Perioperative Care - Definitions, Surgeries, Assessment | PDF

Module One- Perioperative Care Definitions Ambulatory Surgery- AKA outpatient surgery, procedures that do not require and overnight stay Elective Surgery- a surgery or procedure scheduled in advance, doesn’t involve a medical emergency Semi-Elective Surgery- a procedure that is necessary for prese...

Module One- Perioperative Care Definitions Ambulatory Surgery- AKA outpatient surgery, procedures that do not require and overnight stay Elective Surgery- a surgery or procedure scheduled in advance, doesn’t involve a medical emergency Semi-Elective Surgery- a procedure that is necessary for preserving life but doesn’t need to be performed immediately Emergency Surgery- Performed immediately to treat a life threatening or urgent medical condition Informed Consent- Process in which patients are given important information such as risks and benefits about a medical treatment, test, trial, procedure, etc Same Day Admission- when a patient is admitted on the same day as their procedure or surgery Perioperative- “Around the Time of surgery” Diagnosis- to determine the Prescence or extent of pathological abnormality Cure- to eliminate or repair a pathological condition Palliation- to alleviate symptoms without a cure Prevention- to reduce the risk of developing a condition Cosmetic Improvement- to alter physical appearance Exploration- to determine the nature or extent of a disease  Su7ixes Describing Common Surgical Procedures Su#ix Meaning General Orthopedic Urological - Excision/removal appendectomy discectomy nephrectomy ectomy - Looking into Gastroscopy Knee athroscopy Cystoscopy oscopy - Creation of opening Colostomy ----------------------- Ureterostomy ostomy into -otomy Cutting into/incision Tracheotomy Athrotomy Cystotomy -plasty Repair/reconstruction Mammoplasty Total hip arthoplasty urteroplasty Most common inpatient surgeries in Canada C-section knee replacement hip replacement fractures coronary artery angioplasty Ambulatory Surgeries can be performed using general, regional or local anaesthetic usually takes less than 2 hrs and require less than a 3-4 hr stay in post anaesthesia care unit (PACU) do not require overnight hospital stay unless complications arise  several nurses are involved in the surgical patient’s continuum of care throughout the preoperative, intraoperative and postoperative phases. The following information gathered by the paranesthesia nurse before surgery assists these nurses in planning care: - 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, impact of comorbidities, risks, and potential complications associated with surgery Preoperative Admission Assessment: Day of surgery Assessment: All surgical patients have a physical assessment completed and documented by a physician. The extent of the exam depends on the type of surgery and anaesthesia required On the day of surgery the nurse does a focused preoperative assessment involving review of existing information, reinforcement of teaching and review of discharge plans The psychosocial needs of the patient are paramount at this time, as are the needs of the patients companion or family. Each hospital or facility has a concise preoperative checklist that can help the nurse meet the following goals: Subjective Data Psychosocial Assessment- The meaning of surgery should be explored with the patient, as each person has a diWerent perception and anxiety level regarding the procedure, anaesthesia, and postoperative pain. Stress can negatively aWect surgical outcomes, such as causing a longer and more painful postoperative recovery. Coping with Surgery- The way that patients transition through the perioperative period can aWect their postoperative recovery. Many draw on their spirituality, seeking inner peace and sources of hope. As patients, especially outpatients, move through the surgical experience in an accelerated fashion, the perioperative team must be responsive to the patient’s health goals, hopes, and fears in order to provide the necessary sup- port. For many people, spirituality and health are interrelated, thus requiring the interprofessional team to implement a holistic preoperative approach to patient care Health History- During the preoperative interview, the nurse should ask about the patient’s diagnosed medical conditions and current health issues. An organized approach using hospital guidelines and subjective questioning elicits good information regarding the patient’s health history. Initially, the nurse should determine whether the patient understands the reason for surgery. Women should be asked about their menstrual and obstetrical history, including the date of their last menstrual period and the number of pregnancies and births they have had. If the patient states that she might be pregnant, this information should be immediately communicated to the surgeon to avoid maternal and subsequent fetal exposure to anaesthetics during the first trimester. Medications- As part of the preoperative interview, the nurse documents the patient’s current medication use, including the use of OTC medications and herbal products. Patients may be asked to bring their medication bottles when attending the PAC so that the nurse can accurately chart the names and dosages as patients who use a variety of medications may not remember specific details. At this time, it is important also to investigate whether the patient is taking the medication as ordered or has stopped taking it because of cost, adverse eWects, or the belief that ongoing therapy is no longer needed. Allergies-The nurse should inquire about nonpharmaceutical allergies to foods, metals, chemicals, tape, and pollen. The patient with a history of any allergic response has a greater potential for demonstrating hypersensitivity reactions to medications administered during anaesthesia. Patients should also be screened for possible latex allergies Review of Systems: 1. Nervous- Preoperative evaluation of neurological functioning includes assessing the patient’s ability to respond to questions, follow commands, and maintain orderly thought pat- terns. Alterations in the patient’s hearing (e.g., requiring hearing aids) and vision (e.g., requiring glasses, development of glaucoma) may aWect responses and the ability to follow directions. A person’s ability to pay attention, concentrate, and respond appropriately is documented to use as the baseline for postoperative comparison. Impaired cognitive function may aWect the patient’s ability to prepare for surgery, and the nurse must determine whether all preoperative procedures were carried out—for example, bowel preparations. If confusion is noted and persistent, it is important to determine whether there are appropriate resources and support to assist the patient after surgery. 2. Cardiovascular- The purpose of evaluating cardiovascular function is to determine the presence of pre-existing dis- ease or existing concerns so that the patient’s condition can be eWectively monitored during the surgical and recovery periods. If there is a history of cardiac conditions, including hypertension, angina, dysrhythmias, heart failure, or myocardial infarction, or use of pacemakers or implanted cardiac devices, the patient may need a cardiology and anaesthesia consult before surgery. 3. Respiratory- The patient should be asked about any recent or chronic upper respiratory infections. The presence of an upper airway infection may result in the cancellation or postponement of elective surgery because the patient has an increased anaesthetic risk. If the patient has a history of respiratory conditions, they will have an anaesthetic consult before surgery and an appropriate workup. If a patient has asthma, the nurse should inquire about the patient’s recent use of inhaled or oral corticosteroids and bronchodilators. The patient with a severe active airway infection, chronic obstructive pulmonary disease, or asthma is at risk for pulmonary complications, including bronchospasm, laryngo- spasm, hypoxemia, and atelectasis. The patient who smokes should be encouraged to stop at least 8 weeks before surgery to decrease the risk for intraoperative and postoperative respiratory complications  4. Urinary- Before surgery, the patient’s urinary system status should be documented. Results of any renal function tests, such as serum creatinine and blood urea nitrogen (serum urea [nitrogen]), ordered before surgery should be available on the patient’s chart. Male patients who have diWiculties voiding may have an enlarged prostate, which would hinder the insertion of a urinary catheter during surgery and also impair voiding in the postoperative period. This information is documented for the perioperative team. The nurse should inform patients if they will have a catheter after surgery. 5. Integumentary-Any skin rashes, boils, ulcers, or other dermatological conditions should be noted. A history of pressure injuries may necessitate extra padding during surgery, and skin problems may aWect postoperative healing. 6. Musculoskeletal- The nurse should note mobility diWiculties in any aWected joints, as these restrictions influence intraoperative and postoperative positioning and can aWect ambulation. Spinal anaesthesia may be diWicult if the patient cannot flex their lumbar spine adequately to allow easy needle insertion, if the neck is aWected, intubation and airway management may be diWicult 7. Endocrine-Diabetes Mellitus is a risk factor for both anaesthesia and surgery, same with thyroid dysfunction. 8. Immune system- Patients with active chronic infections, such as hepatitis, acquired immune deficiency syndrome (AIDS), or tuberculosis, may be suitable for surgery; however, if the patient has a history of immunosuppression or takes immunosuppressive medications, this will be noted in the patient chart. Impairment of the immune system can lead to delayed wound healing and postoperative infections. If the patient has an acute infection (e.g., active skin rash, acute sinusitis, flu), elective surgery is frequently cancelled. Fluid and Electrolyte Status. The patient should be questioned about vomiting, diarrhea, or difficulty swallowing. Medications that the patient takes that alter fluid and electrolyte status, such as diuretics, should also be identified because serum electrolyte levels may need to be evaluated before surgery. Most patients have restricted fluids because of NPO status before surgery; it is the responsibility of the anaesthesiologist to administer intra- venous (IV) fluids and electrolyte therapy to maintain proper hydration. Nutritional Status. Nutritional extremes in patients require consideration in the perioperative period. For example, if the patient is extremely obese, having notification before surgery allows the perioperative nurse time to prepare the necessary equipment and instrumentation. Obesity stresses the cardiac and pulmonary systems and predisposes the patient to obstructive sleep apnea, which in turn can indicate difficult intubation and postextubation complications. Obesity also increases the risk of deep vein thrombosis (DVT) and surgical site infection Objective Data Physical Examinations Laboratory and Diagnostic testing Nursing Management Preoperative Education General surgery information Ambulatory surgery information Legal preparation for surgery- consent for surgery Day of surgery preparation (nursing role) communication is a major consideration in the patient’s surgical experience. Nurses can help patients understand the questions posed preoperatively by taking a “teach-back” approach to verify that patients understand the information they are given and that, if necessary, culturally appropriate translators are available (Brega et al., 2015). Surgery preparation will vary depending on whether the patient is an inpatient or an outpatient. The nurse prepares inpatients for surgery, but for outpatient procedures, the patient or a family member may have the responsibility of preoperative preparation. Most facilities have preoperative checklists that indicate all pertinent documentation and actions required prior to surgery. The nurse should determine that all preoperative preparations have been completed and that the signed consent for surgery is present before giving any preoperative medications.