Peri-Operative Care NURS 2016

Stages of the Peri-Operative Period Pre-Operative  From time of decision to have surgery until admitted into the OR theatre.

Stages of the Peri-Operative Period Intra-Operative  Time from entering the OR theatre to entering the Recovering Room or Post Anesthetic Care Unit (PACU)

Stages of the Peri-Operative Period Post-Operative  Time from leaving the RR or PACU until time of follow-up evaluation (often as opt-patient)

Some Suffixes  Ectomy  Otomy  Oscopy  Pathy  Rhage  Oma  Itis  Logy  Megaly  Rhea  Lysis  Megaly

Some Prefixes  Chole  Lap  Dys  Cyst  Lith  Carcin  Neo  Ortho  Trans

A Few Terms  Reduction  Resection  Bypass  Excision  I & D  Aspiration  DVT  Dehiscence  Evisceration  Paralytic Ileus

Classifications of Surgery  IEmergency: immediately  IIUrgent: hours  IIIRequired: need surgery in upcoming weeks  IVElective: Should have  VOptional: Not necessary – a choice

Pre-Operative Period  Nursing Assessment Nutritional and Fluid Status Drug and Alcohol use Respiratory Status CV Status Other system (renal, hepatic, immune Medications Psychosocial, spiritual and cultural beliefs

Pre-Operative Period  Nursing Interventions Teaching Physical Prep  Surgical Site  Nutrition and Fluids  Preanesthetic Medication Psychosocial Support  Reducing anxiety and addressing fears

Pre-Operative Period  Teaching Pain management Deep Breathing and Coughing Movement and Ambulation

Pre-Operative Period  Pre-Op Checklist (figure 18.3, page 413) Proper documentation complete Physical and chemical work-up complete Patient physically prepared Current condition

Intra-Operative Period  Nursing Roles: Patient Advocate Scrub nurse  Responsible for ‘sterile’ work  Monitor sterile integrity of procedure  Monitors equipment (instruments, sutures, etc) Circulating nurse  Protects patient safety  Monitors operating room conditions  Monitors surgical team activities

Intra-Operative Period Stages of Anesthesia I: Beginning II: Excitement III: Surgical anesthesia IV: Medullary Depression

Intra-Operative Period: Achieving Anesthesia Inhalation  Halothane and methoxyflurane  Administered via mask or endotracheal tube  Inducation and recovery quite rapid Intravenous  Tranq/Sedatives  Opioids  Neuroleptanalgesics  Dissociative Agents  Barbiturates  Nonbarbiturates

Intra-Operative Period Anesthesia is not always General  Regional  Blocks  Local infiltration

Intra-Operative Period Complications  Nausea and vomiting  Anaphylaxis  Hypoxia  Hypothermia  Malignant Hyperthermia  DIC

Post-Operative Period  Immediate Post-Op PACU Assist and monitor patient in post-anesthetic stage  Airway, circulation, hemorrhage, nausea/vomiting  Recovery Clinical Unit Discharge home

Post-Operative Period : Clinical Unit Primary focus  Neurological status  Pain management  Respiratory function  Circulatory function  Wound care  Fluid Balance  Nutritional status

Post-Operative Period Immediate Assessment  Level of consciousness  Vital Signs (q15 x 2, q30,...)  Wound  Fluid Balance  Pain

Post-Operative Period: Recovery: Day 1 to Discharge  Preventing Respiratory Complications  Relieving Pain  Promoting Cardiac Function  Encouraging Activity  Promoting Wound Healing  Maintaining Body Temp  Monitoring GI Function  Managing Voiding  Providing Support

Post-Operative Period: Complications  Deep Vein Thrombosis  Hematoma  Infection  Wound Dehiscence

Post-Operative Period  Consider the list of Nursing Diagnosis provided  What nursing interventions would be appropriate