1. Slide 1 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Chapter 42 Care of the Surgical Patient - Perioperative Nursing - Influencing Factor - Psychosocial Needs - Socioeconomic & Cultural Needs - Medications - Education & Experiences Chapter 42 Care of the Surgical Patient - Perioperative Nursing - Influencing Factor - Psychosocial Needs - Socioeconomic & Cultural Needs - Medications - Education & Experiences

2. Slide 2 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Surgery  The branch of medicine concerned with diseases and trauma requiring operative procedures  Gave physicians means to treat conditions that were difficult or impossible to manage only with meds  Nurses in first OR cleaned rooms and equipment, performed technical tasks like obtaining supplies, accompanied patient to surgical ward to deliver nursing care  Classified as elective, urgent, or emergency

3. Slide 3 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Surgery  Elective Not necessary to preserve life and performed when patient chooses  Urgent Required to keep additional health problems from occurring  Emergency Performed immediately to save the individual’s life or preserve function of a body part

4. Slide 4 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Surgery for various purposes  Diagnostic study, reconstructive, transplant, constructive  Ablation Amputation or excision of any part of body or removal of a growth or harmful substance  Palliative Therapy designed to relieve or reduce intensity of uncomfortable symptoms without cure Surgical Terminology  See table 42-2, pg 1264

5. Slide 5 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Common Variations of Surgical Settings (Box 42-1)  Inpatient: Patient hospitalized for surgery  One-day (same-day surgery): Patient is admitted the day surgery is scheduled and dismissed the same day  Outpatient: Patient, not hospitalized, who is being treated; individual is admitted either to a short-stay unit or directly to the surgical suit

6. Slide 6 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Common Variations of Surgical Settings (Box 42-1)  Short-stay surgical center (“surgicenter”): Independently owned agency; surgery performed when overnight hospitalization is not required Also called ambulatory surgical center or one-day surgery center  Short-stay unit: Department or floor where a patient’s stay does not exceed 24 hours Sometimes referred to as outpatient

7. Slide 7 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Classification of surgical procedures  Seriousness Major  Extensive reconstruction of or alteration in body parts  Poses great risks to well-being o Examples: Coronary artery bypass, gastric resection Minor  Minimal alteration in body parts  Designed to correct deformities  Involves minimal risks o Examples: Cataracts, tooth extraction

8. Slide 8 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Urgency  Elective Patient’s choice  Example: Plastic surgery, bunionectomy  Urgent Necessary for patient’s health  Examples: Excision of tumor, gallstones, coronary artery bypass  Emergency Must be done immediately to save life or preserve function  Example: Control of hemorrhage, perforated appendix, repair of traumatic amputation

9. Slide 9 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Purpose  Diagnostic Confirm diagnosis; removal of tissue for more testing  Example: Exploratory laparotomy, breast mass biopsy  Ablation Excision or removal of diseased body part or removal of a growth or harmful substance  Examples: Amputation, cholecystectomy  Palliative Relieves or reduces intensity of disease symptoms Will not produce cure  Example: Colostomy, debridement of necrotic tissue

10. Slide 10 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to the Surgical Patient Purpose (continued)  Reconstructive Restores function or appearance to traumatized or malfunctioning tissue  Example: Internal fixation of fractures, scar revision  Transplant Replaces malfunctioning organs or structures  Examples: Kidney, cornea, joints, heart  Constructive Restores function lost or reduced as result of congenital anomalies  Example: Repair of cleft palate, closure of atrial-septal defect

11. Slide 11 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Entire operative process which includes:  Preoperative Before surgery  Intraoperative During surgery  Postoperative Following surgery Concept of perioperative nursing:  Stresses importance of providing continuity of care for surgical patient using nursing process

12. Slide 12 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Perioperative nurses assess:  Patient’s health status preoperatively  Identify specific patient needs  Teach and counsel  Attend to patient’s needs in OR  Follow patient’s recovery Nurse’s major responsibility:  Safe, consistent, and effective nursing interventions during each phase of surgery

13. Slide 13 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Influencing factors  Age Young and older patients’ metabolic needs such as temperature changes, cardiovascular shifts, respiratory needs, and renal function, may not respond to physiological changes quickly To assist to return to maximal level of health, nursing assessments and appropriate interventions should be ongoing  Physical condition Healthy patients have smoother and faster recovery Coexisting health problems are slower to recover Assess each system to identify actual and potential problems

14. Slide 14 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing ABCDE Mnemonic Device to Ascertain Serious Illness or Trauma in the Preoperative Patient  A: allergy to medications, chemicals, environmental products like latex All allergies are reported to anesthesia and surgical personnel before beginning of surgery If allergies exist, an allergy band must be place on arm  B: Bleeding tendencies or use of medications that deter clotting like aspirin, heparin and warfarin sodium Herbal medications increase bleeding times or mask potential blood-related problems

15. Slide 15 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing ABCDE Mnemonic Device to Ascertain Serious Illness or Trauma in the Preoperative Patient  C: Cortisone or steroid use  D: Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but is also known to delay wound healing  E: Emboli; previous embolic events (like lower leg blood clots) may recur because of prolonged immobility Suppressed immune system are higher risk for development of postop infection and have a dininished capacity to fight infection

16. Slide 16 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Influencing factors  Nutritional factors Body uses carbohydrates, proteins, fats to supply energy-producing glucose to its cells Carbohydrates and fats are primary energy producers Protein is essential to build and repair body tissue Stressful condition  Body need for energy and repair increases Patient who maintain a sound, nutritional diet recover more quickly

17. Slide 17 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Influencing factors  Nutritional factors Influenced by: ethnic, cultural, religious, socioeconomic background, history highlights food preferences and dislikes Surgery alters appetite and metabolic functions, therefore must watch-out for malnutrition

18. Slide 18 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Psychosocial needs  Fear of loss of control (anesthesia)  Fear of the unknown (outcome, lack of knowledge)  Fear of anesthesia (waking up)  Fear of pain or inadequate post-operative analgesia (pain control)  Fear of death (surgery, anesthesia)  Fear of separation (support group)  Fear of disruption of life patterns (ADLs, work)  Fear of change in body image and mutilation  Fear of detection of cancer

19. Slide 19 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Socioeconomic and cultural needs  Patients are from different social, economic, religious, ethnic, cultural origin  Geographic location affect the way individual responds  Different cultures react to preoperative experience in different ways Nursing from multicultural perspective assists nurses to have a frame of reference in approaching patients with respect to individually tailor care that promotes recovery

20. Slide 20 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Medications  Review current medication regimen  Multiple medications predisposes patients to adverse drug reactions and interactions with other medications in perioperative setting  Pharmacologic categories used in patients Anesthesia agents, antimicrobials, anticoagulants, hemostatic agents, oxytocics, steroids, diagnostic imaging dyes, cns agents Large number of medications increases the chance of interactions

21. Slide 21 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Medications – cont’d  Ask about herbal remedies/medications See table 42-3, pg 1262  Assess for allergies to drugs that may be given during any phase of surgical experience  Enquire about nondrug allergies: Food, chemical, pollen, antiseptics, latex rubber products  Flag the front of patient’s chart to alert all health care provides to allergy status of patient

22. Slide 22 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Education and experience  Tailor information to a patient’s educational level permits fear to be replace with accurate knowledge  Encourage patient to repeat or summarize what has been presented  Preoperative anxiety level influence Amount of anesthesia required Amount of postoperative pain medication needed Speed of recovery from surgery

23. Slide 23 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing Education and experience – cont’d Unhurried and understanding nurse who listens to patient, family, significant others invites confidence and helps to promote reduction of anxiety levels  In addition to nursing and medical personnel, support can be provided to patients and their families by ministerial staff, social workers, patient advocates during this stressful time  Figure: often, knowledge deficits occur when the patient is undergoing her first surgical experience

24. Slide 24 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Perioperative Nursing