Surgical Nursing Procedures and Classifications

Surgical Nursing

• Surgery is a planned wounding process.

Conditions Requiring Surgical Intervention

• Obstruction, or tıkanma, requires surgical intervention.
• Perforation, which is the puncturing or abnormal opening of an organ, requires surgical intervention.
• Erosion, or yüzeysel doku kaybı, requires surgical intervention.
• Tumors require surgical intervention.

Classification of Surgery: Purpose

• Diagnostic surgery aims to identify the cause of a medical problem.
• Curative surgery intends to correct or resolve a medical issue. It can be constructive, reconstructive, or ablative.
• Palliative surgery focuses on alleviating symptoms without curing the underlying disease.
• Cosmetic or aesthetic surgery enhances appearance.

Classification of Surgery: Urgency

• Elective surgeries are not urgent and can be scheduled in advance e.g. cosmetic surgery, tonsillectomy, cholecystectomy, and cataract surgery,
• Mandatory surgeries must be performed within 24-48 hours examples are bleeding hemorrhoids, ectopic pregnancy, and kidney stones
• Emergency surgeries require immediate action e.g fasciotomy for broken leg compression syndrome, open skull fracture, gunshot injury, extensive burns, urinary obstruction, and intestinal obstruction

Classification of Surgery: Degree of risk

• Surgery can be classified based on the degree of risk it poses to the patient, ranging from low to medium to high risk.

National Guidelines ACC/AHA Surgery-Specific Classification

• High-risk surgeries include emergent operations, particularly in elderly patients, and aortic and other major vascular surgeries.
• Peripheral vascular surgery and prolonged surgical procedures lasting over 2 hours are classified as high-risk due to potential fluid shifts and blood loss.
• Cardiac procedures are also considered high-risk.
• Intermediate-risk surgeries include carotid endarterectomy and head and neck surgery.
• Intraperitoneal and intrathoracic surgeries, orthopedic surgery, and prostate surgery fall into the intermediate-risk category.
• Low-risk surgeries encompass endoscopic procedures, superficial procedures, and cataract surgery (katarak ameliyatı).
• Breast surgery (meme) and cosmetic surgery are also classified as low-risk.

Teamwork in surgery

• Surgical success relies on effective communication and cooperation among team members.

Role of the Nurse in Surgery

• Preparing the patient for surgery (Hastayı ameliyata hazırlamak).
• Observing and supporting the patient during surgery (Ameliyat sırasında hastayı gözlemlemek ve desteklemek).
• Preventing and treating postoperative complications (Ameliyat sonrası komplikasyonları önlemek ve tedavi etmek).
• Preparing the patient for discharge (Hastayı taburculuğa hazırlamak).

ASA Physical Status Classification

• ASA I: A normal healthy patient (Normal sağlıklı hasta).
• ASA II: A patient with mild systemic disease (Hafif sistemik hastalık).
• ASA III: A patient with severe systemic disease that limits disease but is not incapacitating (Hastalığı sınırlayan onu güçsüzleştirmeyen sistematik hastalığı olan).
• ASA IV: A patient with severe systemic disease that is a constant threat to life (Yaşamı sürekli tehdit eden ciddi sistematik hastalığı olan).
• ASA V: A moribund patient who is not expected to survive 24 hours without the operation (Ameliyat olmadan 24 saat yaşaması beklenmeyen ölümcül hasta).
• ASA VI: A patient declared brain dead and whose organs are being removed for transplantation (Beyin ölümü gerçekleşmiş ve organları çıkarılan hasta).

New Approaches in Surgery

• Pre-surgery training helps patients actively participate in their recovery.
• Anesthesia, analgesia, and surgical techniques are used to minimize surgical trauma and physiological stress.
• Fast postoperative rehabilitation (early feeding, early standing up, etc.) sonrası hızlı rehabilitasyon).
• Evidence-based practices are utilized.
• Patient education, evaluation, and team cooperation are important responsibilities of the nurse.

Preoperative Period

• The purpose of nursing care is to assess readiness for surgery, identify dangers and potential risks, prepare the patient for the experience, plan for home care, and provide emotional support.

Pre-operative Evaluation

• Determines risk factors for surgery and postoperative problems.
• Obtains data for planning preoperative and postoperative training.
• Provides basic data about their physical and functional abilities.

Preoperative Evaluation (History)

• A preoperative evaluation includes assessing age, allergies, current health problems, planned surgery, and family history.
• Gathering information on past health history, previous surgeries and anesthesia experiences, medications used, herbal remedies, and alcohol and cigarette consumption contributes to a comprehensive patient profile

Medications and Their Implications for Surgery

• ACE inhibitors can cause hypotension, so blood pressure should be monitored closely.
• Surgeons may recommend withholding certain medications on the morning of surgery.
• Antiplatelet drugs increase the risk of bleeding, so surgeons may want the drug stopped 2 weeks before surgery.
• Corticosteroids decrease inflammation but increase risk of postoperative bleeding, so steroid doses may need adjustment.

Herbs and Surgery

• Certain herbs, like ginger which causes prolongs clotting time with risk of bleeding, may interact with surgery due to potential sedative effects or increased bleeding risk.

Preoperative Physical and Functional Evaluation components

• Neurological, Cardiovascular, Breathing, Gastrointestinal, Genitourinary, Nutrition, Musculoskeletal, Endocrine, and Skin

Preoperative Nursing Diagnoses

• Common nursing diagnoses include lack of information, anxiety, acute pain, risk of injury in the perioperative position, ineffective thermoregulation, and inability to maintain the home.