1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 31 The Person Having Surgery

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  Doctors perform surgery to: Remove a diseased or injured body part Remove a diseased or injured body part Remove a tumor Remove a tumor Repair an injured body part Repair an injured body part Make a diagnosis Make a diagnosis Improve appearance Improve appearance Relieve symptoms Relieve symptoms Restore or improve function Restore or improve function Replace a body part Replace a body part

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  Surgeries are elective, urgent, or an emergency. Elective surgery is done by choice to improve the person’s life or well-being. Elective surgery is done by choice to improve the person’s life or well-being.  The surgery is scheduled in advance. Urgent surgery is needed for the person’s health. Urgent surgery is needed for the person’s health.  It is done to prevent further damage or disease. Emergency surgery is done at once to save life or function. Emergency surgery is done at once to save life or function.  The need is sudden and not expected.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  The person is prepared for what happens before, during, and after surgery. This is done by doctors, nurses, and other health team members. This is done by doctors, nurses, and other health team members. You assist as the nurse and care plan direct. You assist as the nurse and care plan direct.  In hospitals, you will care for patients before and after surgery. Pre-operative refers to before surgery. Pre-operative refers to before surgery. Post-operative refers to after surgery. Post-operative refers to after surgery.  In nursing centers, many residents are recovering from surgery.  Some patients need home care after surgery.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  PSYCHOLOGICAL CARE  Surgery causes many fears and concerns.  Past experiences affect feelings.  Some people do not share their fears and concerns.  Mental preparation is important. Respect the person’s fears and concerns. Respect the person’s fears and concerns.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  The doctor explains the need for surgery to the patient and family. They are told about: They are told about:  The surgical procedure, its risk, and possible complications  The risks from not having surgery  Who will do the surgery  The date and time of the surgery  How long the surgery will take Questions from the patient and family are answered. Questions from the patient and family are answered. Misunderstandings are cleared up. Misunderstandings are cleared up. Instructions about care are given. Instructions about care are given.  After surgery the doctor decides what and when to tell the patient and family about the results.

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Your role Listen to the person. Listen to the person. Refer questions about the surgery or its results to the nurse. Refer questions about the surgery or its results to the nurse. Explain the care you will give. Explain the care you will give.  Explain why the care is needed. Follow communication rules. Follow communication rules. Use verbal and nonverbal communication. Use verbal and nonverbal communication. Perform procedures and tasks with skill and ease. Perform procedures and tasks with skill and ease. Report verbal and nonverbal signs of fear or anxiety. Report verbal and nonverbal signs of fear or anxiety. Report a request to see a member of the clergy. Report a request to see a member of the clergy.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  PRE-OPERATIVE CARE  The goal is to prevent complications before, during, and after surgery.  Pre-operative teaching includes: Pre-operative activities Pre-operative activities  Tests and their purpose  Skin preparation  Personal care  The purpose and effects of pre-operative drugs

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Deep breathing, coughing, and incentive spirometry Deep breathing, coughing, and incentive spirometry Leg exercises Leg exercises Care given in the postanesthesia care unit (PACU) Care given in the postanesthesia care unit (PACU) Vital signs Vital signs Food and fluids Food and fluids Turning and repositioning Turning and repositioning Early ambulation Early ambulation The type and amount of pain to expect The type and amount of pain to expect Treatments and equipment Treatments and equipment Position restrictions Position restrictions

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Before surgery, the following tests are commonly ordered: Chest x-ray Chest x-ray Complete blood count (CBC) Complete blood count (CBC) Urinalysis Urinalysis Electrocardiogram (ECG; EKG) Electrocardiogram (ECG; EKG) Other tests depending on the person’s condition and surgery Other tests depending on the person’s condition and surgery  Tests results must be on the chart by the time of surgery.  Nutrition and fluids The person is NPO for 6 to 8 hours before surgery. The person is NPO for 6 to 8 hours before surgery.  An NPO sign is placed in the person’s room.  The water pitcher and glass are removed.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  Bowel elimination Bowel surgeries may require cleansing the bowel of feces. Bowel surgeries may require cleansing the bowel of feces.  This is called a bowel prep. Sometimes enemas are given to prevent constipation after surgery. Sometimes enemas are given to prevent constipation after surgery.  Urinary elimination Some surgeries require catheters. Some surgeries require catheters. Catheters also allow accurate output measurements during and after surgery. Catheters also allow accurate output measurements during and after surgery. The person without a catheter needs to void before the nurse gives pre-operative drugs. The person without a catheter needs to void before the nurse gives pre-operative drugs.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Personal care before surgery involves: A complete bath, shower, or tub bath A complete bath, shower, or tub bath Removing makeup, nail polish, and fake nails Removing makeup, nail polish, and fake nails Removing all hairpins, clips, combs, wigs, hairpieces, and other items. Removing all hairpins, clips, combs, wigs, hairpieces, and other items.  Some agencies have patients wear a surgical cap. Oral hygiene for comfort Oral hygiene for comfort Removing and storing dentures Removing and storing dentures  Provide denture care. Removing prostheses Removing prostheses  Follow agency policy for safe storage.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  All jewelry is removed and stored for safekeeping. Record its removal and storage according to agency policy. Record its removal and storage according to agency policy.  Skin preparation The doctor orders one or more of the following for the skin prep: The doctor orders one or more of the following for the skin prep:  Cleansing the operative area with an anti-microbial soap  Clipping the hair at and around the operative site  Shaving the skin to remove hair at and around the operative site The incision site and a large area around it are prepped. The incision site and a large area around it are prepped.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  The surgery consent The person’s consent is needed before surgery is done. The person’s consent is needed before surgery is done. An operative permit or surgical consent is signed when the person understands the information given by the doctor. An operative permit or surgical consent is signed when the person understands the information given by the doctor. A parent or legal representative signs for a minor child. A parent or legal representative signs for a minor child. The legal representative signs for a person who is not mentally competent to sign. The legal representative signs for a person who is not mentally competent to sign. The doctor is responsible for securing the written consent. Often this is delegated to an RN. The doctor is responsible for securing the written consent. Often this is delegated to an RN. You do not obtain the person’s written consent for surgery. You do not obtain the person’s written consent for surgery.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  The pre-operative checklist When the pre-operative checklist is complete, the person is ready for surgery. When the pre-operative checklist is complete, the person is ready for surgery. The nurse may ask you to do some of the things on the list. The nurse may ask you to do some of the things on the list.  Promptly report when you complete each task.  Report any observations. Except for bed rails, the entire checklist is completed before the nurse gives pre-operative drugs. Except for bed rails, the entire checklist is completed before the nurse gives pre-operative drugs. The surgical site is marked before the surgery. The surgical site is marked before the surgery.  It is done before the pre-operative drugs are given.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  Pre-operative drugs The nurse gives pre-operative drugs to: The nurse gives pre-operative drugs to:  Help the person relax and feel drowsy  Reduce respiratory secretions to prevent aspiration  Prevent nausea and vomiting Falls and accidents are prevented after the drugs are given. Falls and accidents are prevented after the drugs are given.  Bed rails are raised.  The person is not allowed out of bed.  The person is transported to the operating room (OR) by OR staff.

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  ANESTHESIA  Anesthesia is the loss of feeling or sensation produced by a drug. General anesthesia is the loss of consciousness and all feeling or sensation. General anesthesia is the loss of consciousness and all feeling or sensation.  A drug is given IV.  Or a gas is inhaled. Regional anesthesia is the loss of feeling or sensation in a large area of the body. Regional anesthesia is the loss of feeling or sensation in a large area of the body.  The person is awake.  A drug is injected into a body part. Local anesthesia is the loss of feeling or sensation in a small area. Local anesthesia is the loss of feeling or sensation in a small area.  A drug is injected at the site.

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  Anesthetics are given by: An anesthesiologist (a doctor who specializes in giving anesthetics) An anesthesiologist (a doctor who specializes in giving anesthetics) An anesthetist (an RN with advanced study in giving anesthetics) An anesthetist (an RN with advanced study in giving anesthetics)

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19  POST-OPERATIVE CARE  After surgery, the person is taken to the PACU.  The doctor gives the transfer order and the person is transported to his or her room when: Vital signs are stable. Vital signs are stable. Respiratory function is good. Respiratory function is good. The person can respond and call for help. The person can respond and call for help.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  The room must be ready for the person. You can do the following: You can do the following:  Make a surgical bed. (Lower the bed rails. Raise the bed to its highest position.)  Place equipment and supplies in the room.  Move furniture out of the way for the stretcher.

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21  The PACU staff calls the nursing unit when the person is ready for transfer. The transport is done by PACU nurses. The transport is done by PACU nurses. The person is transferred from the stretcher to bed. The person is transferred from the stretcher to bed.  You assist and help position the person as needed. Vital signs are measured and observations made. Vital signs are measured and observations made. The nurse checks the incision for bleeding. The nurse checks the incision for bleeding. Catheter, IV, and other tube placements and functions are checked. Catheter, IV, and other tube placements and functions are checked. Bed rails are raised. Bed rails are raised. The signal light is placed within the person’s reach. The signal light is placed within the person’s reach. Necessary care and treatments are given. Necessary care and treatments are given. Then the family can be with the person. Then the family can be with the person.

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22  Measurements and observations Your role depends on the person’s condition. Your role depends on the person’s condition. Vital signs are usually measured: Vital signs are usually measured:  Every 15 minutes for the first hour  Every 30 minutes for 1 to 2 hours  Every hour for 4 hours  Then every 4 hours The nurse tells you how often to check the person. The nurse tells you how often to check the person.

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23  Positioning The person is usually positioned: The person is usually positioned:  For easy and comfortable breathing  To prevent stress on the incision  To prevent aspiration Repositioning is done at least every 1 to 2 hours. Repositioning is done at least every 1 to 2 hours. Turning may be painful. Turning may be painful.  Provide support.  Use smooth, gentle motions.  Use pillows and other positioning devices as directed by the nurse. The nurse tells you when to reposition the person and the positions allowed. The nurse tells you when to reposition the person and the positions allowed.

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24  Preventing respiratory complications Respiratory complications include: Respiratory complications include:  Pneumonia (an inflammation and infection of the lung)  Atelectasis (the collapse of a portion of the lung) The following help prevent these complications: The following help prevent these complications:  Deep-breathing and coughing and exercises  Incentive spirometry

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25  Stimulating circulation is important for blood flow in the legs. If blood flow is sluggish, blood clots may form. If blood flow is sluggish, blood clots may form.  A blood clot (thrombus) can break loose and travel through the bloodstream (embolus).  An embolus from a vein can lodge in the lungs (pulmonary embolism).  A pulmonary embolus can cause severe respiratory problems and death. Circulation is stimulated and thrombi prevented by: Circulation is stimulated and thrombi prevented by:  Leg exercises  Ambulation as soon as possible  Elastic stockings  Elastic bandages  Sequential compression devices  No prolonged standing or sitting

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26  Wound healing The incision needs protection. The incision needs protection. Healing is promoted and infection prevented. Healing is promoted and infection prevented. Sterile dressing changes are done by the doctor or nurse. Sterile dressing changes are done by the doctor or nurse. Your agency may let you do simple dressing changes. Your agency may let you do simple dressing changes.  Nutrition and fluids The person returns from the OR with an IV. The person returns from the OR with an IV. Diet progresses from NPO to clear liquids, to full liquids, to a regular diet. Diet progresses from NPO to clear liquids, to full liquids, to a regular diet. Frequent oral hygiene is important when the person is NPO. Frequent oral hygiene is important when the person is NPO. Some patients have nasogastric tubes. Some patients have nasogastric tubes.

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27  Elimination Anesthesia, the surgery, and being NPO affect normal bowel and urinary elimination. Anesthesia, the surgery, and being NPO affect normal bowel and urinary elimination. Pain-relief drugs can cause constipation. Pain-relief drugs can cause constipation.  Measures to promote elimination are practiced as directed by the nurse and the care plan. Intake and output are measured. Intake and output are measured. Report the time and amount of the first voiding. Report the time and amount of the first voiding. Some patients have a catheter after surgery. Some patients have a catheter after surgery. Fluid intake and regular diet are needed for bowel elimination. Fluid intake and regular diet are needed for bowel elimination. Suppositories or enemas may be ordered for constipation. Suppositories or enemas may be ordered for constipation.

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28  Comfort and rest The degree of pain after surgery depends on: The degree of pain after surgery depends on:  The extent of the surgery  The incision site and size  If drainage tubes, casts, or other devices are present  Positioning during surgery For pain relief: For pain relief:  The doctor orders drugs.  The nurse uses the nursing process to promote comfort and rest.  Follow the measures in the person’s care plan.  Personal hygiene is important for physical and mental well-being.