1st-exam-reviewer-112.docx

**Safety in the care of a risk and sick Adult clients** Ensuring safety for risk and sick adult clients is paramount in healthcare. This involves a comprehensive approach that addresses both physical and emotional well-being. Here are some key considerations: - - - - - - - - **Pe...

**Safety in the care of a risk and sick Adult clients** Ensuring safety for risk and sick adult clients is paramount in healthcare. This involves a comprehensive approach that addresses both physical and emotional well-being. Here are some key considerations: - - - - - - - - **Perioperative Nursing** Perioperative nursing encompasses the nursing care provided before, during, and after surgical procedures. This specialized field requires nurses to possess a deep understanding of surgical procedures, patient care, and potential complications. **Key Roles and Responsibilities:** - - - - - - **Preoperative Care in Medical Surgery** Preoperative care refers to the medical and nursing interventions that occur before a surgical procedure. It is a critical phase of patient care aimed at preparing the patient for surgery, minimizing risks, and optimizing postoperative recovery. **Key Components of Preoperative Care:** - - - - - - - - - - - - - - - - - - - - **Key Aspects of Intraoperative Care:** 1. **Anesthesia:** - **General anesthesia:** This involves inducing a state of unconsciousness, pain relief, and muscle relaxation. - **Regional anesthesia:** This targets specific areas of the body, such as the spinal cord or nerves, to block pain sensation without affecting consciousness. - **Local anesthesia:** This is used to numb a small area of the body. 2. **Surgical Procedure:** - The surgeon performs the planned surgical procedure, using specialized instruments and techniques. - Nurses and other surgical team members assist the surgeon, handling instruments, monitoring the patient, and ensuring a sterile environment 3. **Patient Monitoring:** - Vital signs, such as heart rate, blood pressure, respiratory rate, and oxygen saturation, are continuously monitored. - Fluid balance is carefully managed to prevent dehydration or fluid overload. - Blood loss is monitored and replaced as necessary. 4. **Hemostasis:** - Bleeding is controlled using various techniques, including suturing, cauterization, and hemostatic agents. 5. **Wound Closure:** - The surgical incision is closed using sutures, staples, or surgical glue. 6. **Dressing Application:** - A sterile dressing is applied to the wound to protect it from infection and promote healing. 7. **Postoperative Care Preparation:** - The patient is prepared for transfer to the recovery room, including ensuring adequate pain management and monitoring for any complications. **Challenges and Risks:** - - - Postoperative Care in Nursing ----------------------------- Postoperative care is a critical phase of patient care that begins immediately after a surgical procedure and continues until the patient is fully recovered. It involves a range of interventions aimed at promoting healing, preventing complications, and ensuring a smooth recovery. **Key Components of Postoperative Care:** 1. - Continuous or frequent monitoring of heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature to detect any signs of instability. 2. - Assessing pain levels and administering appropriate pain medications to ensure comfort and promote healing. 3. - Inspecting the surgical wound for signs of infection, bleeding, or dehiscence. - Changing dressings as needed and providing appropriate wound care. 4. - Monitoring fluid intake and output to prevent dehydration or fluid overload. - Assessing electrolyte levels and administering fluids or medications as needed. 5. - Encouraging or assisting with oral intake as soon as possible. - Providing supplemental nutrition if necessary. 6. - Assisting patients with early mobilization to prevent complications such as pneumonia and deep vein thrombosis. 7. - Implementing measures to prevent complications such as infection, bleeding, pulmonary embolism, and deep vein thrombosis. 8. - Coordinating patient discharge, providing education on wound care, medications, and follow-up appointments. Classification of Surgical Procedures ------------------------------------- Surgical procedures can be classified based on several criteria, including the type of surgery, the severity of the condition, and the urgency of the procedure. Here are some common classifications: ### Based on Type of Surgery - - - ### Based on Severity of Condition - - ### Based on Urgency of Procedure - - - The classification of surgical procedures based on purpose can be categorized as follows: 1. 2. 3. 4. 5. **PRINCIPLES OF SAFETY, COMFORT AND PRIVACY DURING THE PERIOPERATIVE PERIOD** Theatre Preparation in Nursing ------------------------------ **Theatre preparation** in nursing refers to the process of preparing the operating room (OR) or theater for a surgical procedure. This involves a series of steps to ensure a clean, safe, and organized environment for the patient and surgical team. **Key aspects of theatre preparation include:** - - - - - - - - - - - - - - Sterile Technique ----------------- **Sterile technique** is a set of practices designed to prevent the introduction of microorganisms into a sterile field. This is crucial in healthcare settings, particularly during surgical procedures and invasive procedures, to minimize the risk of infection. **Key principles of sterile technique include:** - - - - - - - - - **Nurses\' Role and Responsibilities During the Intraoperative Phase** Nurses play a pivotal role in the intraoperative phase, ensuring patient safety and assisting the surgical team throughout the procedure. Their responsibilities include: - - - - - - - - - - - - - - - - - **POSTOPERATIVE PHASE** P. Preventing complication O. Optimal respiratory function S. Support psychological well being T. Tissue prefusion and cardio maintenance **O**-Observing and maintaining adequate fluid intake P. Promoting adequate nutrition and elimination A. Adequate fluid electrolyte balance **R**-Renal function maintenance **E**- Encouraging activity and mobility **T**- Thorough wound care for adequate wound healing **I**- Infection control **V**- Vigilant to manifestations of anxiety and promoting ways to relieve it **E**- Eliminating environmental hazards and promoting client safety **NCM112 (1ST EXAM COVERAGE)** **SAFETY AND PREOPERATIVE NURSING CARE** *Pharmacologic key points that is part of Preoperative Nursing* - - - - - - - - - - - **WHAT IS PRE-OPERATIVE NURSING?** - - - - - - - - - - - Surgeries can be performed for variety of reasons, each aimed at addressing specific health concerns and improving patient outcomes: - - - - - - - *Note: Any medications with **Hydrochloric Acid **should be given **POST MEAL **or **WITH MEAL **to avoid getting ulcer.* **PRE-OPERATIVE NURSING** - - - - - - - - **PRE-OPERATIVE PHASE** - - - - **INFORMED CONSENT** - - - - *Note: **Acetaminophine **is given to patients allergic to paracetamol.* **INTRAOPERATIVE PHASE** - - - *Note: Normal range of O2Sat of a patient with COPD is 90-92* **INTRAOPERATIVE CARE** - - - - - - - **POSTOPERATIVE PHASE** - - - - - *Note: The **GCS** (Glasgow Coma Scale) lowest score is **3**, meanwhile the highest is **15**. The score of **7** is considered semi-comatose and is for intubation.* **CLASSIFICATIONS OF SURGICAL PROCEDURE** - Based on purpose: - - - - - - - - - - - - - **Based on Urgency** - - - - - - **SAMPLE QUESTION!** A 72 year old woman is scheduled for s hip replacement is taking several medications on a regular basis. Which drug category might create a surgical risk for this patient? 1. 2. 3. 4. **PRINCIPLES OF SAFETY, COMFORT, AND PRIVACY DURING THE PREOPERATIVE PERIOD** 1. - - - - - - - Equipment commonly found in the Operating Room varies based on the type of surgery being performed. - - - - - - - - **Infection Control** - **Sterile Technique** - - - - - - - - - - - - **Principles of Sterile Technique** - - - - **Sterilization** - - **STERILE VS. NON STERILE INTERACTION** - **Maintaining Sterility** - **Questionable Sterility** - - **Sterile Zones on Gowns** - **Hand Positioning** - **Handling Sterile Items** - - **Movement in Sterile Areas** - **Sneezing and Coughing** - **Sterile Staff Restrictions** - - **Minimizing Contact** - **Observer's Conduct** - The following are the Physiologic assessments necessary during the pre-operative phase: - - - - - - - - \` - - - - - - - - - - - - - - - - **RESPECT SPIRITUAL AND CULTURAL BELIEF** 1. 2. 3. 4. **CIRCULATING NURSE** - - - - - - - - - - - **SCRUB NURSE** - - - - - **STERILE TECHNIQUE MANAGEMENT** - - **INSTRUMENTATION AND EQUIPMENT** - - **WHO SURGICAL SAFETY CHECKLIST** - - - - **POSTOPERATIVE PHASE** - **P - **Preventing and/or relieving complications. **O - **Optimal respiratory function **S - **Support; psychological well-being **T - **Tissue perfusion and cardiovascular status maintenance **O - **Observing and maintaining adequate fluid balance **P - **Promoting adequate nutrition and elimination **E - **Adequate fluid and electrolyte balance **R - **Renal function maintenance **A - **Encouraging activity and mobility within limits **T - **Thorough wound care for adequate wound healing **I - **Infection control **V - **Vigilant to manifestations of anxiety and promoting ways of relieving it **E - **Eliminating environmental hazards and promoting client safety. **PURPOSE, INDICATIONS, NURSING RESPONSIBILITIES FOR DIFFERENT SURGICAL PROCEDURES** **TRACHEOSTOMY** - - - - Emergency tracheostomy may be performed for: - - **Elective tracheostomies **may be performed for chronic illnesses, such as: - - A tracheostomy can make breathing easier for some. For patients on mechanical ventilation or receiving intensive care, a tracheostomy may: - - **Purpose** - - - **Indications** - - - - **TRACHEOSTOMY KIT** - The **Emergency Tracheostomy Kit **should contain the following equipment: - - - - - - **RULES OF NURSES IN TRACHEOSTOMY CARE** - - **INITIAL CARE REQUIREMENTS** - - - **CARE TRANSITION** - - Understanding primary goals of tracheostomy care is essential for effective patient care: - - Emergency management causes of Cardiorespiratory Arrest: - - Potential causes of Obstruction - - - - Early warning signs of Obstruction - - General Sign of Obstruction (Physiological Changes) - - - - - - **Late Signs** - - - \*Do not wait for late signs to develop\* **Can you eat or drink with Tracheostomy?** **INITIAL DIET** - **TRACH TUBE ADJUSTMENTS** - **EATING RESTRICTIONS** - - - - **DECANNULATION** - - - - - Once the tube is removed, a doctor or nurse will bandage the area. **THORACOSTOMY** - - Conditions treated by thoracostomy: - - - - - - **CHAMBERS OF A TRADITIONAL CHEST TUBE DRAINAGE SYSTEM** - - - - - **Water Seal Chamber** - - - **Wet or Dry Suction Control Chamber** - - - **Collection Chamber** - **Suction Chamber** - Chest tube drainage (50-500mL for the first 24 hours) is expected to be **sanguineous **(bright red) for several hours and then change to **serasanguineous **(pink) followed by **serous **(yellow) over a period of few days. \***Notify Physician: \>100mL/hour\*** **Milking** - **Hemothorax** - **Pleural Effusion** - **Empyema** - **Chylothorax** - - - - **Cause** - - **Nursing Responsibilities** **(Chest Tube Care)** - - - - - - - - - - - - - - - - - - - - - - - - - - **LUNG RESECTION** - **Surgical Techniques** - - **Indications** - - - - - - **LOBECTOMY** - - - - - - **Purpose** - **Indications** - **PNEUMONECTOMY** - - - - PREOPERATIVE RESPONSIBILITIES **Assessment** - Evaluate the pt respiratory status, including lung sounds, oxygen saturation, and work of breathing - Obtain a thorough medical history, including smoking history, and current medications **Preoperative Testing** 1. Ensure necessary labs (cbc, BMP, coagulation studies) 2. Verify that the patient has undergone pulmonary function test ENDARTERECTOMY : A Procedure to Improve Blood Flow -------------------------------------------------- **Endarterectomy** is a surgical procedure used to remove atherosclerotic plaque from the inside of an artery, typically the carotid artery or the femoral artery. This plaque buildup can narrow the artery, reducing blood flow and increasing the risk of stroke or heart attack. **Common Indications for Endarterectomy:** - - **Procedure:** 1. 2. 3. 4. 5. **Benefits of Endarterectomy:** - - - **Risks of Endarterectomy:** - - - - **Recovery:** - - - ANEURYSMECTOMY: Surgical Repair of an Aneurysm ---------------------------------------------- **Aneurysmectomy** is a surgical procedure used to repair an aneurysm, which is a bulge or ballooning in the wall of an artery. This condition can be life-threatening, as it can rupture and cause internal bleeding. **Types of Aneurysms:** - - - **Causes of Aneurysms:** - - - - **Symptoms of Aneurysms:** - - - **Aneurysmectomy Procedure:** The specific surgical technique used for an aneurysmectomy will depend on the type and location of the aneurysm. However, most procedures involve: 1. 2. 3. - - 4. **Risks of Aneurysmectomy:** - - - - **Recovery:** - - - PACEMAKER INSERTION: A Procedure to Regulate Heart Rhythm --------------------------------------------------------- **Pacemaker insertion** is a surgical procedure used to implant a device that helps regulate the heart\'s rhythm. This device, called a pacemaker, is used to treat conditions such as bradycardia (slow heart rate), tachycardia (fast heart rate), or heart block. **Indications for Pacemaker Insertion:** - - - - **Procedure:** 1. 2. 3. 4. 5. **Types of Pacemakers:** - - - **Recovery:** - - - **Benefits of Pacemaker Insertion:** - - - Nursing Responsibilities During Pacemaker Insertion and Postoperative Care -------------------------------------------------------------------------- Nurses play a crucial role in the care of patients undergoing pacemaker insertion and during the postoperative period. Their responsibilities include: **Preoperative:** - - - **Intraoperative:** - - - **Postoperative:** - - - - - **Specific Postoperative Considerations:** - - - - - HEART VALVE REPLACEMENt: Nursing Responsibilities ------------------------------------------------- **Heart valve replacement** is a surgical procedure to replace a damaged or diseased heart valve with a prosthetic valve. This procedure is often necessary for patients with conditions such as aortic stenosis, mitral regurgitation, or mitral stenosis. · Tricuspid valve: Located between the right atrium and right ventricle. · Pulmonary valve: Located between the right ventricle and the pulmonary artery. · Mitral valve: Located between the left atrium and left ventricle.   · Aortic valve: Located between the left ventricle and the aorta **Heart valve disease** occurs when one or more of these valves becomes damaged or diseased. This can lead to a variety of problems, including: - - - **Types of Heart Valve Disease:** 1. 2. 3. 4. 5. 6. **Symptoms of Heart Valve Disease:** - - - - - **Nursing responsibilities during the perioperative period of heart valve replacement include:** ### Preoperative Phase - - - ### Intraoperative Phase - - - - ### ### ### Postoperative Phase - - - - - - - - **Specific Nursing Considerations for Heart Valve Replacement:** - - - - - **CONGENITAL ABNORMALITIES** are defects or malformations that are present at birth. They can affect various parts of the body, including the heart, lungs, kidneys, and gastrointestinal system. When these abnormalities are severe or life-threatening, surgical repair may be necessary. **Indications for Surgical Repair of Congenital Abnormalities:** - - - **Nursing Responsibilities During the Perioperative Period:** ### Preoperative Phase - - - ### Intraoperative Phase - - - - ### Postoperative Phase - - - - - - - - **Specific Nursing Considerations for Congenital Abnormalities:** - - - VENTRICULAR ASSIST DEVICE (VAD) INSERTION ----------------------------------------- **A ventricular assist device (VAD)** is a mechanical pump implanted in the chest to help the heart pump blood. It is often used as a bridge to heart transplantation or as a long-term treatment for heart failure. **Indications for VAD Insertion:** - - - **Types of VADs:** - - - **Procedure:** 1. 2. 3. 4. 5. **Recovery:** - - - **Benefits of VAD Insertion:** - - - - **Risks of VAD Insertion:** - - - - HEART TRANSPLANTATION --------------------- **Heart transplantation** is a surgical procedure to replace a diseased or failing heart with a donor heart. This procedure is typically considered for patients with severe heart failure that cannot be managed with other treatments. **Indications for Heart Transplantation:** - - - - **Nursing Responsibilities During the Perioperative Period:** ### Preoperative Phase - - - ### Intraoperative Phase - - - - ### Postoperative Phase - - - - - - - - **Postoperative Medications:** - - - - - **Long-Term Follow-Up:** After heart transplantation, patients will require lifelong follow-up care to monitor the function of the donor heart and prevent rejection. Regular appointments with a cardiologist are essential for monitoring the patient\'s condition and making any necessary adjustments to their medications. LASER THERAPY: A Modern Approach to Treatment --------------------------------------------- **Laser therapy**, also known as **laser treatment**, is a medical procedure that uses concentrated beams of light to interact with tissues. This technology has a wide range of applications in various medical fields. ### Benefits of Laser Therapy - - - - ### Nursing Responsibilities in Laser Therapy Nurses play a vital role in laser therapy procedures, ensuring patient safety and comfort. Their responsibilities typically include: - - - - - ### Medical Applications of Laser Therapy Laser therapy has a wide range of applications in various medical fields, including: - - - - - - - - - - - - - - - TRANSMYOCARDIAL REVASCULARIZATION (TMR/TMLR) VS. CORONARY ARTERY BYPASS GRAFTING (CABG) --------------------------------------------------------------------------------------- **Transmyocardial revascularization (TMR/TMLR)** and **coronary artery bypass grafting (CABG)** are both surgical procedures used to treat coronary artery disease, a condition where the arteries that supply blood to the heart become narrowed or blocked. ### TMR/TMLR - - - - - - ### CABG - - - - - - **Key Differences:** - - -