Nursing Concerns Esophageal – retraction, local change in motility, laceration Indigo carmine for leak assessment Difficulty –> barium swallow, steroids, feeding tube
Displaced Bone Graft
Nursing Concerns Neurological assessment- compare pre to post op status Pain management – separate topic
Mental Health Issues Anxiety Depression Somatization Unrealistic expectations
Anxiety Disorders 18% of general population (40M) Pervasive and variable in expression Kessler RC Arch Gen Psychiatry, 2005 Jun;62(6):
Anxiety Disorders OCD PTSD Social phobias Specific phobias GAD
Depression 10% of general population Variable expression Surgeons do poor job in pre-op recognition May coexist with anxiety syndromes
Depression The 3 Rs Reduced threshold for need for surgery Reduced threshold for reporting pain after surgery Reduced support systems and preop physical prowess
Substance Abuse 240M in Risk Group Chemical5%12M Alcohol 10%24M Tobacco19%46M Associated mental health issue (i.e., anxiety+Etoh)54% use.html
Coping Skill Set Point Readjusted
Postoperative Anxiety Assurance Adequate analgesia Anxiolytics-Ativan, Valium, Xanax Allied health approach (aroma therapy, massage, music, pets, spouse) Anticipation and preop teaching The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Sjöling MSjöling M Patient Educ Couns Oct;51(2):169-76Patient Educ Couns.
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