ANS Unit 4 The Surgical Client

Surgery Involves entering tissue and removing or reconstructing structures that are diseased, injured or malformed

Surgery Intervention Invasive

Perioperative Care Total Span of care: Preop Intraop Postop

Surgical Facilities Hospital Ambulatory center Surgicenter Clinic MD office

Nursing Interventions common to all surgery Emotional support Physically prepare pt. Verify legal aspects Pt. / family teaching Provide pre/post care

Nursing Interventions Amt of time varies with each case and where performed - inpatient vs. out - level of surgery

Level of patient choice in surgery Optional / Elective Required / Nonelective Urgent / Nonelective Emergency

Anesthesia Loss of sensation administered by: - Anesthesiologist - CRNA (anesthetist)

Types of anesthesia General Regional - spinal - local - topical

General anesthesia Eliminate all sensation Loss of consciousness IV, inhalation, rectally Levels vary Often intubated - resps. paralyzed

Regional anesthesia Blocks sensation in an area Consciousness is unaffected

Spinal (regional) Eliminates sensation in legs, lower abd, pelvis spinal - subarachnoid - keep flat afterwards epidural - outside dura

Local (regional) Blocks sensation in circumscribed area of skin and subQ tissues lidocaine to skin

Topical (regional) Inhibits sensation in epithelial tissues Skin and mucous mem. Oragel for baby’s gums

Identifying surgical risks All pt. Evaluated MD does H&P Nurse does own H&P and then THINKS!!

Things to look for: Previous illness Medications: - ASA, Coumadin - Cardiac meds - Diuretics

Verify and collect: Allergies Baseline vital signs Height and weight General health Skin condition

Lab work and Tests MD will order Nurse to check results Call MD if any abnormal

Urinalysis or UA Checks for: - UTI - Renal disease - Diabetes

CBC with differential Looks for: - Anemia - Infection - Decreased immunity

PT & PTT Protime ~ 9-12 seconds Partial thromboplastin time ~ seconds Looks for bleeding tendencies Routine if on anticoags

Fasting Blood Sugar (FBS) Diabetes fasting = nonfasting =

Blood Urea Nitrogen (BUN) Renal disease normal = 7-18

Other ordered tests: Type and crossmatch - for possibility of transfusion CXR-chest x-ray EKG-electrocardiogram