N112-PERIOPREATIVE-2.pdf

PERIOPERATIVE NURSING ART VALENTE DOMINGO ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph THREE PHASES OF...

PERIOPERATIVE NURSING ART VALENTE DOMINGO ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph THREE PHASES OF SURGICAL EXPERIENCE ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Perioperative Nursing Describes the nursing functions in the total surgical experience of the patient. Nursing care provided to surgery patients during the entire inpatient period. Surgical conscience must observed. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ATTRIBUTES OF A PERIOPERATIVE CAREGIVER Sensitivity curiosity communicative versatile FLEXIBLE EMPATHY sense of humor open-minded CONSCIENTIOUSNESS SUPPORTIVE efficiency creative even-tempered LISTENS hygiene ethics ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph BEHAVIORS Self-confidence (or diffidence) Interest (or apathy) Proficiency (or incompetence) Authority (or indecisiveness) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 3 PHASES OF SURGICAL PATIENT PREOPERATIVE INTRAOPERATIVE POST OPERATIVE ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph PREOPERATIVE PHASE ST. Aadapted L EfromXProf.I U S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  PREOPERATIVE Extends from the time the decision is made for surgical intervention to the transfer of the patient to the operating table. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph CONSENT General Consent -is signed by patient or pt’s legal guardian on admission. -health care team are authorized to render routine care/treatment. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LEGAL PREPARATION FOR SURGERY Informed Consent ✓ is a process – not just a document. ✓ surgeon’s responsibility (benefits, risks, alternative therapy, complications, disability) verbally explained to pt’s understanding before the treatment. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LEGAL PREPARATION FOR SURGERY QUESTION What will be the role of a nurse in relation to informed consent? Ans - - - The nurse may ask the pt to sign the consent & witness the signature. He also clarifies the information provided. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LEGAL PREPARATION FOR SURGERY Validation of Consent -voluntary -informed -legal age (18) -mentally competent -given before premedication or going to OR ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LEGAL PREPARATION FOR SURGERY Validation of Consent (who will sign the consent?) minor unconscious minor mentally (emancipated, incompetent married) Cognitively mentally impaired incapacitated adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph LEGAL PREPARATION FOR SURGERY NOTE: -witnessing (1 or more) a consent by authorized people. -In case of emergency, lifesaving measures are given even w/o IC. -right to refuse a surgical procedure. -signed consent form is placed in a prominent place on the pt’s chart ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph PREOPERATIVE PHASE: AIM To ensure that each patient receives holistic preparation for a SAFE and DIGNIFIED surgical experience. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph NURSING RESPONSIBILITIES: PREOPERATIVE PHASE ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph PREADMISSION TESTING 1.Initiates initial preoperative assessment. 2.Initiates teaching appropriate to pt’s. needs. 3. Involves family in interview. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph PREADMISSION TESTING 4.Verifies understanding of surgeon- specific preoperative orders (e.g. bowel preparation, preoperative shower) 5.Assess pt’s. need for postoperative transportation and care. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ADMISSION TO SURGICAL CENTER OR UNIT 1.Completes preoperative assessment. 2.Assess for risks for postoperative complications. 3.Report unexpected findings or any deviations from normal. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ADMISSION TO SURGICAL CENTER OR UNIT 4.Verifies that operative consent has been signed. 5.Coordinates pt. teaching with other nursing staff. 6.Reinforces previous teaching. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ADMISSION TO SURGICAL CENTER OR UNIT 7.Explains phases in perioperative period and expectations. 8.Answers pt’s. and family’s questions. 9.Develop a plan of care. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph IN THE HOLDING AREA 1.Assesses pt’s. status, baseline pain and nutritional status. 2. Review chart. 3. Identifies patient. 4.Verifies surgical site and marks site per institutional policy. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph IN THE HOLDING AREA 5.Establishes intravenous line. 6.Administers medications if prescribed. 7.Takes measure to ensure pt’s. comfort. 8.Provides psychological support. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph OTHER CARE Psychological Assessment and Care Fear of the unknown, anesthesia, pain, death, disturbance of body image, & worries. Nursing Actions: explore client’s feelings, allow pt. to speak openly, give accurate information about surgery, & be empathetic. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph GENERAL PHYSICAL PREPARATIONS BEFORE SURGERY -correct any dietary deficiencies -correct fluid and electrolytes imbalances -restore adequate blood volume with BT -treat chronic diseases (DM, HPN) -treat any infectious diseases ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph TEACHING PREOPERATIVE EXERCISES Diaphragmatic Deep Breathing Exercise Incentive Spirometry Coughing Exercises (splinting of chest) Turning Exercises Foot & leg exercises ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph NURSING RESPONSIBILITIES PREPARING THE PATIENT BEFORE SURGERY ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph THE EVENING BEFORE OF SURGERY -Preparing the skin (full bath) -Preparing the G.I. Tract (NPO, enema) -Preparing for Anesthesia (no alcohol & smoking for @ least 24hrs b4 surgery -Promoting rest & sleep (sedative as ordered) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph EARLY MORNING CARE -morning bath, mouth wash -provide clean gown -remove cosmetics, dentures, contact lenses, hearing aid, jewelry and prostheses. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph EARLY MORNING CARE -take baseline VS before preop medication -check ID band, skin prep -check for special orders (enema, G.I. tube insertion, IV line) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph EARLY MORNING CARE -check NPO -let pt. void before preoperative medication -continue to support emotionally -accomplish “preoperative care checklist” ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Preoperative Phase Decision Preparation (Holistic and Legal) OR ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph INTRAOPERATIVE PHASE NURSING RESPONSIBILITIES ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  INTRAOPERATIVE Extends from the time the client is admitted to the operating room, to the time of administration of anesthesia, surgical procedure is done, until the patient is transported to the RR/PACU. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  INTRAOPERATIVE PHASE Physical Environment of OR Operating Room -it is controlled geographically, environmentally, and bacteriologically, and it is restricted in terms of the inflow and outflow of personnel. -it should be adjacent to the PACU, and SICU. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ANESTHESIA -in Greek “negative sensation” -absence of all sensation, induced by an anesthetic substance/agent. -it is a state of narcosis, analgesia, relaxation, and reflex loss. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph GOAL OF ANESTHESIA to facilitate faster return to baseline function and thereby decrease the risk of anesthesia. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  CHOICE OF ANESTHESIA No ideal agent or technique is suitable for all patients: -is made by the anesthesiologist -low morbidity & mortality -safe agent and technique -produce minimum side effects -potent, rapid onset & easy reversibility ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  MAIN TYPES OF ANESTHESIA 1. General Anesthesia (IV or inhalation) 2. Regional Block Anesthesia (Spinal, Epidural, & Peripheral nerve blocks) 3. Local Anesthesia 4. Moderate sedation ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 1. GENERAL ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph General Anesthesia -is the loss sensation with loss of consciousness. -patient isn’t arousable, not even to painful stimuli. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph General Anesthesia -skeletal muscle relaxation, impaired ventilation and cardiovascular function and elimination of coughing & gagging reflex. -administered IV, or by inhalation (“ane”). ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph General Anesthesia 1. General (commonly used agents) INTRAVENOUS INHALATION Thiopental Na Nitrous oxide Propofol Halothane Fentanyl Enflurane Ketamine Sevoflurane Diazepam Desflurane adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph INTRAVENOUS ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Physiologic Monitor Flow- Through Reservoir Vaporizer “Breathin” Bag Flowmeters Ventilator for Gases Carbon Dioxide Canister ST. A L E X I U S C O L LfromEProf.GECECajandig's lecture material adapted www.stalexiuscollege.edu.ph General Anesthesia Is usually used in pt: Requires significant skeletal muscle relaxant Extremely anxious Uncooperative Refused or contraindicated ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Four Stages of General Anesthesia Stage I : Beginning/Induction Stage II : Excitement Stage III : Surgical Anesthesia Stage IV : Danger ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Four Stages of General Anesthesia 1.Stage I: Beginning/Induction -extends from administration of anesthetic agent to the time of loss of consciousness. -Nsg. Care: assist during induction, close OR doors, keep OR quiet, no unnecessary motions ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Four Stages of General Anesthesia 2. Stage II: Excitement -extends from the time of loss of consciousness to relaxation. -susceptible to external stimuli -Nsg. Care: restrain pt, remain quietly at pt’s side, but ready to assist anes. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Four Stages of General Anesthesia 3. Stage III: Surgical Anesthesia -extends from relaxation to the loss of the most reflexes, depressed vital fxn. -surgical procedure is STARTED. -Nsg. care: position patient and prepare skin only when indicated. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  Four Stages of General Anesthesia 4.Stage IV: Danger -too much anesthesia has been given -extends from too depressed vital functions to respiratory & cardiac failure. -Nsg. care: D/C anesthesia, prepare for CPR. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 5 OBJECTIVES OF GENERAL ANESTHESIA OXYGENATION UNCONSCIOUSNESS ANALGESIA MUSCLE RELAXATION CONTROL OF AUTONOMIC REFLEXES ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  5 OBJECTIVES OF GENERAL ANESTHESIA 1. OXYGENATION brain tissues must be perfused w/ O2 blood. Note: color of blood, amount & kind of bleeding, pulse oximetry, monitor vital fxns. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 5 OBJECTIVES OF GENERAL ANESTHESIA 2. UNCONSCIOUSNESS -pt remains asleep and unaware during the surgical procedure. 3. ANALGESIA -pt must be free of pain during the surgery. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 5 OBJECTIVES OF GENERAL ANESTHESIA 4.MUSCLE RELAXATION -must be constantly assessed to provide necessary amount of drugs. 5.CONTROL OF AUTONOMIC REFLEXES -anesthetic agents affect cardiovascular & respiratory systems. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 2. REGIONAL ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA injection of anesthetic agent around a specific/group of nerve to interrupt pain impulses. Techniques: 1. Nerve block 2. Spinal 3. Epidural ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA NERVE BLOCK -nerve is anesthetized to interrupt sensory, motor and sympathetic transmission. -Ex.: intercostal block (IAP), radial or ulnar block (elbow or wrist), brachial plexus block /axillary block (arm), penile block ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA NERVE BLOCK -Ex.: paravertebral anesthesia (chest & abdominal wall), radial or ulnar block (elbow or wrist), brachial plexus block/axillary block (arm), penile block, transsacral (caudal) block (perineum & lower abdomen) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA (SPINAL & EPIDURAL) SPINAL EPIDURAL SITE SITE injection of drug injection of @ subarachnoid anesthetic agent space (L 4-5) @ epidural space adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Upper needle lies in the subarachnoid space for the injection of the anesthetic..A small catheter is inserted through the needle into the epidural space after which the needle is removed leaving the catheter in place. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  SPINAL ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's EPIDURAL O Lmaterial www.stalexiuscollege.edu.ph LEGE REGIONAL ANESTHESIA SPINAL EPIDURAL USE USE abdominal, pelvic, SAME; post inguinal, lower operative pain extremity, & management urologic procedures adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA SPINAL EPIDURAL ABSORPTION ABSORPTION anesthetic is anesthesia is becoming “fixed” prolonged (CSF – BS) (DM– CSF –BS) rapid onset(2-5mins) slow onset(15-20mins) adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA SPINAL EPIDURAL Identification of Identification of the subarachnoid the epidural space space When CSF Using the loss of appears resistance technique adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA Spinal or Epidural Anesthesia -position pt into knee-chest/C or sitting. -Note: inform pt site prep. (aseptic technique) & possible outcome of insertion. Monitor BP pre-intra-post operative. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph KNEE-CHEST POSITION Sitting Position ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA SPINAL EPIDURAL ADVANTAGES ADVANTAGES pt is conscious Decreased case of: throat reflexes are ✓hypotension maintained ✓headache no respiratory ✓neurological depression complications adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph REGIONAL ANESTHESIA SPINAL EPIDURAL DISADVANTAGES DISADVANTAGES circulatory more difficult depressant effect technique hypotension unpredictable stasis of blood time consuming sensitivity to agent large dose of agent adapted from Prof. EC Cajandig's lecture material ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  3. LOCAL ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LOCAL ANESTHESIA -is the injection of anesthetic agent into the tissues at the planned incision site. -it is combined w/ a local regional block (injection around the nerve) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LOCAL ANESTHESIA -agents used ends w/ “caine” -technique: simple local infiltration and topical -often given in combination w/ epinephrine -LAST may develop when bolus of LA is accidentally injected in the blood vessels ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph LOCAL ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ADVANTAGES ✓ Simple, economical & nonexplosive ✓ Less equipment to be used ✓ Postoperative recovery is brief ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ADVANTAGES ✓ No loss of consciousness ✓ Suitable for pt who ingested food or fluids ✓ Ideal for short and minor surgical procedures ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph DISADVANTAGES ✓ not practical for all procedures ✓ rapid absorption of drug in the bloodstream (harmful) ✓ apprehension may increase ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph CONTRAINDICATIONS ✓ Allergic sensitivity ✓ Local infection or malignancy @ the site of injection ✓ Extreme nervousness or inability to cooperate ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 4. MODERATE SEDATION ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph MODERATE SEDATION -previously referred to as conscious sedation -involves the IV administration of sedatives or analgesics -reduce pt anxiety and control pain ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph MODERATE SEDATION -commonly used in short- term surgical procedures (diagnostic or therapeutic) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph 5. COMPLICATIONS OF ANESTHESIA ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 1.Anesthesia Awareness -Patient may experienced partially awake while under GA Greatest risk: cardiac, obstetric, major trauma pt Prevention: premedication w/ anesthetic agents and avoidance of muscle paralytics ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 2.Nausea, Vomiting, and Pain Cause: manipulation of the abdominal cavity, cerebral ischemia Management: turn head to side, suctioning, antiemetics, citric acid or antacids ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 3.Spinal Headache Cause: large needle, CSF leakage Management: quiet environment, supine bed rest, keep hydrated ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 4.Severe Hypotension and Respiratory Depression Cause: vigorous movement, high spinal anesthesia (total spinal) Management: avoid vigorous movement, O2 support or mechanical ventilation, IV fluids ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 5.Anaphylaxis (life-threatening acute allergic reaction) Cause: exposure to antigen or substance (meds or latex gloves) Management: discontinue, epinephrine (vasoconstriction), Diphenhydramine (Benadryl), intubation (cardiac and respiratory arrest) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 6.Hypoxia, Respiratory and Cardiac Arrest, Urinary retention, Paralysis Cause: ↑ anesthetic agent, aspiration, nerve damage Management: monitoring of VS & O2 sat, mechanical ventilation, IV therapy, CPR, rehabilitation, catheterization ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 7.Hypothermia -body temp. lower than 36.6ºC Cause: low temp in the OR, infusion of cold flds, open body wounds, advanced age, meds Management: OR temp is set at 25-26.6ºC, warm solution to be used, use thermal blanket & minimize body exposure ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph COMPLICATIONS OF ANESTHESIA 7.Malignant Hyperthermia -rare inherited muscle disorder that is chemically induced by anesthetic agents Cause: triggered by inhalation of anesthetic agents and muscle relaxants Management: Goal: decrease metabolism, reverse metabolic and respiratory acidosis, dec. temp, provide 02, use of dantrolene ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph TYPES OF SURGICAL INCISION 1. Butterfly – for craniotomy 2. Limbal – for eye surgeries 3. Halsted/Elliptical – for breast surgeries 4. Abdominal – for abdominal surgeries 5. McBurney’s – for appendectomy 6. Lumbotomy/Transverse – for kidney surgeries. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph TYPES OF SURGICAL INCISION ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph TYPES OF SURGICAL INCISION 7. Subcostal – GB, biliary tract surgery 8. Paramedian Right side – biliary tract, GB Left side – splenectomy, gastrectomy 9. Midline (lower) – female reproductive tract 10. Pfannenstiel – gynecologic surgery. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph TYPES OF SURGICAL INCISION ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery Remember: - explain the purpose - avoid undue pressure on body parts - strap to prevent falls - maintain adequate respiratory & circulatory function, and ensure good body alignment. ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery 1. Supine (Back- lying position) -recommended for mastectomy, herniorrhaphy, abdominal surgeries ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery 2. Lithotomy -supine with legs flexed and supported on stirrups (e.g., D&C, perineal/vaginal repair) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery 3. Trendelenburg -head positioned downward -abdominal & gynecological surgery ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery 4. Reverse Trendelenburg -head positioned upward -abdominal & gynecological surgery ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Positioning the Client for Surgery 5. Modified Fowler’s/Sitting Position -may lead to hypotension 6. Lateral/Side Lying -kidney and thoracic surgery 7. Prone -respiration is restricted 8. Jackknife (Kraske Position) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph Sitting Jacknife (Kraske Position) ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph  Intraoperative Phase OR Induction of Anesthesia Surgical Procedure PACU/RR ST. Aadapted L EfromXProf. IU S Clecture EC Cajandig's O Lmaterial LEGE www.stalexiuscollege.edu.ph THANK YOU ART VALENTE DOMINGO [email protected] 0910 911 **** ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph