Fundmental

Pain Management and Skin Integrity

• Phantom pain can occur after amputation and persist for years.
• Nonopioid analgesics like NSAIDs and acetaminophen have specific contraindications and monitoring requirements.
• Opioid analgesics can suppress respiration and cause physical dependence.
• Specific considerations and side effects exist for medications like codeine sulfate and hydromorphone.
• Morphine sulfate is used for various conditions but has multiple contraindications and side effects.
• Pressure injuries and impaired skin integrity can result from factors like atelectasis and hypostatic pneumonia.
• Crutch walking techniques and gaits like two-point, three-point, four-point, and swing-through are used based on client ability.
• Proper technique for going up and down stairs with crutches is important for client safety.
• Nutrition, tissue perfusion, immobility, and incontinence all impact skin integrity.
• The process of wound healing involves inflammatory, fibroblastic, and maturation stages.
• Primary and secondary intention wounds have different characteristics and healing processes.
• Indications of infection in wounds include redness, pain, fever, drainage changes, and odor.

Surgical Wound Care and Postoperative Management

• Tertiary intention involves delayed primary closure, with wounds intentionally left open for irrigation and debris removal before closing by first intention.
• Different types of wound drainage include serous, serosanguineous, sanguineous, and purulent, indicating different stages of healing and potential complications.
• Risk factors for pressure ulcers include skin pressure, shearing, immobility, malnutrition, incontinence, and decreased sensory perception.
• Interventions for preventing pressure ulcers include repositioning, avoiding direct massage, ensuring adequate nutrition, keeping the skin dry, and providing range-of-motion exercises.
• Pressure ulcers are classified into four stages based on skin integrity, tissue involvement, and wound characteristics.
• Obtaining informed consent for surgery involves the surgeon explaining the procedure, the nurse obtaining the client's signature, and considerations for minors, incapacitated clients, and psychiatric clients.
• Preoperative care includes NPO status, IV line insertion, administration of IV fluids, and measures for elimination, deep-breathing, and coughing exercises, leg and foot exercises, and psychosocial preparation.
• Guidelines to prevent wrong site and wrong procedure surgery involve marking the operative site, conducting a time out before the surgical procedure, and confirming the correct client and surgical site.
• Postoperative care aims to prevent complications, promote healing, and restore the client's health, including monitoring airway patency, vital signs, circulation, bleeding, and neurological status.
• Additional postoperative care measures include encouraging deep-breathing and coughing exercises, antiembolism stockings, ambulation, positioning, and assessing the surgical site, skin, and consciousness.
• Monitoring and maintenance of NPO status until the return of gag reflex and peristalsis are also crucial postoperative care measures.
• Overall, the text covers comprehensive information on surgical wound care, including different types of wound healing, risk factors, interventions, preoperative care, guidelines for preventing wrong site and wrong procedure surgery, and detailed postoperative care.