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PREPARING FOR THE PATIENT IN SURGERY

PREPARING FOR THE PATIENT IN SURGERY. WEEK 6. Why Me? Thoughts that run thru the pt’s mind. Pt’s often question why them? Component that make up the individual: Physical Need : any need or activity related to genetics, physiology, or anatomy.

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PREPARING FOR THE PATIENT IN SURGERY

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  1. PREPARING FOR THE PATIENT IN SURGERY WEEK 6

  2. Why Me?Thoughts that run thru the pt’s mind • Pt’s often question why them? • Component that make up the individual: • Physical Need: any need or activity related to genetics, physiology, or anatomy. • Psychological Need: Any need or activity related to the ID and understanding of one’s self. • Social Need: Any need or activity related to one’s ID or interaction with another person or group. • Spiritual Need: Any need or activity related to one’s ID and understanding place in the universe.

  3. Why Me? • All of these needs exist as a group, not individually. • However, each individual is unique as each handles each situation differently. • Family members must be considered as well with consideration of their physical, psychological, social, and spiritual issues (maintain communication prn)

  4. Reasons for Surgery • Genetic deformity – Cleft Lip • Trauma – MVA • Nonmalignant tumor – Uterine Fibroid • Malignant tumors – Colon cancer • Disease - HIV • Condition – Kidney Stone • Psychological state – Facelift (Rhytidectomy)

  5. Preparing for the Patient in Surgery Requires Knowledge of: • HOLISTIC APPROACH Recognizing our patients as a person, not the case in OR #4 or the radical mastectomy in OR #4 • Maslow’s “Hierarchy of Needs”, a view of human development • “Life Tasks Approach” to psychosocial needs pg 61 • Cultural and Religious Influences • The “Nursing Process” as applicable to the ST

  6. Maslow’s Hierarchy of Needs

  7. Physiological Needs • Most basic biological or survival needs of the patient • Oxygen • Water • Food • Temperature regulation

  8. Safety Needs • Patient’s perception of placing trust that their environment is safe • Trust in surgeon • Trust in staff/institution • Warmth provided • Protected from infection by asepsis • Positioned comfortably • Injury prevented

  9. Love and Belonging Needs(Social) • Recognized and cared for as an individual • Caring for others • Interacting with others: family, friends, church members, and co-workers

  10. Esteem Needs • Positive regard for one’s self and others • To be respected and respect others

  11. Self-Actualization • To fulfill what one views as their potential or purpose in life

  12. Application of Maslow in Surgery • Prioritization of care in surgery • Trauma for example: biological issues take precedence (oxygen, blood loss control, pain relief, and infection control) • Can also recognize patient’s rights • Provide competent care • Provide safety, privacy, and respect

  13. Development and Change • Life Tasks Approach (Table 4-2, pg. 61) • The Life Tasks Approach gives us a way to understand a surgical patient’s needs and fears

  14. Development and Change • Open to page 61 - discuss

  15. Death and Dying • 3 accepted definitions of death: • Cardiac death: complete absence of heartbeat and respiration. • Higher Brain Death: irreversible loss of higher brain function. PT still has respiration, BP, and heart beat w/o the aid of a respirator. • Whole-Brain Death: irreversible loss of all brain function. Includes flat EEG, lack of pupil reflexes, and hypothermia.

  16. Cultural Considerations • Gives us a perspective of the surgical patient’s thoughts and feelings about health care needs • Language can be a huge barrier • Cultural considerations can help us for when we can’t communicate, as well as when we can

  17. Asian Americans • Chinese: • silence is valued • touch is limited • fear invasive procedures • distrustful of doctors and health care workers who perform painful procedures • both parents involved in decisions regarding their children

  18. Asian Americans continued • Japanese: • touch is limited • feel direct eye contact disrespectful • stoic • family needs come first • eldest child cares for elderly

  19. Asian Americans continued • Vietnamese: • eye contact disrespectful • father is decision maker • use titles when addressing • do not ask direct questions

  20. Asian Americans continued • Filipinos: • avoid eye contact • value nonverbal communication • family needs come first

  21. Hispanic Americans • Father needs to be there when speaking to male children • Familial and personal privacy valued/very modest • Father decision maker and provider for family • Women tend to the ill • Fearful of hospitals/may see as a “place to die”

  22. American Indians • Avoid prolonged direct eye contact • Family members are responsible for each other • Takes time for them to form opinions about health care providers • Elders assume leadership roles • With amputated limbs, may require them to go to the family or stay with patient

  23. Middle Eastern • No touching outside family or spouse • Male dominated culture, therefore is decision maker • Males are only to be alone with their wife, not other females (May require male health care workers) • Females can only be touched by female health care providers

  24. Appalachian • Direct eye contact disrespectful • Kindness valued • Judge health care workers by how they relate to them not by competence • Fearful of hospitals, considered a “place to die” • Care of the ill is provided by family including extended family members

  25. Religious Considerations • ST needs a basic understanding of different religions and their relationship to health care • Religion can raise ethical and legal issues for patients and health care providers • Religion can conflict with modern medical technology

  26. American Indian • Abortion not allowed • Organ transplantation discouraged • Medical treatment views vary

  27. Islam • Privacy important • Medical treatment is encouraged

  28. Roman Catholic • Abortion not allowed

  29. Jehovah’s Witness • No food containing blood • No blood transfusion • Abortion not allowed • Organ transplantation allowed provided organ is stripped of all blood

  30. Special Populations • Pediatric patients • Geriatric patients • HIV, Trauma, Organ Donor or Recipient

  31. Pediatric Patients • Specialty area • Anatomy and physiology differ from adult • Response to anesthesia and other medications differ from adults • Psychologically, communication with child dramatically different • Descriptions of pain and pain locations may not be precise like an adult

  32. Pediatric Patient continued • Surgical team will naturally feel more protective towards children • Communication with infant to two year olds will be limited to reassurances and snuggling • Explanations should be short and appropriate for the three year old to twelve year old

  33. Surgical Team Role with Pediatric Patient • Obtain good anesthesia • Finish surgical procedure effectively, efficiently, and safely • Get the child back to their family as soon as possible • Will be more sensitive to cold room temperatures due to decreased body surface area, so room will be kept very warm

  34. Geriatric Patients • May or may not have diminished mental status/Do not assume all elderly are “senile” as most are not • Pay special attention to physical changes in the body that do affect all elderly and directly influence our care of them

  35. Physical Changes of the Geriatric Patient • Skin loses elasticity causing it to easily bruise or tear • Care must be taken when moving and positioning patient to avoid shearing or bruising of the skin • Care must be taken when applying and removing tape and or other sticking drape materials to avoid thin areas of skin and ripping skin off the body • Sensitive to prolonged pressure over bony prominences/Pad these areas well to avoid ulceration

  36. Physical Changes of the Geriatric Patient • Loss of subcutaneous layer or fatty/protective layer of skin • Causes sensitivity to cold and can result in hypothermia • Use warm blankets and warm fluids • Keep as much of the body insulated as possible • With Bair Huggers always attach/Never leave hose free to just blow onto body as can cause major burns

  37. Physical Changes of the Geriatric Patient • Loss of bone, joint mobility, and muscle mass • Loss of flexibility • More prone to fracturing of the bones • Extreme care with positioning and padding

  38. Physical Changes of the Geriatric Patient • Loss of urinary bladder and bowel control • Don’t be surprised by SURPRISES • Maintain patient integrity and privacy and assist with cleaning at the end of the procedure before transport • SURPRISES that have prolonged contact with the skin can cause breakdown of the skin

  39. HIV, Trauma, Organ Donors or Recipients • Maintain caring environment • Maintain asepsis • Maintain same high level of care to surgeon and patient • Protect the patient from injury from environmental hazards

  40. ST Responsibilities • Ethically and legally responsible to provide service to our surgeon and patient despite how we feel about the culture or religious beliefs of our surgeons or patients • Must provide a caring environment • Must provide surgical asepsis • Must protect the patient from injury • THE PATIENT COMES FIRST

  41. Maintaining the Surgical Environment Continued • Speak in a calm, clear, unhurried tone • Move patients with care paying attention to proper body alignment and any IV lines or other lines that could get snagged during movement from stretcher to OR bed and back • Maintain safety precautions for everything in the OR room that could cause the patient harm or injury • Perform tasks in an efficient and effective manner • BE EXTRA EYES AND EARS FOR THE PATIENT’S NEEDS AND SAFETY

  42. Helping to Maintain the Surgical Environment as the ST • Can introduce self professionally • Maintain communication with the RN circulator throughout the surgical procedure • Aid with reports on where you are in the procedure and status of the patient so the RN circulator can keep the family informed • If assisting the circulator, a touch or squeeze of the patient’s hand can calm a fearful patient • Explain everything you are going to do when the patient is awake (regional anesthesia) • Use appropriate language that can be understood not medical terms

  43. Military Time

  44. Military Time • You will often see military time in the OR, on the chart and used between staff. • It is used to avoid confusion between a.m. and p.m. since we are a 27/7 service. • The main difference between regular and military time is how hours are expressed. Regular time uses numbers 1 to 12 to identify each of the 24 hours in a day. In military time, the hours are numbered from 00 to 23. Under this system, midnight is 00, 1 a.m. is 01, 1 p.m. is 13, and so on.

  45. Military Time Morning After Noon (just add 12) Noon = 1200 1:00 p.m. = 1300 3:00 p.m. = 1500 6:00 p.m. = 1800 • Midnight = 0000 • 1:00 a.m. = 0100 • 3:00 a.m. = 0300 • 6:00 a.m. = 0600

  46. Summary • Reasons for surgery • Recognizing patient as a person: physical psychological social spiritual

  47. Summary continued • Maslow’s Hierarchy of Needs • Life Tasks Approach to development and change • ST role in maintaining surgical environment • Cultural considerations • Religious considerations

  48. Summary continued • Special populations: Pediatric Geriatric HIV, Trauma, Organ donor or recipient • ST responsibilities

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