1. Caring for Clients Having Surgery10
Caring for Clients Having Surgery

2. Learning Outcomes Describe the classifications of surgical procedures.
Discuss the meaning and implications of informed consent, including the nurse’s responsibilities related to informed consent.
Describe interdisciplinary perioperative care, including laboratory and diagnostic tests and related nursing responsibilities.

3. Learning Outcomes
Describe nursing implications for medications prescribed for the surgical client.
Discuss appropriate nursing care for the client in the preoperative, intraoperative, and postoperative phases of surgery.
Identify variations in perioperative care for the older adult.

4. Learning Outcomes
Describe principles of pain management for postoperative pain control.
Compare and contrast outpatient and inpatient surgery.

5. Surgery Surgery, no matter how minor, causes stress and
poses risks for complications
Many variables, such as the procedure performed, age of the client and co-existing medical conditions determine the care a client needs before, during and after surgery

6. Types & Settings of Surgeries
Purpose, Risk factors, Urgency (table 10-1)
Inpatient
Admitted to hospital before and after surgery
Outpatient (Ambulatory)
Performed outside of the hospital
Under local or general anesthesia

7. Inpatient Surgery Hospitalized client
Administered regional, general, or conscious sedation anesthesia
Costly
Teaching and emotional support differ from outpatient surgery

8. Outpatient Surgery Nonhospitalized client
Administered local or general anesthesia
Discharged immediately after procedure or short time after procedure
More cost effective than inpatient care
Physical care same as inpatient surgery
Teaching and emotional support differ from inpatient surgery

9. Perioperative Nursing
Describes entire span of surgery
Preoperative phase
Intraoperative phase
Postoperative phase

10. Informed Consent
Legal document required for procedures or therapeutic measures
Protects the client, nurse, physician, health care facility
Most states require 18 years of age or older to sign - Married minors and emancipated minors may sign consent
Spouses, children, significant other cannot sign instead of a capable adult

11. Psychological Preparation of Client and Family for Surgery
Significant and stressful event that produces anxiety
Listen actively to verbal and nonverbal communication
Establish trusting relationship
Use of therapeutic communication

12. Surgical Risk Factors Advanced age Obesity Malnutrition
Dehydration/electrolyte imbalance
Cardiovascular disorders
Respiratory disorders
Diabetes mellitus
Renal and liver dysfunction
Alcoholism
Smoking
Medications
Anticoagulants
Diuretics
Antihypertensives/ antidepressants
(table 10-2)

13. Laboratory/Diagnostic Studies (Preoperative)
Physical Preparation : LABS
Complete blood count (CBC)
Serum electrolytes
Coagulation studies
Urinalysis
Chest x-ray
Electrocardiogram (ECG)

15. Physical Preparation Physical Preparation
Preoperative Medications, pg 207
Antibiotics
Benzodiazepines/Sedatives/Tranquilizers
Opioids
Histamine-2 receptor antagonists
Proton Pump Inhibitors
Antiemetics
Anticholinergics
REVIEW: Drug Therapy Table 10-4, pg 207

16. Physical Preparation Physical Preparation Skin preparation
Insertion of indwelling urinary catheter
Bowel preparation
Withholding of food and fluids

17. Preoperative Assessment
Medical history
Accurate height and weight
Assistance after the surgical procedure
Understanding of surgical procedure
Informed consent
Vital signs
*Review Box Checklist

18. Preoperative Teaching
Laboratory and diagnostic tests
Prescribed preparations
Time to arrive at the hospital
Preparations for day of surgery
Medication taken night before
Informed consent
Timetable for surgery and recovery room

19. Preoperative Teaching
Location of waiting area
Procedure for transfer to recovery room
Anticipated postoperative routine and devices or equipment
Postoperative pain control

20. Surgical Team Surgeon Surgical assistant Anesthesiologist
Circulating nurse
Scrub nurse

21. OR Environment Isolated; Restricted access
Filtered air; Positive pressure maintained
Three designated zones: Unrestricted zone; Semi-restricted zone; Restricted zone
Efficient design; Stainless steel furniture
Temperature < 70ºF
Specific OR attire: Decreases microbial growth

22. Intraoperative Medications
General anesthesia
Regional anesthesia
Conscious sedation
Antidotes for reversal of effects

23. Infection Control
Nursing Interventions to Prevent Periop Complications:
Surgical attire
Surgical scrub
Client preparation

24. Intraoperative
Positioning

25. TABLE 10-5 (continued) Common Surgical Positions

26. Immediate Postoperative Period
Client safety; Critical considerations; Observation, monitoring
Initial assessment
Respiratory status; circulatory status, intake and output, LOC, and pain
Major responsibility: Client’s PACU stay
Prevent potential post-op complications
Hemorrhage; Shock; Hypoxia; Aspiration (pg )

27. Nursing Interventions to Promote Wound Healing
Wounds heal by primary, secondary, and tertiary intention
Monitor for wound drainage
Serous drainage
Sanguineous drainage
Purulent drainage
Teach client wound care

29. Postoperative Medications
Opioid analgesics
Nonsteroidal anti-inflammatory drugs

31. Postoperative Complications
Cardiovascular complications
Shock
Hemorrhage
Deep venous thrombosis
Pulmonary embolism

32. Postoperative Complications
Respiratory complications
Pneumonia
Atelectasis
Elimination complications
Urinary retention
Altered bowel elimination

33. Postoperative Complications
Wound complications
Infection
Dehiscence
Evisceration

34. Postoperative Teaching
Wound care
Manifestations of a wound infection
How and when to take a temperature
Limitations or restrictions on activities
Control of pain