1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 40 Nursing Care of the Perioperative Client

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Surgical Interventions Surgery according to urgency –Emergency Requires immediate intervention to sustain life –Urgent Necessary to maintain health in non-life-threatening situations –Elective Convenient for client and physician (continued)

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Surgical Interventions Interventions based on expected outcomes –Diagnostic and exploratory –Reconstructive –Curative –Palliative –Transplant

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Setting Minor surgery –Ambulatory care centers –Physician offices Urgent or elective surgery –Outpatient surgery areas One-day surgery centers Freestanding ambulatory clinics

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Client Safety The Joint Commission National Patient Safety Goal for surgeries and procedures: –Prevent surgical infections –Identify intended site –Perform time-out

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anesthesia General Regional Local

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Assessment –Nursing history –Medical history –Medications Herbs Allergies (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Assessment –Age-related considerations –Social and cultural considerations –Spiritual considerations –Psychosocial status (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Assessment –Physical assessment General survey –Head and neck –Upper extremities –Anterior and posterior chest and abdomen –Lower extremities (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Diagnosis –Deficient knowledge –Anxiety –Fear (continued)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Planning and outcome identification –Collaboration Surgeon Anesthesia provider Registered nurse (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Implementation –Surgical consent form –Preoperative checklist –Client teaching Types of surgical incisions Postoperative exercise instruction (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Implementation –Other devices Antiembolism stockings Pneumatic compression device Continuous passive motion device Transcutaneous electrical nerve stimulation (TENS) unit PCA (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Implementation –Physical preparation Skin preparation Nutrition Gastrointestinal preparation Urinary elimination Safety precautions Medications (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Preoperative Phase and the Nursing Process Evaluation –Client’s ability to verbalize and demonstrate exercises –Documentation

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase Surgical environment Holding area Occupational hazards

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase and the Nursing Process Assessment –Client’s identification band –Surgical site confirmation –Ability to position client –Preparation of operating room (OR) bed –Availability of accessories (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase and the Nursing Process Diagnosis –Risk for perioperative-positioning injury –Risk for injury –Risk for infection –Hypothermia (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase and the Nursing Process Planning and outcome identification –Meet surgeon’s needs for positioning –Alleviate or prevent client problems –Determine best mode of client transfer –Prepare equipment and positioning aids –Collaborate (continued)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase and the Nursing Process Interventions –Surgical asepsis –Skin preparation –Positioning and draping –Electrical hazards –Heat loss –Monitoring of physiological functioning (continued)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intraoperative Phase and the Nursing Process Evaluation –Transfer to post-anesthesia care unit

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Assessment –Respiratory status Airway Breathing (continued)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Assessment –Total assessment Circulation Neurologic status Fluid and metabolic status Pain Wound management (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Diagnosis –Ineffective airway clearance –Ineffective breathing pattern –Ineffective tissue perfusion –Deficient fluid volume –Imbalanced nutrition Less than body requirements (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Diagnosis –Urinary retention –Acute pain –Risk for infection –Situational low self-esteem (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Planning and outcome identification –Post-anesthesia care unit (PACU) care –Post-PACU care –Prioritized according to type of anesthesia and surgical interventions (continued)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Interventions –Monitor respiratory status Extubation –Monitor circulatory status –Monitor neurologic status –Monitor fluid and metabolic status –Manage pain (continued)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Evaluation and discharge from PACU –Is conscious, oriented, and moves all extremities –Demonstrates full return of reflexes –Clears airway and coughs effectively –Exhibits stable vital signs –Has adequate intake and output –Controls body temperature –Has stable wounds (continued)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Ongoing postoperative care –Ineffective airway clearance –Ineffective tissue perfusion –Deficient fluid volume –Imbalanced nutrition –Urinary retention –Acute pain –Risk for infection (continued)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Postoperative Phase and the Nursing Process Evaluation –Ongoing process –Refer to diagnoses and outcomes –Variable time frame