oncology fluids & electrolytes perioperative
TRANSCRIPT
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G0Mitosis
G1
G2
S
Cell Cycle a series of events within the cell thatprepare the cell for dividing into two
daughter cells
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WARNING SIGNS
(C.A.U.T.I.O.N.A.L)(C.A.U.T.I.O.N.U.S)
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CHANGE IN BOWELOR BLADDER HABITS
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A SORE THAT DOES NOTHEAL
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UNUSUAL BLEEDINGOR DISCHARGE
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THICKENING OR LUMP INBREAST OR ELSEWHERE
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Indigestion or difficulty swallowing
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OBVIOUS CHANGE IN WARTOR MOLE
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NAGGING COUGHOR
HOARSENESS
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UNEXPLAINED WEIGHT LOSS
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SEVERE ANEMIA
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EARLY DETECTION: main goalof treatment of breast cancer
BSE: MONTHLY self examination; age 20-40:breast exam every 2-3 years by a physician; 40 years =
annual
Mammogram: baseline 35-40 years; mammogram everyyear or very other year fro ages 40-50; mammogramyearly after age 50
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hard irregular mass felt in the
superior medial quadrant ofthe breast at the 2 oclock
position approximately 2.5 cmfrom the margin of the areola
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Breast SELF EXAMINATION
1. Start from age 20
2. Done after menstruation3. One week after menstrual
period4. During standing position,
note symmetry of breast5. Lying position, elevate
shoulders on side examinedwith pillow support
6. Palpate the breast fromperiphery to the center incircular motion
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STAGE 1
Breast tumors are very small and measure less than 2 cm. in
size; early breast cancer
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STAGE 2
Breast tumors measure between 2 and 5 cm. and the lymph nodes mayhave become affected. There is no sign of spread of breast cancer to
any other part of the body; still termed early breast cancer
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STAGE 3
Breast tumors are larger than 5 cm. and the lymph nodes are usuallyaffected, but there is still no sign that the disease has spread any further
throughout the body. locally-advanced breast cancer
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STAGE 4
Breast tumors are of any size, but in addition the lymphnodes are affected and the cancer has spread to other
parts of the body. advanced or metastatic breast cancer
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SUMMARY
1. Biopsy (FNAB)
2. Surgery (lumpectomy; simple mastectomy, MRM)
3. Chemotherapy
4. Radiation
5. Hormone therapy1. Tamoxifen2. Oophorectomy3. Corticosteroids4. Adrenalectomy and hypophysectomy
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NURSING CARE
Preoperative:
HISTORY AND P.E.
Tetanus prophylaxis and prophylactic antibiotic forulcerated tumors
Rehabilitation medicine
Intraoperative
DECISION Suction drain
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Post operative
Analgesics
Arm rehabilitation exercises
Discharge after 48 hours with tube drains and withinstructions:
Care of tube drain
Intake of analgesics
Arm rehabilitation exercises Follow up visit 5-7 days after discharge
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Post operative
Prevent lymphedema
ARM ADDUCTED, JP drain present
Instruct JP system After discharge, teach abduction, elevation 7-10
days to prevent contractures
Finger, hand, wrist, elbow, shoulder movement
throughout No venipuncture, injections, parenteral fluids
No shaving or deodorant to affected side
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Post operative
Post mastectomy arm exercises
1-2 days: focus on elbow, wrist and hand ofaffected side (extends, flexes elbow, gentlysqueezes a soft rubber ball and does DB tofacilitate lymph flow)
2nd day: add shoulder shrugs and ROM includingflexion and abduction; self care activities; not raisethe arm above shoulder height until drains areremoved
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Post operative
Post mastectomy arm exercises
10th day: active assisted ROM 2x a day; pain meds30 min prior = lymphedema and loss of shouldermobility
6th week: water aerobics; avoid using weights toprevent edema and subsequent swelling
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Post operative Arm precautions after mastectomy
Affected arm never used for BP, venipuncture,injection
No constricting clothing or jewelry including wristwatch on affected arm
Do not carry heavy objects in affected arm
Wear rubber gloves when washing dishes
Use unaffected arm when removing food from hotoven or wear padded glove pot holder
Use a thimble when sewing
Use cream or lotion to keep the skin soft
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Post operative Outdoor activities
Wear gloves when gardening
Wear protective clothing or use sunscreen to
prevent sunburn
Use insect repellant fro insect bits
Immediately wash cuts and scratches
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Follow up
Second follow up is 30 days after operation
Adjuvant therapy started within 6 weeks of operation
Frequency of follow up
First 2 years: every 6 months; earlier if with symptoms
After 2 years: yearly
Routine annual contralateral breast mammography
Symptom directed metastatic work up
Gynecological evaluation annually if on tamoxifen
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Early detection methods
SBE monthly Clinical breast exam every 3 years @ 20-39 and annually
thereafter
Annual PSA and DRE for men > 50 y.o.; annual testing for
men age 40 and over who are at high risk PE every 3 years, ages 20-39 and yearly over 40 y.o.
Pelvic exam every 3 years until 40, then yearly
Pap smear
Yearly fecal occult blood at 50; sigmoidoscopy q5y; doublecontrast enema q5y or colonoscopy q10y
TSE monthly (testes smooth, firm, oval shaped; rightlarger and higher; left smaller and lower)
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CHEMOTHERAPY
may or may not include Hormone Therapy
adjuvant treatment
can be taken by mouth, by injection, by intravenous
injection or by intravenous pump at set cycles or rounds
cause the fast growing cancer cells to stop dividing, stopgrowing and die
can be given before surgery to shrink a tumor or aftersurgery to reduce the chances of recurrence
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Side Effects mouth sores
nausea and vomiting
loss or thinning of hair
loss of appetite tiredness; loss of energy
sleep disturbances
temporary or permanent menopause (and sideeffects)
hot flashes
low red blood cell count; low white blood cell count
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1. Report side effects of chemotherapy2. Take medicines prescribed for side effects3. Severe side effects might improve with treatment
changes or dose reduction
4. Restrict activities5. Ask for help with chores6. If necessary cut back on hours at work7. Rest when tired8. Plan meals ahead for day of treatment and a couple of
days after
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9. Arrange for help with young children at treatment time10. Nibble dry crackers to help nausea11. If you are unable to eat, drink lots of liquids (juice,
peppermint tea, soup, Boost etc.)
12. Meditation and visualization can help reduce sideeffects13. Reward yourself with a small gift after each treatment
(flower, perfume, bubble bath etc)
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Woman in position for radiation treatment, from the side.Side radiation treatment beam is shown.
A bright yellow indicates breast being treatedB light yellow part of the beam, beam in air, not touching womanC opening of the linear acceleratorD arm holder
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Woman in position for radiation treatment, from the front. Middleradiation beam is shown.
A bright yellow indicates breast being treatedB light yellow part of the beam, beam in air, not touching woman
C opening of the linear acceleratorD arm holder supports woman's right arm
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INTERNAL RADIOTHERAPY
brachytherapy radiotherapy with implants thin tubes, seeds or rods containing radioactive material
are placed either directly into the cancer or close to it
alone, or combined with external radiotherapy
Temporary (one to six days) Permanent (remain in the body but are no longer
radioactive after being in place for some weeks or
months)
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INTERNAL RADIOTHERAPY
may send some radiation outside your body into thesurrounding area
Once the implant is removed, all radioactivity is removedfrom youthat is, you are not radioactive and there is nodanger to anyone else
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EXTERNAL RADIOTHERAPY
a machine directs radiation onto the cancer andsurrounding tissue
the length of treatment depends on many things, such asthe type of cancer, its location, and whether it is intendedto cure the cancer or to provide palliative treatment
a special x-ray machine called a simulator is often usedto pinpoint, very precisely, the area of the body to betreated
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EXTERNAL RADIOTHERAPY
permanent marks, which are fine dots, may be used toensure the radiation is delivered to the same site on adaily basis. These small, black 'tattoos' are about thesize of a pinhead.
external radiotherapy does not make you radioactive. Itis quite safe for you to be with other people when youare having treatments and after.
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SIDE EFFECTS tiredness inflamed, dry, itchy skin
peeling or darkening skin wet, moist, blistering skin surface (like a bad sunburn) swelling, heaviness, tenderness of the breast pinching or mild jabbing sensations thickening of the breast skin or tissue change in size of the breast lump in the throat during treatment heartburn during treatment difficulty swallowing during treatment
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1. Do not remove colored ink marks on the skin unless toldto do so
2. Wash with lukewarm water only and blot dry
3. Avoid soap, lotion, ointment or perfume on treatment
area
4. Do not shave or use deodorant in armpit on thetreatment side
5. You can dust your armpit with cornstarch
6. Avoid exposing treatment area to sun or hair dryers
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7. Wear a very loose fitting bra or camisole. If you havehad a mastectomy ask you doctor if you can wear yourprosthesis.
8. Do not scratch when itchy
9. If side effects persist or are aggressive ask your doctorfor special treatment products.
10.Continue doing post surgery exercises
11.Maintain a well balanced diet
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ORAL
CANCER
Tobacco use; mouth
sore that doesnt heal,
sore throat,
dysphagia,hgoarseness;
LEUKOPLAKIA;
ERYTHROPLAKIA
Clinical 1. SURGERY;
RADIATION
2. SOFT DIET TO
ALLOW AREATO HEAL
3. TUBE
FEEDINGS;
TRACHEOSTO
MY CARE
LUNG
CANCER
SMOKING
Chronic cough,
hoarseness,
hemoptysis, weightloss, loss of appetite,
fever, wheezing,
repeated bouts of
pneumonia, chest pain
CT scan; PET
scan; cytologic
analysis of
sputum; fiberopticbronchoscopy;
lymph node
biopsy; chest x-ray
Surgery
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ESOPAHGEAL
CARCINOMA
1. Ingestion of
corrosive
substance
like acids or
alkali
2. Esophagealstasis, like
muscular
problem of
esophagus
3. Alcohol
4. Smoking
Progressive
dysphagia
Anorexia
and weightloss; Back
and
substernal
pain
Hoarseness
of voice
Chronic
cough
Barium
swallow
Endoscopy
with biopsy
CT scan
Endoscopic
ultrasound
1. Nutrition
2. Palliative
3. Supportive
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LARYNGEAL
CANCERPROGRESSIVE
hoarseness;
dysphagia; lump
in the throat;burning
sensation when
drinking hot
liquids;persistent sore
throat
1. Laryngectomy (partial - clients
voice preserved; or total loss of
smell and speech; permanent
stoma needed)PRE-OP: routine; communication
mode; post op teaching before
procedure
POST-OP: routine post op care; checkfor hemorrhage, Atelectasis and
pneumonia; stoma care (avoid
water, aerosols, sprays; suction,
DBCT; humidified air, oralhygiene, hemovac make sure
deflated; establish
communication; speech therapist
consulted
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GASTRIC CANCER
1. Excess intake of
nitrate - cured,
salt cured andsmoke cured
foods
2. Smoking
3. Chronic
achlorhydria4. Pernicious
anemia
5. (+) family history
6. Excess intake of
raw foods
7. Drinking large,
volume of hot tea
8. Atrophic gastritis
Progressive loss
of appetite
Gastric fullness
(early satiety)Dyspepsia
(+) Guaiac stool
N & V
Hematemesis;
melenaPain induced by
eating relieved by
vomiting
Palpable mass
Anemia, pallor,weight loss
Occult blood
test
UGI series
UGI endoscopyBlood chemistry
1. Gastrectomy
Dumping
syndrome
Hemorrhage orbleeding
Pernicious
anemia
HODGKINSA EARLY 20S; Presence of 1 Radiation (1& 2)
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HODGKIN SA
LYMPHOMA
(malignancies of
lymphoid tissue; Blymphocytes; due to
Epstein Barr virus;
UNKNOWN CAUSE)
Most common in the
cervical, axillary,
inguinal nodes
EARLY 20 S;
55-75 Y.O.;
MEN
NIGHT
SWEATS,
WEIGHT
LOSS, FEVER,
FATIGUE,
PAINLESS
ENLARGEMENT
OF ONE OR
MORE LYMPH
NODES ON
ONE SIDE OF
THE NECK
Presence of
Reed Sternberg
cells
Test to stage:
1. Chest x-
rays; CT
scans of
head,neck,
chest,
abdomen,
pelvis;
PET of
entire
body;
CBC, Bone
marrow
biopsy
1. Radiation (1& 2)
2. Chemotherapy
(3 & 4)
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Staging
STAGE I single LN region, lymphoid
structure or extralymphatic site STAGE II 2 or more LN on same side of
diaphragm, localized extra
lymphatic involvement
STAGE III LN regions or structures on both
sides of the diaphragm, involve
the spleen or localized extranodal
disease STAGE IV diffuse or disseminated extra
lymphatic disease
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Chemotherapy
Depends on clients age, general condition
ABVD REGIMEN (DOXORUBICIN, BLEOMYCIN,
VINBALSTINE, DEACARBAZINE)
MOPP REGIMEN (NITROGEN MUSTARD,
VINCRISTINE, PROCARBAZINE, PREDNISONE
Radiation therapy(EARLY STAGE OF Hodgkinsdisease)
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Subtype Incidence Prognosis
Lymphocytepredominant Adults and males Localized atdiagnosis;
excellent
prognosis
Nodularsclerosing
MOST COMMON Good if diagnosedearly
Mixed cellularity Adults and males Poorer prognosis
Lymphocytedepleted
LEAST COMMON Poor prognosis
Manifestation HODGKINS NON HODGKINS
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Manifestation HODGKIN S NON HODGKIN S
LAD Localized, single
(cervical,
subclavicular)
Multiple peripheral
(mesentery)
SPREAD Orderly &
continuous
Diffuse & unpredictable
EXTRANODAL
INVOLVEMENT
RARE EARLY & COMMON
BONE MARROW UNCOMMON COMMON
FEVER, night
sweats, wt. loss
COMMON UNCOMMON
Other
manifestations
Fatigue, pruritus,
splenomegaly,
anemia, neutrophilia
Abdominal pain,
nausea, vomiting,
dyspnea, cough, CNS
symptoms
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COLORECTAL Change in FECAL OCCULT BLOOD
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COLORECTAL
CANCER
FAMILY HISTORY;ethnic
background;
colorectal
polyps; chronic
inflammatorybowel diseases;
> 50 y.o.;
smoking;
alcohol intake;
high fat; low
fiber; obesity;
DM
Change in
bowels:
tarry,
pencil or
ribbonshaped,
bloody
stools
Abdominal pain;diarrhea,
vomiting,
obstipation
, rectal
pressure;bleeding
FECAL OCCULT BLOOD,
SIGMOIDOSCOPY,
COLONOSCOPY, BARIUM
ENEMA, DRE
SURGERY, CHEMOTHERAPY
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ASCENDING (RIGHT) COLON CANCER
Occult blood in stool; Anemia; anorexia andweight loss; abdominal pain above umbilicus;palpable mass
DISTAL COLON/RECTAL CANCER
Rectal bleeding; changed bowel habits;constipation or diarrhea; pencil or ribbon shapedstool; tenesmus; sensation of incomplete bowelemptying
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Barium Enema
apple core Polypoid or plaque-like
lesion
Colonoscopy
Access to biopsy
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DUKES CLASSIFICATION
Stage A
confined to bowelmucosa; 80-90% survival
rate
Stage B
invading muscle wall
Stage C
lymph node involvement
Stage D metastases or locally
unresectable tumor;
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MANAGEMENT
Surgery
Hemicolectomy for ascending and transversecolon CA
Abdomino perineal resection (APR) forrectosigmoid cancer
There are 2 incisions: lower abdomenincision to remove sigmoid and perinealincision to rev\move the rectum
T- binder is used to secure perinealdressing
Necessitates permanent colostomy Chemotherapy (Fluouracil)
Radiation (adjuvant therapy for rectal CA)
RADIATION THERAPY
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RADIATION THERAPY
Internal BRACHYTHERAPY
1. Implanted into affectedtissue or body cavity
2. Ingested as a solution3. Injected as a solution
into the bloodstream orbody cavity
4. Introduced through acatheter into the tumor
SEALED OR UNSEALED Sealed
(temporary/permanent) Bed rest Use long handled
forceps Unsealed
Flush toilet 2x ormore
External TELETHERAPY
TIME, DISTANCE,SHIELDING 10 30 MINUTES 6 FEET PRIVATE ROOM
NO PREGNANT NURSE ROTATE NURSE(minimize exposure)
Lead apron Mark No deodorant, irritants to
skin etc. Avoid rubbing
Three step analgesic ladder for cancer pain
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Three step analgesic ladder for cancer paincontrol (WHO 1986)
1. BY THE MOUTH oral medication if possible
2. BY THE CLOCK regularly not as required
3. BY THE LADDER increasing potency of analgesiafor increasing severity of pain
Three step analgesic ladder for cancer pain
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Three step analgesic ladder for cancer paincontrol (WHO 1986)
Strong opioid
+/- non opioid
+/- adjuvant
Weak opioid
+/- non opioid
+/- adjuvant
Non opioid
+/- adjuvantNON OPIOID ANALGESICS
Paracetamol, Aspirin, NSAIDs
WEAK OPIOID ANALGESICSCodeine, Codeine paracetamolmixtures; dextropropoxyphene
STRONG OPIOID ANALGESICS
Morphine and related compounds
Prostate cancer Frequency, 1. Dx: DRE, needle biopsy, PSA;
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Etiology: Unknown
nocturia,
hesitancy,
urinary retention
, p y, ;
increase in acid and alkaline
phosphatases
2. Tx: radical prostatectomy;
radiation, hormone
manipulation; bilateral
orchiectomy
Bone metastasis: spinal cord
compression, pathologicfractures
Bladder Cancer
Chronic bladderinfection, smoking
Painless
hematuria,
dysuria and
frequency
1. Dx: cystoscopy
2. Cystectomy with one type of
urinary diversion: ILEAL
CONDUIT
Bladder Cancer 1. Pre op: routine; bowel prep
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p ; p p
2. Post op: routine; stoma care
3. Stoma care:
1. Check color; increase stomalheight is normal; monitor
excessive edema and
bleeding, monitor for
obstruction (decrease UO);
empty pouch when half full;
cleans periostomal skin with
mild soap and water; check
appliance in AM; maintain
urine acidity; report s/Sx of UTI
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Peri operative Nursing
PREOPERATIVE
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Assess STRESS (vaso vagal response)
Diagnose FEARS
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Fears of surgery at different developmental stages
AGE GROUP SPECIFIC FEARS NURSING considerations
Toddler SEPARATION TEACH parent to expectregression
Preschooler MUTILATION Allow child to play with models;encourage expression of feelings
School ager LOSS OF CONTROL Explain procedures in simpleterms; allow choices whenpossible
Adolescent LOSS OFINDEPENDENCE,
being different frompeers, e.g. alteration inbody image
Involve adolescent in proceduresand therapies; expect resistance;
express understanding ofconcerns; point out strengths
PREOPERATIVE
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Plan/Implementation
Age appropriate preparation for health care proceduresAGE SPECIAL NEEDS Typical fears
Newborn Include parents
Mummy restraints
Loud noises
Sudden movements
6-12 month Model desiredbehavior
Strangers, heights
Toddler Simple explanations;use distractions; allow
choices
Separation from parents;animals, strangers; change in
environment
Preschooler Encourageunderstanding by
playing with puppets,dolls; demo equipment;talk at childs eye level
Separation from parentsGhosts
Scary people
PREOPERATIVE
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Plan/Implementation
Age appropriate preparation for health care proceduresAGE SPECIAL NEEDS Typical fears
School ager Allow questions
Explain why
Allow to handleequipment
Dark, injury
Being alone
Death
Adolescent Explain long termbenefit
Accept regression
Provide privacy
Social incompetence
War, accdietns
Death
PREOPERATIVE
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Plan/Implementation
Promote safe environment PARENTAL INVOLVEMENT SAME NURSE TO CARE FOR THE CHILD (CONSISTENCY)
PROVIDE OBKJECTS THAT RECREATE FAMILIARSURROUNDINGS
Preparation for surgery Pre op check list: Informed consent; lab tests; skin prep; bowel
prep
IVs
NPO
Pre op meds, sedation and antibiotics
Removal of dentures, jewelry and nail polish
Nutrition (may need TPN or tube feedings pre op
PREOP TEACHING GUIDE
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FACTORS FOR NURSE TO ASSESS BEFORE TEACHING
History of illness
Rationale for surgeryNature of Surgery
Factors related for patients readiness for learning (age, mental status, pre
existing knowledge about condition)
CONTENT AREAS TO COVER DURING TEACHING
Elicit patients concerns
Provide info to clear up misconceptions
Explain preop procedures; remove jewelry and nail polish
Lab tests; skin prep
Rationale for withholding food and fluids (NPO)
Preop meds and IV line
Teach preop procedure (DBCT, leg exercises, moving in bed, incentivespirometry, equipment to expect post op)
Explain importance of reporting pain after surgery; relieve pain
PREOPERATIVE
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Evaluation
Is the preop checklist complete? Is the patient able to demonstrate post op exercises?
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PREOPERATIVE
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PREOPERATIVE
History Allergies Present medications Past medical illness Alcohol and drug use
Female patients: ask about pregnancy (LMP) Others:
Any loose teeth, dentures Glasses or contact lenses Hearing aid Jewelry Joint implants, metal implants, pacemaker Body piercing
PREOPERATIVE
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PREOPERATIVE
Surgical risks Age Obesity Medical illness Fluid and electrolyte status
Present medication Nature and location of present condition Magnitude and urgency of surgical procedure Mental attitude of the patient towards surgery
Caliber of the professional health team and ORfacilities
PREOPERATIVE
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PREOPERATIVE
Patient teaching
Diagnostic tests Concerns about anesthesia Diet; OR procedure IV therapy What to expect in the PACU
Pain control
Informed consent
Pre op exercises DBCT Incentive spirometry Foot and leg exercises Getting out of bed
PREOPERATIVE
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PREOPERATIVE
Skin preparation
Reduce number of microorganism near the incisionsite
Full bath the evening or morning of surgery Document
Bowel preparation AFTER 3 make the call
Pre op DRUGS
ANTI cholinergics; sedatives; anti anxiety; narcoticanalgesics; H2 receptor antagonists
FINAL CHECK
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INTRAOPERATIVE
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INTRAOPERATIVE
Role of the nurse
Positions during surgery
Types of anesthesia
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ANESTHESIA
MEDICATION SIDE EFFECTS Nursing considerations
Generalanesthesia via
inhalation(halothane)
Resp, circ depressionDelirium during
induction and recoveryNausea and vomiting,
aspiration during
induction, myocardialdepression and hepatic
toxicity
Check history of sensitizationMaintain airway
Protect and orient client
Monitor vital signs and labs
Prevent aspiration post op byelevating hear of bead andturning head to side unless
contraindicated
Nitrous oxide Hypotension, post op
nausea and vomiting
Monitor VS
Adequate oxygenation,especially during emergence
ANESTHESIA
MEDICATION SIDE EFFECTS Nursing considerations
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MEDICATION SIDE EFFECTS Nursing considerations
IV thiopentalsodium
(Pentothal)
Resp depression, lowBP, laryngospasm;
poor musclecontraction, irritating toskin and subQ tissue
Monitor VS, esp. airway andbreathing
Straps for operative table, properpositioning
Protect IV site, check placementperiodically
Spinalanesthesia,
saddle
Hypotension,headache
Monitor Vs, encourage fluids
Conductionblocks
(epiduralcaudal)
Hypotension,respiratory depression
Headache not experienced
Monitor VS
Localanesthesia
Excitability, toxicreaction (resp difficulty,
vasoconstriction)
Monitor patient
Do not use with epinephrine onfingers (circulation is less
optimal)
ANESTHESIA
MEDICATION SIDE EFFECTS Nursing considerations
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MEDICATION SIDE EFFECTS Nursing considerations
Conscioussedation
(Valium)
Respiratorydepression, apnea,
hypotension,bradycardia
Never leave the client alone
Constantly monitor airway, LOC,
pulse oximetry, ECG
VS q15-30 minutes
Assess clients ability to maintain
patent airway an respond toverbal commands
Plan/Implementation
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1. Monitor effects of anesthesia post induction2. Continuously monitor VS
3. Aseptic technique4. Appropriate grounding devices5. Fluid balance6. Perform sponge/instrument count
Potential complications1. Nausea and vomiting2. Hypoxia3. Hypothermia
4. Malignant hyperthermia Inherited muscle disorder chemically induced by
anesthesia; stop surgery, treated with 100% oxygen,skeletal muscle relaxant, sodium bicarbonate
POST - OPERATIVE
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OS O
Respiratory
Check breath sounds Turn, cough and deep breath (C/I: brain, spinal and eye
surgery)
Assess pain level
Teach how to use incentive spirometer
PCA
Get out of bed as soon as possible
Cardiovascular
VS q15min x 4; q30min x 2, q1H x 2 then as needed Monitor I & O
Check potassium levels
Monitor CVP
POST - OPERATIVE
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Neuropsychological
Stimulate patient post anesthesia Monitor LOC
GIT Check bowel sounds in 4 quadrants for 5 minutes
Keep NPO until bowel sounds are present Provide good mouth care while NPO Provide anti emetics for nausea and vomiting Check abdomen for distention Check for passage of flatus and stool
GUT Monitor I & O Encourage to void Notify physician if unable to void within 8 hours Catheterize if needed
POST - OPERATIVE
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Extremities
Check pulses
Assess color, edema, temperature
Inform patient not to cross legs
Apply anti embolic stockings before getting out of bed
Monitor for Homans sign
Wounds
Dressing
Document amount and character of drainage
Physician changes first post op dressing
Use aseptic technique
Note presence of drains
POST - OPERATIVE
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Wounds
Incision
Assess site (edematous, inflamed, excoriated)
Assess drainage (serous, serosanguinous, purulent)
Note type of sutures
Note if edges of wound are well approximated Anticipate infection 3-5 days post op
Debride wound if needed to reduce inflammation
Change dressing frequently to prevent skin breakdown andminimize bacterial growth
Drains
GI tubes
POST - OPERATIVE
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Prevent post op complications
Septicemia
Paralytic ileus
Urine retention
Wound infection; dehiscence; evisceration
Intestinal obstruction Hiccups
Post of psychosis
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Prevent post op complications
Atelectasis Hypostatic pneumonia Constipation Abdominal distention Venous pooling
Thrombophlebitis
RULE OF THUMB Fever 1st 24 hours PULMONARY INFECTION Fever within 48 hours UTI Fever within 72 hours WOUND INFECTION
POTENTIAL COMPLICATIONS OF SURGERY
COMPLICATION ASSESSMENT Nursing considerations
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g
Hemorrhage Decreased BP,increased pulse, cold,
clammy skin
Replace blood volume; monitorVS
Shock Decreased BP,increased pulse, cold,
clammy skin
Treat cause, oxygen, IV fluids
Atelectasis and
pneumonia
Dyspnea, cyanosis,
cough, tachycardia,elevated temp, pain
on affected side
Experienced second day post op;
suctioning, postural drainage,antibiotics, cough and turn
Embolism Dyspnea, pain,hemoptysis,
restlessness, ABGlow, high CO2
Experienced second day post op;Oxygen, anticoagulants, IV fluids
DVT Positive homans sign Experienced 6-14 days up to 1year later; anti coagulant
POTENTIAL COMPLICATIONS OF SURGERY
COMPLICATION ASSESSMENT Nursing considerations
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Paralytic ileus Absent bowelsounds, no flatus or
stool
Nasogastric suction
IV fluids
Decompression tubesInfection of
woundElevated WBC,temperature;
positive cultures
3-5 days post op
Antibiotics, aseptic technique
Good nutrition
Dehiscence Disruption ofsurgical incision or
wound
5-6 days post opLow fowlers position, no
coughing, NPO, notify AP
Evsiceration Protrusion of woundcontents
5-6 days post op
Low fowlers position, no coughing
NPO, cover viscera with sterilesaline dressing; notify AP
Urinaryretention
Unable to void;bladder distention
8-12 day post op
Catheterize as needed
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POTENTIAL COMPLICATIONS OF SURGERYCOMPLICATION ASSESSMENT Nursing considerations
Urinary infection Foul smelling urine
Elevated WBC
5-8 days post op
Antibiotics
Force fluids
Psychosis Inappropriate affect Therapeutic communication
Medication
POST - OPERATIVE
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DISCHARGE PLANNING
Medication Diet Activity Home care procedures and referrals
Potential complications Return appointments
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