Perioperative Nursing Care 2024.pptx

Perioperative Nursing Care Sue Cagir DNP, MS, RN, CNE Student Learning Outcomes Describe a comprehensive preoperative assessment to identify pertinent health and surgical risk factors Describe considerations related to preoperative nursing care of older adults’ patients, patients who are obes...

Perioperative Nursing Care Sue Cagir DNP, MS, RN, CNE Student Learning Outcomes Describe a comprehensive preoperative assessment to identify pertinent health and surgical risk factors Describe considerations related to preoperative nursing care of older adults’ patients, patients who are obese, and patients with disabilities Identify legal and ethical considerations related to obtaining informed consent for surgery Identify preoperative nursing teaching measures that decrease the risk for infection and other postoperative complications Describe the interdisciplinary approach to care and the roles of the surgical team members during the intraoperative phase of care Identify adverse effects of surgery and anesthesia Compare types of anesthesia regarding use, advantage, disadvantages and nursing responsibilities Use the nursing process to optimize patient outcomes during the intraoperative period Describe the responsibilities of the postanesthesia care nurse in prevention of immediate postoperative complication Compare postoperative care of the ambulatory surgery patient with that of the hospitalized surgery patient Identify common postoperative problems and the assessment parameters appropriate for the early detection of postoperative complications Describe the gerontologic consideration related to postoperative management Identify variables that affect wound healing Perioperative Care Preoperative – procedures or teaching completed before a surgical procedure reduce potential complications and postoperative discomfort – reduce anxiety, and increase participation in care. Intraoperative- begins when a client enters the surgical suite and ends with a transfer to the post- anesthesia recovery area. Nursing focuses on safety, client advocacy, and health team collaboration. Postoperative – begins when a client enters the post- anesthesia recovery area and continues until discharge from the healthcare facility Preoperative Phase – Nursing Interventions Take client history Identify risk factors- infants, elderly, chronic illness, malnutrition, respiratory conditions, obesity, and emergent procedures. Check for informed consent (a nurse may witness only) Perform a baseline assessment Height Weight Verify NPO status Preoperative Phase - Medications Anesthesia Antibiotics (prophylactic) Inhalation (Mask) Anticholinergics (dry Intravenous secretions) Regional (Spinal, Epidural) Sedatives Topical (Skin) Regional Anesthesia  Preoperative Client Education Phase Fears and Anxiety Medication Diagnostic Tests: Hold anticoagulants for 7 to 10 days Laboratory Profile prior to surgery (e.g., warfarin or aspirin) Chest X-rays Invasive Procedures (IV, Foley) ECG Incentive Spirometer Pregnancy Test for Turn, position, and perform early Females ambulation , including leg exercises Analgesics and pain control methods Routine and expected postoperative care Intraoperative Phase Begins when a client enters the surgical suite and ends with the client being transferred to the post-anesthesia care unit Nursing focus is on Safety - fall, airway Client Advocacy Health team collaboration  Intraoperati ve Phase The Universal Protocol The Universal Protocol (Safety initiative from the Joint Commission) Conduct a pre-procedure verification process Mark the procedure site – with the patient awake to agree to the surgical procedure being done – mark the site with an X Perform a ”time out” before starting the procedure Intraoperative Phase Collaborative Care Perioperative Nursing Staff Holding- presurgical holding area Circulator- not sterile Scrub- sterile hands instruments during the procedure Specialty- example: orthopedic, cardiac surgery Intraoperative Phase – Nursing Intervention Implement role according to established standards Maintain a safe environment Ensure strict asepsis Apply grounding devices Ensure correct sponge needle and instrument count Position client Remain alert to complications – Malignant Hyperthermia Communicate with the surgical team (interprofessional) Intraoperative Phase – Therapeutic Measures Blood transfusion Radiology Biopsy Laboratory profiles Complication in the Operating Room Monitor History of Genetics – Neurological – Muscular Dystrophy Better monitoring techniques Increasing end-tidal CO2, Increase Heart Rate – early symptoms Hyperthermia – late symptoms  Treatment Give Dantrolene Sodium 2.5/kg IV Immediately every 5 minutes until symptoms subside (Skeletal Muscle Relaxant) Oxygen 100% Treat Hyperkalemia Stop Treatment after core Treat Arrhythmia temp is < 38 C Monitor Renal Function (Foley) Decrease Temperature Cooling Blankets Cold Saline IV Solution Ice Packs Postoperative Phase- Begins when a client enters the post-anesthesia recovery area and continues until discharge from the health care facility Post-Anesthesia Care Unit (PACU) –Immediate recovery period Ongoing Nursing Assessment Pulmonary Verify airway and check gag reflex Assess for bilateral breath sounds Encourage coughing and deep breathing Circulatory Compare vital signs to baseline Assess tissue perfusion (mottling)  Neurological Evaluate the level of consciousness Assess reflexes and movement Genitourinary Monitor intake and output Assess urinary output (color, clarity, and amount) Gastrointestinal Assess for bowel sounds Assess for abdominal distention Integument (Skin) Assess Color Assess Wound Assess Drainage Insertion Sites Post Operative Nursing Interventions Verify IV fluid type, rate, and site Check dressings for type and amount of drainage Identify drainage, including color and amount If NG tube is, determine the type and amount of suction ordered Position in Semi Fowlers to facilitate maximum oxygenation Monitor oxygen saturation Ensure thermoregulation (monitor temp every 4 hours) Provide pain management Maintain NPO until the client is alert and a gag reflex returns Ambulatory Surgery Patients – go home the same day – discharge instructions is essential NCLEX A nurse is caring for a client who arrived in the PACU following a total hip arthroplasty. The client is not responding to verbal stimuli. Which of the following actions should the nurse preform first? A.Compare and contrast peripheral pulses. B.Apply a warm blanket. C.Assess dressings. D.Place the client in a lateral position. Common Postoperative Complications Atelectasis – collapsed lung, not taking deep breaths Symptoms- Tachycardia, Tachypnea, Shallow Respirations Interventions- Incentive Spirometer Turn Cough and Deep Breath Early Ambulation Hydration Monitor respiratory rate and rhythm Mucolytics – if pneumonia –productive cough I Cough Common Postoperative Complications Respiratory Depression Symptoms - Bradypnea, Shallow Respirations, Decreased LOC Cause- Anesthesia (PCA), Narcotics Interventions Monitor respiratory rate and rhythm Monitor client’s LOC Regulate narcotics Oxygen Therapy – monitor oxygen saturation Narcotic antagonist – naloxone Common Postoperative Complications Hypoxia Symptoms- confusion, increased blood pressure, tachypnea Interventions- Monitor Vital Signs, Oxygen Therapy, resolve underlying problems Nausea Interventions- comfort measures, relaxation, mouth care, Antiemetic, NG tube to decompress the stomach Hypotension – Blood loss – Give IV Fluids -monitor urinary output, lung sounds (prevent hypovolemic shock) Common Postoperative Complications Urinary retention/hesitancy – usually from regional anesthesia- inability to void Bladder Distention, Restlessness, increased B/P Intervention- Bladder Scan, intake output, bed pain, walk to the bathroom Decreased peristalsis/paralytic ileus Hypoactive/absent bowel sounds, no flatus Interventions – NG to decompress the stomach, limit narcotics, ambulation, Prokinetic agents: metoclopramide as prescribed Common Postoperative Complications Wound Hemorrhage Bleeding from drainage tubes or surgical site- signs of shock Interventions- Assess site, Identify early signs, monitor drainage device, keep patent, avoid tension at the surgical site Thrombophlebitis Symptoms: Redness, warmth, calf tenderness/pain, edema at the site Interventions: Early ambulation, apply anti-embolic stockings or sequential compression devices as Types of Surgical Drains JP Drain Hemovac Monitor output Common Postoperative Complications Delayed wound healing Edema, redness, pallor, separation at edges, absence of granulation tissue Interventions: Splint incision as needed, Abdominal Binder, Promote High Protein Diet Wound Infection Signs of delayed healing with purulent/discolored drainage, pain in incisional area Promote a healthy diet, adequate fluid intake, adequate rest, and exercise Wound Care, Antibiotics as prescribed Common Postoperative Complications Wound dehiscence/evisceration Dehiscence- open wound revealing underlying tissue Evisceration - open wound revealing underlying organs Interventions- position the client to decrease tension at the suture line Apply sterile saline-soaked gauze, notify the surgeon, instruct the patient not to cough or strain, and provide emotional support Common Postoperative Complications Common Postoperative Complications Urinary tract infection (5-8 days) Frequent, urgency, dysuria, malodorous, cloudy urine Interventions: Wipe front to back after urination Limit use of an indwelling catheter, encourage voiding Increase fluids 3/L day, cranberry juice Antibiotics as prescribed Uroanalgesics as prescribed  NCLEX A nurse is planning care for a client to prevent post-operative atelectasis. Which of the following interventions should the nurse include in the plan of care? (select all that apply) A. Encourage use of incentive spirometer every hour. B. Instruct the client to splint the incision when coughing and deep breathing. C. Reposition the client every 2 hr D. Administer antibiotic therapy as ordered E. Assist with early ambulation References Brunner & Suddarth's Textbook of Medical Surgical Nursing(14th ed.). (2018). Philadelphia, PA: Wolters Kluwer. Content mastery series review model: RN Adult Medical Surgical Nursing (10.0 ed.). (2019). ATI Nursing Education.