peri-op nsg
TRANSCRIPT
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Peri-operative Nursing
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Phases of Peri-operative period
PRE- operative phase
INTRA- operative phase
POST- operative phase
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PRE-Operative Phase
Begins when the decision to havesurgery is made and ends when
the client is transferred to theoperating table
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INTRA-Operative Phase
Begins when the client istransferred to the operating table
and ends when the client isadmitted to the post-anesthesiaunit
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Post-operative Phase
Begins with the admission of theclient to the PACU and ends when
healing is complete
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PERIOPERATIVE TEAM
1. ANESTHESIOLOGIST or NURSEANESTHESIST
- makes preoperative assessment toplan type of anesthetic to be
administered
- to evaluate clients physical status2. PROFESSIONAL O.R. NURSE
- makes preop nursing assessments
and documents intraoperative care plan
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PERIOPERATIVE TEAM
3. CIRCULATING NURSE
- manages the OR
- protects clients safety and healthneeds by monitoring activities of
members of the surgical team
- monitors conditions in the OR
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PERIOPERATIVE TEAM
4. SCRUB NURSE- responsible for scrubbing before
surgery
- sets up sterile tables & equipment
- assists surgeon and surgical assistants
during the operation itself
5. PACU NURSE
- cares for the client until he/she
recovers from the effects of anesthesia
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PRINCIPLES OF SURGICALASEPSIS
1. OR personnel must practice strict
Standard Precautions
2. All items used in the OR must besterile
3. All personnel must perform a
surgical scrub
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PRINCIPLES OF SURGICALASEPSIS
4. All OR personnel are required to wear
specific, clean attireshedding the
environment
- must wear:
a. sterile gown
b. glovesc. special shoe covers
d. hair cover cap
e. mask
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PRINCIPLES OF SURGICALASEPSIS
5. Any personnel harboring pathogenicmicrobes must report themselves unableto be in the OR
6. Scrubbed personnel wearing sterileattire should touch only sterile items
7. Sterile gown and drapes have defined
borders of sterility.8. Unsterile personnel must stay at the
periphery of the sterile operating area
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PRINCIPLES OF SURGICALASEPSIS
9. Sterile supplies are unwrapped and
delivered by the circulating nurse
10. The utmost caution & vigilancemust be used when handling sterile
fluids
11. Anything that is used for one clientmust be discarded or, in somecases, resterilized
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Activities in the Pre-op
Assessing the clients
Identifying potential or actual healthproblems
Planning specific care
Providing pre-operative teaching
Ensure consent is signed
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Consent
The surgeon is responsible forobtaining the consent for surgery
No sedation should be administeredbefore SIGNING the consent
The nurse may serve as witness
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Activities during the Intra-op
Assisting the surgeon as scrub nurseand circulating nurse
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Activities in the POST-op
Assessing responses to surgery
Performing interventions to promotehealing
Prevent complications
Planning for home-care
Assist the client to achieve optimalrecovery
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TYPES of SURGERY
According to PURPOSE
According to degree of URGENCY
According to degree of RISK
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According to PURPOSE
Diagnostic Establishes a diagnosis
Palliative Relieves or reduces pain or
symptomsAblative Removes a diseased body part
Constructive Restores function or appearance
Transplant Replaces malfunctioningstructures
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According to degree of urgency
Emergencysurgery
Preserves function or life
Performs immediately
Elective
surgery
Performed when condition
is not imminently lifethreatening
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According to degree of RISK
MajorSurgery
Involves high degree of risk
Complicated or prolonged
Minor
Surgery
Involves low risk
Produces few complicationsPerformed as day surgery
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Surgical Risk
Extremes of age
Malnourished
ObeseCo-morbid conditions
Concurrent medications
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Pre-operative Interventions
Ensure signed consent form
Obtain nursing history, PE and lab exam
Provide pre-operative teaching as to thenature of surgery, what to expect andways to manage post-operativediscomforts
Perform physical preparations- shaving,hygiene, enema, NPO, medications
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Pre-op nutrition
Assess order for NPO
Solid foods are withheld for about 8hours before general anesthesia
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Pre-op elimination
Laxatives, enemas or both may beprescribed the night before surgery
Have the client void immediatelyBEFORE transferring them to the OR
Foley catheter may be inserted asordered
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Pre-op hygiene
Bath the night before surgery withantiseptic soap
Shaving of the skin is usually done inthe OR
Removal of jewelry and nail polish
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Pre-op psychological preparation
Be alert to the clients anxiety level
Answer questions or concerns
Allow time for privacy
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Pre-operative medications
Pre-op Drugs Example Purpose
Analgesics Meperidine To decrease pain anddecrease anesthetic dose
Anti-histamine Diphenhydramine To decrease occurrenceof allergy
H-2
antagonist
Cimetidine To decrease gastric fluidand acidity
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Pre-operative teaching
Leg exercises To stimulate blood circulationin the extremities to preventthrombophlebitis
Deep breathingand Coughing
Exercises
To facilitate lung aeration andsecretion mobilization toprevent atelectasis andhypostatic pneumonia
Done every two to four hours
Positioning andAmbulation
To circulation, stimulate respiration,decrease stasis of gas
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Intra-operative phaseinterventions
Determine the type of surgery andanesthesia used
Position client appropriately for
surgeryAssist the surgeon as circulating orscrub nurse
Maintain the sterility of the surgicalfield
Monitor for developing complications
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Anesthesia
General anesthesia
Loss of all sensation and
consciousness
Regional or Local anesthesia
Loss of sensation in ONE areawith consciousness present
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GENERAL Anesthesia
Protective reflexes are lost
Amnesia, analgesia and hypnosis
occurAdministered in two ways:
Inhalational
Intravenous
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REGIONAL Anesthesia
TOPICAL Applied directly on the skin
INFILTRATION Injected into a specific area ofskin
NERVE BLOCK Injected around a nerve
SPINAL
Subarachnoid
Low spinal anesthesia
EPIDURAL Epidural space is injected withanesthesia
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Patient Positioning
Provides optimal visualization
Provides optimal access forassessing and maintaininganesthesia and function
Protects patient from harm
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Position Patient during Surgery
Abdominal surgeries Supine
Bladder surgery Slightly trendelenburg
Perineal surgery Lithotomy
Brain surgery Semi-fowlers
Spinal cord surgeries Prone mostly
Lumbar puncture Side lying, flexed body
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Functions of the nurse during OR procedure
SCRUB NURSEAssists the surgeon
Maintains sterility
Handles instruments
Drapes patient
Counts sponges
Wears sterile gown, gloves
CIRCULATINGNURSE
Assists the Scrub nurse
Positions the patient for
surgery
Positions any equipments
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POST Operative Interventions
Maintain patent airway
Monitor vital signs and note for early
manifestations of complicationsMonitor level of consciousness
Maintain on PROPER position
NPO until fully awake, with passageof flatus and (+) gag reflex
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POST Operative Interventions
Monitor the patency of the drainage
Maintain intake and output
monitoringCare of the tubes, drains and wound
Ensure safety by side rails up
Pain medication given as ordered
Measures to PREVENT post-opComplications
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Post-operative interventions
PAIN MANAGEMENT
Pain is usually greatest during the 12-36 hours after surgery
Narcotic analgesics and NSAIDS maybe prescribed together for the earlyperiod of surgery
Provide back rub, massage, diversionalactivities, position changes
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Post operative interventions
POSITIONING
Clients who have spinal anesthesia isusually placed FLAT on bed for 8-12hours
Unconscious client is placed side lyingto drain secretions
Other positions are utilized BASED onthe type of surgery
P i I i
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Post-operative Interventions
Some Examples of Position Post Op
Mastectomy Semi-fowlers, affectedarm elevated
Thyroidectomy Semi fowlers , head
midlineHemorrhoidectomy Semi-prone, side-lying
Laryngectomy Fowlers
Pneumonectomy Lateral, affected side
Lobectomy Lateral, unaffected
side
P i I i
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Post-operative Interventions
Some Examples of Position Post Op
Aneurysmal repair(abdomen)
Fowlers 45 degrees
Amputation of lower
extremities
Flat, with stump
elevated with pillowCataract surgery Fowlers 45 degrees
Supratentorial
craniotomy
Folwers
Infratentorialcraniotomy
Flat on bed, supine
Spina bifida repair Prone
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Post-operative Interventions
Deep breathing and coughingexercises Q2-4 hours to removesecretions
Leg exercises Q 2 hours topromote circulation
Ambulation ASAP preventsrespiratory, circulatory, urinary
and gastrointestinal complications
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Post-operative Interventions
Hydration after NPO to maintainfluid balance
Suction, either gastro orrespiratory to relieve distention,to remove respi secretions
Diet progressive, usually givenwhen bowel sounds and gag reflex
return
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WoundCare
Inspect dressing hourly
Change dressing daily
Inspect for signs of infection redness, swelling, purulent
exudate
Maintain wound drainage
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Diet
NPO usually immediately after surgery
Progressive diet
Assess the return of the bowel sounds
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Liquid Diet Vs Soft diet
Clear liquid Full liquid Soft dietCoffee
Tea
Carbonated
drink
Bouillon
Clear fruit
juice
Popsicle
Gelatin
Hard candy
Clear liquid PLUS:
Milk/Milk prod
Vegetable juices
Cream, butter
Yogurt
Puddings
Custard
Ice cream and
sherbet
All CL and FL
plus:
Meat
Vegetables
Fruits
Breads and
cereals
Pureed foods
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Urinary Elimination
Offer bedpans
Allow patient to stand at the bedsidecommode if allowed
Report to surgeon if NO URINE outputnoted within 8 hours post-op
C
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CPTChest Physiotherapy
Chest physiotherapy is based on thefact that mucus can be knocked orshaken form the walls of the airwaysand helped to drain from the lungs.
The usual PVD SEQUENCE is asfollows- POSITIONING, Percussion,
Vibration, and removal of secretionsby SUCTIONING or Coughingfollowed lastly by oral hygiene
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Incentive Spirometry
This operates on the principle thatspontaneous sustained maximalinspiration is most beneficial to thelungs and has virtually no adverse
effects.
The incentive spirometer measuresroughly the inspired volume and
offers the incentive of measuringprogress
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Post operative complications
Atelectasis
Pneumonia
Collapsedalveoli due tosecretions
Inflammationof alveoli
Assess breathsounds
Repositioning
Deep breathingand coughing
Chest physio
Suctioning
Ambulation
Thrombophlebitis Inflammationof the veins
Leg exercisesMonitor for
swelling
Elevated
extremities
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Post-operative ComplicationsHypovolemicShock
Loss ofcirculatoryfluid volume
Shock position
Determine cause andprevent bleeding
O2, IVF
Urinaryretention
Involuntaryaccumulationof urine
Encourage ambulation
Provide privacy
Pour warm water
Catheterize
Pulmonaryembolism
Embolusblocking thelung blood
flow
Notify physician
Administer O2w
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Post-operative complications
Constipation Infrequentpassage ofstool
High fiber dietIncreased fluid
Ambulation
Paralytic ileus Absent bowelsound
Encourageambulation
NPO untilperistalsis returns
Woundinfection Occurs about3 days aftersurgery
Daily wounddressing
Antibiotics
Maintain drain
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Post-operative complicationsWounddehiscence
Separation ofwound edges atthe suture line
Cover the wound
with sterile normalsaline dressing
Place in low-Fowlers
Notify MD
Woundevisceration
Protrusion ofthe internal
organs andtissues throughwound
Cover the woundwith saline pad
Place in low-
fowlers
Notify MD
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To emphasize
The over-all goal of nursing care duringthe PRE-OPERATIVE phase is toprepare the patient mentally and
physically for the surgery
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To emphasize
The over-all goal of nursing care duringthe INTRA-OPERATIVE phase is tomaintain client safety
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To emphasize
The over-all goals of nursing careduring the POST-OPERATIVE phase areto promote healing and comfort,
restore the highest possible wellnessand prevent associated risk
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