Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 27 Perioperative Care

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Is the following statement true or false? Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart. Question

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins True. Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart. Answer

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Operative Care Perioperative care is care that clients receive before, during, and after surgery Nurses assume general responsibilities when caring for clients during the preoperative, intraoperative, and postoperative periods of perioperative care

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period Starts when client, or his family in an emergency situation, learn that surgery is necessary Ends when client is transported to the operating room

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Surgery According to Urgency

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Inpatient surgery –Term used for procedures performed on a client who is admitted to the hospital, expected to remain at least overnight, and needs nursing care for more than 1 day after surgery –Clients who have inpatient surgery undergo prior laboratory and diagnostic tests

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Inpatient surgery (cont’d) –Anesthesiologist: physician who administers chemical agents that temporarily eliminate sensation and pain –Anesthetist: nurse specialist who administers anesthesia under the direction of a physician

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Removal of a cataract falls under which type of surgery? a. Required b. Emergency c. Urgent d. Elective

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a. Required The type of surgery conducted for the removal of a cataract is called “required surgery.” Surgery for relieving an intestinal perforation is an example of an “emergency surgery.” Removal of a malignant tumor is an example of an “urgent surgery.” Removal of a superficial cyst is known as an “elective surgery.”

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Outpatient surgery –Term used for operative procedures performed on clients who return home the same day

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Advantages and Disadvantages of Outpatient Surgery

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Outpatient surgery (cont’d) –Clients remain in the outpatient surgical suite for a brief time and get discharged by midafternoon or early evening when: oThe client is awake and alert oVital signs are stable oOral fluids are retained

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Laser surgery –Used as an alternative to many previously conventional surgical techniques such as reattaching the retina, removing skin tattoos, and revascularizing ischemic heart muscle

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Laser surgery (cont’d) –Advantages oCost effectiveness oReduced need for general anesthesia oMinimal blood loss oLess time recuperating

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Laser surgery (cont’d) –Laser technology requires unique safety precautions such as eye, fire, heat, and vapor protection –Various safety measures are taken during laser surgery Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Informed consent –Permission for a procedure that a client gives after an explanation of the risks, benefits, and alternatives

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Surgical Consent Form

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative blood donation –Autologous transfusion: self-donated blood –Directed donors: blood donors chosen from among the client’s relatives and friends oIf directed donation not used, it is available for use by other clients Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following types of surgeries is used for removal or replacement of defective tissues to restore function? a. Palliative b. Exploratory c. Curative d. Diagnostic

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c. Curative Curative surgery is used for the purpose of removal or replacement of defective tissues to restore function. Relief of symptoms or enhancement of function without cure is called palliative surgery. Exploratory surgery is a more extensive means to diagnose a problem. Removal and study of tissues to make a diagnosis is called diagnostic surgery.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Immediate preoperative care –Nursing assessment oSurgical risk factors  Low hemoglobin and red cells  Cardiopulmonary disease  Malnutrition  Dehydration Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Immediate preoperative care (cont’d) –Preoperative teaching oDeep breathing oCoughing oLeg exercises oPostoperative pain management Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Immediate preoperative care (cont’d) –Physical preparation oSkin preparation oElimination oFood and fluid restrictions Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Period (cont’d) Immediate preoperative care (cont’d) –Physical preparation (cont’d) oCare of valuables oSurgical attire oDisposition of dentures and prostheses

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Immediate preoperative care (cont’d) –Preoperative medications –Psychosocial preparation –Preoperative checklist Preoperative Period (cont’d)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preoperative Checklist

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Receiving room Operating room Surgical waiting area Intraoperative Period

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Intraoperative Period (cont’d) Anesthesia –General: central nervous system –Regional: specific area of the body oLocal oSpinal, epidural, peripheral nerve blocks –Conscious sedation: clients are sedated, a state of relaxation and emotional comfort but not unconsciousness; client can respond verbally and physically

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following postoperative complications is a protrusion of abdominal organs through separated wounds? a. Wound infection b. Adynamic ileus c. Dehiscence d. Evisceration

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer d. Evisceration A postoperative complication in which abdominal organs protrude through separated wounds is called evisceration. A wound infection indicates proliferation of pathogens at or beneath the incision. An adynamic ileus signifies lack of bowel activity, and dehiscence indicates separation of incisional edges.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Postoperative Period Immediate postoperative care –Initial postoperative assessments –Preparing the room –Monitoring for complications Continuing postoperative care –Food and oral fluid intake

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Postoperative Period (cont’d) Continuing postoperative care (cont’d) –Promoting venous circulation oPneumatic compression device oAntiembolism hose –Wound management –Elimination

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Pneumatic Compression Device

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Postoperative Period (cont’d) Continuing postoperative care (cont’d) –Discharge instructions oHow to care for the incision site oSigns of complications to report oWhich foods to consume or avoid oWhen and where to return for a medical appointment

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Applicable nursing diagnoses –Deficient knowledge, fear, acute pain –Risk for ineffective therapeutic regimen management, infection, impaired gas exchange, deficient fluid volume –Ineffective breathing pattern, airway clearance –Impaired skin integrity, disturbed body image

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Chronic health concerns in older clients may increase preoperative/postoperative periods Muscle atrophy occurs in older adults who have been on bed rest as little as 1 or 2 days; range-of-motion exercises can maintain mobility Important to assess client’s support system for care at home; client may need home rehabilitation services or extended care admission

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Wound healing may occur more slowly due to impaired circulation and oxygenation; poor hydration and nutrition Postoperative signs and symptoms may be more subtle or delayed; change in mental status may be early indicator of infection Cardiac status of older adults is monitored carefully after surgery