Perl-operative Nursing Phases of Perl-operative period 1. PRE- operative phase 2. INTRA- operative phase 3. POST- operative phase PRE-Operative Phase Begins when the decision to have surgery is made and ends when the client is transferred to the operating table INTRA-operative Phase Begins when the client is transferred to the operating table and ends when the client is admitted to the post-anesthesia unit Post-operative Phase Begins with the admission of the client to the PACIFIC and ends when healing is complete Activities in the Pre-pop 1 . Assessing the clients 2. Identifying potential or actual health problems 3.
Planning specific care 4. Providing pre-operative teaching 5. Ensure consent is signed Activities during the Intra-pop 1 . Assisting the surgeon as scrub nurse and circulating nurse Activities in the POST-pop 2. Assessing responses to surgery 3. Performing interventions to promote healing 4. Prevent complications 5. Planning for home-care 6. Assist the client to achieve optimal recovery TYPES of SURGERY 1 . According to PURPOSE 2. According to degree of URGENCY 3. According to degree of RISK Effects of Surgery on the Client Stress response (Neuroscience response) is activated Resistance to infection is lowered due to surgical incision
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Vascular system is disturbed due to severing of blood vessels and blood loss Organ function may be altered due to manipulation Factors influencing Surgical Risk Age Nutrition Fluid and Electrolyte balance General health status: infection, cardiovascular disease, pulmonary problems, liver dysfunctions, renal dysfunctions or metabolic disorders Medications affecting Surgery Anticoagulants like aspirin and UNSAID should be discontinued 2 weeks Tranquilizer may cause hypertension and shock Antibiotics like encyclopedias may intensify effects of anesthesia Diuretics may cause electrolyte imbalance antiphon may cause hypertension Psychological support Assess client’s fears, anxieties, support system and patterns of coping Establish a trusting relationship with client and family Explain routine procedures, encourage fertilization of fears and allow clients to ask questions Provide for spiritual care if needed Preoperative teaching Assess client’s level of understanding of surgical procedure and its implications Answer questions, clarify and reinforce explanations given by the surgeon Explain routine pre-pop and post-pop procedures Teach coughing and deep breathing exercise, splinting of incision, turning side to did.
Explain its importance in preventing complications Assure client that pain medication will be given Pre-operative teaching Physical Preparation Obtain hex of past medical conditions Perform baseline head to toe examinations including vital signs Ensure that diagnostic exams are performed CB, Electrolytes, APT/APT, Urinalysis, EGG, Blood typing, Chest Cray Prepare client skin Shower with antibacterial soap to cleanse skin Skin prep if ordered: shave or clip hairs and cleanse appropriate areas to reduce bacteria on skin Administer enema if ordered Promote adequate rest and asleep Instruct client to remain NP after midnight to prevent vomiting and aspiration Pre-pop elimination Laxatives, enemas or both may be prescribed the night before surgery Have the client void immediately BEFORE transferring them to the OR Foley catheter may be inserted as ordered Legal Responsibility Surgeon obtains operative permit (Informed consent) 1. Surgical procedure, alternatives, possible complications, disfigurements 2.
Part of nurse’s role as client advocate to confirm that clients understands information given Informed Consent An active shared decision making process between the provider and the recipient of are. 3 conditions 1 . Adequate disclosure of the diagnosis, nature and purpose of treatment, risk and consequences, probability of successful outcome and prognosis if treatment is not done. 2. Patient must demonstrate a clear understanding and comprehension of information being provided 3. Recipient of care must give consent voluntarily, not persuaded or coerced to undergo the procedure. Consent are not needed for emergency care if; 1. There is an immediate threat to life 2. Experts agree that it is an emergency 3. Client is unable to consent 4. A legally authorized person cannot be reached
Preparation Immediately before surgery Obtain a baseline vital signs Provide oral hygiene and remove dentures Remove client’s clothing and dress in clean gown Remove nail polish, cosmetics, Jewelry Instruct to empty bladder Check identification band Intra-operative phase interventions Determine the type of surgery and anesthesia used Position client appropriately for surgery Assist the surgeon as circulating or scrub nurse Maintain the sterility of the surgical field Monitor for developing complications Preparing the surgical site Purpose of prepping is to reduce the unit of organisms available to migrate to the surgical wound. Task is the responsibility of the circulating nurse Principle of scrubbing from the clean area to dirty area is observed at all times Anesthetics Anesthetics are drugs that are used to cause complete or partial loss of sensation. The numerous anesthetics can be broadly classified as : 1. General 2.
Local anesthetics General Anesthesia Loss of sensation with loss of consciousness Skeletal muscle relaxation Analgesia Elimination of somatic, autonomic and endocrine response including coughing, gagging and vomiting Protective reflexes are lost Amnesia, analgesia and hypnosis occur Administered in two ways: Inhalation Intravenous IV anesthetics Produces rapid, smooth induction, may be used alone in short procedures Common IV anesthetics: methodical, Sodium tapeline (Penetrate), modally Disadvantages: poor relaxation, respiratory and myocardial depression in high doses, bronchiole’s, laryngitis’s, hypertension and respiratory depression Dissociation Agents Produce state of profound analgesia, amnesia and lack of awareness without loss of consciousness Astatine (Catalan) Side effects: tachycardia, hypertension, respiratory depression, hallucinations Precautions: decrease verbal, tactile and visual stimulation during recovery period
Narcoleptics Produces state of narcoleptic analgesia characterized by reduced motor activity and analgesia without loss of consciousness Fontanel citrate (Innovator) SE; hypertension, brickyard, respiratory depression, skeletal muscle rigidity, twitching Precaution: reduce narcotic dose to prevent respiratory depression Local Anesthesia Local anesthetics are drugs that cause a loss of sensation in limited areas of the body to abolish pain. They are powerful nerve blockers injected locally. Systemic absorption of the anesthetics can produce numerous side effects. Examples of Local anesthetics: The “CANINES” Loading Debasing Procaine Terracing The side effects of local anesthetics Local effects- local irritation and skin breakdown CONS effects if systemic absorption occurs- headache, restlessness, anxiety, dizziness, tremors and blurred vision.
GIG system- nausea, vomiting Cardiac- arrhythmias, peripheral vacillation, myocardial depression, and rarely, cardiac arrest Nursing Responsibilities Maintain emergency equipment on standby to provide life-support in cases of severe reactions Ensure that drugs are available for managing hypertension, cardiac arrest ND CONS alterations. Provide adequate hydration to patients receiving spinal anesthesia. Position the client supine for up to 12 hours after spinal anesthesia to minimize spinal headache Provide safety and comfort measures such as side-rails up, frequent skin care and supportive care Give health teaching to explain things the patient needs to know to allay fears. Stages of Anesthesia Depth Usually trained individuals with the special equipments ready for life support administer the agents The patient undergoes through a predictable stages known as STAGES of ANESTHESIA: 1 to 4