PERI-OPERATIVE NURSING THREE PHASES PRE-OPERATIVE INTRA-OPERATIVE POST-0PERATIVE

GENERAL INFORMATION Pre-operative begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room Intra-operative begins when the patient is transferred to the surgery & ends when transferred to the recovery room Post-operative begins when the patient is admitted to the recovery room & ends with follow up evaluation in the clinical setting or home

PRE-OPERATIVE SURGERY Carolyn Frye-Shegog

GENERAL INFORMATION PURPOSE OF SURGERY SURGERY SETTINGS INFORMED CONSENT

CLASSIFICATION OF SURGERY ACCORDING TO PURPOSE: DIAGNOSTIC CURATIVE PALLIATIVE RECONSTRUCTIVE PREVENTIVE EXPLORATORY COSMETIC

MAJOR AND MINOR SURGERY

TERMINOLOGY ECTOMY: REMOVAL OF AN ORGAN RRHAPHY: SUTURE OF A PART SCOPY: LOOKING INTO OSTOMY : MAKING AN OPINING PLASTY :REPAIR OR RESTORE OTOMY: CUTTING INTO

AMBULATORY SURGERY ADVANTAGES: Less psychological distress associated with hospitalization Decreased exposure to hospital infections Economic savings Consumer satisfaction

FACTORS AFFECTING ADAPTATION TO SURGERY AGE: NEUROENDOCRINE RESPONSE: SURGICAL PROCEDURE: PREVIOUS HOSPITALIZATIONS AND SURGERIES: SPIRITUAL BELIEFS: TYPE OF ADMISSION

PSYCHOSOCIAL REACTIONS TO SURGERY: EMOTIONAL RESPONSES TO SURGERY: FEAR OF THE UNKNOWN FEAR OF ANESTHESIA; FEAR OF PAIN: UNIVERSAL –FEAR OF MUTILATIONS OR ALTERED BODY IMAGE FEAR OF DEATH FEAR OF SEPARATION AND ROLE CHANGE

NON VERBAL COMMUNICATION OF FEARS AND ANXIETIES RAPID SPEECH JOKING MAKING LIGHT OF SITUATION WITHDRAWAL

NURSES ROLE RECOGNIZING AND UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:

PRE-OPERATIVE NURSING ASSESSMENT PSYCHOLOGICAL ASSESSMENT: Social History: smoking, alcohol consumption, occupation etc. Family health history Past health history & home medication:

MEDICATIONS CON’T STEROIDS-should not be stopped abruptly Antidepressants can increase hypotensive effects of anesthesia Antibiotics such as neomycin, kanamycin can combine with certain anesthetics & lead to respiratory paralysis Insulin dosage may need to be adjusted-check with the physician ASA thins blood so may increase post-op bleeding Antihypertensives & cardiac drugs can’t be stopped abruptly Check for the use of OTC drugs for glaucoma

PHYSIOLOGICAL ASSESSMENT Respiratory HX of dyspnea, coughing, hemoptysis COPD, or URI Smoker? Record baseline breath sounds Diagnostic tests;; ABG’S CXR, FPT’S

CARDIOVASCULAR HX OF CARDIO OR CEREBRAL VASCULAR DISEASE PACEMAKER ARTIFICIAL VALVES ANTICOAGULANT THERAPY

CNS: (ENTRAL NERVOUS SYSTEM) HX of stroke, TIA’S, NEUROMUSCULAR DISORDERS SUCH AS MYASTHENIA GRAVI, ESPECIALLY IMPORTANT TO ASSESS MENTAL STATUS LOC

PRE-OPERATIVE NURSING CARE PRE – OPERATIVE TEACHING THE NURSE IS RESPONSIBLE TO: FIND OUT WHAT PT. KNOWS INCLUDE FAMILY USE SIMPLE TERMS EVALUATE PT. UNDERSTANDING USE AUDIOVISUAL AIDS ASK FOR RETURN DEMONSTRATION

PRE-OPERATIVE TEACHING USUAL TOPICS COVERED Preoperative tests Preoperative routines Schedule PACU FAMILY DIRECTIONS POSTOP THERAPIES PAIN MANAGEMENT DIET

PRE-OPERATIVE NURSING ASSESSMENT PSYCHOLOGICAL ASSESSMENT SOCIAL HISTORY FAMILY HEALTH HISTORY PAST HEALTH HISTORY PHYSIOLOGICAL HISTORY

PREOPERATIVE PHYSICAL PREPARATION PRE-OP PHYSICAL PREPARATION NUTRITIONAL NIGHT BEFORE SURGERY, LIGHT MEAL OR LIQUID DIET SPECIFIC IV FLUIDS NPO AFTER MIDNIGHT POSSIBILITY OF LIGHT BREAKFAST ON DAY OF

PRE-OP PHYSICAL PREP Intestinal NPO Enemas until clear Laxatives Antibiotics to decrease intestinal flora

PRE-OP PHYSICAL PREP Skin prep Bathe before surgery Shaving operative site Scrub with betadine/other antiseptic

Three important components of consent form Adequate disclosure Sufficient comprehension Voluntary consent