H&H module 1

Definitions

• Ambulatory surgery, also known as outpatient surgery, does not require an overnight stay.
• Elective surgery is scheduled ahead of time and is not a medical emergency.
• Semi-elective surgery is necessary for preserving life but doesn't need immediate performance.
• Emergency surgery is performed immediately to treat life-threatening or urgent medical conditions.
• Informed consent is a process where patients receive crucial information, including risks and benefits of medical treatments, tests, trials, and procedures.
• Same Day Admission occurs when a patient is admitted on the same day as their surgery or procedure.
• The perioperative period is defined as the time "around the time of surgery."
• Diagnosis is the determination of the presence or extent of a pathological abnormality.
• Cure refers to the elimination or repair of a pathological condition.
• Palliation is the alleviation of symptoms without providing a cure.
• Prevention is aimed at reducing the risk of developing a condition.
• Cosmetic improvement involves altering physical appearance.
• Exploration is performed to determine the nature or extent of a disease.

Suffixes Describing Common Surgical Procedures

• -ectomy: Excision or removal.
  • Appendectomy: Removal of the appendix.
  • Discectomy: Removal of a disc.
  • Nephrectomy: Removal of a kidney.
• -oscopy: Looking into.
  • Gastroscopy: Looking into the stomach..
  • Knee arthroscopy: Looking into the knee.
  • Cystoscopy: Looking into the bladder.
• -ostomy: Creation of opening into.
  • Colostomy: Creation of an opening into the colon.
  • Ureterostomy: Creation of an opening into the ureter.
• -otomy: Cutting into or incision.
  • Tracheotomy: Incision into the trachea.
  • Arthrotomy: Incision into a joint.
  • Cystotomy: Incision into the bladder.
• -plasty: Repair or reconstruction.
  • Mammoplasty: Reconstruction of the breast
  • Total hip arthroplasty: Reconstruction of the hip
  • Ureteroplasty: Repair of the ureter.

Common Inpatient Surgeries in Canada

• Common inpatient surgeries include C-sections, knee replacements, hip replacements, fractures, and coronary artery angioplasty.

Ambulatory Surgeries

• Ambulatory surgeries can be performed using general, regional, or local anesthesia.
• These surgeries usually take less than two hours and require a post-anesthesia care unit (PACU) stay of three to four hours.
• Ambulatory surgeries typically don't require an overnight hospital stay unless complications arise.

Perioperative Nursing Care

• Numerous nurses are involved in the surgical patient's continuum of care throughout the preoperative, intraoperative, and postoperative phases.
• Information that helps nurses plan care includes:
  • The disorder necessitating surgery.
  • Awareness of comorbidities.
  • Identification of the patient's response to the stress of surgery.
  • Assessment of results of preoperative diagnostic tests.
  • Consideration of bodily alterations, the impact of comorbidities, risks, and potential complications associated with surgery.

Preoperative Admission Assessment

• The initial contact for preoperative evaluation occurs at the preoperative admission clinic (PAC), where a perianaesthesia nurse interviews the patient.
• These interviews are done in person or by telephone at least one day before surgery; patients with complex conditions may need anesthesia or interprofessional team consultation.
• Preoperative assessments involve physical assessments, collecting admission data (including medications and food allergies), consent forms, preanesthesia evaluation, patient's weight and airway history, and laboratory/diagnostic tests.
• The session educates the patient, family, or caregivers, and allows them to ask questions.
• The information provided includes:
  • Policies for taking routine medication on the day of surgery.
  • Information on which medications or herbal remedies to stop prior to surgery and when to stop them (e.g., anticoagulants).
  • Nothing-by-mouth (NPO) instructions.
  • Pain management options.
  • Infection prevention and wound care.
  • Instructions for postoperative exercises.
  • Postoperative discharge and care.

Day of Surgery Assessment

• All surgical patients will have a physical assessment completed and documented by a physician.
• The extent of the exam depends on the surgery type and anesthesia required.
• On the day of surgery, the nurse does a focused preoperative assessment involving the review of existing information, reinforcement of teaching, and review of discharge plans.
• Psychosocial needs of the patient and their family are paramount.
• Each hospital or facility has a preoperative checklist to help nurses.
• Confirm and identify changes to the patient's physical status.
• Confirm preoperative consultations.
• Communicate mobility or sensory deficits to the perioperative team.
• Determine the patient's psychological status and reinforce coping strategies.
• Establish baseline data (i.e., vital signs) for comparison intra- and postoperatively.
• Review all medications that may affect the surgical outcome.
• Ensure that the lab and diagnostic results are documented and communicated to the appropriate personnel.
• Support the patient's language, family, culture, and spiritual/religious needs.
• Assess whether the patient has adequate information and that the consent form is signed.
• Ensure patient understanding of the discharge plan and postoperative support and care.

Subjective Data

• Explore the meaning of surgery with the patient.
• Each person has different perceptions/anxiety levels toward surgery.
• Stress affects the surgical outcome, causing a longer and more painful recovery.
• The way patients transition through the perioperative period affects their postoperative recovery.
• Patients draw on their spirituality and inner peace for hope.
• The perioperative team should respond to the patient’s health goals, hopes, and fears.
• Spirituality and health are interrelated; provide a holistic approach to care.
• The nurse should ask about diagnosed medical conditions and current health issues.
• Women should be asked about menstrual and obstetrical history.
• If the patient says she might be pregnant, it should be communicated to the surgeon.
• The nurse documents the patient's current medication use, including OTC medications and herbal products.
• Whether the patient is taking the medication as ordered should also be investigated.

Effects of Herbs and Supplements During the Perioperative Period

• Echinacea may cause immune suppression if taken over a long term.
  • Discontinue use as far in advance of surgery as possible.
• Ephedra is a stimulant, decongestant, and bronchodilator, often taken for weight loss.
  • Discontinue use at least 24 hours preoperatively.
• Feverfew may increase clotting time.
  • Avoid preoperative use.
• Garlic may increase clotting time and potentiate the effects of anticoagulants.
  • Discontinue use at least 7 days preoperatively.
• Ginger may increase bleeding.
  • Avoid preoperatively.
• Ginkgo biloba may increase bleeding, especially in patients taking anticoagulants.
  • Discontinue use at least 36 hours preoperatively.
• Ginseng may falsely elevate digoxin levels and potentiate MAOIs.
  • Discontinue use at least 7 days preoperatively.
• Goldenseal may cause hypotension and may increase edema and potentiate the effect of insulin.
  • Avoid preoperative use.
• Kava may prolong the effects of certain anesthetics and have motor reflexes.
  • Discontinue use at least 24 hours preoperatively.
• Licorice may cause elevated BP or electrolyte imbalance.
  • Do not use for more than 7 days.
• Saw palmetto may have additive effects with other hormone therapies.
• St. John's wort may prolong the effects of anesthetic agents, potentiate opioids, and cause peripheral neuropathy.
• Valerian potentiates sedative-hypnotics and may prolong anesthesia recovery time.
  • Taper the dose for 1–2 weeks preoperatively.
• Vitamin E may increase bleeding.

Review of Systems

• Allergies: Nurses should ask about nonpharmaceutical allergies to food, metals, chemicals, tape, and pollen, and they should screen for possible latex allergies.
• Nervous System: A preoperative evaluation includes assessing a patient's ability to respond to questions, follow commands, and maintain thought patterns.
  • Document a person's ability to pay attention, concentrate, and respond appropriately to use as a baseline for postoperative comparison.
• Cardiovascular: Evaluate cardiovascular function to ensure that any conditions can be effectively monitored.
  • Patients may need a cardiology and anesthesia consult before surgery if they have cardiac conditions.
• Respiratory: Patients should be asked about recent/chronic upper respiratory infections.
  • If a patient has asthma, the nurse should inquire about the recent use of inhaled or oral corticosteroids and bronchodilators.
  • Patients who smoke should be encouraged to stop at least eight weeks before surgery to decrease the risk of complications.
• Urinary: Document the patient’s urinary system status before surgery.
  • Male patients that have trouble voiding can have enlarged prostates, which hinders the insertion of a catheter.
• Integumentary: Any skin rashes, boils, ulcers, or other dermatological conditions should be noted.
• Musculoskeletal: Note mobility difficulties in any affected joints.
  • Spinal anesthesia may be difficult if the patient cannot flex their lumbar spine adequately.
• Endocrine: Diabetes and thyroid dysfunction are risks for both anesthesia and surgery
• Immune: If the immune system is impaired, this leads to delayed wound healing and postoperative infections.
  • Elective surgery is cancelled if they have an acute infection.
• Fluid and Electrolyte Status: Patient should be questioned about vomiting, diarrhea, or difficulty swallowing.
  • Identify medications that alter fluid and electrolyte status.
  • It is the responsibility of the anesthesiologist to administer IV fluids and electrolyte therapy to maintain proper hydration.
• Nutritional Status: Nutritional extremes in patients require consideration in the perioperative period.
  • Obesity stresses the cardiac and pulmonary systems and predisposes patients to obstructive sleep apnea.
  • Obesity also increases the risk of DVT and surgical site infection.

Objective Data

• Objective data includes physical examinations and lab and diagnostic testing.

Nursing Management

• Nursing management covers preoperative education, general/ambulatory surgery information, and legal preparation for surgery (consent).

Day of Surgery Preparation (Nursing Role)

• Nurses can help patients understand questions preoperatively by asking them to teach the information back..
• Surgery preparation depends on whether the patient is an inpatient or an outpatient.
• The nurse should determine that all preoperative preparations have been completed.