N5400 Week 3 Perioperative Nursing Care PDF

N5400: WEEK 3 PERIOPERATIVE NURSING CARE Chapter 30 in Fundamentals Text (9th edition) Learning Objectives After today’s lecture you will be able to: Describe the surgical experience - Perioperative phases, classifications of surgery, types of anesthesia, informed consent and...

N5400: WEEK 3 PERIOPERATIVE NURSING CARE Chapter 30 in Fundamentals Text (9th edition) Learning Objectives After today’s lecture you will be able to: Describe the surgical experience - Perioperative phases, classifications of surgery, types of anesthesia, informed consent and advance directives, and outpatient/same-day surgery. Conduct a preoperative nursing history and physical assessment to identify patient strengths as well as factors that increase risks for surgical and postoperative complications. Identify assessments and interventions specific to the prevention of complications in the immediate and early postoperative phases. Use the nursing process to develop an individualized care plan for the surgical patient during each phase of the perioperative period. 2 Perioperative Phases Preoperative Intraoperative Postoperative 3  Drag picture to placeholder or click icon to add Classification of Surgical Procedures 4 Types of Anesthesia I. General II. Moderate Sedation/Analgesia III. Regional I. Nerve Blocks II. Spinal Anesthesia III. Epidural Anesthesia IV. Topical & Local 5 Informed Consent & Advanced Directives Informed Consent Legal document Protects patient, provider, facility Nurse witnesses signature Advanced Directives Legal document Living Will Durable Power of Attorney 6  Drag picture to placeholder or click icon to add Nursing Strategies in the Older Periop Patient 7 NURSING PROCESS: PREOPERATIVE CARE Nursing Process: Preop Care Pre-op assessment includes: - The health history and physical assessment - Identifying risk factors and allergies that could cause adverse events - Identifying medications and treatments the patient is currently receiving - Determining the teaching and psychosocial needs of the patient and their support system - Determining postsurgical support and referral needs for recovery Usual presurgical screening tests: - Chest x-ray - Electrocardiography (ECG) - Complete blood cell count (CBC) - Electrolyte levels - Urinalysis 9 Preop Considerations for Outpatient Surgery 10 Preop Health History Developmental level Medical and surgical history (*allergies) Medication history (Rx and OTC) Nutritional status Use of alcohol, illicit drugs, or nicotine Activities of daily living and occupation Coping patterns and support systems Sociocultural needs 11 Surgical Risks of Rx Medications Anticoagulants: precipitate hemorrhage Diuretics: electrolyte imbalances, respiratory depression from anesthesia Tranquilizers: increase hypotensive effects of anesthetic agents Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse Antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants 12 Surgical Risks of OTC or Herbal Medications Aspirin & Gingko bleeding Echinacea & Kava liver damage Garlic supplements lower BP Ginseng raise BP, rapid HR Ephedra raise BP, abnormal heart rhythms St. John’s Wort harder to recover from effects of anesthesia Valerian harder to wake after anesthesia, abnormal heart rhythms 13 Focused Preoperative Physical Assessment 14 Preop: Nursing Diagnoses 15 Preop: Outcome Identification and Planning Verbalizes physical and emotional readiness for surgery Demonstrates and verbalizes understanding of coughing, turning, deep-breathing, use of incentive spirometry, leg exercises, and early ambulation (videos 7-2  7-7) Verbalizes expectations of postoperative pain management Maintains fluid intake and nutritional balance to meet healing needs 16 Preop: Implementation & Evaluation 17 NURSING PROCESS: INTRAOPERATIVE CARE Intraop: Assessment Patient identification/verification process Name, DOB, consents, preop checklist information Final verification just prior to beginning the procedure, time-out Team agree on ID of patient, correct surgical site (marked by surgeon), and the procedure to be performed Patient anesthetized, positioned, prepped, and draped Nurse continually assesses patient during procedure and monitors supplies used to maintain safety 19 Introp: Nursing Diagnoses 20 Intraop: Outcome Identification and Planning Remain free of neuromuscular injury Remain free from wrong-site, wrong-side, wrong-patient surgical procedure Maintain fluid and electrolyte balance Maintain skin integrity (other than for the incision) Have symmetric breathing patterns Be free of injury from burns, retained surgical items (inaccurate count of sharps, instruments, and soft goods such as surgical sponges used during the procedure), and medication errors Remain free from surgical site infection Maintain normothermia 21 Introp: Implementation & Evaluation Positioning Draping Documenting Patient assessment, item counts, vital signs, urine output, blood loss, pulse oximetry, body temp, positioning, medications, dressings and drains, specimens, equipment used, and responses to care Transferring to the PACU Handoff: patients care, procedure, tourniquet time, drains, medications used, presenting condition, patient response Evaluation 22 NURSING PROCESS: POSTOPERATIVE CARE Immediate Postop Assessment & Care (Q 10-15 min) Respiratory Status RR, rhythm, depth, breath sounds, SPO 2, CO2 skin color, return of gag reflex, airway patency Cardiovascular Status ECG/HR and rhythm, skin color, BP, peripheral pulses bilaterally, hypothermia, shivering Central Nervous System Status Level of alertness (unconscious responds to touch/sounds drowsiness awake/not oriented awake/oriented), movement Spinal anesthesia neuro checks every 15 minutes x 1 hour Fluid Status Skin turgor, v/s, urine output, wound drainage, IV fluid intake, blood products Wound Status Dressing over incision: amount, consistency, color of drainage, any tubes or drains and amount and type of drainage Gastrointestinal status Nausea and vomiting Pain Assessment General Condition 24 Ongoing Postop Assessment & Care 25 Postop: Nursing Diagnoses 26 Postop: Outcome Identification and Planning Carry out leg (including foot and ankle) exercises every 2 to 4 hours Deep breathe and cough effectively every 2 hours Engage in early ambulation Verbalize decreasing levels of pain Regain and maintain a balanced intake and output Regain normal bowel and bladder elimination Exhibit a healing surgical incision Remain free of infection Verbalize any concerns about appearance of wound Verbalize and demonstrate wound self-care 27 Postop: Implementation and Evaluation 1 of 2 Preventing cardiovascular complications Hemorrhage, shock, thrombophlebitis/venous thromboembolism Preventing respiratory complications Pulmonary embolism, atelectasis, pneumonia 28 Postop: Implementation and Evaluation 2 of 2 Preventing surgical site complications Promote a return to health Elimination needs, fluids/nutrition needs, comfort/rest needs Helping the patient cope Providing outpatient surgery postoperative care Evaluation 29 End of PowerPoint 30