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Definition of Perioperative Nursing
The provision of nursing care by an RN preoperatively, intraoperatively, and postoperatively to a patient undergoing an operative or invasive procedure.
MLNGCeleste, RN, MD
Areas in Which Perioperative Nursing Is Practiced
• Perioperative nursing is practiced in– Hospital operating rooms– Interventional radiology suites– Cardiac cath labs– Endoscopy suites– Ambulatory surgery centers– Trauma centers– Pediatric specialty hospitals– Physician offices MLNGCeleste, RN, MD
Functions of thePerioperative Nurse
• Advocate
• Protector
• Teacher
• Change agent
• Manager of patient care
MLNGCeleste, RN, MD
Nursing Roles in the OR
– Circulating Nurse– Scrub person– RN first assistant (RNFA)– Perioperative educator– Specialty team leader– Perioperative manager
MLNGCeleste, RN, MD
Surgical Attire
• Gowns
• Gloves
• Masks
• Hair covering
• Protective eyewear
MLNGCeleste, RN, MD
Goals of Patient Safety
• Provide safe patient care– Knowledge of procedure– Ensure the correct patient, correct site, correct level, and correct
procedure– Knowledge of positioning– Adhere to safe medication administration guidelines– Perform surgical counts
• Provide a safe environment– Adhere to asepsis– Promote coordinated and effective communication
MLNGCeleste, RN, MD
Phases of Perioperative period
• PRE- operative phase
• INTRA- operative phase
• POST- operative phase
MLNGCeleste, RN, MD
PRE-Operative Phase
• Begins when the decision to have surgery is made and ends when the client is transferred to the operating table
MLNGCeleste, RN, MD
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
MLNGCeleste, RN, MD
Post-operative Phase • Begins with the admission
of the client to the PACU and ends when healing is complete
MLNGCeleste, RN, MD
TYPES of SURGERY
• According to PURPOSE
• According to degree of URGENCY
• According to degree of RISK
According to PURPOSE
Diagnostic Establishes a diagnosisEg. Biopsy, laparoscopy
Palliative Relieves or reduces pain or corrects a problem eg. Gastrostomy tube insertion
Ablative Removes a diseased body partEg. appendectomy
Constructive Restores function or appearanceEg. Face lift
Transplant Replaces malfunctioning structures eg. Kidney transplant
According to degree of URGENCY
Emergency surgery
Preserves function or life
Performed immediately
Elective surgery
Performed when condition is not imminently life threatening
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OTHER Classification
Indication for
surgery
examples
I.Emergent
life threatening
Without delay Trauma (gunshot, etc.)
II Urgent 24-30 hrs AP, Cholecystitis
III. Required Plan within weeks or month
Cataracts, thyroid
IV. Elective No emergency CS, hernia
V. Optional Personal preference
Cosmetic surgery
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Other types of SurgeryPROPHYLACTIC
PREVENTATIVE
Prevents a more serious condition from developing
INPATIENT SURGERY
Client has been in the hospital prior to the decision to have a surgery
OUTPATIENT SURGERY
Client enters the hospital to have surgery done
According to degree of RISK
Major Surgery
Involves high degree of risk
Complicated or prolonged, Large amount of blood loss
Minor Surgery
Involves low risk
Produces few complications
Performed as day surgery
MLNGCeleste, RN, MD
Activities in the Pre-op• Assessing the clients: Nursing history, physical and
emotional assessment, medication history• Identifying potential or actual health problems
(comorbidities)• Ensure necessary test were done including proper
referrals and consultation• Educate about recovery from anesthesia and
postoperative care• Providing pre-operative teaching • Ensure consent is signed• Start an IV infusion• Address questions of the patient and family
Consent
• The surgeon is responsible for obtaining the consent for surgery
• No sedation should be administered before SIGNING the consent
• The nurse may serve as witness
INFORMED CONSENT
• EMANCIPATED MINOR- below legal age of 18 but who is living independently from parents or who is already living in with a partner; with children of their own
Health factors (Preoperative) that may affect the outcome of the Surgery• Nutritional status• Drug or alcohol abuse• Respiratory status• Cardiovascular status• Hepatic and renal Factors• Endocrine Function• Immune function• Previous medication use• Psychosocial factors• Spiritual and cultural beliefs
Surgical Risk
• Extremes of age• Malnourished• Obese• Co-morbid conditions (HPN,
cardiac disease, diabetes, renal failure)
• Concurrent medications (aspirin, diuretic, insulin, antihypertensives, steroids)
Pre-operative Interventions
• Secure consent (operative permit)• Obtain nursing history, PE and lab exam• Provide pre-operative teaching as to the
nature of surgery, what to expect and ways to manage post-operative discomforts
• Perform physical preparations- shaving, hygiene, enema, NPO, medications
Pre-op nutrition
• Assess order for NPO
• Solid foods are withheld for
about 8 hours before general anesthesia
Pre-op 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
Pre-op hygiene • Bathe the night or morning before
surgery with antiseptic soap• Shaving of the skin is usually done in
the OR• Removal of jewelry and nail polish
*CONTACT LENSES/ HEARING AIDS/ DENTURES
Pre-op psychological preparation
• Be alert to the client’s anxiety level
• Answer questions or concerns
• Allow time for privacy
• Preparing the skin (shaving, using antiseptic solution)
• Asking the patient to void
• Administering Preanesthetic medications
• Transporting the patient to the presurgical area
Pre-operative medications
Pre-op Drugs Example Purpose
Anti-anxiety
Diazepam To decrease nervousness
Promote relaxation
Anti-cholinergic
Atropine Decreases secretions
Prevent bradycardia
Muscle relaxant
Succinylcholine To promote muscle relaxation
Anti-emetic Promethazine To prevent nausea and vomiting
Antibiotic Cephalosporin To prevent infection
Pre-operative medications
Pre-op Drugs
Example Purpose
Analgesic Meperidine (DEMEROL)
To decrease pain and decrease anesthetic dose
Anti-histamine
Diphenhydramine (BENADRYL)
To decrease occurrence of allergy
H-2 antagonist
Cimetidine (TAGAMET)
To decrease gastric fluid and acidity
• Pre-operative teaching Leg exercises To stimulate blood circulation
in the extremities to prevent thrombophlebitis
Deep breathing and Coughing
Exercises
To facilitate lung aeration and secretion mobilization to prevent atelectasis and hypostatic pneumonia
Done every two to four hours
Positioning and Ambulation
To stimulate circulation, stimulate respiration, decrease stasis of gas
Pre-operative teachingPre-operative teaching
Assisting patient to semi-Fowler’s position, leaning forward.
Having patient splint a chest or abdominal incision by holding a
folded bath blanket or pillow against the incision.
Telling patient to take a deep breath and hold it for three seconds.
Encouraging patient to "hack" out three short coughs after holding
breath.
With mouth open, patient should take a quick breath.
Encouraging patient to cough deeply once or twice and then take
another deep breath.
An incentive spirometer helps increase lung volume and promotes
inflation of the alveoli.
Assisting patient to semi-Fowler’s position.
Setting the volume goal indicator on the spirometer.
Patient holding the device and placing lips around the mouthpiece to create a seal, then taking a deep
breath in.
The patient can observe progress toward the goal by watching the balls or diaphragm of spirometer
elevate or lights go on (depending on equipment used). Have patient
repeat exercise 5 to 10 times every 1 to 2 hours while awake
Assisting patient to a semi-Fowler’s position with knees bent.
Raising patient’s right foot and keeping it elevated for a few
seconds.
Extending the lower portion of the leg.
Lowering the entire leg to the bed. This exercise is repeated five times
with each leg.
Patient pointing toes of both feet toward the foot of the bed, with
both legs extended.
Patient pulling toes toward chin, as if a string were attached to them
Having patient make circles with both ankles, first one way and then
the other.
Instructing patient to raise one knee and reach across to grasp the side rail on the side of the bed toward which he or she will be turning.
Helping patient to rollover while he or she pushes with the bent leg and
pulls on the side rail.
Showing patient how to use a small pillow to splint a chest or abdominal
incision while turning.
After patient is turned, providing support with pillows behind the
patients back.
Pre-operative screening test
CBC Determine Hgb and Hct, infection
Blood type Determined in case of blood transfusion
Serum electrolytes
Evaluates the fluid and electrolyte status
FBS Evaluates diabetes mellitus
BUN, Creatinine Assess the renal function
ALT, AST, Bilirubin
Evaluates the liver function
Serum albumin Evaluates nutritional status
CXR and ECG Respiratory and Cardiac status
MLNGCeleste, RN, MD
Activities during the Intra-op
Provide patient safety, maintain an aseptic environment, ensure proper function of the equipments, position the client, emotional support, assisting the surgeon as scrub nurse, circulating nurse, nurse assistant,
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
Principles of Sterile TechniqueMLNGCeleste, RN, MD
Basic Guidelines in Surgical Asepsis
• All materials in contact with the surgical wound and used within the sterile field must be sterile.
• Gowns are considered sterile in front from the chest to the level of the sterile field.
• Sterile drape
• Items should be dispensed to a sterile field by methods that preserve the sterility
• Movement of the surgical team are from sterile to sterile and from unsterile to unsterile area
• Movement around a sterile field must not cause contamination of the field
• When a sterile barrier is breached, the area , must be considered contaminated
Operating Room Team
direct patient care team
• The team is likely a symphony orchestra
• Each person is an integral entity in harmony with his colleagues
1. THE STERILE TEAM
2. THE UNSTERILE TEAM
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The Sterile Team– Operating surgeon– Assistants to the surgeon: Another surgeon
(1st assist), surgical resident doctor (2nd assist), RN assist (3rd assist)
– Scrub Nurse– They:
• Scrub their hands and arms• Don sterile gloves and gown• Enter the sterile field (all items for the surgical
procedure are sterilized)
MLNGCeleste, RN, MD
The Unsterile Team– Anesthesiologist or anesthetist– Circulating nurse– Technicians – They:
• Don’t enter the sterile field• Function outside of the sterile field• Maintain sterile technique
MLNGCeleste, RN, MD
Functions of the nurse during OR procedure
SCRUB NURSE •Assists the surgeon
•Maintains sterility
•Set up sterile tables, Prepares and Handles instruments, sutures
•Drapes patient
•Counts sponges, needles, instruments
•Wears sterile gown, gloves
CIRCULATING NURSE
•Assists the Scrub nurse
•Positions the patient for
surgery
• Positions any equipment
•Monitors/coordinates all activities•Controls the physical and emotional atmosphere in the room•Protects the pt’s safety and health
Scrub Nurse– Maintain safety of the sterile field– Knows the sterile and aseptic technique– Prepares the instruments– Assists the surgeon with the instruments– PRIVATE SCRUB NURSE (employed by the
surgeon)
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Circulating Nurse– Monitors/coordinates all activities
– Controls the physical and emotional atmosphere in the room
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SEDATION
• MINIMAL SEDATION
• MODERATE SEDATION
• DEEP SEDATION
• ANESTHESIA
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Minimal sedation
- drug induced state in which a patient can respond normally in verbal commands
- cognitive function and coordination may be impaired
Levels of Sedation
Moderate sedation
- depressed level of consciousness that does not impair ability to maintain a patent airway
- calm, sedate a patient combined with analgesic
- Midazolam/Diazepam
Deep Sedation - a drug induced state in
which a patient cannot be easily aroused but can respond purposefully after repeated stimulation
- inhaled or intravenous - Volatile anesthetic
(halothane, Isoflurane) - Gas anesthetic (Nitrous
oxide)
ANESTHESIA
• absence of sensation
• state of narcosis (severe CNS depression produced by pharmacological agents), analgesia, relaxation and reflex loss
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• Loss of the ability to maintain ventilatory function
• Client requires assistance to maintain a patent airway.
• Cardiovascular function may be affected as well
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Anesthesia - a state of narcosis, analgesia,
relaxation and reflex loss
• General anesthesia– Loss of all sensation and
consciousness; cardiovascular and ventilatory functions are impaired
• Regional or Local anesthesia– Loss of sensation in ONE area with
consciousness present
Methods of Anesthesia Administration
• Inhalation
• Intravenous
• Regional Anesthesia: Epidural & Spinal
• Local Conduction Blocks: Local Infiltration
GENERAL ANESTHESIA• the patient is unconscious and does
not see, hear, or feel anything. It provides pain relief, muscle relaxation, and amnesia so you don't remember the details of your surgery.
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GENERAL Anesthesia
• Administered in two ways: – Inhalational
– Intravenous
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PURPOSES OF GENERAL ANESTHESIA• pain relief (analgesia) • blocking memory of the procedure (amnesia) • producing unconsciousness • inhibiting normal protective body reflexes to
make surgery safe and easier to perform • relaxing the muscles of the body
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Stages of General Anesthesia• Stage I (Beginning Anesthesia/ INDUCTION
PHASE)
- patient may still be conscious, senses inability to move extremities
- patient feels warm, dizzy with a feeling of detachment
- patient may have ringing, buzzing in the ear, still conscious, sense inability to move extremities
- noises are exaggerrated
- avoid unnecessary noises or motions
• Stage II: Excitement - time from loss of consciousness to loss of reflexes - Characterized by struggling,
shouting, talking, crying. - pupils dilate, rapid pulse and
irregular RR - restrain the patient
Stage III: SURGICAL ANESTHESIA
(MAINTENANCE PHASE)
- Surgical anesthesia is reached
- patient is unconscious and lies
quietly
- respirations and CR are regular- may be maintained in hours
(if properly given)
*EMERGENCE PHASE90
• Stage IV: Medullary Depression - stage is reached when too much
anesthesia is given - RR becomes shallow, pulse is
weak and thready, pupils widely dilated and become unresponsive to light, cyanotic
- Without proper treatment death will follow
- Discontinue anesthetic abruptly, cardiopulmonary support is initiated
G A: INHALATIONAL ADMINISTRATION
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G A: INTRAVENOUS ADMINISTRATION
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G A: HALOTHANE
• is a powerful anesthetic and can easily be overadministered.
• Advantages: pleasant odor• Disadvantages: little pain relief
(combined with other agents to control pain)
• Adverse reactions: – cardiac dysrhythmia– Hepatotoxicity
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G A: ENFLURANE (ETHRANE)
• is less potent and results in a more rapid onset of anesthesia and faster awakening than halothane.
• Adverse reaction: Increases ICP and the risk of seizure (contraindicated among patients with seizure disorders)
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G A: ISOFLURANE (FORANE)
• is not toxic to the liver but can cause some cardiac irregularities.
• Isofluorane is often used in combination with intravenous anesthetics for anesthesia induction.
• Awakening from anesthesia is faster than it is with halothane and enfluorane.
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G A: SEVOFLURANE
• Does not cause cardiac arrhythmias and coughing that is why this is replacing halothane for induction of pediatric clients
• this agent is rapidly eliminated and allows rapid awakening
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NITROUS OXIDE (LAUGHING GAS)
• is a weak anesthetic and is used with other agents, such as thiopental, to produce surgical anesthesia.
• It has the fastest induction and recovery and is the safest because it does not slow breathing or blood flow to the brain.
• Adverse effect: it diffuses rapidly into air-containing cavities and can result in a collapsed lung (pneumothorax) or lower the oxygen contents of tissues (hypoxia).
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• LARYNGOSCOPE
Establishing AIRWAY PATENCY: ENDOTRACHEAL INTUBATION
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POST G.A. Effects• Headache • vision problems, including blurred
or double vision
• shivering or trembling • muscle pain • dizziness, lightheadedness, or faintness • drowsiness • mood or mental changes • nausea or vomiting • sore throat • nightmares or unusual dreams
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Potential adverse effects of anesthesia
• Myocardial depression, bradycardia• Anaphylaxis• CNS agitation, seizures, respiratory
arrest• Oversedation or under sedation• Agitation and disorientation• Hypothermia• Hypotension• Malignant hyperthermia
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PRECAUTION
• A complete medical history including a history of allergies in family members, is an important precaution. Patients may have a potentially fatal allergic response to anesthesia known as malignant hyperthermia (a muscular disorder induced by anesthesia), even if there is no previous personal history of reaction.
• WARNING SIGN: TACHYCARDIA
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Discharge Instructions post- GA
• Do not consume alcohol• Do not drive a car or operate heavy
machinery• Do not sign any legal documents• Do not make any important decisions• Someone should stay with you at least
for the first 24 hours after your surgery.
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INTRAVENOUS MEDICATIONS FOR G A
• used to induce or maintain surgical anesthesia & hypnosis with use of barbiturates, benzodiazepines, hypnotics and opioid agents
• nonexplosive, require little equipment and easy to administer
• useful for short procedures
• disadvantage: respiratory depressants• EX : ketamine, thiopental (a barbiturate),
methohexital (Brevital), etomidate, propofol (Diprivan)
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Commonly Used IV MedicationsMedication Usage Advantage DisadvantageMuscle Relaxant
Succinlcholine
(Anectine)
Intubation
Short cases
Rapid onset
Short duration
Myalgias, fasciculation, tissue trauma, paralysis
Anxiolytic/Sedative
Diazepam
Amnesia,
Hypnotic
Good sedation Prolonged duration, residual effects
Barbiturates
Thiopental
Induction Offers good induction
Cause laryngospasm
Dissociative Anesthesia
Ketamine (ketalar)
Induction
Short cases
Pt maintains airway
Large doses may cause hallucination,respiratory depression
Opioid Analgesic
Morphine
Perioperative
pain
Inexpensive, good
CV stability
Dec in BP and RR
Opioid Analgesic
Fentanyl (sublimaze
Postoperative
pain
Good CV stability
MLNGCeleste, RN, MD
REGIONAL Anesthesia- a form of local anesthesia
- the patient is awake
TOPICAL Applied directly on the skin
INFILTRATION Injected into a specific area of skin
NERVE BLOCK Injected around a nerve
SPINAL Subarachnoid
Low spinal anesthesia
EPIDURAL Epidural space is injected with anesthesia
INTRASPINAL ANESTHESIA
• best reserved for operations below the umbilicus e.g. appendectomy, hernia repairs, gynecological and urological operations and any operation on the perineum or genitalia.
1. epidural
2. intrathecal (subarachnoid)
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INTRASPINAL ANESTHESIA
TETRACAINE
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EPIDURAL ANESTHESIA
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INTRATHECAL (SUBARACHNOID)
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Patient Positioning• Provides optimal visualization
• Provides optimal access for assessing and maintaining anesthesia and function
• Protects patient from harm
MLNGCeleste, RN, MD
Position Patient during Surgery
Abdominal surgeries Supine
Bladder surgery Slightly trendelenburg
Perineal surgery Lithotomy
Brain surgery Semi-fowler’s
Spinal cord surgeries Prone mostly
Lumbar puncture Side lying, flexed body
MLNGCeleste, RN, MD
A. ABDOMINAL SURGERY1. Abdominal Laparotomy2. Herniorrhaphy3. Cholecystectomy4. Pancreaticoduodenectomy (Whipple’s)5. Pancreatectomy6. Splenectomy7. Bariatric Surgery
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B. BREAST SURGERY1. Mastectomy
2. Breast Biopsy
3. Mammoplasty
4. Breast Augmentation, Breast Repair, Breast Lifting
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C. OBSTETRIC & GYNECOLOGIC SURGERY1. D & C2. Vaginal/Abdominal Hysterectomy3. Perineorrhaphy4. Salphingo-Oophorectomy5. Tuboplasty of the Fallopian tubes6. Ceasarian Section – low transverse, classical, Pfannensteil (‘bikini cut’)
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D. GENITOURINARY SURGERY1. Circumcision2. Vasectomy3. Orchiectomy4. Cystectomy5. Transurethral Resection of the Prostate/Bladder (TURP/TURB)6. Nephrectomy7. Ureterolithotomy8. Pyelolithotomy
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MLNGCeleste, RN, MD
Activities in the POST-op • Maintain patent airway• Monitor VS• Assessing responses to surgery and anesthesia• Performing interventions to promote healing • Prevent complications• Planning for home-care• Assist the client to achieve optimal recovery
POST Operative Interventions
• Transfer the postoperative patient to the PACU: anesthesiologist/anesthetist
• Nursing Objective: provide care until the patient recovers from the effects of anesthesia, is oriented, has stable VS and shows no evidence of hemorrhage or other complications
• ASSESS your patient
PACU- Post-Anesthesia Care/Recovery Unit
1. Immediate and continuous assessment every 15 minutes initially
2. Check airway patency, vital signs, surgical site, drain, recovery from anesthesia, pain control, fluid status, postop orders
3. When stable, discharge to hospital room or home
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POST Operative Interventions
• Maintain patent airway• Maintain cardiovascular stability• Monitor vital signs and note for early
manifestations of complications• Monitor level of consciousness• Maintain on PROPER position• NPO until fully awake, with passage
of flatus and (+) gag reflex
POST Operative Interventions
• Monitor the patency of the drainage• Maintain intake and output monitoring• Care of the tubes, drains and wound • Ensure safety by side rails up• Pain medication given as ordered• Measures to PREVENT post-op
Complications
POST Operative Interventions PARAMETERS to consider before
discharging a postop patient from PACU1. ACTIVITY – can move all 4 extremities2. RESPIRATION – can deep breath and cough3. CIRCULATION 4. CONSCIOUSNESS – fully awake5. COLOR - pink
Post-operative interventions
PAIN MANAGEMENT
• Pain is usually greatest during the 12-36 hours after surgery
• Narcotic analgesics and NSAIDS may be prescribed together for the early period of surgery
• Provide back rub, massage, diversional activities, position changes
Post operative interventions
POSITIONING
• Clients who have spinal anesthesia is usually placed FLAT on bed for 8-12 hours
• Unconscious client is placed side lying to drain secretions
• Other positions are utilized BASED on the type of surgery
Post-operative InterventionsSome Examples of Position Post Op
Mastectomy Semi-fowlers’, affected arm elevated
Thyroidectomy Semi fowlers’, head midline
Hemorrhoidectomy Semi-prone, side-lying
Laryngectomy Fowler’s
Pneumonectomy Lateral, affected side
Lobectomy Lateral, unaffected side 149
Post-operative InterventionsSome Examples of Position Post Op
Aneurysmal repair (abdomen)
Fowler’s 45 degrees
Amputation of lower extremities
Flat, with stump elevated with pillow
Cataract surgery Fowler’s 45 degrees
Supratentorial craniotomy
Fowlers’
Infratentorial craniotomy
Flat on bed, supine
Spina bifida repair Prone 150
Wound Care
• Inspect dressing hourly
• Change dressing daily
• Inspect for signs of infection redness, swelling, purulent exudate (SEROUS EXUDATE – normal)
• Maintain wound drainage
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Diet
• NPO usually immediately after surgery
• Progressive diet
• Assess the return of the bowel sounds
Post-operative Interventions
• Hydration after NPO to maintain fluid balance
• Suction, either gastro or respiratory to relieve distention, to remove respiratory secretions
• Diet progressive, usually given when bowel sounds and gag reflex return
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Liquid Diet Vs Soft dietClear liquid Full liquid Soft diet
Coffee
Tea
Carbonated drink
Bouillon
Clear fruit juice
Popsicle
Gelatin
Hard candy
Clear liquid PLUS:
Milk/Milk prod
Vegetable juices
Cream, butter
Yogurt
Puddings
Custard
Ice cream and sherbet
All CL and FL plus:
Meat
Vegetables
Fruits
Breads and cereals
Pureed foods
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Urinary Elimination
• Offer bedpans
• Allow patient to stand at the bedside commode if allowed
• Report to surgeon if NO URINE output noted within 8 hours post-op
Post-operative Interventions • Deep breathing and coughing
exercises Q2-4 hours to remove pulmonary secretions
• Leg exercises Q 2 hours to promote circulation
• Ambulation ASAP prevents respiratory, circulatory, urinary and gastrointestinal complications
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DEEP BREATHING
• Aka ABDOMINAL BREATHING
• CHEST and ABDOMEN ENLARGE OR EXPAND
• Diaphragm is depressed• 10 deep breaths each time• Deep breathing FULLY
EXPANDS THE ALVEOLI166
CPTChest Physiotherapy• Chest physiotherapy is based on the
fact that mucus can be knocked or shaken form the walls of the airways and helped to drain from the lungs.
• The usual PVD SEQUENCE is as follows- POSITIONING, Percussion, Vibration, and removal of secretionsby SUCTIONING or Coughing followed lastly by oral hygiene
Chest PhysiotherapyChest Physiotherapy
PERCUSSION & VIBRATION
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VIBRATING
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PERCUSSION
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Incentive Spirometry
• This operates on the principle that spontaneous sustained maximal inspiration is most beneficial to the lungs and has virtually no adverse effects.
• The incentive spirometer measures roughly the inspired volume and offers the “incentive” of measuring progress
INCENTIVE SPIROMETRY
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Incentive Spirometry
SPLINTING WHILE COUGHING
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SPLINTING WHILE COUGHING
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LEG EXERCISES
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POSTMASTECTOMY EXERCISES
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POSTMASTECTOMY EXERCISES
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POSTMASTECTOMY EXERCISES
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Post operative complicationsAtelectasis
Pneumonia
Collapsed alveoli due to secretions
Inflammation of alveoli
•Assess breath sounds•Repositioning•Deep breathing and coughing•Chest physio•Suctioning •Ambulation
Thrombophlebitis Inflammation of the veins
•Leg exercises •Monitor for swelling•Elevated extremities
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ATELECTASIS
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PNEUMONIA
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DEEP VENOUS THROMBOSIS
*HOMAN’S SIGN184
DEEP VENOUS THROMBOSIS
(+)HOMAN’S SIGN
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EMBOLUS: MIGRATION OF A CLOT
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PULMONARY EMBOLISM
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Post-operative ComplicationsHypovolemic Shock
Loss of circulatory fluid volume
•Determine cause and prevent bleeding•O2, IVF
Urinary retention
Involuntary accumulation of urine
•Encourage ambulation
•Provide privacy
•Pour warm water
•Catheterize
Pulmonary embolism
Embolus blocking the lung blood flow
•Notify physician•Administer O2
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HYPOVOLEMIC SHOCK
MODIFIED TRENDELENBURG
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Post-operative complications
Constipation Infrequent passage of stool
•High fiber diet•Increased fluid•Ambulation
Paralytic ileus Absent bowel sound
•Encourage ambulation •NPO until peristalsis returns
Wound infection
Occurs about 3 days after surgery
•Daily wound dressing•Antibiotics•Maintain drain
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WOUND HEALINGPRIMARY INTENTION
SECONDARY INTENTION
TERTIARY INTENTION
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WOUND DISRUPTION
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Post-operative complications
Wound dehiscence
Separation of wound edges at the suture line
•Cover the wound with sterile normal saline dressing•Place in low-Fowler’s•Notify MD
Wound evisceration
Protrusion of the internal organs and tissues through wound
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Wound DEHISCENCE
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Wound DEHISCENCE
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Wound EVISCERATION
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INCISIONAL HERNIA
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INCISIONAL HERNIA
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INCISIONAL HERNIA
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NURSING MANAGEMENT in the POSTOPERATIVE PHASE
• Preventing respiratory complications
• Relieving pain• Encouraging activity• Promoting wound healing• Maintaining normal body
temperature• Managing GI function• Nutrition• Resumption of urinary function
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MLNGCeleste, RN, MD
To emphasize
• The over-all goal of nursing care during the PRE-OPERATIVE phase is to prepare the patient mentally and physically for the surgery
To emphasize
• The over-all goal of nursing care during the INTRA-OPERATIVE phase is to maintain client safety
To emphasize
• The over-all goals of nursing care during the POST-OPERATIVE phase are to promote healing and comfort, restore the highest possible wellness and prevent associated risk
SCRUB OUT !!!