2. ANS Unit 4 The Surgical Client

3. Surgery Involves entering tissue and removing or reconstructing structures that are diseased, injured or malformed

4. Surgery Intervention Invasive

5. Perioperative Care Total Span of care: Preop Intraop Postop

6. Surgical Facilities Hospital Ambulatory center Surgicenter Clinic MD office

7. Nursing Interventions common to all surgery Emotional support Physically prepare pt. Verify legal aspects Pt. / family teaching Provide pre/post care

8. Nursing Interventions Amt of time varies with each case and where performed - inpatient vs. out - level of surgery

9. Level of patient choice in surgery Optional / Elective Required / Nonelective Urgent / Nonelective Emergency

10. Anesthesia Loss of sensation administered by: - Anesthesiologist - CRNA (anesthetist)

11. Types of anesthesia General Regional - spinal - local - topical

12. General anesthesia Eliminate all sensation Loss of consciousness IV, inhalation, rectally Levels vary Often intubated - resps. paralyzed

13. Regional anesthesia Blocks sensation in an area Consciousness is unaffected

14. Spinal (regional) Eliminates sensation in legs, lower abd, pelvis spinal - subarachnoid - keep flat afterwards epidural - outside dura

15. Local (regional) Blocks sensation in circumscribed area of skin and subQ tissues lidocaine to skin

16. Topical (regional) Inhibits sensation in epithelial tissues Skin and mucous mem. Oragel for baby’s gums

17. Identifying surgical risks All pt. Evaluated MD does H&P Nurse does own H&P and then THINKS!!

18. Things to look for: Previous illness Medications: - ASA, Coumadin - Cardiac meds - Diuretics

19. Verify and collect: Allergies Baseline vital signs Height and weight General health Skin condition

20. Lab work and Tests MD will order Nurse to check results Call MD if any abnormal

21. Urinalysis or UA Checks for: - UTI - Renal disease - Diabetes

22. CBC with differential Looks for: - Anemia - Infection - Decreased immunity

23. PT & PTT Protime ~ 9-12 seconds Partial thromboplastin time ~ 20 - 45 seconds Looks for bleeding tendencies Routine if on anticoags

24. Fasting Blood Sugar (FBS) Diabetes fasting = 60 - 110 nonfasting = 60 - 125

25. Blood Urea Nitrogen (BUN) Renal disease normal = 7-18

26. Other ordered tests: Type and crossmatch - for possibility of transfusion CXR-chest x-ray EKG-electrocardiogram