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

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

3. 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

4. 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

5. 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

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

7. 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

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

9. 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

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

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

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

13. 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…

14. 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

15. 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

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

17. 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

18. 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

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

20. 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

21. 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

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

23. 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

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

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

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

27. 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

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

29. 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

30. 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

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

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

33. 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

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

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

36. THE END!!!!!