nursing care of the surgical patient n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Nursing Care of the Surgical Patient PowerPoint Presentation
Download Presentation
Nursing Care of the Surgical Patient

Loading in 2 Seconds...

play fullscreen
1 / 34

Nursing Care of the Surgical Patient - PowerPoint PPT Presentation


  • 264 Views
  • Uploaded on

Nursing Care of the Surgical Patient. The PeriOperative Continuum of Care. Marymount University NU 331 : Fall 2011. Surgery. What is it? Where is it performed? Who does it?. Categories of Surgery. By anatomic location Procedure to be performed Purpose of surgery .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Nursing Care of the Surgical Patient' - margo


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
nursing care of the surgical patient

Nursing Care of the Surgical Patient

The PeriOperative Continuum of Care

Marymount University

NU 331: Fall 2011

surgery
Surgery

What is it?

Where is it performed?

Who does it?

categories of surgery
Categories of Surgery
  • By anatomic location
  • Procedure to be performed
  • Purpose of surgery
categories of surgery1
Categories of Surgery
  • Urgency of Surgery

- Elective

- Urgent

- Emergent

  • Degree of Risk
    • Minor
    • Major
medical terminology
MedicalTerminology

-ectomy

-ostomy

-otomy

-plasty

-orraphy

-scopy

perioperative continuum of care
PeriOperativeContinuum of Care
  • PreOperative Phases of Care
  • IntraOperative Care
  • PostOperative Phases of Care
preoperative phases of care
PreOperative Phases of Care

PreOperative Screening

- Interview and Assessment

- Physical and Function Examination (baseline)

- Laboratory and Diagnostic Tests

- Education and Interventions

- Paperwork (patient’s chart is generated from the above)

slide8

Interview & Assessment

* * Listen to the Patient * *

    • Obtained via phone or in-person
    • Patient Identification (2 identifiers)
    • Patient asked to state their surgeon & their procedure
      • site and lateral side if applicable
    • Current Health Problem
    • Plans for autologous blood donation
    • Allergies
  • Drug, Latex, Foods, Contact, Environmental
    • Height and Weight
      • BMI calculated
slide9

Interview & Assessment

  • Past medical and surgical history
  • Experiences with anesthesia
  • Family history
  • Review of systems
  • Medications
  • Pain
  • Risk Score for post-op nausea & vomiting (PONV)
  • Social Implants or prosthesis
  • Psychosocial
  • Cognitive & perceptual
  • Activity/Mobility
  • Nutrition and Elimination
  • Advance Directives / Health Care Durable Power of Attorney
  • Other ?
slide10

Physical and Functional Examination (baseline)

  • Generally performed by pt’s primary physician, NP, or PA.
  • Faxed to PreOP Screening
  • Neurological,Cardiovascular, Respiratory, GI, GU,

Musculoskeletal, Endocrine, Nutritional, Integumentary

  • If applicable, clearance and recommendations
    • Medical, Cardiac
slide11

Laboratory and Diagnostic Tests

- *Completed before or day of surgery

- Common labs for surgery: CBC, BMP/CMP,

Type & Screen or Crossmatch, Urinalysis, hCG

- Chest X-Ray, EKG

- Tests based on patient’s age, specific history,

type of surgery, anesthesia classification system

Nursing Responsibilities with Labs/Tests

- Ensure results are on chart

- Call anesthesia and/or surgeon for any abnormal findings

- Tailor tests to the patient

slide12
Education and Interventions

To prepare patient for surgery, postoperative recovery,

and discharge!

To optimize patient outcomes!

To promote patient safety!

To promote patient satisfaction!

* Patient is an active participant!

slide13
Education and Interventions

Include but not limited to:

  • Procedural – surgery and anesthesia
    • Medications prior to surgery
    • Food and fluids
    • Preps
  • Sensation and comfort
    • (what they will see, hear, feel, smell)
  • Patient role
  • Skills training info (joint replacement class)
  • Psychosocial support
    • Ride home
    • Caregiver at home
potential nursing diagnoses
Potential Nursing Diagnoses
  • Knowledge Deficit
  • Anxiety
  • Acute Pain
  • Risk for Ineffective Thermoregulation
  • Others ?
slide15

Day of Surgery

Unless surgery is an emergency or pt is already

hospitalized… most patients come to the hospital

the day of surgery for their final preparation.

- Review of PreOp History and Assessment

- Physical and Functional Assessment of Patient

- Review of Chart

- Teaching

day of surgery nursing assessment
Day of Surgery: Nursing Assessment

Patient Identification and Surgery Verification!

Allergies

What time did you last eat or have a bite of food? Fluids?

Medications

Document Vital Signs

Height and Weight

Nursing History

Cultural Considerations

Nursing Physical and Functional Assessment

Review of Systems

slide17
Review chart for completeness

Labs/tests

If abnormalities, have they been reconciled?

If required, history & physical, and

medical clearance from pt’s primary

Operative Consent

Anesthesia Consent

Complete Pre-OP Checklist

Pre-Op

C

H

E

C

K

L

I

S

T

consents
CONSENTS
  • Informed Consent
      • Adequate disclosure
      • Understanding & comprehension
      • Voluntary consent
  • Nurse Role
      • Witness Only
      • Advocate for patient as needed
teaching listen to the patient
Teaching - Listen to the patient
  • Individualized for the patient and the type of surgery
  • Increases patient satisfaction and fear
  • Supplements teaching of surgeon & PreOp Screening Dept
  • Includes but not limited to:
    • Progression postoperatively through continuum of care
    • Realistic view of surgery (without creating heightened anxiety)
    • Initial recovery from anesthesia will be in PACU with continuous monitoring
        • Describe continuous monitoring
    • Pain scale and pain management
    • PONV & PDNV (post op/ post discharge nausea & vomiting)
teaching
Teaching
  • Sensory information
    • Nerve blocks, long acting local anesthetics
  • Procedural information
    • Prepare for tubes, drains, colostomy if applicable
  • Restrictions
    • Dietary, physical restrictions, driving, returning to work

* D O C U M E N T

  • If it is not documented… it was not done!
intraoperative nursing
IntraOperative Nursing
  • Definition
  • Important Aspects
  • OR Locations
    • Unrestricted
    • Semi-Restricted
    • Restricted
  • Surgical Team:
    • Surgeon
    • Anesthesia Care Provider (ACP)
    • Scrub Nurse
    • Circulating Nurse
intraoperative nursing positioning
IntraOperative Nursing: Positioning
  • Occurs after anesthesia given
  • Pt positioned for type of surgery
  • Padding and support (equipment) to maintain position
  • Position routinely monitored during the procedure by circulating nurse (and documented)
  • Important Points:
    • Maintain proper alignment
    • Prevent pressure = nerve damage & skin breakdown
    • Prevent occlusion of blood vessels = tissue death
    • Care to avoid known areas of weakness or pain
intraoperative nursing patient advocate
IntraOperative Nursing: Patient Advocate
    • TIME OUT / Procedural Pause
      • Joint Commission UNIVERSAL PROTOCOL
  • Watches out for & speaks for the patient
    • Patient is anesthetized!
  • Maintains sterile field - prevent infection
  • Maintain safety - position, meds, procedure etc
  • Maintain modesty - cover patient
  • Question anything that doesn’t seem “right”
conscious sedation
Conscious Sedation

For patients undergoing sedation for short-term therapeutic,

diagnostic or surgical procedures at the bedside or in OR:

  • A drug induced minimally depressed level of consciousness
    • Pt does not lose consciousness
  • Pt is less aware of pain and the procedure
  • Ability to follow verbal commands
  • Requires a specially trained nurse to monitor the patient after medications are given
  • Possible complications
    • Respiratory depression or obstruction
    • Hypoxia
    • Hypotension
conscious sedation nursing responsibilities
Conscious Sedation: Nursing Responsibilities
  • Following the administration of conscious sedation the nurse has no other responsibility than to monitor the patient:
    • Cannot leave the pt unattended or compromise continuous monitoring!
    • Standard of care is based on anesthesia standards of practice
conscious sedation nursing responsibilities1
Conscious Sedation: Nursing Responsibilities
  • Monitor airway
  • Monitor and document vital signs (every 5 minutes)
  • Monitor LOC:
  • Position:
  • Monitor for potential complications of procedure
  • Document
general anesthesia
General Anesthesia
  • Definition: loss of sensation, loss of consciousness, total skeletal relaxation, loss of somatic & autonomic responses, & loss of certain reflexes such as cough /gag reflex.
  • Performed by anesthesiologist/CRNA only
  • Used for skeletal surgeries, prolonged surgeries, other types of anesthesia contraindicated, or anxious
  • Consists of inhaled & IV meds with certain adjunct meds
  • Requires constant monitoring:
    • Airway (possible vent)
    • Circulatory (fluid & electrolyte balance)
    • Safety (due to loss of sensation & reflexes)
intraoperative nursing complications
IntraOperative Nursing: Complications

Malignant Hyperthermia (http://www.mhaus.org/)

  • Rare but with a genetic link
    • Metabolic disease characterized by very high temps and skeletal rigidity
    • Triggers: Succinylcholine with inhaled anesthesia, stress, trauma & heat
    • Patho: Intracellular calcium level increases resulting in hypermetabolism in skeletal muscle causing rigidity, hyperthermia, hypoexemia etc.
    • High temp is a late sign/symptom = MONITOR!
    • Treatment: Dantrolene
postoperative nursing
PostOperative Nursing
  • The period beginning when the patient leaves the OR suite and arrives in the recovery room (PACU)
  • Continues until the patient is discharged home or is admitted into the hospital
  • PACU Care:
    • Begins with report from circulating nurse or anesthesia
    • ABC’s vital
    • Care based on body systems
    • Teaching
    • Discharge instructions vs report to the floor nurse
postoperative nursing body systems
PostOperative Nursing: Body Systems
  • Respiratory
  • Cardiovascular
  • Neurovascular
  • Pain
  • Integumentary
  • Gastrointestinal
  • Urinary
postoperative nursing teaching
Postoperative Nursing: Teaching

Begins when patient arouses and continues until discharge from PACU. Should include:

  • Pain management
  • PONV/PDNV management
  • Maintaining normal temperature
  • If diabetic check their blood sugar more often… follow up with endocrinologist
  • Drain management
  • Other meds ordered and why
  • Other meds ordered and why
  • Activity level
  • Dietary restrictions
  • Wound care
  • Bowel regularity
  • Signs & symptoms to report to nurse or MD
  • Follow-up care

Answer all patient questions!

potential nursing diagnoses1
Potential Nursing Diagnoses
  • Risk for impaired gas exchange
  • Risk for imbalanced fluid volume
  • Risk for decreased cardiac output
  • Risk for imbalanced body temperature or thermoregulation
  • Risk for infection
  • Readiness for enhanced comfort
  • Risk for Nausea (anesthesia, narcotics, secondary to anesthesia/surgery)
  • Deficient knowledge related to postoperative care
  • Other?
postoperative complications
PostOperative: Complications
  • Atelectasis and Pneumonia
  • Risk for constipation, ileus and abdominal distention
  • Urinary retention
  • Wound Infection
  • Wound dehiscence and evisceration
  • Wound drains
  • Thromboemboli