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