FUNDAMENTALS OF NURSING LESSON #18 THE SURGICAL PATIENT (PRE-OPERATIVE)

DEFINING SURGERY SURGERY IS PERFORMED: To dx To amputate or excise To relieve symptoms To transplant organs To reconstruct/construct To restore function

DEFINING SURGERY TYPES OF SURGERY: Elective Not necessary to preserve life Performed when pt chooses Urgent Required to keep additional problems from happening Emergent To save life and/or preserve fx of body parts

DEFINING SURGERY PURPOSE OF SURGERY: Palliative To decrease symptoms but does not cure Ablative Amputation or excision of body part or harmful substance Diagnostic To help dx a disease or problem

DEFINING SURGERY PURPOSE OF SURGERY: Reconstructive Constructive to restore a nonfunctioning part Constructive To change or repair a part Transplant To replace a dysfunctional part

DEFINING SURGERY DEGREE OF SURGERY: Both have elements of risk… Minor Major

DEFINING SURGERY SURGICAL SETTINGS: Inpatient Pt is hospitalized Same day, one day, or outpatient Short stay or admitted temporarily to surgical suite Short stay Does not exceed 24 hours

FACTORS THAT INFLUENCE SURGERY Age Young and old tolerate poorly Physical condition Must have good pt assessment Nutritional factors Takes preparation for surgery

FACTORS THAT INFLUENCE SURGERY Metabolism Chemical process generating energy for growth, excreting waste Anabolism “building up” phase of metabolism Catabolism “tearing down” substances to use for energy

FACTORS THAT INFLUENCE SURGERY Cachexia Thin wasted General ill health Malnutrition Marked weakness Emaciated Associated with serious disease

FACTORS THAT INFLUENCE SURGERY PSYCHOSOCIAL NEEDS: Fear Loss of control Unknown Anesthesia Pain Death

FACTORS THAT INFLUENCE SURGERY PSYCHOSOCIAL NEEDS: Fear Separation from family/home Body disfigurement Detection of CA Being helpless/powerless

FACTORS THAT INFLUENCE SURGERY SOCIOECONOMIC NEEDS: Allow pt to express feelings CULTERAL NEEDS: Allow pt to practice whenever possible EDUCATION/EXPERIENCE: Must assume pt does not know anything…

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS BENEFITS OF GOOD TEACHING: Will help pt overcome fear of unknown Will decrease: Anxiety Amount of anesthesia needed Post-surgical pain Corticosteroid production Will increase: Wound healing

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS PRE-OP NURSING INTERVENTIONS: Individualized assessment of pt Age Infection/med history Nutritional status Type of surgery Preference of surgery History of disease

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS LAB & DIAGNOSTIC TESTS: Common pre-op labs: UA CBC Blood profile (electrolytes) Chest x-ray EKG PT/PTT

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS INFORMED CONSENT: Pt must sign before beginning of procedure Explains risks/benefits Must be witnessed MDs responsibility Pt signature cannot be obtained within 4 hours of taking mind altering medication May need interpreter

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS GI PREP: NPO at least 8 hours prior Can put sign up…NO FLUIDS/FOOD Can do oral care but don’t swallow Enema might be ordered Antibiotic might be ordered

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS SKIN PREP: Shave body part Wash with antibacterial soap Hair removal debatable Keep skin intact Do thorough skin assessment

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS RESPIRATORY PREP: Must vent lungs post-op Teach use of IS TCDB To prevent atelectasis and pneumonia Contraindicated with: Increased ICP Cataract surgery ENT surgery

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS RESPIRATORY PREP: IS use: Exhale through nose Place mouthpiece in mouth Inhale slowly to maximum possible and hold Perform X 10 q 2 hours or dr’s order

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS RESPIRATORY PREP: Coughing Teach proper technique Splint abdomen if necessary Pursed lip breathing Deep breath from diaphragm MD’s order

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS CIRCULATION: Blood with lie dormant if pt lies flat Teach leg exercises pre-operatively Decrease risk for thrombus Decrease risk for embolus Decrease risk for infarct Decrease risk for thrombophlebitis OBESE PATIENTS ARE AT RISK DUE TO IMMOBILITY

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS CIRCULATION: Leg pump exercises Antiembolic stockings (TED hose) SCDs OBESE PATIENTS ARE AT RISK DUE TO IMMOBILITY

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS CIRCULATION: Antiembolic stockings (TED hose) SCDs

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS VITAL SIGNS: True picture of response to anesthesia Must have baseline to make comparison

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS GU: Tell pt you will assess bladder fullness post-op Might come out of surgery with a catheter Might encourage fluid intake to flush meds

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS OTHER TEACHING Wound and dressing pt might have Pain control Possible devices/tubes pt might have

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS PRE-OP MEDICATION: Used to enhance anesthesia Morphine & Demerol Decrease amount of anesthesia used Decrease respiratory secretions Teach pt about medication

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS PRE-OP MEDICATION: Have pt void Pull up side rails X 4 for transport Anesthetic agents…alter sensations Must think pt safety

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS PRE-OP MEDICATION: Depends on: MD’s order and preference Pt preference and medical status Type of surgery being performed

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS ANESTHESIA: Is the absence of awareness/feeling General: Drug induced unconsciousness Analgesia Amnesia Muscle relaxation

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS ANESTHESIA: Is the absence of awareness/feeling Regional: Specific region or body part No loss of consciousness Nerve blocks Spinals Epidurals

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS ANESTHESIA: Is the absence of awareness/feeling Local: Topical or into tissues Loss of sensation to immediate area

PREOPERATIVE TEACHING, POSTOPERATIVE BENEFITS PRE-OPERATIVE CHECKLIST REVIEW See quantum…

THE END!!!!!