Module 1A - Perioperative Nursing - Preoperative Phase

UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory,...

UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory [TRANS] UNIT XX: PERIOPERATIVE NURSING - PREOPERATIVE PHASE Period of time when the patient is transferred from the Module 1A operating room table to when he or she is admitted to the Perioperative Nursing - Preoperative Phase post anesthesia care unit (PACU). o Patient on the OR table then surgery will be performed Outline then after surgery patient will be transferred to the 1. Define the different phases of perioperative patient care. PACU (also known as the recovery room or RR). 2. Recognize the meaning of surgical terminologies and their implications. 3. Postoperative Phase 3. List the principles of asepsis in the care of patient during Period of time that begins with the admission of patient to preoperative, intraoperative and postoperative phase. the PACU and ends after a follow-up evaluation in the 4. Differentiate among the various types and purposes of clinical setting or home. surgery. 5. Discuss the legal and ethical considerations and issues o Patient in the PACU/RR stay for about 2 hours. in obtaining informed consent for surgery. o Patient is stable (v/s, no complications) - PACU for 2 6. Describe appropriate nursing care for people having hours before going to their room (ward), and home (if surgery in the preoperative, phase of surgery. OPD). 7. Create a nursing process framework for providing individualized care for people about to undergo surgery. Goal of Perioperative Care 1. Fewer surgical complications Surgery The outcome of the surgical experience is a positive Medical treatment that involves operations or manipulations outcome. on the patient’s body and, usually, cutting the body open. 2. Shorter hospital stays o Invasion – requires informed consent Because the patient is at risk for infection. o Help cure or repair 3. Better patient satisfaction with care o Making the patient risk for infection, that is why the 4. Better health outcomes operating room is sterile Perioperative Period Illustration of Surgery in an Operating Theater CTTO: https://twitter.com Surgical Terminologies Table 1: Prefixes CTTO: https://cdn.xxl.thumbs.canstockphoto.com Prefixes Meaning without, absence Perioperative Nursing Anuria, sometimes called a– Period of time that constitutes the surgical experience anuresis, refers to the lack which include the preoperative, intraoperative, and of urine production. postoperative phases. external, outside Ectopic pregnancy occurs Three (3) Phases ecto– when a fertilized egg implants and grows outside 1. Preoperative Phase the main cavity of the uterus. Period of time when the decision for surgical intervention is below made to when the patient is transferred to the operating Infratemporal fossa is an room table. infra– irregular space at the lateral From the admission of the client to the hospital to the time aspect of the skull. that the surgery begins. between o The patient agreed to have surgery to brought to the Intercostal muscles are OR and placed on the operating table. inter– muscles that present within the rib cage. 2. Intraoperative Phase within Intraperitoneal means intra– within or administered through the peritoneum. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 1  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory all digestive fluid that can form pan– Pancreas is an organ and a in the gallbladder. gland. gallbladder around, near Cholecystitis is a redness cholecyst Pericardium is a serous and swelling (inflammation) peri– membrane that encloses the of the gallbladder. heart common bile duct many Choledocholithiasis is the Polyphagia is an excessive choledocho presence of at least one or extreme hunger. It is also gallstone in the common bile poly– a symptom of DM duct. (polyphagia, polydipsia, and cartilage polyuria) Chondrocytes are the cells chondro false responsible for cartilage Pseudoglaucoma is formation. pseudo– defined as false or deceptive vagina glaucoma with or without colpo Colposcopy is a test to take ocular damage. a closer look at the cervix. behind rib Retroperitoneal means Costochondritis is an retro– situated or occurring behind costo inflammation of the cartilage the peritoneum. that connects a rib to the above breastbone (sternum). Supraclavicular fossa is an abdomen supra– anatomically complex region Laparotomy is a surgical lapar of the upper neck. incision (cut) into the abdominal cavity. Table 2: Root kidney Root Meaning Nephropathy is the nephro gland deterioration of kidney Adenoma is a benign tumor function. adeno eye originating in glandular tissue. oculo Oculomotor nerve is the joint third cranial nerve (CN III). Arthroscopy is a procedure ovary arthro Oophoropexy is a for diagnosing and treating joint problems. procedure used to help keep self oophoro a woman fertile by Autoimmune is a condition preventing damage to the in which the body's immune ovaries during radiation auto therapy. system mistakes its own healthy tissues as foreign testis and attacks them orchi Orchitis is an inflammation eyelid of one or both testicles. Blepharitis is a common bone blephar eye condition that makes Osteoporosis is a disease your eyelids red, swollen, osteo that weakens bones to the irritated, and itchy. point where they break heart easily. cardio Cardiomegaly is an ear enlarged heart. oto Otomycosis is a fungus head infection in the outer ear. Encephalopathy means vein cephalo Phleboliths are small blood damage or disease that affects the brain. phlebo clots in a vein that harden brain over time due to Cerebrospinal fluid is a calcification. cerebro clear, colorless, watery fluid renal pelvis that flows in and around Pyelitis is an inflammation pyel your brain and spinal cord. of the renal pelvis and lip calyces. cheilo Cheiloplasty is a surgical fallopian tube lip restoration Salpingostomy is a bile procedure in which the salpingo chole Cholelithiasis or gallstones contents of the fallopian are hardened deposits of tubes are removed by making an opening. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 2  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory Table 3: Suffix Table 4: Operative Terms Suffix Meaning Operative Terms Meaning pain localized collection of pus –algia Myalgia is a muscle pain. puncture abscess *When there is a liver Amniocentesis is a abscess, the body tries to procedure when amniotic fight the infection. –centesis fluid is removed from the abnormal sticking together of adhesion uterus for testing or separate surfaces treatment. removal of a limb or viewing appendage of the body Laparoscopy allows a amputation surgeon to access the inside *Debridement –copy of the abdomen (tummy) *Above or below the joint and pelvis without having to connection between two make large incisions in the tubular organs skin. removal, surgical incision of *The small intestine has Lumpectomy is a surgery anastomoses three parts: the duodenum, –ectomy to remove cancer or other jejunum, and ileum. abnormal tissue from the *Stomach to jejunum – breast. bypassing the duodenum inflammation of because it has a problem. –itis Mastitis is a breast anoplasty repair of anus inflammation. removal of vermiform appendectomy stone, calculus appendix –lith Hepatolith is a concretion in examination of tissue from a the liver. living body. science, study biopsy Biology is a branch of *Autopsy is done to dead –logo science that deals with living patients. organisms and their vital excision of the foreskin of the processes. penis circumcision destruction, dissolution –lysis Hemolysis is a destruction *Smegma of RBCs in the blood. direct examination or viewing tumor of the uterus and adnexa Glaucoma is a group of eye culdoscopy through an instrument diseases that can cause passed through the wall of –oma vision loss and blindness by the vagina damaging a nerve in the separation of surgical back of your eye called the incision or rupture of a wound optic nerve. closure creation of new or artificial opening for drainage *The incision site will open. Colostomy creates an *We take care of the incision –ostomy opening for the colon, or site. large intestine, through the *ADLs must be carefully abdomen. dehiscence performed as tolerated. fixation or suturing in place *Splinting – caring of surgical –pexy Rectopexy is used to repair site a rectal prolapse. *Deep breathing coughing repair or surgical formation prevents respiratory of complications –plasty Rhinoplasty is surgery that *When the patient cough, we changes the shape of the need to support the incision nose. site. repair, suturing of widening of the ostium uteri Episiorrhaphy is a surgical to permit scraping of the repair of injury to the vulva walls of the uterus by suturing. –rrhaphy *Episiotomy is a cut dilatation and curettage *These scrapes of tissue and (incision) made in the tissue be sent to the laboratory to between the vaginal opening examine if there is and the anus during malignancy in the uterus. It childbirth. will also clean it. dissect to cut apart tissue Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 3  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory removal of an organ from its *Presence of purulent supporting structure. drainage (because it contains puss). *The organs are anchored in protrusion of the rectum into enucleation rectocele the body. When there is a the vagina broken one, it will be re- surgical removal of a attached to supporting considerable portion of an structures. organ protrusion of internal organ resection through a wound/surgical *Bariatric surgery is incision. performed to prevent being fat. *The internal organ has to divert, as arterial blood to evisceration already come out. shunt vein, or cerebrospinal fluid to *Don’t push, get a normal peritoneal cavity saline and gauze cover and call a doctor for referral to the Aseptic / Sterile Technique operating room to bring back the organ inside the body. excision removal/ cutting Surgical Asepsis fissure narrow slit/cleft/cracklike abnormal tubelike Definition of Terms communication between 1. Asepsis: absence of microorganisms that cause diseases. body cavities or organs. o The patient is free from infection. 2. Aseptic technique: method by which contamination with *Hemodialysis is done to microorganisms is prevented. patients with renal failure o In wound care, the doctor will clean it first then fistula because the toxins go to the afterwards they will assess it, this is done after the blood. surgery. *Create a fistula (AV fistula). o If there are no orders on the chart, do not yet open the An arteriovenous (AV) fistula wound. is an irregular connection o The nurse has a role in giving health education to between an artery and a vein. patient as well as significant others about proper removal of hemorrhoids wound care because most of the time, nurses are in hemorrhoidectomy contact with patients. (almoranas) surgical repair of a hernia 3. Sterile: free of microorganisms including spores (inactive hernioplasty but viable state of microorganisms in the environment). (luslos) cutting and withdrawal of o Higher level incision and drainage discharge o Observed in the operating room because the patient is excision or removal of an as risk for infection. isthmectomy isthmus (connects part of an o Remember that the physical barrier is the skin. When organ – isthmus) there is break in the continuity in the skin, the nursing excision of a portion of the diagnosis will be “impaired skin integrity.” intestinal resection bowel 4. Contaminated: soiled with microorganisms. wound produced by tearing o Example: body fluid of the patient. of tissue. 5. Infection: Invasion of the body by pathogenic laceration microorganisms. *There is tearing. 6. Microorganism: living organism, invisible to the naked eye excision of the posterior arch laminectomy including bacteria, fungi, viruses, and molds. of a vertebra. construction or alteration in 7. Pathogenic: capable of causing disease. mammoplasty size or contour of the female o Normal intestinal flora is already present in the body breast. and they are beneficial to us that helps in digestion suturing of cyst walls to (Yakult). edges of the wound, 8. Sterile technique: method by which contamination with marsupialization microorganisms is prevented to maintain sterility. following evacuation to remain the wound intact. 9. Surgically clean: mechanically cleansed but unsterile. mastoidectomy excision of mastoid cells. 10. Surgical conscience: an individual’s personal sense of containing pus honesty and integrity with regard to adherence to the principles of aseptic technique. Assessment data to collect: o Below the waist is considered unsterile. purulent -Assess ROI -Fever Signs of infection -Incision site Fever Pain Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 4  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory Redness / inflammation 3. Articles Used in The Procedure Once it is wrapped and taped, it is properly labeled and the Cardinal Signs of Inflammation date of sterilization (sterilization also has validity). Based on visual observation, the ancients characterized inflammation by five cardinal signs, namely Preventive Measures o Redness (rubor) All supplies must be properly checked of its sterility o Swelling (tumour) Proper packaging of supplies and sterilizing procedures o Heat (calor; only applicable to the body' extremities) Fomites: contaminated articles. o Pain (dolor) o Objects or materials that are contaminated o Loss of function (functio laesa) 4. Circulating Air Note: Surgically cleaned – mechanically cleaned but not sterile, Preventive Measures it needs to undergo sterilization. Keep OR doors closed o Buzzer Five (5) Sources of Contamination o Receiving recovery room – OR complex o ‘Yung suot sa labas ilalagay lang sa isang lugar tulad 1. Skin ng sapatos. Not only to patient but also skin who is performing the o Sa OR complex, may baon na shoeware, ‘di pwede operation suot although out ang uniform. How to prevent skin contamination: Minimize traffic in and out of the OR o Handwashing o Selective ▪ Two types: Avoid scattering of powder in OR Surgical handwashing / hand scrub - more Keep sterile tables when not in use extensive to remove most bacteria or Regular cleaning of the OR microorganism in the hand before wearing the o Kahit hindi ginagamit gloves (there is no need to apply alcohol Proper ventilation because it is considered sterile already). Ultraviolet rays’ disinfection if possible Medical handwashing - caring for a wound o Even in ward in private hospitals of patient. o Proper gloving technique 5. The Scrub Team’s Hair and Patient’s Hair o Proper attire Make sure that there would be no hair outside the cap. o Once the drapes are places, they cannot be removed because it is considered sterile Preventive Measures o Skin preparation Hair must be properly tucked under head cap. Hair follicles or strands must be removed from the operative Two (2) Types of Bacterial Flora site. A. Transient Bacterial Flora Principles of Aseptic Technique Can be reduced by washing with soap and water or by using Only sterile items are used within the sterile field. suitable antiseptics. o Factors breaking the sterility: ▪ Once the paraphernalia drops below the waist or B. Resident Bacterial Flora below the surface of the table. Lives and multiplies on the skin. With conventional “Mayo scissors down” scrubbing, the population that the team carry out a proper ▪ The back of the scrub team. scrub up technique with ample use of antiseptics. Sterile persons are gowned and gloved. Preventive Measures Items of doubtful sterility must be considered unsterile. Proper attire o Basis: surgical conscience. If feeling mo ‘yung item na ‘to di na sterile, unsterile… HINDI WALANG Proper scrub up technique PWEDE PA.” Proper gloving technique Whenever a sterile barrier is permeated it must be Keep a sharp look out for holes or tears in gloves or gowns considered contaminated. Exclusion from the operating room personnel with skin o Surface of the back table is sterile lesion o Sterile pataas ng or table then unsterile na ‘yung sa Proper preoperative skin preparation to patient baba. Draping of the operative site Sterile gowns are considered sterile in front from the shoulder to level of the sterile field and at the sleeves 2 2. Respiratory Tract inches above the elbow cuff. Tables are sterile only at table level. Preventive Measures o Even the packages enclosed can be considered Wear mask properly (covers nose, mouth, cheek, and chin) unsterile. Minimize forceful talking and laughing during operation Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 5  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory The edges of anything that encloses sterile contents are 6. Spores: inactive but viable state of microorganisms in the considered unsterile. environment cells produced by bacteria and fungi which can The sterile field is opened/created as close as possible to develop into new bacteria or fungi. the time of use. 7. Shelf life: the time a sterile package maybe kept in storage. o Open it the nearest time that the doctor will cut. Sterile areas are continuously kept in view. Chemical Disinfection o To maintain surgical conscience. It doesn’t always kill spores Sterile persons touch only sterile items or areas; unsterile Absolute strength is not always known person touch only unsterile items or areas. Long timing period is necessary for effectiveness o Sterile to sterile It is difficult to submerge some articles o Unsterile to unsterile It is not suitable for some materials Movement within or around sterile field must not Disinfected materials may cause irritation of the tissues if contaminate the field. not rained off o Kapag naka scrub kana (sterile kana) pati positioning Ability of the disinfectant to damage materials limits the mo. Be cautious on body movements. maximum concentration which can be used o Unsterile part of katawan ay back (back-to-back). Can be corrosive, may mga materials na hindi ginagamitan Wet areas are to be considered contaminated. Moisture (it is not suitable for some materials), may cause contamination. The stronger the concentration of the chemical solution, the Dressing and supplies once removed from the sterile more corrosive it may have the ability to damage the container are considered contaminated. instrument. Wrappers on sterile packages should be of a double thickness and of sufficient size so that the package may be Factors That Influence Action of Chemical opened without contamination. Disinfection Sterile packages should have identifications as to sterility Cleanliness of the object; presence of tissue, blood, or other and contents. material will inactivate the chemical/solution. Sterile drapes should not be removed once they are placed. o The more soiled or contaminate, the more kailangan Unsterile persons avoid reaching over a sterile field and ng proper care. Kailangan ng matapang or aggressive sterile persons must avoid leaning to unsterile fields. na disinfection. Skin cannot be sterilized. Concentration of the chemical. Proper shaving of the operative site. o Malakas ba or hindi the more concentrated, Surgical hand scrub must be performed before the makakasira ng instruments in the long run. operation. Length of time the object is submerged in the chemical. Initial knife is discarded from the sterile field after the first Examples of Chemical Disinfectants incision. Formaldehyde (Formalin) Change gloves if it gets hole intraoperative. Glutaraldehyde (Cidex) Simple Rules of Aseptic Technique Phenol 100% Know what is sterile Lysol Know what is not sterile Zephiran chloride 17% Keep the two apart Perfektan Endo solution Remedy contamination immediately Limitations of Chemical Disinfection Sterilization and Disinfection It doesn’t always kill spores. Absolute strength is not always known. Definition of Terms Long timing period is necessary for effectiveness. 1. Disinfection: the chemical or physical process of It is difficult to submerge some articles. destroying all pathogenic microorganisms except the spore- It is not suitable for some materials. bearing ones. Disinfected materials may cause irritation of the tissues if 2. Pathogenic microorganisms: living organisms, invisible not rained off. to the naked eye that cause infectious disease. Ability of the disinfectant to damage materials limits the 3. Antiseptics: agents that reduce or prevent the growth of maximum concentration which can be used. microorganisms on living tissue (e.g., betadine). o Skin aseptic Two (2) Methods of Sterilization 4. Disinfectants: agents that kill all growing or vegetative forms of microorganisms, thus completely eliminating them 1. Physical Sterilization from inanimate objects (e.g., Lysol) o Antiseptic on patients or humans A. Moist Heat o Disinfectant on things or objects Kills all bacteria by coagulating or denaturing of the protein o Spores are viable state of microorganism (pasulpot pa of the bacteria. lang sila). o Sa proteins, sa bacteria protein siya galing pati 5. Sterilization: process by which all pathogenic and non- membrane wala ng protein synthesis tas mamamatay pathogenic microorganisms including spores are killed. sila nasisira ‘yung integrity ng bacteria Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 6  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory a. Boiling (Non-Pressure Sterilizer) Note: Kills only vegetative bacteria. Disinfection does not kill spores. Sharp instruments are not included. When subject to Sterilizing kills spores. boiling, they can become dull. Chemical disinfectants can kill bacteria, but they do not Minimum of 20 minutes. destroy their spores. A process called sterilization destroys spores and bacteria. b. Saturated Steam Under Pressure Autoclaving is recommended for sterilization of linens and Disinfection Versus Sterilization instruments. Disinfection differs from sterilization by its lack of “sporicidal power.” B. Dry Heat Recommended for use only where direct contact of material Medico-Legal Aspects with steam is impractical or not available. Adherence to correct protocol para hindi mademanda. c. Dry Heat Autoclave (Hot Air Oven) Three (3) Potential Legal Involvement Used for oil, ointment, and powders. May be used for glassware and sharp instruments and 1. Consent for Operation needles to prevent rusting (60 minutes). Hindi pwedeng operahan ang tao kapag ‘di pumayag. Merong critical decision of the patient to undergo surgical 2. Chemical Sterilization procedure. Accomplished by the use of ethylene oxide gas. Only after appropriate explanation of the condition and Sterilize items that are heat or moisture sensitive. surgical procedure: o Using gas o Condition o Bakit need? Chemical Methods of Sterilization o Anong gagawin sa operation? o Complication of operation o Cost of operation o Paano ‘yung magiging outcome pagkatapos ng operation? o Kung ‘di siya papaopera, ano ‘yung pwedeng mangyari at pwedeng gawin? o Give adequate information the decision is based on good judgement. o All information should be given and voluntary and in a form. Informed consent is: o Autonomous o Voluntary CTTO: https://microbenotes.com o Prior to administration of psychoactive premeds and Mas gagamitin ang sterilization, paki-erase ang limitations. nurse may sign as witness o Surgeon is responsible in providing a clear and simple Ethylene Oxide Gas explanation Chemical agent that kills microorganisms, including spores, Before the client signs the consent and information is given by interfering with the normal metabolism of protein and to the patient, hindi dapat binigyan ng sedative or reproductive process, resulting in death of cells. medications, dapat clear ‘yung mind niya to make decision. Diagnostic procedure kahit anong pinasok mo sa patient Limitations of Disinfection (MRI, contrast media, or any invasive procedure) needs It doesn’t always kill spores. consent! Absolute strength is not always known. o Catheterization Long timing period is necessary for effectiveness. o Radiation It is difficult to submerge some articles. Informed consent come from competent patients (sila ‘yung Disinfected materials may cause irritation of the tissues of makakapag-sign and give consent physically. not rained off. Incompetent patients like these conditions cannot sign. The ability of the disinfectant to damage materials limits the o Coma maximum concentration which may be used. o Mentally ill patient It is not suitable for some materials. o Cognitively impaired / difficulty understanding o Children Factors That Determine Shelf Life Condition of the storage. Informed Consent Material used for packaging. Patient’s autonomous decision about whether to undergo a Seal of the package. surgical procedure. Integrity of the package. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 7  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory Voluntary and written consent from the patient at least 18 The scrub nurse and the circulating nurse work hand in years old before non-emergent surgery to protect patient hand. from unsanctioned surgery as well as the surgeon from claims of unauthorized surgery or battery. 3. Injury to the Patient Patient signs the consent prior to administration of During the 3 phases, clients may suffer from injuries. psychoactive premeds and nurse may sign as witness. Burns The surgeon is responsible in providing a clear and simple o Nasunog si px, sinara mo naman maayos kaya lang explanation of what the surgery entails: benefits, dinikit mo sa katawan niya (first degree burn… tsaka alternatives, risks, complications, disfigurement, disabilities ‘di mo sinabihan so oh tingnan mo baka napapaso na and what to expect postoperatively. siya. Falls Indications for Informed Consent o Sedative given katapos magawa lahat ng toiletries, Invasive procedure activity para nakahiga nalang, then handrails ‘di mo Use of anesthesia nataas then nahulog then negligence ‘di mo Non-surgical procedures which might be slightly risky hinarangan higaan. Radiation o Health education: binigyan na po namin ng sedative o pampatuog ang px baka mahulog. Criteria for Valid Informed Consent Infection Voluntary consent: freely given, without coercion. o By not doing aseptic technique. Competent patient: individuals who are autonomous and Improper identification of the patient can give/withhold consent. Giving of wrong drugs o Hydrochloride kalahating vial lang. Incompetent Patient ▪ Nubain – opioid analgesic – pampaalis ng sakit, Individual who is not autonomous and cannot give or pampa-high siya. withhold consent. Binigay mo 2 vials – wrong drug, wrong Those who are mentally ill, cognitively impaired, dosage neurologically incapacitated. Be cautious, we save lives, we never destroy lives Informed Patient Loss of specimen Consent should be in writing and should include the o Naoperahan nga, kinuha tissue inalis then dadalhin sa following: laboratory then poorly identified. Kung hindi nalagyan, o Explanation of procedure and risks naligaw. o Benefits and alternatives o An offer to answer questions about procedure Two (2) Categories of Surgery o Instructions that a patient may withdraw o A statement informing patient if protocol differs from 1. Emergency Surgery customary procedure Done immediately to save life or limb. 2. Loss of Sponges E.g., ruptured aneurysm, gunshot wound, and acute appendicitis. When to do sponge count? o Before start of the operation 2. Elective Surgery (Scheduled Surgery) o Before the closure of the peritoneum Done at the patient’s and surgeon’s convenience. o Immediately after the closure of the peritoneum o Closure of fascia Four (4) Classification of Surgery 1. According to Purpose A. Diagnostic: to establish or confirm a diagnosis. o Need examine ang px para malaman ang nagiging problem niya. B. Exploratory: to estimate the extent of disease or confirm a diagnosis. o To check or explore or view kung gaano extensive ‘yung disease process. o Laparotomy para makita ano na ‘yung affected. C. Ablative: “ablate” mean to take away, cut off. It involves removal of a diseased organ. o To remove diseased organ or dysfunctional organ para marelieve si px. D. Palliative: to remove symptoms of a disease. o In such a way the symptom of px is mas lalong marelieve siya. The circulating nurse have the list. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 8  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory o Px is suffering from extreme pain and there is a D. Debulking surgery: done when the entire cancer cannot problem with and if they cut off the certain nerve be removed without serious damage to the body. endings para di magtransmit ng pain impulses or o Surgeon takes out only that portion of the tumor that sensation, they can do that. can be removed safely. E. Reconstructive: repair of tissues or organs whose function o The rest of the tumor may be killed with radiation or appearance has been damaged. therapy/chemotherapy. o Nakagawa ‘yan pero nasira may nabali para mabuo E. Electrosurgery: use of an electrical current to destroy muli. cancer cells. F. Constructive: performed to repair a congenitally F. Laser surgery: uses a beam of lights instead of a scalpel. malformed tissue or organ. o Sa mata para gumanda panginin ng patient. o Malformation that are congenital. G. Mohs surgery: removal of skin cancer by shaving off one o They build up or repair or probably build the structure. layer at a time. G. Curative: to remove or repair a damaged or diseased H. Prophylactic surgery: used to prevent cancer when there organ. is a good chance that a particular body tissue will become cancerous in the future. 2. According to Risk Involved I. Palliative surgery: does not treat the underlying diseases A. Major: removal or manipulation of a major organ. but is done to control symptoms of cancer such as pain. Complicated and prolonged with higher risk of J. Staging surgery: used to determine the extent of the complications after such surgeries (e.g., nephrectomy) cancer, or how large it is and how much it has spread Can cause death throughout the body. Make use of general anesthesia. o Stage 1 - pinakamababa level Includes surgeries of the head, neck, chest and abdomen. Examples: Recovery time can be lengthy and may involve a stay Cataract surgery or phacoemulsification – risk: minor in intensive care or several days in hospital. o The patient is not asleep, only sedated B. Minor: removal or surgery on less important body structure. Appendectomy: purpose: ablative at the same time curative Usually done under local anesthesia. Facial surgery: Purpose Naputol ‘yung tip ng daliri, kapag napreserve, pwede i- o Is it congenital or by accident? attach then pwede na umuwi minor lang kase. o Congenital: constructive o Accident: reconstructive 3. According to Urgency Explorative laparotomy: A. Urgent: performed for reasons of health, within 12-24 o Purpose: agnostic hours. o Urgency: emergency o Within the day Breast augmentation: B. Imperative: surgical intervention within 24-48 hours. o Urgency: optional C. Emergency: requires immediate surgical intervention, no unnecessary delays. Note D. Required: done for conditions necessitating surgery but A client when agreeing to agree to consent to surgery, it which maybe scheduled or planned within a few weeks or a requires very big decision (informed consent, the client month. needs to know all the necessary information). o Pwede schedules according to which is convenient. E. Elective: done in cases wherein surgical intervention is Effects of Surgery on the Client needed to improve well-being though not absolutely After the surgery, we anticipate the different effect. necessary for life. Stress response is elicited o Cases wherein pinili mong magpa-suregry pero ‘di o Financial problem naman kailangan. o Fear F. Optional: done in cases wherein surgery is not necessary o Depression for health, but for the patient’s psychological needs. o Will somebody take care of them / support system o ‘Di naman kailangan pero for aesthetic purpose and Defense against infection is decreased increasing self-esteem. o Mataas metabolic demand (ginamit na nga energy) o Breast augmentation then kailangan pa lumaban. Vascular system is disrupted 4. According to Type o Connected to physiological stress. A. Biopsy: removal of a piece of tissue from an organ or other o Risk for surgery (bleeding) when bleeding pwede part of the body for microscopic examination to confirm or magkashock (hypovolemic shock) can lead to death. establish a diagnosis, estimate prognosis, or to follow the o People can die from hemorrhage. course of a disease. o Internal hemorrhage ‘di mo makikita. B. Curative surgery: to remove all diseased or malignant Organ function/s are disrupted (cancerous) tissue, which is meant to cure the disease o Connected to physiological stress (removal of tumor, appendectomy). o E.g., liver and kidney C. Cryosurgery: involves the use of liquid nitrogen or a very ▪ When surgery, anesthesia and medication is cold probe to freeze cancer cells. given, these will make metabolites (waste product) o Freeze liquid nitrogen that needs to be eliminated. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 9  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory ▪ Sometimes these are affected. Hindi lumalabas o Our mind is very strong. ‘yung waste product ng gamot. Napaka- o Attitude happens a lot in recovery. importanteng i-check ang renal function prior Understanding of surgical procedures surgery and function of renal function. Expected outcomes Lifestyle maybe changed Use of alcohol, tobacco and other substances (lifestyle) o Amputation due to DM, mag-c’cause ng pagbabago sa o Can interfere with the intraoperative and operative buhay niya. – psychological impact on patients’ life. phase of client, it can affect the outcome of surgery. o Cholecystectomy – kailangan diet less in fat kase Use of medicines, remedies, therapies kailangan mo ng (wala ka ng gallbladder na mag- Blood donations s’store ng bile). Bile is used to digest fat. o Nagkaroon na ba ng hypersensitivity reaction? There may be change in body image Allergies o E.g., reconstructive surgery (na-aksidente ka) the Knowledge about the perioperative period fracture sa katawan then reconstruct pwede ‘di Adequacy of the client’s support system mangyari as like it before / hindi na ganon katulad ng o Who will take care of the patient after the surgery? dati) bababa self-esteem. o If we know more about, we are able to provide the care o AV fistulae dialysis the clients need. o Nursing intervention: vent out to relieve their feeling, support system. Be therapeutic, listen to them and B. Physical Examination validate their feelings. Give them comfort. Must be brief but complete Head to toe approach (cephalocaudal) Surgical Risk Factors Age Determine Nutritional status Nutritional status Fluid and electrolytes o Obese (mahihirapan si doctor because it will cut off on General health skin) maraming layers na dadaanan Medications Height and weight Mental health and attitude Body mass index (BMI) Skin fold measurements (by caliper) Preoperative Nursing - Nursing Process Mid-upper arm circumference Time beginning with patient’s decision to have surgery and Serum protein level ending at the time of the induction of anesthesia. Nitrogen balance 1. Assessment o Fluid and electrolyte status. o Important to cope up with the demands of the body C. Nutritional and Fluid Status D. Respiratory Status Advise patient to stop smoking 6 weeks prior to surgery. Teach breathing exercises (Usually DBE) → to be done after the operation for promotion of lung expansion and prevent pneumonia. All of these and any health teachings should be taught before the operation. o History: the client is smoking: 6 weeks prior surgery to relax o Complications of surgery is respiratory disorder (pneumonia and atelectasis) o Pneumonia is brough about the infection A. Nursing History o DBCE: inhale and exhale (this will allow lung Physical condition → general health/medical condition expansion) Medical history – meron bang previous surgical experience ▪ Purpose of coughing is i-mobilize ‘yung plema or o First time ba secretion na nakadikit sa respiratory tract. Previous experience → surgical procedures/anesthesia ▪ Mahirap mag cough pag may tahi (dehiscence) Allergies (dye in diagnostic test if MRI or contrast CT scan) they need to support or splinting the incision site o To prevent further complications (hypersensitivity (pillow) para pag nag cough, ‘di masyado malakas reactions) ‘yung pressure. Family health history o Incentive spirometry can also be done to promote lung o Familial tendency expansion. Mental attitude (in going to surgery) ▪ Taught prior to surgery. o Important kase ‘di lang during the ongoing na surgical Note: procedure, when going to surgery and after, ang px If the client has respiratory infection, postpone the surgery. contributes to the healing and recovery of px. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 10  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory E. Cardiovascular Status Anaesthesia interaction with some medications can HPN → no surgery (postpone) cause respiratory difficulties, hypotension, and circulatory o The doctor would usually prescribe NTG patch to lower collapse. down blood pressure. Anticoagulants (including aspirin) may cause Avoid sudden changes in position, prolonged intraoperative and postoperative hemorrhage → monitor for immobilization, hypotension, hypoxia, and overloading the bleeding. Assess prothrombin time (PT) and partial cardiovascular system. thromboplastin time (PTT). Any abnormality should be referred to the doctor to have o Anticoagulant (blood thinners) are medicines that help better management or proper intervention. prevent blood clots. Diuretics – water pill - losing electrolyte imbalance. o Aspirin is considered maintenance drug for patients Blood thinners to prevent blood clot – clients have high who already had stroke. risk of bleeding (aspirin or acetyl salicylic acid) Diuretics (particularly thiazides) may lead to fluid and electrolyte imbalances, producing altered cardiovascular F. Hepatic and Renal Function response and respiratory depression → monitor fluid input Optimal liver function is essential so that medications, and output and electrolytes. Assess cardiovascular and anesthesia, body wastes, toxins will be removed from the respiratory status. body. Antihypertensives (particularly phenothiazines) increase Surgery is contraindicated in patients with acute renal the hypotensive effects of anaesthesia → closely monitor insufficiency because of the role of the kidneys in blood pressure. anesthesia excretion. Antidepressants (particularly monoamine oxidase inhibitors) increase the hypotensive effects of anaesthesia G. Endocrine Function → closely monitor blood pressure (has antihypotensive DM patient are prone to hypoglycemia and effect). hyperglycemia. Antibiotics (particularly the ‘mycin’ group) may cause Hypoglycemia may develop during apnea and respiratory paralysis → monitor respirations anesthesia/postoperatively due to inadequate carbohydrate (can compromise the respiration). consumption or excessive administration of insulin. Herbal supplements some may prolong the effects of Risk for infection because of poor wound healing in anaesthesia or may increase the risks of bleeding or raise hyperglycemia. blood pressure → these should be discontinued at least 2 Acidosis and glucosuria should be watched out for. weeks before surgery. Perform CBG (Capillary Blood Glucose) but usually fasting blood sugar (FBS) is used before, during, and after surgery. L. Physical Preparations Maintain the blood glucose at or below 200 mg/dl. Use of corticosteroids places the patient at risk for adrenal a. Diagnostic / Laboratory Tests insufficiency. Provide baseline data or reveal problems that may place Patients with thyroid disorders are at risk for thyrotoxicosis the person at additional risk during and after surgery. and respiratory failure. Performed preadmission within a week prior to elective surgery as part of the assessment process. H. Immune Function A. CBC (anemic) Determine allergies and document any sensitivity to o When the client medications and past adverse reactions. B. FBS (to see blood sugar level) Identify substances that triggered past allergic reactions C. Electrolyte studies (sodium, potassium – muscle such as medications, blood transfusions, contrast agents, contraction of the heart, chloride) latex, and food product. D. Coagulation studies Antibiotics are given prior to surgery because it serves as ▪ PTT prophylaxis (“loading dose”). ▪ APTT Strict asepsis should be ensured. E. Urinalysis F. BUN (blood urea nitrogen) I. Neurologic System G. Creatinine Mental status, LOC, orientation, and ability to follow ▪ Products of muscle metabolism and protein commands. metabolism. Motor and sensory deficits. ▪ Mataas – hindi nakakalabas and ‘yung functioning affected din. Tapos magbibigay ka pa ng J. Musculoskeletal System medications. Presence of prosthesis (artificial), joint replacements, and ▪ CPR clearance (internist gagawa) go signa if other orthopedic history. qualified na for surgery. H. Chest x-ray K. Medications I. Electrocardiogram (ECG) It is important to know what medication is the patient taking J. Pregnancy test for females because it can have drug interaction especially on the anesthesia that will be given. 2. Diagnosis Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 11  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory When you make, you identify the nx diagnosis that is o Skin prep is the first step in the prevention of surgical appropriate to the client based on the assessment done. wound infection. o Actual or potential o Before scheduled surgery, the surgeon may ask the ▪ Actual - meron nang signs and symptoms – actual client to shower using antiseptic solution such as (meron siyang ineffective tissue perfusion – blood betadine. Instruct client to be especially careful to clean supply to the certain parts of the body is not around the proposed surgical site. enough. o Cleaning reduces contamination of the surgical field ▪ Potential - wala pang sakit per nand’yan ‘yung and reduces the number of organisms at the site. mga factors na nakakapag-contribute na Note: magkakaroon ng problem. Shaving is a controversial step because many health care Judgment or conclusion of the patient’s health problems professionals believe that shaving contaminates the surgical made after reviewing all the assessment data. site and traumatizes the skin around the area where the A. Actual: is one the patient currently exhibits during incision will be made. assessment. Preparing patient for tubes, drains and vascular access. B. Potential: are those that the patient is not presently o Preparation reduces the client’s anxiety and fear, and experiencing, but may develop if appropriate interventions the family’s negative reaction. are not implemented. ▪ Tubes Client may need an indwelling catheter Preoperative Nursing Diagnoses before, during or after surgery to keep the Knowledge deficient bladder empty and to monitor the renal o Giving adequate information to make wise decision for function. their surgery and lessen their anxiety. Nasogastric tube may be inserted before Fear r/t effects of surgery, risk of death abdominal surgery to decompress or empty Anxiety the stomach and the upper bowel Anticipatory grieving r/t possible changes in body image ▪ Drains are often placed during surgery to help Ineffective individual coping remove fluid from the surgical site. ▪ Vascular access is for fluids, drugs and IV 3. and 4. Planning and Implementation anesthetics administration. Plan – kung anong gusto mong mangyari. Rest and sleep: o IC has been obtained o Promote rest and sleep Ensuring informed consent. o Hygiene/bath Implementing diet restrictions. o Remove cosmetics and nail polish o The client is restricted to NPO for 6-8 hours before o Remove all hairpin and clips surgery. o Remove dentures o Ensures that the stomach contains limited volume of o Provide an OR gown gastric secretions, which decreases the risk for Anxiety: aspiration. o Pre-op teaching Note: o Encouraging communication NPO before surgery is controversial because older adults, o Promoting rest who fast for 8 hours or more may have imbalances of fluids, o Using distractions electrolytes and blood glucose level. Teaching family and significant others: Administering regularly scheduled medications. o Assess the readiness and desire of the family to take o Discontinue meds that were advised to be an active part in client’s care. discontinued. o Involve the family in all aspects of education o Administer preoperative medications (like antibiotics as loading doses, narcotic analgesics, etc.) Preoperative Teaching on Post-Operative ▪ Loading dose of antibiotic Procedures and Exercises ▪ Ensuring the safety of the patient Should start at the physician’s office or during preadmission ▪ Medications can be given IV testing. ▪ 18 gg needle – for BT instances Preoperative care health teaching must be based of o The physician may also prescribe other drugs to be developmental stage of patient. given by IV route to maintain the drug level in the blood. Intestinal preparation A. Breathing Exercises o To prevent injury to the colon and to reduce the number Deep or diaphragmatic breathing /expansion breathing of intestinal bacteria. exercise. o Evacuation of bowel (enema) is needed when there is o Use of incentive spirometry. a major abdominal, pelvic or perineal surgery To promote complete lung expansion, thereby preventing Skin preparation pulmonary problems. o May shine-shave at mayroon din hindi depende sa o Coughing and splinting order. Performed along deep breathing every 1 to 2 hours after o Provide a warm, comfortable and private environment. surgery to keep lungs clear, allow full expansion, thereby preventing pneumonia and atelectasis. Jopar Jose C. Ramos | Bachelor of Science in Nursing 3-A 12  UA-CONP: C-RLE112 aidè à vivrè Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory, #HelpLive Immunologic Response, and Cellular Aberration (Acute and Chronic) Laboratory Splinting of area during coughing provides support and o Anticholinergics: atropine sulfate and scopolamine reduces pain. o Barbiturates/Tranquilizers: Phenobarbital midazolam (Dormicum) → sedative B. Leg Procedures and Exercises o Prophylactic antibiotic: 1 hour before the surgery Antiembolism stockings and elastic wraps- provides Turn client to side if patient is unconscious and wants to graduated compression of the legs, may be used during or vomit. after surgery along with exercises and early ambulation to promote venous return. Documentation Pneumatic compression devices enhance venous blood flow by providing intermittent periods of compression on the legs. Leg and ankle exercises also promote venous return, urge client to practice these exercises before surgery. Turning in bed Lessens risk for circulatory, respiratory, or gastrointestinal dysfunction following surgery. C. Range of Motion Exercises Passive or active range of motion exercises helps prevent joint rigidity and muscle contracture. Client should perform 3 to 5 times, 3 to 4 times per day while bedridden. Early ambulation Mobility soon after surgery stimulates intestinal motility, enhances lung expansion, mobilizes, mobilizes secretions, promotes venous return, prevents joint rigidity, and relieves pr