Perioperative Nursing PDF

Perioperative Nursing z z  Introduction z § In modern society, surgery has become a common method of treating disease and promoting health. In the last few decades, the complexities of surgery have increased greatly, and entire organ systems can be transplante...

Perioperative Nursing z z  Introduction z § In modern society, surgery has become a common method of treating disease and promoting health. In the last few decades, the complexities of surgery have increased greatly, and entire organ systems can be transplanted to replace nonfunctioning body parts. All surgical procedures can potentially affect a person’s functional abilities. The impact can be great and permanent or brief and temporary. The goal of perioperative nursing practice is to assist clients and their families and significant others to achieve a level of wellness equal to or greater than that which they had before the procedure.  z § Therefore, client care during the perioperative phase demands knowledge of and skill in perioperative care and also requires an in- depth understanding of related disease processes that have brought the client to seek treatment. § To provide quality care, perioperative nursing incorporates application of the nursing process and allows for multiple nursing roles.  Learning Outcomes z § At the end of this Discussion, the learner should be able to: 1. Discuss the different conditions requiring surgical interventions. 2. Classify surgical procedures according to purpose, degree of risk, urgency. 3. Design plan of care for a client during the preoperative, intraoperative and postoperative period. 4. Appreciate the knowledge, skills and attitudes necessary for providing quality of care of clients undergoing surgery  The Perioperative Period z § Perioperative period is divided into three phases, namely, preoperative period, intraoperative period and post operative period.  z § The Preoperative phase extends from the time the client is admitted to surgical unit, to the time he/she is prepared physically, psychosocially, spiritually and legally for the surgical procedure, until he/she is transported into the operating room The Intraoperative phase extends from the time the client is admitted to the operating room, to the time of administration of anesthesia, surgical procedure is done, until he/she is transported to the recovery room (RR) / postanesthesia care unit (PACU)  z § The POSTOPERATIVE PHASE extends from the time the client is admitted to the recovery room, to the time he is transported back into the surgical unit, discharged from the hospital, until the follow-up care.  z The Four Types of Conditions Requiring Surgery OPET O - Obstruction. Impairment to the flow of vital fluids, E.g. blood, urine, bile, cerebrospinal fluid (CSF) P - Perforation. Rupture of an organ, e.g., ruptured appendicitis, ruptured uterus E – Erosion. Wearing off of a surface or membrane, e.g. peptic ulcer. T – Tumors. Abnormal new growths, e.g., breast tumor, bone tumor, lung tumor, brain tumor  z Classification of Surgical Procedures § 1. Diagnostic. To confirm the presence of a disease condition, e.g. biopsy. 2. Exploratory. To determine the extent of the disease condition, e.g., exploratory laparotomy (exploration of the abdominal cavity and abdominal organs). 3. Curative. To treat the disease condition. The different types of curative surgeries are as follows: z § 3.1. Ablative. Involves removal of an organ. Suffix used is “ectomy.” Appendectomy- removal of the appendix z Hysterectomy -removal of the uterus Oophorectomy- removal of the ovary. Mastectomy- removal of the breast. Pneumonectomy- removal of a lung. Tonsillectomy- removal of tonsils. Cholecystectomy- removal of the gall bladder. § 3.2 Constructive. Involves repair of congenitally defective organ. Suffixes used are “plasty,” “orrhaphy,” “pexy.” E.g. § Cheiloplasty- repair of cleft lip. Uranoplasty- repair of cleft palate. Herniorrhaphy- repair of hernia. Orchidopexy- repair of undescended testes. § 3.3 Reconstructive. Involves repair of damaged organ. E.g. plastic surgery after severe burns, scar revision.  z § 4. Palliative. To relieve distressing signs and symptoms, not necessarily to cure the disease. E.g., colostomy, debridement of necrotic tissues, resection of nerve roots.  z According to Degree of RISK/ MAGNITUDE/ EXTENT § 1. Major Surgery. E.g., craniotomy; open heart surgery; pneumonectomy; total abdominal hysterectomy with bilateral salphingo-oophorectomy (TAH-BSO) The criteria for major surgery are as follows: - Involves high risk of morbidity or mortality - It is extensive and prolonged. Involves a considerable period of time - It may involve large amount of blood loss. -Vital organs are manipulated or removed - Involves great risk of occurrence of complications. § 2. Minor Surgery. E.g., appendectomy, tonsillectomy, blepharoplasty (repair of eyelids) - Generally, the procedure is not prolonged. - Involves lesser risk. - Does not usually involve serious complications  z According to URGENCY § 1. Emergency. The surgery should be done immediately to save the client’s life or limb. E.g., emergency hysterectomy due to rupture uterus; emergency amputation of a limb due to crushing injury emergency appendectomy due to acute appendicitis § 2. Imperative. The procedure should be done 24 to 48 hours E.g., profusely bleeding peptic ulcer, evacuation of blood clots from the brain 3. Planned Required. The procedure is necessary for the well- being of the client. However, it may be scheduled weeks or months E.g., tonsillectomy, thyroidectomy, cataract extraction. § 4. Elective. The procedure is not absolutely necessary for survival. Delay of omission will not cause adverse effect. E.g., removal of simple, non-toxic goiter. 5. Optional. The procedure is requested by the client. It is usually for aesthetic purposes. E.g., rhinoplasty (repair of the nose); blepharoplasty (repair of the eyelids)  z Thank you !