Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE

Meet the Patient The experience of surgery is a routine event for everyone involved EXCEPT for the patient!

Nursing Management after Surgery

Postoperative Phase: Plan of Care System Assessments and related nursing diagnoses

System Assessments Respiratory Cardiovascular Fluid Status Nutrition Elimination Activity Wound Healing

The real reason dinosaurs Respiratory Pulmonary assessment data TCDB C/I: CHI, eye sx O2 therapy IPPB I.S. The real reason dinosaurs became extinct.

Cardiovascular Cardiac assessment data Leg exercises “Okay, Williams, we’ll vote… how many here say the heart has four chambers?” Cardiac assessment data Leg exercises Avoiding venous statsis ICD/hose

Fluid Status Hydration status data Drainage amts vital signs daily weights! IV therapy Blood therapy

Nutrition NPO status Progression of diet check bowel sounds Feedings TPN “The Nurse says a trip-o’-loomin’ cow-filler is feeding Grandma. It has three loops--one for breakfast, one for lunch, and one for dinner!”

Elimination Urinary output Bowel activity Ambulation!!!! retention?!! Dehydration Catheter is the last resort! Bowel activity bowel sounds flatus Ambulation!!!!

Activity OOB ASAP!! Psychological impact Needs encouragement! Usually within 24 hrs Psychological impact Needs encouragement!

Physiology of Wound Healing Inflammatory Stage “insult” Proliferative Stage reinforcemen/framework Maturation Stage “settling in”

Wound Healing: First Intention Scar formation is minimal Properly closed Heal with little tissue reaction

Wound Healing: Second Intention Wound is left open to granulate Resultant in scar formation “Healing by granulation”

Wound Healing: Third Intention Two opposing granulation surfaces are brought together Scar is deeper and wider “Delayed closure”

Factors Affecting Wound Healing Age Hemorrhage Hypovolemia Local Factors Nutritional Deficits Oxygen deficit Drainage Medications Systemic Disorders Wound Stressors

Wound Care “Just a friendly suggestion…next time you do a dressing change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”

Post-op Pain Control What is pain? Factors affecting pain Administration Preventative Approach PRN vs ATC Routes of Administration Intramuscular Intravenous PCA pump/Epidural lines

Post-op Pain Control Common Pain Medication Demerol Morphine Dilaudid Stadol NSAIDs Side Effects of Pain medication*

Managing Potential Complications Shock/Hemorrhage Deep Vein Thrombosis (DVT) Pulmonary Embolism Respiratory Complications Urinary Retention Intestinal Obstruction Wound Complications

Surgery Specific Care Postoperative Uniquities and “worries”

Remember Mr. P? Case Study Review

Perioperative Nursing "Dr. Trueman, can I be excused? My brain is full."