PREPARING FOR THE PATIENT IN SURGERY
WEEK 6
Why Me?Thoughts that run thru the pt’s mind
Pt’s often question why them? Component that make up the individual:
Physical Need: any need or activity related to genetics, physiology, or anatomy.
Psychological Need: Any need or activity related to the ID and understanding of one’s self.
Social Need: Any need or activity related to one’s ID or interaction with another person or group.
Spiritual Need: Any need or activity related to one’s ID and understanding place in the universe.
Why Me? All of these needs exist
as a group, not individually.
However, each individual is unique as each handles each situation differently.
Family members must be considered as well with consideration of their physical, psychological, social, and spiritual issues (maintain communication prn)
Reasons for Surgery
Genetic deformity – Cleft Lip Trauma – MVA Nonmalignant tumor – Uterine Fibroid Malignant tumors – Colon cancer Disease - HIV Condition – Kidney Stone Psychological state – Facelift (Rhytidectomy)
Preparing for the Patient in Surgery Requires Knowledge of:
HOLISTIC APPROACH Recognizing our patients as a person, not the case in OR
#4 or the radical mastectomy in OR #4 Maslow’s “Hierarchy of Needs”, a view of human
development “Life Tasks Approach” to psychosocial needs pg 61 Cultural and Religious Influences The “Nursing Process” as applicable to the ST
Maslow’s Hierarchy of Needs
Physiological Needs
Most basic biological or survival needs of the patient
Oxygen Water Food Temperature
regulation
Safety Needs
Patient’s perception of placing trust that their environment is safe
Trust in surgeon Trust in staff/institution Warmth provided Protected from infection
by asepsis Positioned comfortably Injury prevented
Love and Belonging Needs(Social)
Recognized and cared for as an individual
Caring for others Interacting with
others: family, friends, church members, and co-workers
Esteem Needs
Positive regard for one’s self and others To be respected and respect others
Self-Actualization
To fulfill what one views as their potential or purpose in life
Application of Maslow in Surgery
Prioritization of care in surgery Trauma for example: biological issues
take precedence (oxygen, blood loss control, pain relief, and infection control)
Can also recognize patient’s rights Provide competent care Provide safety, privacy, and respect
Development and Change
Life Tasks Approach (Table 4-2, pg. 61)
The Life Tasks Approach gives us a way to understand a surgical patient’s needs and fears
Development and Change
Open to page 61 - discuss
Death and Dying 3 accepted definitions of
death: Cardiac death: complete
absence of heartbeat and respiration.
Higher Brain Death: irreversible loss of higher brain function. PT still has respiration, BP, and heart beat w/o the aid of a respirator.
Whole-Brain Death: irreversible loss of all brain function. Includes flat EEG, lack of pupil reflexes, and hypothermia.
Cultural Considerations
Gives us a perspective of the surgical patient’s thoughts and feelings about health care needs
Language can be a huge barrier Cultural considerations can help us for
when we can’t communicate, as well as when we can
Asian Americans
Chinese: silence is valued touch is limited fear invasive procedures distrustful of doctors and health care workers
who perform painful procedures both parents involved in decisions regarding
their children
Asian Americans continued
Japanese: touch is limited feel direct eye contact disrespectful stoic family needs come first eldest child cares for elderly
Asian Americans continued
Vietnamese: eye contact disrespectful father is decision maker use titles when addressing do not ask direct questions
Asian Americans continued
Filipinos: avoid eye contact value nonverbal communication family needs come first
Hispanic Americans
Father needs to be there when speaking to male children
Familial and personal privacy valued/very modest
Father decision maker and provider for family Women tend to the ill Fearful of hospitals/may see as a “place to die”
American Indians
Avoid prolonged direct eye contact Family members are responsible for each other Takes time for them to form opinions about
health care providers Elders assume leadership roles With amputated limbs, may require them to go to
the family or stay with patient
Middle Eastern
No touching outside family or spouse Male dominated culture, therefore is
decision maker Males are only to be alone with their wife,
not other females (May require male health care workers)
Females can only be touched by female health care providers
Appalachian
Direct eye contact disrespectful Kindness valued Judge health care workers by how they
relate to them not by competence Fearful of hospitals, considered a “place to
die” Care of the ill is provided by family
including extended family members
Religious Considerations
ST needs a basic understanding of different religions and their relationship to health care
Religion can raise ethical and legal issues for patients and health care providers
Religion can conflict with modern medical technology
American Indian
Abortion not allowed Organ transplantation discouraged Medical treatment views vary
Islam
Privacy important Medical treatment is encouraged
Roman Catholic
Abortion not allowed
Jehovah’s Witness
No food containing blood
No blood transfusion Abortion not allowed Organ transplantation
allowed provided organ is stripped of all blood
Special Populations
Pediatric patients Geriatric patients HIV, Trauma, Organ Donor or Recipient
Pediatric Patients
Specialty area Anatomy and physiology
differ from adult Response to anesthesia
and other medications differ from adults
Psychologically, communication with child dramatically different
Descriptions of pain and pain locations may not be precise like an adult
Pediatric Patient continued
Surgical team will naturally feel more protective towards children
Communication with infant to two year olds will be limited to reassurances and snuggling
Explanations should be short and appropriate for the three year old to twelve year old
Surgical Team Role with Pediatric Patient
Obtain good anesthesia Finish surgical procedure
effectively, efficiently, and safely
Get the child back to their family as soon as possible
Will be more sensitive to cold room temperatures due to decreased body surface area, so room will be kept very warm
Geriatric Patients
May or may not have diminished mental status/Do not assume all elderly are “senile” as most are not
Pay special attention to physical changes in the body that do affect all elderly and directly influence our care of them
Physical Changes of the Geriatric Patient
Skin loses elasticity causing it to easily bruise or tear Care must be taken when moving and positioning patient
to avoid shearing or bruising of the skin Care must be taken when applying and removing tape
and or other sticking drape materials to avoid thin areas of skin and ripping skin off the body
Sensitive to prolonged pressure over bony prominences/Pad these areas well to avoid ulceration
Physical Changes of the Geriatric Patient
Loss of subcutaneous layer or fatty/protective layer of skin
Causes sensitivity to cold and can result in hypothermia
Use warm blankets and warm fluids
Keep as much of the body insulated as possible
With Bair Huggers always attach/Never leave hose free to just blow onto body as can cause major burns
Physical Changes of the Geriatric Patient
Loss of bone, joint mobility, and muscle mass
Loss of flexibility More prone to
fracturing of the bones
Extreme care with positioning and padding
Physical Changes of the Geriatric Patient
Loss of urinary bladder and bowel control
Don’t be surprised by SURPRISES
Maintain patient integrity and privacy and assist with cleaning at the end of the procedure before transport
SURPRISES that have prolonged contact with the skin can cause breakdown of the skin
HIV, Trauma, Organ Donors or Recipients
Maintain caring environment Maintain asepsis Maintain same high level of care to
surgeon and patient Protect the patient from injury from
environmental hazards
ST Responsibilities
Ethically and legally responsible to provide service to our surgeon and patient despite how we feel about the culture or religious beliefs of our surgeons or patients
Must provide a caring environment Must provide surgical asepsis Must protect the patient from injury THE PATIENT COMES FIRST
Maintaining the Surgical Environment Continued
Speak in a calm, clear, unhurried tone Move patients with care paying attention to proper body
alignment and any IV lines or other lines that could get snagged during movement from stretcher to OR bed and back
Maintain safety precautions for everything in the OR room that could cause the patient harm or injury
Perform tasks in an efficient and effective manner BE EXTRA EYES AND EARS FOR THE PATIENT’S
NEEDS AND SAFETY
Helping to Maintain the Surgical Environment as the ST
Can introduce self professionally Maintain communication with the RN circulator
throughout the surgical procedure Aid with reports on where you are in the procedure and
status of the patient so the RN circulator can keep the family informed
If assisting the circulator, a touch or squeeze of the patient’s hand can calm a fearful patient
Explain everything you are going to do when the patient is awake (regional anesthesia)
Use appropriate language that can be understood not medical terms
Military Time
Military Time You will often see military time in the OR,
on the chart and used between staff. It is used to avoid confusion between a.m.
and p.m. since we are a 27/7 service. The main difference between regular and
military time is how hours are expressed. Regular time uses numbers 1 to 12 to identify each of the 24 hours in a day. In military time, the hours are numbered from 00 to 23. Under this system, midnight is 00, 1 a.m. is 01, 1 p.m. is 13, and so on.
Military Time
Morning
Midnight = 0000 1:00 a.m. = 0100 3:00 a.m. = 0300 6:00 a.m. = 0600
After Noon (just add 12)
Noon = 1200 1:00 p.m. = 1300 3:00 p.m. = 1500 6:00 p.m. = 1800
Summary
Reasons for surgery Recognizing patient as a person:
physical
psychological
social
spiritual
Summary continued
Maslow’s Hierarchy of Needs Life Tasks Approach to development and
change ST role in maintaining surgical
environment Cultural considerations Religious considerations
Summary continued
Special populations:
Pediatric
Geriatric
HIV, Trauma, Organ donor or recipient ST responsibilities