Definition of Surgery
Art and science of treating diseases, injuries, and deformities by operation and instrumentation
What are the perioperative Nursing stages
- Preoperative care
- Intraoperative care
- Post-anesthetic care
- Post-operative care
Preoperative care
Preparing client for sx
Intraoperative care
Care during sx
Post-anesthetic care
Recovery room or PACU
Post-operative care
on floor care or home setting
PACU
Post anesthesia care unit
What are the preoperative care steps
- client interview
- nursing assessment
- pre-op teaching
- legal preparation
- pre-op checklist
What does a nursing assessment involve
- Nursing history (previous experience with sx and anesthesia)
- physical examination (allergies, meds, age, nutrition, past medical history, systems, lab work)
- Risk Factors ( meds, physical/mental impairments, mobility limitations, smoking, ETOH, street drugs, occupation, VS, WT
ETOH
ethanol (alcohol)
VS
vital signs
WT
weight
What needs to consist during a Pre-op teaching period
- food and fluid restrictions (pre and post-op)
- medications if any, permitted (determined by physician)
- any need for surgical site prep
- written instructions (post-op exercises)
- post-op expectations (ie. pain management, tubes, ambulation)
What are the 2 Nurse’s roles with consent
- Legal
2. Ethical
What do Nurse’s need to do with a Legal consent
act as a witness to verify that the person who signed the consent is the client or the legal guardian
What do Nurse’s need to do with Ethical consent
as the client’s advocate, ensure that the client understands the information and that the form has been signed and witnessed before the client receives preoperative medication
What are the Intraoperative care steps
- operative room
- surgery performed
- psychosocial assessment
- physical assessment
- chart review
- admission to holding area or OR (OR nurse will admit the patient after going through all of these)
What are the Post-operative care steps
- Get report from OR nurse
- Assessments
- Systems (lungs, cardiac)
- VS, ABC’s
- pain
- hypothermia (temp)
- color
- nausea vomiting
- incision site, drainage, collecting devices
- lines (IV,NG, catheter, drains, 02)
- documentation
- post-op exercises
- elastic stockings
- post-op wash
- discharge planning (starts at admission)
What is the postanesthesia discharge criteria
- client needs to be awake (or baseline)
- VS stable
- no excess bleeding or drainage
- no respiratory depression
- oxygen saturation is over 90%
- pain is controlled
- report has been given
When should you document your findings and patients assessment
- every 15 minutes until stable
- then every 30 minutes X 2
- Then every hour X 4
- then every 4-8 hours as condition warrants
Post-op exercises
Deep Diaphragmatic breathing
- assist client to comfortable sitting or standing position
- apply pt’s hand below rib cage and inhale
- feel hands separate from each other
- do not use shoulders or chest to inhale
- do this 3 times (slow breaths)
- repeat breathing exercises 3-5 times
Post-op exercises
Controlled coughing
- explain the importance of an upright position
- two slow, deep breaths, inhaling through the nose and out through the mouth
- do this 3 times, on the third breath, count to 3 and cough 2-3 times
- apply pillow over incision line and place hands over the pillow
- instruct client to examine characteristics or sputum
Post-op exercises
Turning and ambulating
- lay supine
- bend knees, press heal against mattress and lift buttock
- place left hand on pillow around incision for stability
- use right hand to pull with hand rails to turn
- turn every 2 hours while awake
Post-op exercises
Incentive spirometer
- slow deep breaths
- inhale slowly
- constant flow
- try for the same result as pre-op time
