Surgery Nursing Concepts PDF

The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN PERIOPERATIVE SURGERY NURSING...

The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN PERIOPERATIVE SURGERY NURSING 1 2 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Period Perioperative nursing pertains to the 1. Pre-operative period ü When the decision to have surgery is made and ends when the client is transferred to the TYPES OF SURGERY nursing care operating table provided 2. Intraoperative period ü When the client is transferred throughout the to the operating table and ends when the client is admitted in entire surgical the PACU experience of the 3. Postoperative period ü When the client is admitted to patient. the PACU and ends when the healing is complete. 3 4  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Types of Surgery FUNCTIONAL CONCEPTS ON Purpose: TYPE OF SURGERY Degree of Degree of Urgency: Risk: Diagnostic Emergency ACCORDING TO Major Exploratory Urgent Minor Curative/ Required Ablative Elective PURPOSE Palliative Optional Constructive Reconstructive Aesthetic Transplant 5 6 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Diagnostic Surgery Exploratory Surgery To diagnose a disease. To know the extent of the diseases. Biopsy Example: Exploratory laparotomy Needle Biopsy Incisional Biopsy Excisional Biopsy involves aspirating involves aspirating the involves aspirating the tissue surrounding wedge or portion of the tumor and surrounding the tumor tumor. tissue. The Moss Report. (n.d.). The Hidden Danger Jaypee Digital. (n.d.). Chapter 16: [Title of the of Needle Biopsies. chapter if available]. In [Title of the book]. Jaypee Digital. (n.d.). Chapter 16: [Title of the https://www.themossreport.com/the-hidden- Retrieved from chapter if available]. In [Title of the book]. Trial Exhibits Inc. (n.d.). Exploratory Laparotomy. Trial Exhibits Inc. Retrieved from danger-of-needle-biopsies/ https://www.jaypeedigital.com/eReader/chapter/ https://www.jaypeedigital.com/eReader/chapter/ https://www.trialexhibitsinc.com/library/library-item/exploratory-laparotomy 9789350258903/ch16 9789350258903/ch16 FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 7 8  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Curative/Ablative Surgery Palliative Surgery To cure the disease. It does not cure but rather relieves Usually involves the removal of diseased or reduces pain or symptom. body tissue. Example: Example: Colostomy Appendectomy Mastectomy Oophorectomy Splenectomy Gastrectomy MedIndia. (n.d.). Gastrectomy. MedIndia. https://www.medindia.net/surgicalprocedures/gastrectomy.htm FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 9 10 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Transplant Surgery KIDNEY TRANSPLANT REJECTION Surgery to transfer organ or body TYPES tissue. Example: Heart transplant Kidney transplant § Hyperacute- few minutes § Acute- first week to 3 months § Chronic- years Associated Press. (2022, January 10). Surgeons Successfully Transplant Pig Heart into Human Patient. AP News. https://apnews.com/article/pig-heart-transplant-maryland- a25576010ff2b7915b53e8144c3dd3cf FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 11 12  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Constructive vs. Reconstructive Surgery Aesthetic Surgery To correct congenital To restore function To improve physical features that defect or anomalies brought by trauma Example Example are normal Cheiloplasty– for cleft lip Breast reconstruction Example: Palatoplasty– for cleft palate after mastectomy Rhinoplasty Closure of Congenital Breast augmentation Heart Defects Cleveland Clinic. (n.d.). Rhinoplasty. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/11011-rhinoplasty FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 13 14 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Emergency Surgery Used for life-and-death situations TYPE OF SURGERY wherein surgery is done immediately. Should be done without delay to preserve life Example: Skull fracture, Internal bleeding, rib fracture, extensive burn, rupture appendix, rupture ectopic pregnancy ACCORDING TO THE DEGREE OF URGENCY FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 15 16  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Urgent Surgery Functional Concept ® To be done within 24 to 48 hours. Delay of the surgery could potentially lead to adverse health outcomes for the client. Example: Appendectomy Appendectomy is the standard Cholecystectomy and most effective treatment for acute appendicitis. Health Travellers Worldwide. (n.d.). Appendectomy. Health Travellers Worldwide. https://www.healthtravellersworldwide.com/treatments/appendectomy/ FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 17 18 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Required Surgery Elective Surgery Client requires surgery within few weeks. Client should have surgery at the Failure to have surgery is catastrophic convenience of client. Failure to have Example: Thyroid disorder surgery is not catastrophic. Benign prostatic hypertrophy Example: Cataract Superficial cyst Children's Hospital of Philadelphia. (n.d.). Pediatric Thyroid Surgery. Children's Hospital of Derma Essentia. (n.d.). Sebaceous Cyst. Derma Essentia. https://www.dermaessentia.com/blogs/knowledge/sebaceous-cyst Philadelphia. https://www.chop.edu/treatments/pediatric-thyroid-surgery FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 19 20  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Optional Surgery FUNCTIONAL CONCEPTS ON Surgery depends on the preference of the client Example: Cosmetic surgery TYPE OF SURGERY ACCORDING TO THE DEGREE OF RISK Cohen, D. (2019, May 27). Most Popular Facial Plastic Surgery. Cohen Plastic Surgery. https://www.cohendoc.com/blog/2019/05/27/most-popular-facial-plastic-surgery-198379 FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 21 22 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Major Surgery Minor Surgery HIGH RISK LITTLE RISK Involve large blood Less possible complication loss Could be done as day surgery Example: More complicated Tooth extraction Prolonged surgery AV fistula creation More possible Circumcision complication Example: Transplant Heart Surgery Amputation Medtronic Diabetes. (n.d.). Advice for Surgery with Kangaroo Point Medical Centre. (n.d.). Circumcision. Kangaroo Point Medical Centre. Diabetes. Medtronic Diabetes. https://www.medtronic- https://kangaroopointmedicalcentre.com.au/urology-clinic/circumcision/ diabetes.com/en-MENA/blog/advice-surgery-diabetes Fresenius Kidney Care. (n.d.). Dialysis Access Types. Fresenius Kidney Care. https://www.freseniuskidneycare.com/treatment/dialysis/access-types FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 23 24  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON PREOPERATIVE Pre-operative phase When the decision to have surgery PERIOD is made and ends when the client is transferred to the operating table 25 26 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Pre-operative Period Pre-operative Period Focus: Preparation for Surgery The nurse focus during preoperative period is preparation of: Goal: Best physical and emotional q Consent condition for surgery. q Physical Preparation q Health Education 27 28  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Informed consent should contain INFORMED CONSENT the following: q The nature of and purpose of surgery q Alternative options and their risk q Benefits and risk of surgery q Name and qualification of the HCP performing the procedure q Right to refuse. 29 30 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON The nurse acts as a witness The Healthcare Provider who will during the signing of informed perform the procedure should be consent. This includes ensuring the one to obtain the informed the client is competent to sign consent. the consent and that it is voluntary. 31 32  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Those who can give Those who cannot Informed Consent consent are those: give consent are: Is required when there is q At least 18 years old Anesthesia with sedation, Invasive q Coherent, conscious, q Minors and mentally q A mentally ill Procedures, and Radiation. competent person q Voluntarily q Emancipated minors q Unconscious 33 34 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept ® Functional Concept ® If you cannot or are unable to obtain In emergency situations, if it is consent from the client, obtain consent impossible to obtain consent from the following: from the client or an authorized 1. Spouse person, the procedure required 2. Son or daughter 3. Either parents to benefit the client’s life may 4. Brother or sister of legal age be done without liability for 5. Guardian/Next of Kin failure to obtain consent. FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 35 36  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept ® FUNCTIONAL CONCEPTS ON The nurse is tasked to collect the Make sure that informed signature on the form and is not consent has been signed before responsible for the information giving preoperative medication included on the form or provided such as sedatives and by the healthcare provider. tranquilizers. FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 37 38 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Pre-operative Period FUNCTIONAL CONCEPTS ON Physical Assessment: q Height Physical q Weight q Vital Sign q Different body system assessment Preparation q Cardio q Respi q Endo q Renal q GIT q Integ 39 40  The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Diagnostic Exam: q CBC q Serum and Electrolytes British Heart Foundation. (n.d.). Chest X-ray. British Heart Foundation. https://www.bhf.org.uk/informationsupport/tests/chest-x-ray Fusion Diagnostics. (n.d.). CT Scan. Fusion Diagnostics. https://fusiondiagnostics.in/service/ct-scan/ q Kidney Function: Urinalysis, Creatinine and BUN q Liver Function: AST, ALT, LDH, Bilirubin, Coagulation q Endocrine Function: FBS q Screening Test: CXR, ECG, MRI, CT Scan q Pregnancy Test Queen's University. (n.d.). Normal Electrocardiogram (ECG). PET Scan Mumbai. (n.d.). PET Scan for Brain. PET Scan Queen's University Elentra. in Mumbai. https://elentra.healthsci.queensu.ca/assets/modules/ECG/n ormal_ecg.html https://www.petscaninmumbai.com/blog/pet-scan-for- brain/ 41 42 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept ® FUNCTIONAL CONCEPTS ON Psychological Assessment: The presence of electrolyte q Fear of the unknown imbalance in a pre-op client q Fear of Pain needs to be reported to the q Fear of Death healthcare provider. q Loss of work, job, and support q Concern on threat of permanent incapacity FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 43 44  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Other Assessment: q Use of OTC The worst of all fears among q Use of Herbal Medication clients undergoing surgery is the fear of the unknown. q Comorbid condition and the medication for comorbid condition q Previous surgery q Social Resources 45 46 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept ® Functional Concept ® C hamomile Medications which can G inger arlic potentially cause bleeding should be stopped inseng 10 days before surgery. inkgo can cause BLEEDING! FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 47 48  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON q Presence of contraption Pre-operative assessment q Smoking History should include assessment q Allergies of risk behaviors. q Alcoholism 49 50 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Pre-op Medications Condition that affects Drug that affects outcome of surgery outcome of surgery q Bleeding disorder q Antibiotic Drug Use q Diabetes mellitus q Anticholinergic Atropine Reduce secretions q Chronic pain q Anticoagulants Scopolamine q Heart Disease q Anticonvulsant q Obstructive Sleep q Antidepressant Vistaril (hydroxyzine), Reduces the amount of anesthetic apnea (MAOI) Phenergan needed. (promethazine) Reduces anxiety and provides q URTI q Antidyshrythmic & antiemetic effect. q Liver disease Antihypertensive q Fever q Corticosteroid q Renal disease q Diuretics q Immunologic disorder q Insulin 51 52  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Pre-op Medications FUNCTIONAL CONCEPTS ON Nursing Interventions for Drug Use Postoperative Medication Demerol (meperidine), Reduce anxiety and promote Roxanol (morphine sulfate) relaxation Verify the client’s identity prior to giving medications. Nembutal (pentobarbital sodium), Most pre-operative drugs cause DIZZINESS – Promote sedation Seconal (secobarbital sodium) ensure side rails are up and informed consent has been sign before giving preoperative medication. Make sure call bell is within reach. Make sure that client has companion at all times 53 54 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Bowel Preparation Skin Preparation Depending on the healthcare provider's To lower the risk of orders, enemas, wound infection, laxatives, or both can take a shower or bat be administered. h the night before Preoperative enemas surgery. are no longer routine, On the surgical site, but an enema may be hair trimming or ordered for bowel clipping is permitted surgery. instead of shaving. NexMedical. (n.d.). Pre-Operative Applicators. NexMedical. https://www.nexmedical.com/products/skin-disinfection-pre- operative-preparation/pre-operative-applicators/ 55 56  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Diet Pre-operative Period NPO after midnight is no longer prescribed. Always review the healthcare provider’s prescribed diet Health Education preoperatively. Clear liquid diet – Withhold 2 hours prior to surgery Breast milk- Withhold 4 hours prior prior to surgery. Light meal- withhold 6 hours prior to surgery Heavy meal- withhold 8 hours prior to surgery 57 58 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Health teaching to client Teach the client about exercises regarding: to perform postoperatively such q Exercises as deep breathing and q Postoperative restrictions coughing, leg exercises q What contraptions to expect (quadriceps setting, foot circles q What are the post-op calf pumping), and early priorities ambulation 59 60  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Verywell Health. (n.d.). How to Stop Coughing After Surgery. Verywell Health. https://www.verywellhealth.com/how-to-coughing-after-surgery-3156822 61 62 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Leg Exercises Teach the client what Quadriceps setting Foot circles Calf pumping contraptions to expect postoperatively: NGT, IFC, wound drains, IV lines, and O2 support. 63 64  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Postoperative restriction: Clients after mastectomy should not have blood pressure taken on the affected side. 65 66 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON A client with a post- arteriovenous (AV) fistula should not have blood pressure INTRAOPERATIVE taken or blood taken on the affected arm. PERIOD No pressure, no puncture 67 68  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS Intraoperative phase Asepsis, homeostasis, When the client is transferred to hemostasis, and safe the operating table and ends when administration of anesthesia are the client is admitted in the PACU the goals during the Intraoperative Period. 69 70 The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON WHO Surgical Safety Checklist World Health Organization. (n.d.). Safe Surgery Saves Lives Starter Kit. https://cdn.who.int/media/docs/default- source/patient-safety/safe-surgery/starter_kit- sssl.pdf?sfvrsn=9cef94b8_7 71 72  The Ray A. Gapuz Test Prep System for the PNLE RN During Sign In: 1. 2. Client identity is confirm Surgical Site marking WHO Surgical Safety Checklist 3. Pulse oximeter 4. Allergy, DOB, Risk for increased blood loss is assessed. SIGN IN is done before the induction of anesthesia. 73 74 The Ray A. Gapuz Test Prep System for the PNLE RN WHO Surgical Safety Checklist During Time-out: 1. Surgical team member introduce themselves 2. Client identity, procedure, and site marking are confirmed. 3. Check antibiotic has been Surgical site marking is done given 4. Ensure imaging is displayed when there is laterality or the body organ has left and right sides. 75 76  The Ray A. Gapuz Test Prep System for the PNLE RN During Sign-out: WHO Surgical Safety Checklist 1. Ensure complete count of instruments, needles, and sponges. 2. Label the specimen 3. Surgeon, anesthesiologist, and nurse plan for recovery and management of the client TIME OUT is done before the skin incision. 77 78 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN WHO Surgical Safety Checklist FUNCTIONAL CONCEPTS ON SIGN OUT is done before the client leaves the operating room. Anesthesia 79 80  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Anesthesia is the state of narcosis, analgesia, Administration of General Anesthesia relaxation, and loss of consciousness 1. Inhalation: 2. Intravenous Administration: Includes volatile liquids Barbiturates and gas anesthetic: Non-barbiturates hypnotics 1. General Anesthesia 2. Regional Anesthesia Volatile liquid: produces Benzodiazepine anesthesia when their Opioid agents Causes analgesia, amnesia, Causes a temporary interruption vapors are inhaled. unconsciousness, and loss of Dissociative agents of nerve impulses to and from a Desflurane reflexes. specific area or region of the Isoflurane body. Enflurane Chief disadvantage: Halothane Respiratory & cardiac Spinal anesthesia Epidural anesthesia Gas anesthetic: depression combine with oxygen Local anesthesia/Infiltration Topical anesthesia such as Nitrous oxide. Nerve block 81 82 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Types of Regional Anesthesia Nursing Care for General Anesthesia Oxygen and emergency resuscitative equipment must Regional Anesthesia be available. Causes a temporary Maintain calm environment interruption of nerve Use safety precaution with flammable agents. impulses to and from a Provide for safety. specific area or region of Maintain a side-lying position to prevent aspiration after spinal anesthesia the body. Restrict oral intake after general anesthesia 83 84  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept Types of Regional Anesthesia 1. Topical Anesthesia ü Numb the surface of the body Client receiving regional ü Applied to skin and mucous membrane anesthesia is aware and ü Open skin surfaces, awake. wounds and burns ü Example: ü Proparacaine ü Tetracaine ü Lidocane ü Bupivacaine 85 86 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Types of Regional Anesthesia Types of Regional Anesthesia 2. Nerve Block 3. Local anesthesia ü Injected to a nerve or ü Also known as infiltration. group of nerve to provide temporary ü Injected to specific or localized area pain relief. in the body ü Example: ü For minor surgical procedure. ü Tooth extraction: Cranial nerve 5 ü Example: ü Episiotomy/episior ü Small wound rhaphy: Pudendal ü Biopsy block 87 88  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Types of Regional Anesthesia Functional Concept 4. Spinal anesthesia ü Also known as subarachnoid block Spinal Anesthesia or ü Injected into the subarachnoid space Subarachnoid Block surrounding the Produces anesthesia of the spinal cord ü Requires lumbar lower abdomen, perineum, puncture. ü Major disadvantage: and lower extremities. Spinal headache 89 90 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept Functional Concept Spinal Anesthesia or The position of choice for Subarachnoid Block the client after spinal is to Requires an assessment of lie flat on the bed for 6–8 the ability to move the hours to prevent a spinal extremity post-op. headache. 91 92  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Functional Concept Types of Regional Anesthesia 5. Epidural anesthesia The most dangerous complication ü Injected into the during the induction of spinal epidural space that surrounds the dura anesthesia or subarachnoid block is mater of spinal cord. For Hypotension. minor surgical procedure. ü Major advance: Absence Increasing IV fluid is the priority of spinal headache. nursing intervention if the client ü Major disadvantage: develops hypotension after spinal Technical challenge of introducing the anesthesia anesthesia. 93 94 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Stages of Anesthesia COMPLICATIONS OF Stage 1: Beginning/Onset From administration of anesthesia to LOC Drowsy, dizziness, hallucination occurs, ringing or buzzing in the ears, feeling of detachment, LOC ANESTHESIA Shouting, struggling, increase Stage 2: Delirium/Excitement autonomic activity, increase From LOC to loss of lid reflex VS, dilated pupil. § Headache-spinal anesthesia Stage 3: Surgical Small pupil but reactive to § BP changes- general From loss of lid reflex to loss of most reflexes light, return of VS to normal anesthesia § Malignant hyperthermia- Stage 4: Stage of Danger/Medullary Cardiac or respiratory depression or arrest Succinylcholine 95 96  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Malignant Hyperthermia FUNCTIONAL CONCEPTS ON Is an inherited muscle Management: disorder that causes Terminate the Nursing hypermetabolic state. surgery Acute, life-threatening IV dantrolene to medical emergency relax the muscle Trigger by inhaled Diagnosis 100% oxygen anesthetics and Ice IV 0.9% NaCl succinylcholine Cooling blanket Manifestation: Indwelling urinary Tachycardia (initial) catheter – monitor Extremely elevate I&O temperature (late) Muscle rigidity Damage to CNS 97 98 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Nursing diagnosis during intraoperative period Ineffective protection Impaired skin integrity Positioning Ineffective peripheral tissue perfusion Risk for deficient fluid volume Risk for aspiration Risk for injury Risk for imbalance body temperature 99 100  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Positioning during surgery Prevent straining or injury to muscle bone, and ligaments Position should promote normal joint range of motion and good body alignment. Maintain position using strap belt Pad body prominences Bowel resection Vaginal surgery Mastectomy Rectal surgery Repair of hernia Abdominoperineal resection D&C 101 102 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Members of Spinal surgery Laminectomy Cranial surgery Surgical Team Thoracic surgery Abdominal surgery 103 104  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Anesthesiologist assesses the The surgeon performs the client before the surgery to check procedure or surgery and heads if the client is a good surgical the surgical team. candidate and supervises the client's condition throughout the surgical procedure. 105 106 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Roles of Scrub & Circulating Nurse Roles Scrub Circulating Equipment Gather equipment Ensure equipment The scrub nurse and circulating before surgery is working properly nurse are the nursing tandem in Specimen Label specimen Handles specimen to be delivered to the OR for every surgery. the laboratory Sterility Maintains sterility during surgery Guarantees sterility of instruments & supply Prepares all supply Monitors the room & instrument using for breaks In sterile sterile technique technique 107 108  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Roles of Scrub & Circulating Nurse Roles of Scrub & Circulating Nurse Roles Scrub Circulating Roles Scrub Circulating Sponges, Keep accurate count Document the count Other Function Handles supplies and Monitor responsible cost, compliance associated with of sponges, sharps, of sponges, sharps, instrument during Sharps, & and instruments and instruments surgery operating room procedures. Instruments during surgery during surgery Minimizes Coordinates all Assisting surgeon Assisting anesthesia conversation and personnel in the OR personnel Communication traffic within the OR and with other suite departments Prepare sterile field, Assist with position Documenting care Other Function Performs the and performs surgical provided. aftercare skin prep 109 110 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON The scrub nurse and The nurse reports any discrepancy anesthesiologist accompany the in the counting of needles, surgical client to the PACU after instruments, and sponges to the surgery. surgeon so that immediate and appropriate action is instituted. The circulating nurse assists anesthesia personnel during surgery. 111 112  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Surgical Environment Surgical Environment is divided Surgical into 3 zones: q Unrestricted Zone Environment q Semi-restricted Zone q Restricted Zone 113 114 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN Surgical Environment FUNCTIONAL CONCEPTS ON Unrestricted Semi-restricted Restricted zone zone zone q Patient reception area and holding area q Hallway of OR suite q Operating theater and sterile core area. Principles of Surgical Asepsis q Scrub clothes, q Street clothes q Scrub attire shoes cover are allowed (scrub clothes and caps, and masks caps) is required. are worn. q Interfaces with q Surgical other instruments are departments processed 115 116  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Medical asepsis includes all practices intended to Asepsis is the freedom from confine a specific microorganism to a disease-causing specific area, limiting the number, growth, and transmission of microorganisms. microorganisms. In medical asepsis, objects are referred to as clean or dirty (soiled, contaminated) 117 118 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Surgical asepsis, or sterile technique, refers to those practices that keep an Use surgical aseptic technique for area or object free of all invasive procedures (e.g., injections, microorganisms; it includes practices catheterizations). that destroy all microorganisms and spores. 119 120  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Moisture causes contamination. Principles of Asepsis Never assume that an object is sterile. Only sterile surfaces or articles Always face the sterile field. may touch other sterile surfaces or articles. Sterile articles may touch only sterile surface/articles to If an unsterile object comes into maintain sterility. contact with a sterile object or Sterile equipment/areas must be kept above the waist & on sterile area, it renders the sterile top of the sterile field. object and area contaminated. The sterile gowns are considered Prevent unnecessary traffic & air currents around sterile area sterile in front, from the chest to Open, unused sterile articles are no longer sterile after the the level of the sterile field. procedure All material in contact with A person who is considered sterile who becomes surgical wound or used within contaminated must reestablish sterility sterile field must be sterile Surgical technique is team effort. 121 122 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Principles of Asepsis POSTOPERATIVE The sleeves are also considered sterile, extending 2 inches above the elbow to the stockinette cuff. PERIOD The top surface of a draped table is considered sterile. Items of doubtful sterility are considered unsterile. If a sterile package is opened, the edges are considered unsterile. 123 124  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Postoperative phase Determining When the client is admitted to the PACU and ends when the healing Readiness for is complete. Discharge from the PACU 125 126 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Aldrete Discharge Scoring Is a tool used to assess the client’s readiness for discharge from the PACU. Scores: Score of 8-10 can be discharge Score of 7 or less must remain in the PACU until condition improves or be transferred intensive care unit (ICU) 127 128  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Nursing Management Postoperative care and discharge plan begin in the preoperative during Postoperative phase when preoperative teaching is implemented. Period 129 130 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Priority goals during the post-operative Priority Assessment period Assessment of airway Breath position sound, monitor for secretion, avoid supine Homeostasis O2 sat and ventilation Movement of chest, hook pulse oximeter Cardiovascular status Assess pulse, skin color, CRT, arrhythmia, and BP Hemostasis and prevent shock Level of consciousness Assess LOC using GCS Preventing post-operative complications Cough and gag reflex Respiratory complication Ability to move extremities For spinal anesthesia Deep vein thrombosis Skin color Fluid status IV fluid administration, monitor I&O, monitor F&E Wound infection Postoperative pain Pain and discomfort alleviation Drains Pain and safety 131 132  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON Types of drainage from wounds Normal Abnormal Serous wound Sanguineous is drainage looks characterized as clear or straw red drainage due colored. to trauma to blood vessels. Serosanguineous is Purulent is yellow, characterized by gray, or green pink-colored drainage that drainage, as serous comes out of a drainage is mixed wound when with a small amount infection invades of blood cells. the area. 133 134 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Serous fluid and Serosanguineous is normal. Nursing While Sanguineous, Purulent, and Diagnosis Hemorrhage is abnormal. 135 136  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Nursing diagnosis during postoperative period Acute pain Postoperative Complications Ineffective airway clearance Ineffective breathing pattern Impaired skin integrity Risk for infection Risk for injury Risk for deficient fluid volume Disturbed body image 137 138 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Respiratory Complication Atelectasis & Pneumonia Atelectasis Pneumonia Assessment: Both has dyspnea, crackles, A collapsed or airless Inflammation of the productive cough, and elevated body temperature. state alveoli of the lungs Management: Complication: Airway Onset: 3-5 days Reposition Q2H obstruction Cause: Encourage deep breathing and coughing Onset : 1-2 days Infection exercises. Caused: Aspiration Encourage use of incentive spirometry Accumulated secretion Immobility Provide chest physiotherapy and postural Failure to do deep drainage breathing and Increase oral fluid intake coughing exercises Early ambulation. Failure to ambulate 139 140  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN INCENTIVE SPIROMETRY Functional Concept ® IN A POST-OP CLIENT, THE USE OF INCENTIVE SPIROMETRY HELPS PROMOTE DEEP BREATHING and COUGHING. copyright 2012 by R.A. Gapuz. FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM 141 142 The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON FUNCTIONAL CONCEPTS ON Hemorrhage Management: Hemorrhage is the blood Put pressure on the site of bleeding loss from a leaking blood IV fluids vessel that may require Blood transfusion emergency treatment to Ligation of bleeding blood vessel control bleeding. Administer vitamin K and Tranexamic acid as Manifestation: Restlessness prescribed Hypotension Notify the MD Tachypnea Rapid but weak pulse Cold, clammy skin Bleeding characteristic depends on damage blood vessel 143 144  The Ray A. Gapuz Test Prep System for the PNLE RN The Ray A. Gapuz Test Prep System for the PNLE RN FUNCTIONAL CONCEPTS ON