
Report special needs and concerns.
Preop Client Prep
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Client should remove most clothing
and wear a hospital gown.
Valuables should remain with family
member or be locked up.
Tape rings in place if they can’t be
removed.
Remove all pierced jewelry.
(Continued)
Preop Client Prep (Continued)
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Client wears an identification band.
Dentures, prosthetic devices, hearing
aids, contact lenses, fingernail polish,
and artificial nails must be removed.
Preoperative Medication
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Reduce anxiety.
Promote relaxation.
Reduce pharyngeal secretions.
Prevent laryngospasm.
Inhibit gastric secretion.
Decrease amount of anesthetic
needed for induction and
maintenance of anesthesia.
PREOPERATIVE MEDICATIONS
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ANTICHOLINERGICS: Glycopyrrolate (robinal)
decreases respiratory secretions.
ANTIANXIETY: Lorazepam (ativan) reduces
anxiety.
HISTAMINE-2 RECEPTOR ANTAGONIST:
Cimetidine (tagamet) decreases gastric acidity and
volume.
NARCOTICS: Demerol (meperidine) decreases the
amount of anesthesia needed to sedate the client.
SEDATIVES: Midazolam (versed) promotes sleep
or conscious sedation and decrease anxiety.