STUDENT Chapter 42 - Care of Surgical Patient.pptx

Chapter 42 Care of the Surgical Patient Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Objectives 1. Identify the purposes of surgery. 2. Distinguish amon...

Chapter 42 Care of the Surgical Patient Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Objectives 1. Identify the purposes of surgery. 2. Distinguish among elective, urgent, and emergency surgery. 3. Explain the concept of perioperative nursing. 4. Discuss the factors that influence an individual’s ability to tolerate surgery. 5. Discuss considerations for the older adult surgical patient. 6. Describe the preoperative checklist. Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 2  Objectives (Continued) 7. Explain the importance of informed consent for surgery. 8. Explain the procedure for turning, deep breathing, coughing, and leg exercises for postoperative patients. 9. Differentiate among general, regional, and local anesthesia. 10. Explain conscious (moderate) sedation. 11. Describe the roles of the circulating nurse and the scrub nurse during surgery. Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 3  Objectives (Continued) 12. Discuss the initial nursing assessment and management immediately after transfer from the postanesthesia care unit. 13. Identify the rationale for nursing interventions designed to prevent postoperative complications. 14. List the assessment data for the surgical patient. 15. Identify the information needed for the postoperative patient in preparation for discharge. 16. Discuss the nursing process as it pertains to the surgical patient. 4 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  DID YOU PRE-READ????  During the preoperative period, the anesthesiologist prescribes Versed 3.5 mg to be administered IM. This medication, when prescribed prior to surgery, serves which important function? A) The medication aids in the reduction of postoperative pain. B) The anticoagulation effects of the medication reduce operative bleeding. C) The bactericidal actions aid in preventing infection. D) The administration of this medication promotes sedation.  Discuss common laboratory tests that could be 5 completed prior to surgery; include electrolytes. Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Perioperative Nursing Refers to nursing’s role throughout surgery Preoperative Intraoperative Postoperative Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 6  Perioperative Nursing  What phase is this? Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 7 Influencing Factors Age Physical condition Nutrition Psychosocial needs Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 8  Influencing Factors cont’d The older patient RECOVER slower Increased RISK of aspiration, atelectasis, pneumonia, thrombus formation, infection Increased risk for toxicity LONGER teaching time All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9  Purposes of Surgery  Diagnostic  Ablative  Palliative  Reconstructive  Curative  Preventative – Which celebrity??  Transplant  Constructive  Cosmetic 10 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Classification of Surgeries Elective Urgent Emergent Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 11  Case Study  The nurse is providing care for two patients in an urgent care setting.  Patient A was found to have gallstones and an infected gallbladder, and has a white blood cell (WBC) count of 27,000. Patient A is scheduled for gallbladder surgery immediately.  Patient B was found to have a poorly functioning gallbladder with no stones and no infection. Patient B’s WBC count is normal and he denies pain. Patient B is given a referral to a local surgeon’s office.  What classification of surgery will each have and what is an explanation for the different approaches with each patient? 12 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Preoperative Nursing  Thorough assessment  Thorough health history  Complete and accurate list of medications  Preoperative teaching  HOW TO PREVENT POST-OP COMPLICATIONS Examples?? 13 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Pre-Op Checklist 14 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. What is this form? What is the nurse’s responsibility? When is this obtained? What are the requirements for the patient’s status? 15 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Preventing Postoperative Complications  Turning – How often?  Deep breathing  Coughing  SCDS, TEDS  What does the picture on the right demonstrate?  What is the usual order?  What is this 16 purpose? Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Preventing Postoperative Complications cont’d  Coughing  Which post-op  Prevents?? complication can  Usually this prevent? contraindicated in spinal, cranial, and eye surgeries  What is this example? 17 All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.  Anesthesia General Regional Local Conscious (Moderate) Sedation Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 18  Anesthesia cont’d General Produces amnesia, analgesia, muscle paralysis, and sedation Can be reversed What types of surgeries would require general anesthesia? All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19  Anesthesia cont’d  Regional  Results in loss of sensation in an area of the body  Sometimes used for pain control  The patient does not lose consciousness  Examples? All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20  Anesthesia Cont’d Local Loss of sensation at the desired site Most commonly injected or applied topically – i.e. Lidocaine during dental procedure All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21  Conscious (Moderate) Sedation Drugs that depress CNS and decrease LOC; also causes amnesia Combinations of sedatives, tranquilizers, anesthetics, or anesthetic gases Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 22  Nurse’s Roles During Surgery What type of Nurse is What type of Nurse is this? this? Prepares equipment; Checks to ensure equipment Arranges sterile and is functioning properly nonsterile supplies Observe breaks in sterile Counts sponges, needles, technique and instruments WITH circulating nurse Performs appropriate Observes progress of assessments surgical procedure Counts sponges, needles, Hands surgeon instruments, and equipment BEFORE and sponges, and necessary AFTER surgery supplies during procedure Identifies and handles surgical specimens correctly Maintains count of sponges, Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 23  Which unit is the patient in? What should the nurse monitor here? 24 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Assessment of the Surgical Patient  VITALS: T-P-R-BP-Pain  What are normal ranges of the above VS?  Pain assessment  Addictive during perioperative period?  When to give analgesics?  Objective data?  Subjective data? 25 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Assessment of the Surgical Patient Cont’d  Incision assessment  Monitor bleeding  Color  Exudate/ Drainage Descriptive terms??  Temperature  Wound edges  Identify the wound complications on the right. All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26 Assessment of the Surgical Patient Cont’d  Urinary function  Urination may not occur for 6-8 hours  If patients do not void within 8 hours, catheterization may be necessary  Assess for fluid deficit  Venous STASis  Assess for Strength of pedal pulses Edema in legs Aching legs Redness in legs Skin color Skin temperature All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27 Post-Operative Assessment 28 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved.  Preparing the Surgery Patient for Discharge  Discharge instructions should include  Wound care guidelines  Medications  Activities  When to call the health care provider  When to follow up Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 29  Medications for the Perioperative Period  What are common medications you have heard/seen used during the perioperative period?  Analgesics  Antiemetics  Antibiotics  Anticoagulants 30 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Problem List – BACK OF BOOK  Ineffective airway clearance  Ineffective breathing pattern  Risk for infection  Fear  Knowledge deficit  Impaired tissue integrity  Pain  Impaired communication  Impaired mobility All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 31 Discuss Main Topics from each: Delegation Considerations in Perioperative Nursing ABCDEF Pneumonic Preoperative Considerations for Commonly Ingested Herbs Postoperative Comfort Measures for Pain All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 32  Medications with Special Implications for the Surgical Patient  As listed below, identify the drug class of the medications and implications for the surgical patient  Warfarin  Lopressor  Dilantin  Prednisone  Furosemide  Ginseng  Insulin  ASA 33 All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.  CBC  WBC - 5,000 - 10,000/mm3  RBC - 4.2 - 6.2 million/mm3  Hgb - 12 – 18 g/dL  Hct - 35% - 54%  Platelet Count - 150,000 – 400,000 mm3  PT - 12 – 14 seconds  aPTT - 20 – 25 seconds  INR - 0.8 - 1.1  BMP  Sodium (Na) - 135 – 145 mEq/L  Potassium (K) - 3.5 – 5 mEq/L  Chloride (Cl) - 96-106 mEq/L  Blood Urea Nitrogen (BUN) – 11 – 23 mg/dL  Creatinine (Cr) - 0.2 - 0.9 mg/dL  Glucose (Glu) - 70 – 115 mg/dL  Calcium - 8.4 – 10.6 mg/dL  Magnesium - 1.3 – 2.1 mg/dL Labs 34 Copyright © 2019, 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. 35