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Published byGriffin Hunter Modified over 8 years ago
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ANS Unit 4 The Surgical Client
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Surgery Involves entering tissue and removing or reconstructing structures that are diseased, injured or malformed
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Surgery Intervention Invasive
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Perioperative Care Total Span of care: Preop Intraop Postop
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Surgical Facilities Hospital Ambulatory center Surgicenter Clinic MD office
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Nursing Interventions common to all surgery Emotional support Physically prepare pt. Verify legal aspects Pt. / family teaching Provide pre/post care
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Nursing Interventions Amt of time varies with each case and where performed - inpatient vs. out - level of surgery
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Level of patient choice in surgery Optional / Elective Required / Nonelective Urgent / Nonelective Emergency
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Anesthesia Loss of sensation administered by: - Anesthesiologist - CRNA (anesthetist)
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Types of anesthesia General Regional - spinal - local - topical
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General anesthesia Eliminate all sensation Loss of consciousness IV, inhalation, rectally Levels vary Often intubated - resps. paralyzed
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Regional anesthesia Blocks sensation in an area Consciousness is unaffected
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Spinal (regional) Eliminates sensation in legs, lower abd, pelvis spinal - subarachnoid - keep flat afterwards epidural - outside dura
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Local (regional) Blocks sensation in circumscribed area of skin and subQ tissues lidocaine to skin
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Topical (regional) Inhibits sensation in epithelial tissues Skin and mucous mem. Oragel for baby’s gums
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Identifying surgical risks All pt. Evaluated MD does H&P Nurse does own H&P and then THINKS!!
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Things to look for: Previous illness Medications: - ASA, Coumadin - Cardiac meds - Diuretics
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Verify and collect: Allergies Baseline vital signs Height and weight General health Skin condition
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Lab work and Tests MD will order Nurse to check results Call MD if any abnormal
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Urinalysis or UA Checks for: - UTI - Renal disease - Diabetes
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CBC with differential Looks for: - Anemia - Infection - Decreased immunity
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PT & PTT Protime ~ 9-12 seconds Partial thromboplastin time ~ 20 - 45 seconds Looks for bleeding tendencies Routine if on anticoags
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Fasting Blood Sugar (FBS) Diabetes fasting = 60 - 110 nonfasting = 60 - 125
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Blood Urea Nitrogen (BUN) Renal disease normal = 7-18
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Other ordered tests: Type and crossmatch - for possibility of transfusion CXR-chest x-ray EKG-electrocardiogram
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