1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 29 The Surgical Patient

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Describe the concerns of patients who are about to have surgery. List the various types of anesthesia. Shave the area to be operated on. Prepare the patient’s unit for the patient’s return from the operating room.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Give routine postoperative care when the patient returns to the room. Assist the patient with deep breathing and coughing. Apply elasticized stockings or bandages and pneumatic hosiery.

4. Copyright © 2008 Delmar Learning. All rights reserved. Introduction Patients facing any surgical procedure tend to be fearful. Remember that these patients require great emotional and physical support. Such support should be given from the time each patient is admitted through the time the patient is discharged.

5. Copyright © 2008 Delmar Learning. All rights reserved. Hair Removal Follow facility policies for preoperative hair removal: –A doctors’ order may be required to do a shave –Some people have coarse body hair that dulls the razor Replace as often as needed

6. Copyright © 2008 Delmar Learning. All rights reserved. Hair Removal Follow facility policies for preoperative hair removal: –Clippers and scissors may also be used for hair removal –Remove hair as close to the time of procedure as possible

7. Copyright © 2008 Delmar Learning. All rights reserved. Preoperative Responsibilities Nursing assistant should do the following before a patient has surgery: –Remove patient’s dentures –Remove prostheses, including contact lenses, hearing aids, and glasses –Recheck vital signs Inform RN if they are abnormal

8. Copyright © 2008 Delmar Learning. All rights reserved. Pain Perception Before surgery –Patient is given medication to promote relaxation Keep the side rails up –Do not allow the patient to get up unattended after medication has been given

9. Copyright © 2008 Delmar Learning. All rights reserved. Pain Perception During surgery –Anesthetics are given to prevent pain After surgery –Medications are given to reduce discomfort

10. Copyright © 2008 Delmar Learning. All rights reserved. Anesthesia Given to prevent pain, to relax muscles, and to induce forgetfulness

11. Copyright © 2008 Delmar Learning. All rights reserved. Anesthesia Anesthetic agent and method of administration –Determined by the location and type of surgery to be performed –Length of time needed for surgery –Patient’s physical condition

12. Copyright © 2008 Delmar Learning. All rights reserved. Anesthesia Two main types of anesthetics: 1. General anesthetics induce the patient to become unconscious

13. Copyright © 2008 Delmar Learning. All rights reserved. Anesthesia Two main types of anesthetics: 2. Local anesthetics induce the loss of feeling in a specific area –Spinal anesthesia is given by inserting a long needle into the cerebrospinal fluid –If this anesthesia is given, keep the head of the bed flat postoperatively until instructed by the RN

14. Copyright © 2008 Delmar Learning. All rights reserved. Surgical Care The care of the surgical patient can be divided into three parts: –Preoperative –Operative –Postoperative

15. Copyright © 2008 Delmar Learning. All rights reserved. Perioperative Hypothermia Anesthesia and some sedatives –Disrupt internal ability to regulate temperature Drugs –Promote heat loss by reducing shivering response –Prevent blood vessel constriction

16. Copyright © 2008 Delmar Learning. All rights reserved. Perioperative Hypothermia Opening body cavities during surgical procedure –Further cools internal structures Open body cavities combined with administration of blood and IV fluids –Further contribute to temperature loss

17. Copyright © 2008 Delmar Learning. All rights reserved. Perioperative Hypothermia Some facilities: –Monitor patients’ temperatures throughout procedure, especially children Body temperature –Cannot return to normal until anesthetic wears off –This allows normal temperature regulating responses to take over

18. Copyright © 2008 Delmar Learning. All rights reserved. Perioperative Hypothermia Pain –Further decreases effectiveness of these responses Return to normal temperature may take two to five hours –Depending on degree of hypothermia and age of patient

19. Copyright © 2008 Delmar Learning. All rights reserved. Antiembolism Hosiery Physician may order antiembolism hosiery –Also called elastic hosiery or GPS compression hosiery

20. Copyright © 2008 Delmar Learning. All rights reserved. Antiembolism Hosiery Never guess at hosiery size Measure legs with a disposable tape measure –Compare measurements with size chart –Refer to Figure 29-16 Follow policies for periodic hosiery removal and circulation checks

21. Copyright © 2008 Delmar Learning. All rights reserved. Antiembolism Hosiery