1. DMU College medicine &health science Bure cumpas PERI OPERATIVE NURSING CARE FOR 2 ND YEAR MIDWIFERY STUDENTS 17 December 20181YALEMGETA B

2. Learning objectives 1. Describe the major assessment skills, needed in the pre operative,intra operative, and postoperative stages. 2. Explain the purpose of informed consent. 3. Perform general postoperative measures such as: obtaining vital sings, assessing level of consciousness, assessing surgical pain. 4. Report and document post operative complication. 17 December 2018YALEMGETA B2

3. Peri operative Peri operative refers to the management and treatment of the client during the three phases of surgery: – Pre operative – Intra operative – Post operative 17 December 20183YALEMGETA B

4. Cont... Preoperative (before surgery) – Refers to the time interval that begins when the decision is made for surgery until the client is transferred to the operating room (OR The intraoperative (during surgery) – Begins when the client is transferred to the OR and ends with client transfer to a post anesthesia care unit (PACU). 17 December 20184YALEMGETA B

5. Cont… Postoperative (after surgery) Begins when the client leaves the OR and is taken to a PACU and continues until the client is discharged. The surgical team consists of – The patient – The anesthesiologist or anesthetist – The surgeon – Assistant surgeon – The intraoperative nurses(midwifes) 17 December 20185YALEMGETA B

6. Pre-operative care Purpose To prepare the patient emotionally, mentally and physically for surgery. To prevent any complication before, during and after surgery. 17 December 20186YALEMGETA B

7. Cont… Preparation for Surgery – Assessment of health factors that affect patients preoperatively Nutritional and Fluid Status Drug or Alcohol Use Respiratory Status Cardiovascular Status Hepatic and Renal Function Immune Function Endocrine Function Previous Medication Use Psychosocial Factors Spiritual and Cultural Beliefs 17 December 20187YALEMGETA B

8. Preoperative interventions of midwifes – Preoperative teaching Mobility and active body movement – The goals of promoting mobility postoperatively are to improve circulation, prevent venous stasis, and promote optimal respiratory function 17 December 20188YALEMGETA B

9. Cont… Pain Management – The patient is instructed to take the medication as frequently as prescribed for pain relief Cognitive coping strategies » Imagery—The patient concentrates on a pleasant experience or restful scene. 17 December 20189YALEMGETA B

10. Cont… Distraction—The patient thinks of an enjoyable story or recites a favorite poem or song Optimistic self-recitation—The patient recites optimistic thoughts (“I know all will go well”). 17 December 201810YALEMGETA B

11. General preoperative nursing intervention Vital sign and lab Managing Nutrition and Fluids – NPO to prevent aspiration. Preparing the Bowel for Surgery – Enema Preparing the Skin – To decrease bacteria 17 December 201811YALEMGETA B

12. Cont… It is important that the patient be in a good state of physical health before he has surgery. Unless it is an emergency operation. He should have balanced diet, fluid, sleep and rest before his surgery The patient’s mental state is important to his recovery. Try to relieve his fears about the operation and any fear of death:explain to him what will be done and that every measure will be taken for his safety. 17 December 201812YALEMGETA B

13. Cont… Informed consent Is an agreement after complete information including the risk of treatment and facts relating to it has been provided by the physicians Informed consent is only possible when the client: - understands the provided information - speaks the language and - is conscious, mentally competent, and not sedated 17 December 201813YALEMGETA B

14. Cont… This informs the following – Witnessing the exchange between the client and physician – Establishing that client understand the information – Witnessing the clients signature Shaving Purpose To minimize the danger of infection by decreasing the number of bacteria on the skin 17 December 201814YALEMGETA B

15. Intraoperative Nursing Management Intraoperative nursing interventions – The physical environment of a surgery suite is designed primarily to promote Electrical safety Medical and surgical asepsis Comfort and privacy of the patient Communication among the surgical team – Medical and surgical asepsis – Part of the surgical team 17 December 201815YALEMGETA B

16. Postoperative Nursing Management Post- operative Care Purpose To prevent any complication from anesthesia To detect any sign of post- operative complications To rehabilitate the patient 17 December 201816YALEMGETA B

17. Cont… Postanesthesia care unit (PACU), – The post anesthesia care unit (PACU), – also called the post anesthesia recovery room, is located adjacent to the operating rooms. 17 December 201817YALEMGETA B

18. Post anesthesia care unit (PACU) – Patients still under anesthesia or recovering from anesthesia are placed in this unit for easy access to experienced,highly skilled nurses(midwifes),anesthesiologists or anesthetists, surgeons, advanced hemodynamic and pulmonary monitoring and support, special equipment, and medications. 17 December 201818YALEMGETA B

19. Cont…  Causes of death documented within the first 24 hours of anesthetic administration and surgical procedure - Obstruction of airway - Laryngospasm - Hemorrhage - Cardiac arrest, and - Inappropriate administration of medications Contributing factors for this include: Inadequate postoperative patient care Lack of standardized observation parameters, and Absence of medical supervision 17 December 201819YALEMGETA B

20. Postoperative Observation of the Patient  The duration and type of postoperative observation and care will vary according to the following: Patient’s condition (e.g., alert and oriented vs. unresponsive) Need for physiologic support (e.g., ventilator dependent, vs. awake and extubated) Complexity of the surgical procedure Type of anesthesia administered (e.g., a general inhalation agent vs. local infiltration physiologic status (e.g., stable vs. unstable vital signs 17 December 201820YALEMGETA B

21. Cont… As the patient enters the recovery room (RR), his/her immediate physiologic and psychologic status is reported to the recovery room nurse(midwife) by the accompanying personnel (usually the circulating nurse, assistant surgeon, or anesthesia provider). The recovery room nurse(midwife) observes the postoperative patient’s wound (for bleeding), catheter, drain material, and intravenous infusions (whether they are in place). the nurse / midwife monitors the vital signs of the patient as prescribed. 17 December 201821YALEMGETA B

22. Nursing Management in the PACU The nursing management objectives for the patient in the PACU are to provide care until the patient has recovered from the effects of anesthesia (eg, until resumption of motor and sensory functions) is oriented, has stable vital signs, and shows no evidence of hemorrhage or other complications. 17 December 201822YALEMGETA B

23. Cont… Assessing the Patient  the cornerstones of nursing care in the PACU: -Frequent, skilled assessments of the patient’s airway, respiratory function, -cardiovascular function, -skin color, - level of consciousness, and ability to respond to commands a After the initial assessment, vital signs are monitored and the patient’s general physical status is assessed and documented at least every 15 minutes. 17 December 201823YALEMGETA B

24. Cont… Maintaining a Patent Airway The primary objective in the immediate postoperative period is to maintain ventilation and thus prevent hypoxemia and hypercapnia Both can occur if the airway is obstructed and ventilation is reduced (hypoventilation ) 17 December 201824YALEMGETA B

25. Cont… Maintaining Cardiovascular Stability To monitor cardiovascular stability, the nurse assesses the patient’s mental status; vital signs; cardiac rhythm; skin temperature, color, and moisture; and urine output The primary cardiovascular complications seen in the PACU include hypotension and shock, hemorrhage, hypertension, and dysrhythmias 17 December 201825YALEMGETA B

26. Cont… Relieving Pain and Anxiety The PACU nurse monitors the patient’s physiologic status, manages pain, and provides psychological support in an effort to relieve the patient’s fears and concerns Controlling Nausea and Vomiting Nausea &vomiting are common issues in the PACU  At the slightest indication of nausea, the patient is turned completely to one side: to promote mouth drainage and prevent aspiration of vomitus, which can cause asphyxiation and death 17 December 201826YALEMGETA B

27. Cont… Positioning An unconscious or semiconscious client is placed on one side with the head slightly elevated, if possible, or in a position that allows fluids to drain from the mouth. Unless contraindicated, elevation of affected extremities (e.g., following foot surgery) with the distal extremity higher than the heart promotes venous drainage and reduces swelling 17 December 201827YALEMGETA B

28. Deep-Breathing and Coughing Exercises Deep-breathing exercises help remove mucus, which can form and remain in the lungs due to the effects of general anesthetic and analgesics. These drugs depress the action of both the cilia of the mucous membranes lining the respiratory tract and the respiratory center in the brain. 17 December 201828YALEMGETA B

29. Cont… Discharge of the Postoperative Patient from the Recovery Room Most patients remain in the recovery room (RR) for at least one hour or until they have sufficiently recovered from anesthesia and that their vital signs have stabilized and they are capable of reasonable self-care. The patient’s condition is scored according to vital signs, activity level, and consciousness. 17 December 201829YALEMGETA B

30. Cont… After discharge from the recovery room, the patient is transported to a patient care unit (ward) or an intensive care unit (if present) or to home with follow-up appointment. A physician is responsible for the patient’s discharge from the recovery room. 17 December 201830YALEMGETA B

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