Perioperative care Jana Heřmanova, Hana Svobodova

Three phases Preoperative Intraoperative Postoperative

Types of surgery According to purpose – Diagnostic – Palliative – Ablative – Constructive/reconstructive – Transplant

…types of surgery According to degree of urgency – Emergency surgery – Elective surgery

…types of surgery According to degree of risk – Major surgery – Minor surgery

The risk factors Age General health Nutritional status Medications – Anticoagulants – Diuretics Mental status

Preoperative phase Informed consent – Nature and intention of surgery – Name and qualification of the person performing surgery – Risks, including damage, disfigurement, even death – Chances of success – Possible alternative measures – The right of the client to refuse consent

…preoperative phase Routine tests – CBC – Blood group and crossmatching – Serum electrolytes – FBS (hemocoagulation) – Urea and creatinine – Liver tests (AST, ALT, LDH, bilirubin) – Urine analysis – Chest x-ray – ECG

Preoperative teaching Information – what will happen, when, expected sensations, discomfort Psychosocial support to reduce anxiety The roles of the client and the family in preoperative period, during surgery and after surgery Skills training

Moving Deep breathing Coughing Splinting incision with the hands or a pillow Using an incentive spirometer

Physical preparation Nutrition and fluids – NPO – Fluids up to 2 hours prior – Light breakfast 6 hours – Heavy meal 8 hours Elimination – Enema (not routine) – Retention catheters when neccessary Hygiene – Shower – Trimmed nails, remove polish, cosmetics – Remove jewelry, denture Rest and sleep – Offer sedatives Valuables – Label and put in safekeeping

…physical preparation Medications – Sedatives – Narcotics – Anticholinergics – Antihistamins – Neuroleptoanalgesics Vital signs Prostheses – Check and remove dentures, loose teeth, lenses, etc. Skin preparation – shaving Antiembolic stockings

Intraoperative phase Surgical skin preparation Positioning – Visualization of and access to the surgical site – Optimal access for assessing and maintaining anesthesia and vital functions – Protection of the client from harm

Postoperative phase Clients admitted to PACU (ICU) Discharged to standard unit when: – Are conscious and oriented – Able to maintain clear airway, deep breathe, cough – Vital signs stable – Protective reflexes (swallowing) – Able to move four extremities – I + O adequate (30ml/hr) – Afebrile – Dressings dry and intact, no obvious bleeding

Ongoing postoperative care - assessment Vital signs Skin color and temperature – tissue perfusion Comfort – level and localization of pain Dressing and bedclothes Fluid balance – IV intake, urinary output, amount of drainage Drains and tubes – color, consistency, amount of drainage Check suction equipment

Potential problems Pneumonia Pulmonary embolism Atelectasis Hemorrhage Trombophlebitis Urinary retention Nausea and vomiting Constipation Postoperative ileus Wound complications – Infection – Dehiscence – Evisceration Postoperative depression/delirium

…management Pain Positioning Deep breathing and coughing exercise Leg exercises Moving and ambulation Hydration Diet Urinary elimination Suction Wound care Wound drains and suction

Tube drain

Penrose drain

Tube drain

Tube drain, gravity drainage

Jackson-Pratt, Redon

Thoracic drainage