chapter 12 nursing care of patients having surgery
TRANSCRIPT
Chapter 12
Nursing Care of Patients Having Surgery
Surgery Urgency LevelsEmergencyUrgentElective Optional
Purposes of SurgeryPreventiveDiagnostic Exploratory Curative Palliative Reconstructive
Types of SurgeryOpen IncisionMinimally Invasive Surgery
“Keyhole,” “Endoscopic” Scope Robotic Laser
Robotic Surgery – da VINCI
Three Perioperative PhasesPreoperative
Decision for Surgery to Transfer to SurgeryIntraoperative Transfer to Surgery to PACU
Postoperative PACU to Recovery
Preoperative PhaseLPN/LVN Role
Assist in Data CollectionReinforce Explanations/Instructions Provide Emotional/Psychological Support
Factors Influencing Surgical Outcomes
Emotional ResponsesAgeHydration/NutritionSmoking and AlcoholDiseases
Preadmission Surgical Patient Assessment
Health HistoryRisk FactorsEducation Discharge Planning Referrals Diagnostic Testing
Preadmission Surgical Patient Assessment (cont’d)
Pregnancy Test Advance Directive
Preoperative Teaching
Preoperative RoutinesDate/Time of Admission/SurgeryAdmission ProceduresLength of Stay, Items to Bring and WearRecovery after SurgeryFamily InformationDischarge Criteria
Preoperative InstructionsNPO Medications Bowel PrepPain Control
Preoperative Instructions (cont’d)Postoperative Exercises
Deep Breathing and Coughing Incentive Spirometry Leg Exercises
Incentive Spirometry
Preoperative Patient: Assessment
Health HistoryMedicationsPhysical Assessment
Preoperative Nursing Diagnoses
AnxietyFearDeficient Knowledge
Preoperative ConsentGives Legal Permission for Surgery
Informed Consent Physician’s ResponsibilityNo Sedation When SigningVoluntaryCan Withdraw at Any TimeValid 30 Days
LPN/LVN Role: Witnessing Consents
Ensure Patient Has Been Informed
Direct Questions to Physician
Signature Indicates Observed Voluntary Signing of Consent
Preparation for SurgeryPreoperative Preparation ChecklistPreoperative Medications
Preoperative Checklist
Transfer to Surgery
Holding Area
Holding AreaVerifications
Patient DataSurgical SiteTime Out
IV InsertionIV Antibiotic
Intraoperative Phase Begins
Arrival in SurgeryExplain What to ExpectPositionSafety Tubes Placed After AnesthesiaSkin Prep
Intraoperative PhaseLPN/LVN Role
Scrub Nurse Sterile Instrument Field
Assists Physician
AnesthesiaGeneral Anesthesia
Loss of Sensation, Consciousness, Reflexes IV or Inhalation Route
Local AnesthesiaLoss of Sensation to Body RegionInjection of a Local Agent
Endotracheal Tube
Malignant HyperthermiaRare Hereditary Muscle Disease Triggered by Some Types of General Anesthesia Agents
Spinal Anesthesia
AnesthesiaAdjunct Agents Conscious Sedation
Surgery
PACU
Postoperative PhasePACU Nursing Diagnoses
Risk for AspirationIneffective Breathing Pattern
Ineffective Airway Clearance
Deficient Fluid Volume
Risk for Injury
Postoperative Phase (cont’d)PACU Nursing Diagnoses (cont’d)
Disturbed Sensory Perception
Acute Pain
Family Visitation Keep InformedMaintain Confidentiality (HIPAA)
PACU Discharge CriteriaStable Vital SignsSao2 Greater Than 90%Awake, Baseline Level of ConsciousnessRespirations Not DepressedBleeding Controlled
Nursing Diagnoses for Postoperative Patients
Ineffective Airway Clearance Ineffective Breathing Pattern Acute Pain Deficient Fluid Volume Ineffective Tissue Perfusion Impaired Urinary Elimination
Nursing Diagnoses for Postoperative Patients (cont’d)
Urinary RetentionRisk for InfectionImpaired Skin IntegrityImbalanced NutritionConstipationImpaired Physical Mobility
Complication Prevention
Complication Prevention (cont’d)
Stapled Incision
Healing Phases
Wound Dehiscence/Evisceration
Ambulatory Surgery Discharge Criteria
Stable Vital SignsNo BleedingNo Nausea/Vomiting Controlled Pain Voided as Indicated No Dizziness When Upright
Discharge InstructionsWritten Instructions/SignedTeaching
Wound Care Medications Complications Equipment
Discharge Instructions (cont’d)Follow-up Physician’s VisitPrescriptions
Discharge Teaching
Home Health CareRN
Assessment, Complex Nursing Care, Teaching
LPN/LVN Basic Nursing Care
Assistants ADLs, Chores