Perioperative nursing PPT.pdf

PERIOPERATIVE NURSING  DEFINATIONS OF TERMS: AEROBE- microorganism that grows with oxygen. Anaerobe- microorganism that grows in the complete absence of oxygen. Antibiotic- medication used treat infection. Antisepsis – prevention of growth of microorganis...

PERIOPERATIVE NURSING  DEFINATIONS OF TERMS: AEROBE- microorganism that grows with oxygen. Anaerobe- microorganism that grows in the complete absence of oxygen. Antibiotic- medication used treat infection. Antisepsis – prevention of growth of microorganism to prevent infection Antiseptic- a substance that tends to inhibit the growth of microorganism. Asepsis-absence of microorganism Sepsis- presence of microorganism Contaminated- anything that is infected by microorganism (e.g soiled materials)  Cross contamination- transfer of microorganism to patient to patient Cross infected- transfer of microorganism from inanimate object to patient Bacteriostatic – retired with growth bacteria Disease – a specific illness a set of sign and symptoms Disinfection- process of destroying pathogenic organisms Disinfectant -agent that can be applied to object to destroy microorganism Microorganism- microscopic entity capable of carrying on living process Opportunists- bacteria that doesn’t normally invade the Septicemia- presence of infection in the blood Spore- a reproductive element, produced sexually or asexually, of one of the lower organisms, such as protozoa, fungi, algae, etc.  Sterile filed- area the site of infection into the tissue on an area prepared for. Sterile technique- process or method which contamination with microorganism is prevented to maintain the sterility through the procedure. STERILIZATION- process by which all organism pathogenic and nonpathogenic in the spores are killed. Terminal Disinfection- procedure applied for the destruction of pathogenic microorganism at the end of operative procedure. Droplet- particles as expelled by means of talking, sneezing coughing that carried out microorganism. Infection- invasion of microorganism in the body  SUFFIXES RELATED TO OPERATING ROOM NURSING Centesis- puncture to aspirate Desis – fusion Ectomy- surgical excision/ removal Otomy- cutting into organ or tissue Lysis- freezing of Rrhaphy- repair of Oscopy- examination of an organ by viewing Ostomy -creation of an artificial or new opening Pexy to fix suture in place Plasty- restoration of the lost part  ROOT WORD RELATED TO OPERATING ROOM NURSING Adeno- gland Blepharo- eyelids Chole-gall Cholfcyst- gallbladder Cardio-heart Col-colon colpo-organ Cranio- brain Cysto- urinary bladder Dest- teeth Derma- skin  Myo- muscle Nephro-kidney Neuro-nerve Oophor – ovary Opthalm- eye Choledo- common bile duct orchio – testicle Os- bone Ortho- joints Ot – ear Phleb – vein Procto – anus Pyelo- pelvis of kidney Rhino- nose  HISTORY/FRAMEWORK OF PERIOPERATIVE NURSING 1894 Dr. Hunter Robb O Introduce the team concept. O Provide patient care O Senior nurse must act as scrub nurse/sterile Nurse O Student nurse must act as the circulating nurse. 1910 O American Nurses Association declared that senior nurse must act as circulating nurse and up to now ongoing. 1919 O National league for nursing education committee added the operating concept in the nursing curriculum.  1940-1945 O The year declaration of acute shortage of nurses O Start of world war 2 O Surgical technicians armies served as nurse due to shortage of nurses January 1949 O Association of Operating Room Nurse was born O Edith first president in the AORN 1978 O Association of Operating Room Nurse was born in the Philippines Florence Nightingale O First nursing leader to use statistics due to generate pictures of measures that will improved 2st operative outcome.  Melchora Aquino O Founder of military nursing in the Philippines. Dr. Joseph Bell O Create a specialize training for the operating room nurses. Hippocrates O Father of surgery O Use alcohol to disinfect and numb the wound William Mortem O The one who discover the anesthesia. Neuber O First who use the cap, mask and gown  Ignaz Semmelweiss O First use the role of nurses in the 3 phases O Preoperative O Post-operative O Intra operative Bloodgood O The one who first use the sterile gloves. South Africa O First successful heart surgery India O First successful cosmetic surgery USA O First who conduct the bone marrow transplant  OPERATING ROOM Also called surgery center, the unit of the hospital where surgery procedure is performed. Purpose An operating room may be designed and equipped to provide care to patients with a range of conditions or it may be designed and equipped to provide specialized care to the patients. Surgical Conscience “DO NOT DO UNTO OTHERS WHAT YOU DO NOT LIKE OTHERS DO UNTO YOU”  PERIOPERATIVE PERIOD 1. PREOPERATIVE PHASE Starts when an informed consent for surgery has given until the time patients is place in the surgical table. 2. INTRAOPERATIVE PHASE Starts from the patients being place on the surgical table until patient recovery room. 3. POSTOPERATIVE PHASE Begins when the clients is admitted in the ward and extend through follow up or clinic evaluation.  CONDITIONS REQUIRING SURGICAL INTERVENTIONS 1. EROSION Condition where surface of a tissue are worn or eaten away Wearing off blood vessel wall, when it happen the individuals is prone to bleeding, anemia like to set in. 2. OBSTRUCTION Condition where arteries and tubes are clogged or blocked. Passageway of vital substances like blood, oxygen, spinal fluid and urine are obstructed. 3. PERFORATION Rupture or break in the walls of organ. 4. TUMORS Abnormal growth of tissue.  2 DEGREE OF RISK/MAGNITUDE OR EXTENT/ OR TYPE OF OPERATIONS 1. MAJOR SURGERY H- HIGH RISK E- EXTENSIVE L- LARGE AMOUNT OF BLOOD VESSELS P- PROLONGED V- VITAL ORGANS ARE REMOVED G- GREAT RISK OF COMPLICATION 2. MINOR SURGERY G- GENERALLY NOT PROLONGED L- LEADS TO FEW SERIOUS RISK  CATEGORIES/CLASSIFICATION OF SURGICAL PROCEDURES 1. DIAGNOSTIC O Establish/determine presence of disease condition. O Determining an answer to a suspicion. 2. BIOPSY O Removal of certain amount with tissue for the pathologist to examine microscopically to determine its nature. O NEEDLE BIOPSY -Removal of specimen by aspirating with the used of needle or trocar. O INCISION BIOPSY -Removal of only part of a lesion by cutting it. O EXCISION BIOPSY -Removal of entire lesion 3.EXPLORATORY O Done for the purpose of estimating the extent of disease or injury and for confirmation. 4. CURATIVE O To treat the disease condition. 5.ABLATIVE O Removal of damaged organ. 6.RECONSTRUCTIVE O Partial or complete repair of damaged organ and restoration to normal appearance and function. 7.CONSTRUCTIVE O Repair the body organ which has been defective from birth to improve function and appearance. E.g cheiloplasty 8.PALLIATIVE O Done to relieve distressing sign and symptoms but not necessarily to cure the disease.  2 TYPES OF THE SURGICAL TEAM Sterile team Surgeon First Assist Second Assist Scrub nurse Others (Student Nurse, Surgical Intern, Nurse Trainee) Non-Sterile Team Anesthesia provider Circulating Nurse Nurse Anesthetist Others (nursing auxiliary, biomedical technician, laboratory, xray personnel)  FUNCTION OF THE SURGICAL TEAM THE STERILE TEAM SURGEON O Heads of the surgical team and is regarded at the “ CAPTAIN OF THE SHIP” O Makes the perioperative diagnosed based on the observed clinical manifestations: selects and performs the surgical procedure to cure or alleviate a disease and provides perioperative, intraoperative and post-operative care to the client. O Assumes full responsibility for all acts of medical judgment and for the management. O Determines the appropriate surgical position in the consultation with aesthesia provider.  FIRST ASSISTANT O Performs skin preparation O Places the client on the position decide by the surgeon O Help maintain visibility of the surgical site, control bleeding, close wounds and apply dressing. O Handle tissues O Documents the operating techniques used.  SCRUB NURSE BEFORE OPERATION With the help of the circulating nurse, identifies the client by taking his or her first, middle and last name and date of birth. However, the nurse can also ask the following:  Name of the surgeon  Contemplated operation  Signed consent  Compliance to NPO  Removal of any prosthesis, jewelry, nail polish and lipstick  Check for the following documents that are necessary for the surgery, blood transfusion forms and diagnostic result.  SCRUB NURSE O Validates with the surgeon his/her preference of sutures and surgical instrument and supplies. O Prepares protective attire such as eye gear or apron. O Accounts for all sponges, sharps and instrument before and after the procedure. O Check and label drugs and syringes that will be used in the operation.  SCRUB NURSE DURING THE PROCEDURE O Prepares and arranges sterile instruments and supplies needed during the surgery. O Establishes and maintain the integrity, safety and efficiency of the sterile field throughout the procedure. O Anticipates, plans for the responds to the needs of the member. O Informs the surgeon of the drug used during the surgery. O If the 23 scrub nurses necessary, one may prepare the supplies that will be used during the operation while the others passes the instrument.  SCRUB NURSE AFTER THE OPERATION O Accounts for all sponges, needles and instrument after surgery. O Cleans the patient by removing unnecessary prep, solution adhesive tapes, and blood. O Assist in the transfer of the client from the OR bed top the stretcher or hospital bed using an assistive device. O Assist in the after care of the room O Ensures that all specimens removed from the clients are properly labelled.  NON-STERILE TEAM ANESTHESIOLOGIST O Induces and maintain anesthesia at the required level O Manages untoward physiologic reactions of the client throughout the procedure. O Oversees the care of the client in the PACU until the client gain control. O Participates in the hospital cardiopulmonary resuscitation program as the supervisor. O Act as consultant or manager for problem of acute chronic respiratory insufficiency, therapy as well as the variety of nother fluid and electrolyte and metabolic disturbances. O Documents the induction of anesthesia and response of the client  CIRCULATING NURSE BEFORE OPERATION O With the help of the scrub nurse, identifies the client by taking his or her first, middle and last name and date of birth. However, the nurse can also ask the following:  Name of the surgeon  Contemplated operation  Signed consent  Compliance to NPO  Removal of any prosthesis, jewelry, nail polish and lipstick  Check for the following documents that are necessary for the surgery, blood transfusion forms and diagnostic result.  CIRCULATING NURSE O Accompanies the client when he/she transfer in the OR table. O Identifies and reports any potential danger in the environment or stressful situation. O Keep personal items of the client, such as religious article, hearing aid, eyeglasses, dentures, jewelry and the like if the client alone. Otherwise, endorses these items to the relatives. O With the scrub nurse sets up the operating room and positions the equipment appropriately.  Ensures that the or table is draped and lifting linen or board, arm board covers safety straps head cover and leggings for the clients are available for.  Ensures that OR lights and negatoscope are functioning.  CIRCULATING NURSE O Records all sponges, sharps and instrument O Ensures the safety and comfort of the client on the way to and from OR:  Checks for the effectiveness and safety of the equipment.  Ensures that OR table is locked  Applies necessary straps restrains on the client and places him/her in a comfortable position.  Provides roll or pads necessary to avoid pressure on the client  Checks if the stretcher to be used is functioning well. O Assists the anesthesiologist in inducting anesthesia.  CIRCULATING NURSE Helps the first assistant or nursing assistant in placing the client in the desired position. Prepares equipment needed for the skin preparation. Directs all activities of all learners Applies electrosurgical pas as needed.  CIRCULATING NURSE DURING THE PROCEDURE O Provides promptly any supply and instrument O Provides assistance. O Acts as communication link between events, and between team members in the sterile field. O Directs or supervises the scrub nurse. O Request for blood. O Ensures that everyone complies with. O Ensures patient safety.  CIRCULATING NURSE AFTER THE OPERATION Determines the outcome of the final counts as correct or incorrect. Writes an incident report on. Records ant medication the surgeon used in the surgical site. Makes the pathology request and conduct proper documentation and labelling of the specimen. Gives health teaching to the client relatives. Assists in transferring the patients from the OR table. In some institutions monitors the health situation of the client in the recovery room Helps in the after care in OR.  BIOMEDICAL TECHNICIANS Checks for safety and standards compliance regarding the instruments and equipment’s to be used during surgery. Set ups and operates facility owned equipment to be used.  NURSING AUXILIARIES Assists the client in getting into and out of the OR. Run errands for OR Assists in the positioning the OR light properly.  ANESTHESIA Is a state or narcosis (severe central nervous system depression produced by pharmacological agents,) analgesia, relaxation, and reflexes loss. There is loss of ability to maintain ventilator function, like wise cardiovascular function maybe impaired Cause of depression  TYPES OF ANESTHESIA General anesthesia Balanced anesthesia Local or regional block anesthesia Spinal or epidural anesthesia  GENERAL ANESTHESIA Action When the anesthetic takes the form of an inhalant or introduced through iv push, it breaks the association of pathways in the cerebral cortex it will lead more or less of lack sensory perception and motor function Different levels of unconsciousness ❑ Induction stage ❑ Excitement stage ❑ Operative stage ❑ Danger stage  TECHNIQUES IN ADMINISTRATING ANESTHESIA Inhalation- mask inhalation endotracheal TIVA (Total intravenous administration) nsg intervention give local anesthesia and slow IV push.  COMPLICATION OF G.A Aspiration- due to depression of pharyngeal and laryngeal reflex Massester muscle rigidity (MMR) LOCKJAW Malignant hyperthermia – resulting from calcium levels in muscle cells and muscle metabolism serum calcium and serum metabolism is lead metabolic and acidosis problem. Hypoxia - bought by excitement coughing holding of breath vomiting and laryngospasm death. Cardiac dysrhythmias- cause of excessive of suctioning through the endotracheal tubing.  BALANCED ANESTHESIA Neuroleptic analgesia is a state of intense analgesia and amnesia achieved by administering a combination of narcotic and neuroleptic drugs. Methods of administration Balanced anesthesia is accomplished by combine iv admin and inhalation of drugs Adverse effect balanced ❑ It may produce a detached apathetic stage/ state ❑ It may affect the behavior and attitude of the client postoperatively to client manifest anger irritably preoccupation lead to dead  LOCAL AND REGIONAL ANESTHESIA Topical application- the anesthetic is applied directly to the skin. Onset within a minute. Local infiltration- the drugs is injected intracutaneously and subcutaneously into the tissues and around the incisional site and black sensory nerve stimuli after origin.  Regional anesthesia ❑ Loss of sensation in particular body part is produced by inhibiting the transmission of sensory nerve impulses to the area/ specific nerve Nerve block ❑ Is the injection of an anesthetic drug into and around a nerve group of nerves in the involved area.  SPINAL AND EPIDURAL ANESTHESIA ❑ This type of regional anesthesia where the drug is delivered to selected area referred to as dermatomes to prevent motor and sensory sensation. Spinal and epidural anesthesia is injected between the l3 and l4 levels Spinal anesthesia - (or intrathecal block) prevents the transmission of impulses at the spinal ganglia and motor roots Epidural anesthesia- involves injection into the epidural space which lies between the Dura meter the outermost sheath covering the spinal cord and the walls of the vertebral column.  COMPLICATIONS OF SPINAL AND EPIDURAL ANESTHESIA Transient or permanent neurologic complication from 4 th trauma and loss of spinal fluid with intracranial pressure syndrome Ruptured nucleus pulposus True spinal headache causes by persistent CSF leak through the needle hole in the dura. Respiratory paralysis medullary hyperfusion causes by sympathetic block Hypotension brought by circulatory depressant effect and stasis of blood SURGICAL NEEDLES  THE COMMON CAUSES OF FEARS OF THE PREOPERATIVE CLIENT ARE AS FOLLOWS: Fear of the unknown. Fear of anesthesia Fear of pain Fear of death Fear of disturbance of body image Fear and worries from loss of finances  THE NURSE SHOULD ASSESS THE PATIENT FOR MANIFESTATIONS OF FEARS THAT INCLUDE THE FOLLOWING: Anxiousness Bewilderment Anger Tendency to exaggerate Sadness, evasiveness, tearfulness, and clinging behavior Inability to concentrate Short attention span. Failure to carry out simple directions  THE LEGAL ASPECTS OF SURGICAL INTERVENTIONS: WRITTEN INFORMED CONSENT (OPERATIVE PERMIT, SURGICAL PERMIT) The purposes of the written informed consent are as follows: 1. To ensure that the client understands the nature of the treatment including the potential complications and disfigurement. These are explained by the surgeon. 2. To indicate that the client's decision was made without pressure. 3. To protect the client against unauthorized procedure 4. To protect the surgeon and the hospital against legal action by a client who claims that an unauthorized procedure was performed.  THE CIRCUMSTANCES REQUIRING WRITTEN INFORMED CONSENT ARE AS FOLLOWS: 1. Any surgical procedure where scalpel, scissors, suture, hemostats or electrocoagulation may be used. 2. Any invasive procedure, or procedure that involves entry into a body cavity. Eg paracentesis, bronchoscopy, cystoscopy. Colonoscopy, proctosigmoidoscopy. 3. Any procedure that involves general anesthesia, local infiltration anesthesia or regional block anesthesia.  THE REQUISITES FOR VALIDITY OF WRITTEN INFORMED CONSENT ARE AS FOLLOWS: 1. Written permit/ consent is best and is legally acceptable. 2. The physician is responsible for obtaining patient's consent. 3. Patient's signature is obtained with the client's complete understanding of what is to occur, what is the treatment to be done and possible consequences, alternative treatments and possible consequences, risks and benefits of each treatment options. Adults sign their own consent unless he/she is physically and mentally incapacitated. If the patient is a child or minor (below 18 years old). the parent or legal guardian will sign the consent. 4. Consent is obtained before sedation. 5. The patient is not under the influence of drugs or alcohol. 6. The consent is secured without pressure or duress. 7. Signature of witness is required. The nurse, physician or other authorized persons may sign as witness. 8. In an emergency situation, to preserve life or to prevent serious impairment to life and the individual patient is in capable of giving consent, the next of kin may give consent. If reaching the next of kin is not possible, the physician may institute treatment without written consent from the patient or relative. Two physicians sign the consent and document the medical necessity of the procedure. 9. Emancipated minors are allowed to sign written consent. Emancipated minors are those who are married, those who live on their own or financially independent from their parents. 10. The patient is aware that consent, even when signed can be withdrawn at any time.  THE PHYSICAL PREPARATION OF THE PATIENT BEFORE SURGERY INCLUDE THE FOLLOWING: 1. Correcting any dietary deficiencies. 2. Reducing an obese person's weight, as time permits. 3. Correcting fluid and electrolyte imbalances. 4. Restoring adequate blood volume with blood transfusion. 5. Treating chronic diseases - DM, heart disease, renal insufficiency, bleeding disorders. 6. Treating any infectious process. 7. Treating an alcoholic person with vitamin supplementation, IV fluids or oral fluids, if dehydrated.  PRE-OPERATIVE TEACHING Patient has the right to know what to expect and how to participate effectively during the surgical experience. Preoperative teaching increases patient satisfaction and may reduce postoperative fear, anxiety and stress. Teaching may also decrease complications, the duration of hospitalization and the recovery time following discharge. In some surgical settings, patients arrive only a short time before scheduled surgery like in ambulatory surgery and patients who will be hospitalized postoperatively Preoperative teaching is generally done in the surgeon's office or preadmission surgical clinic and reinforced on the day of surgery.  In some situations, the patient had been admitted several days before surgery for treatment of certain disease conditions. The best time to do preoperative teaching in this situation is in the afternoon or evening before the scheduled surgery Generally, preoperative teaching includes three types of information sensory, process and procedural.  SENSORY INFORMATION Holding area may be noisy, Drugs and cleaning solutions may be smelled. Operating room (OR) can be cold, warm blankets are available Talking may be heard in the OR but may be distorted because of masks. Questions should be asked if something is not understood. OR bed will be narrow. A safety strap will be applied over the knees Lights in the OR may be very bright. Monitoring machines (ticking and ringing noises) may be heard when awake. The purpose is to monitor and ensure safety  OR INTRUMENTS Straight scissor Myo scissor curved Metzembum scissor Scalpel holder Bobcock Tissue forcep Allis Thumb forcep Towel clamps Kelly curve Kelly straight Mixter Deaver wide Army navy Ribbon or malleable Richardson Balfour CAUTERY MACHINE AUTOCLAVE OPERATING ROOM