Perioperative Nursing Management - Part II PDF

Intra and Post Operative Nursing Management Dr. Salwa Attia  Intraoperative Phase Begins when the patient is transferred on to the operating room table and ends when he or she is admitted to the post- anesthesia care unit (PACU) (the recovery area).  Goals of nursing care...

Intra and Post Operative Nursing Management Dr. Salwa Attia  Intraoperative Phase Begins when the patient is transferred on to the operating room table and ends when he or she is admitted to the post- anesthesia care unit (PACU) (the recovery area).  Goals of nursing care during intraoperative phase: 1.To ensure client safety. 2.Promote the principle of asepsis. 3.Homeostasis: Homeostasis is the dynamic process in which the body maintains balance by constantly adjusting to internal and external stimuli 4.Safe administration of anesthesia  Members of the Surgical Team Patient Circulating nurse Scrub role Surgeon Registered nurse first assistant Anesthesiologist, anesthetist  Basic Guidelines for Surgical Asepsis All material within sterile field must be sterile Gowns sterile in front from chest to level of sterile field, sleeves from 2 inches above elbow to cuff Only top of draped tables considered sterile Movements of surgical team are from sterile to sterile, from unsterile to unsterile only  The Surgical Team Surgeon has the most important role in this phase, there are key members of the surgical team, he is dependent upon other members of the team for the patient’s emotional well being and physiologic monitoring  Anesthesiologist or anesthetist : Provides smooth induction of the patient’s anesthesia in order to prevent pain. This member is also responsible for maintaining satisfactory degrees of relaxation of the patient for the duration of the surgical procedure Anesthesiologist is responsible for assessing pulmonary status, Inquiring about preexisting pulmonary infections. Knowing the patient’s history of smoking. Scrub Nurse or Assistant – a nurse or surgical technician who prepares the surgical set-up, maintains surgical asepsis while draping and handling instruments, and assists the surgeon by passing instruments, sutures, and supplies. Circulating Nurse – respond to request from the surgeon, anesthesiologist or anesthetist, obtain supplies, deliver supplies to the sterile field, and carry out the nursing care plan. Nursing Functions Circulating Nurse 1. Assures cleanliness in the OR. 2.Guarantees the proper room temperature, humidity and lighting in OR. 3. Make certain that equipment's are safely functioning. 4.Ensure that supplies and materials are available for use during surgical procedures. 5.Monitors aseptic technique while coordinating the movement of related personnel. 6. Monitors the patient throughout the operative procedure to ensure the person’s safety and well being. The responsibilities of the scrub nurse are: 1. Performs surgical hand scrub. 2. Dons sterile gown and gloves aseptically. 3. Arranges sterile supplies and instruments in manner prescribed for procedure. 4. Checks instruments for proper functioning. 5. Counts sponges, needles, and instruments with circulating nurse.  Assists with surgical draping of client. Maintains sterile field. Recognizes and corrects breaks in aseptic technique. Hands surgeon instruments, sponges, and necessary supplies during procedure" Identifies and handles surgical specimens correctly. Watches sponges, needles, and instruments so none will be misplaced or lost in wound. Anesthesia: Anesthesia controls pain during surgery or other medical procedures, to keep you comfortable. It can also help control breathing, blood pressure, blood flow, and heart rate and rhythm, when needed. Anesthetics are divided into two classes: 1.Whole body – General anesthesia 2.Those that suspend sensation in certain parts of the body – local, regional, epidural or spinal anesthesia  Question The nurse should know that, postoperatively, a general anesthetic is primarily eliminated by: A. Kidneys B. Liver C. Lungs D. Skin The nurse is caring for a client before surgery who has a question about the preoperative medication. Which of the following people will the nurse communicate this information to? A) Scrub nurse B) Anaesthesiologist C) Circulating nurse D) Registered nurse first assistant (RNFA) Potential Intraoperative complication: Nausea and vomiting Anaphylaxis Hypoxia and other respiratory complication Hypothermia: to prevent Apply warm blankets & continue oxygen as prescribed  Nursing Management in the PACU Provide care for patient until patient has recovered from effects of anesthesia Patient has resumption of motor and sensory function, is oriented, has stable VS, shows no evidence of hemorrhage or other complications of surgery.  Postoperative phase The postoperative phase of the surgical experience extends from the time the client is transferred to the recovery room or postanesthesia care unit (PACU) to the moment he or she is transported back to the surgical unit, discharged from the hospital until the follow-up care.  Goals 1.Maintaining adequate body system functions. 2.Restoring body homeostasis. 3.Pain and discomfort alleviation. 4.Preventing postoperative complications. 5.Promoting adequate discharge planning and health teaching.  Responsibilities of the PACU Nurse Review pertinent information, baseline assessment upon admission to unit Assess airway, respirations, cardiovascular function, surgical site, function of CNS, IVs, all tubes and equipment Reassess VS, patient status every 15 minutes or more frequently as needed Transfer report, to another unit or discharge patient to home  Criteria for discharge of patients from the recovery room: ▪ Vital signs are stable and indicate normal respiratory and circulatory function. ▪ Patient is awake or easily aroused and can call for assistance. ▪ Postsurgical complications have been thoroughly evaluated and under control. ▪ After regional anesthesia, motor and partial sensory functions have returned to all anesthetized areas. Indicators of Hypovolemic Shock Pallor Cool, moist skin Rapid respirations Cyanosis Rapid, weak, thready pulse Decreasing pulse pressure Low blood pressure Concentrated urine  Types of Surgical Drains Figure 19-5  Purpose of Postoperative Dressings Provide healing environment Absorb drainage Splint or immobilize Protect Promote patient’s physical, mental comfort Change the Postoperative Dressing First dressing changed by surgeon Types of dressing materials Sterile technique Assess wound Applying dressing, taping methods Patient response Patient teaching Documentation  Most surgical patients are encouraged to be out of bed as soon as it is indicated. Post Operative Complications: Respiratory- atelectasis, Pulm. Embolus, aspiration, pneumonia Cardiovascular- Hypovolemic shock, deep vein thrombosis Gastrointestinal- N/V, Abd. Distention, paralytic ileus(Absence of peristalsis.) Urinary system - urinary retention Hemorrhage/bleeding Wound infection