perioperative nursing lecture ppt

PERIOPERATIVE NURSING - it is the nursing care rendered to the total surgical

experience of the patient.

3 Phases Preoperative phase

Intraoperative phase

Postoperative phase

EFFECTS OF SURGERY ON A CLIENT

A. Physical Effects

B. Psychological Effects

THE SURGICAL RISK PATIENTSA. Extremes of ageB. Malnourished (emaciation/obesity)C. Dehydrated patientsD. Patients with severe trauma or injury, infection or sepsisE. Patients with cardiovascular diseaseF. Endocrine dysfunctionG. Hepatic/Renal disease

MEDICATIONS THAT CAN AFFECT THE SURGICAL CLIENT Antibiotics

Antidysrhythmics Anticoagulants Corticosteroids Insulin Diuretics Antidepressant

CLASSIFICATIONS OF SURGERY

According to Urgency:1. Emergent – requires immediate attention;

Disorders maybe life-threatening.2. Urgent- surgical problem requires prompt

attention within 24-30hrs3. Required- condition requires surgery within

a few weeks 4. Elective- approximate time for surgery is at

the convenience of the patient, failure to have surgery is not catastrophic

5. Optional- is scheduled completely at the preference of the patient.

CLASSIFICATION OF SURGERYAccording to Degree of Risk: Major- high degree of risk > maybe complicated/prolonged > large losses of blood may occur > vital organs maybe involved > post-op complications may be likely

Minor- little risk with few complications > often performed in a day

CLASSIFICATIONS OF SURGERYAccording to Purpose1. Diagnostic- verifies suspected diagnosis2. Exploratory- estimates the extent of the disease or injury3. Curative- removes/repairs damage tissues4. Ablative- Removing diseased organ that cant wait

anymore5. Reconstructive-partial or complete restoration; bringing

back orig. appearance and function

Cont.

Constructive- repairing damaged tissue/congenitally defective organ

Palliative – relieves symptoms but does not cure the underlying diseases

PREOPERATIVE PHASE

INFORMED CONSENT(OPERATIVE PERMIT)

OBTAINING INFORM CONSENT1. The surgeon is responsible for obtaining the consent for surgery.2. No sedation should be administered to the client before he/she

signs the consent.3. Minors may need a parent or legal guardian to sign the consent

form.4. Older client may need a legal guardian to sign the consent form.5. The nurse may witness the client’s signing of the consent form.6. If the patient is unable to write, an “X” to indicate his sign is

acceptable if there is a signed witness to his mark.

POCEDURES REQUIRING PERMIT1. Surgical procedures where scalpel,scissors, suture,

hemostats or electrocoagulation maybe used.2. Entrance into a body cavity3. Radiologic procedure, particularly if contrast material is

required.4. General anesthesia, local infiltration and regional block

PHYSICAL PREPARATION OF PATIENT THE NIGHT BEFORE SURGERY

1. NPO- 6-8hrs (general and spinal anesthesia) 2-4hrs (local anesthesia)

2. Bowel Prep- for major abdominal surgery

3. Skin prep- shower with antibacterial soap

PREOPERATIVE TEACHING/VISIT Physical Preparation

Psychological Preparation

POSTOPERATIVE EXERCISES

Deep breathing - every 2hrsCoughingSplinting  Turning – every 2hrs

FOOT AND LEG EXERCISE

INCENTIVE SPIROMETERPositive Effects - provides stimulus

for a spontaneous deep breath

- reduces atelectasis

- opens airways - stimulates

coughing - encourage active

individual participation in recovery

PREOPERATIVE MEDICATIONS1. Narcotic analgesic 2. Anticholinergics

3. Sedatives

4. Prophylactic antibiotic

SURGICAL CHECKLIST Identification and verification Review of patient’s record Consent form Patient preparedness

1. NPO status 2.Proper attire (hospital gown) 3. Skin prep, if ordered 4. IV started with correct gauge needle 5. Dentures or plates removed 6. Jewelry, contact lenses 7. allow patient to void

G 24G 22 G 20 G18

IV Cannulas

INTRAOPERATIVE PHASE

ASEPTIC TECHNIQUE

A group of procedures that prevent contamination of microorganisms through the knowledge of contain and control.

Sterile Technique• Methods by which contamination of

an item is prevented by maintaining the sterility of an item/area involved with the procedure.

BASIC PRINCIPLES OF ASEPTIC TECHNIQUE 1. All items used within the sterile field must be sterile.2. A sterile barrier that has been permeated must be

considered contaminated.3. The edges of a sterile wrapper or container are

considered unsterile once the package is opened.4. Gowns are considered sterile from chest to the level

of the sterile field, and the sleeves to 2inches above the elbows.

• Tables are sterile at table level only.• Sterile persons and items touch only

sterile areas; unsterile persons and items touch only unsterile areas.

• Movement around the sterile field must not contaminate the field.

• All items and areas of doubtful sterility are considered contaminated.

RECOMMENDED PRACTICE IIIItems used within the sterile field should be sterile

Event-related sterility system - sterility is not altered overtime, but may be

compromised by certain events/environmental conditions

Shelf life - refers to the time an item may remain on the

shelf and still maintain its sterility.Spaulding Criteria - are used to determine the potential for

transmission of infectious agents.

RECOMMENDED PRACTICE IVAll items introduced to a sterile field should be opened,

dispensed and transferred by methods that maintain item sterility and integrity.

1. The surgical team should practice careful aseptic technique during all invasive surgical procedures.

2. Unscrubbed individuals should open wrapped sterile supplies by opening the wrapper flap farthest away from them first.

3. Sharps and heavy objects should be presented to the scrubbed person/opened on a sterile surface.

4. Peel pouches should be presented to the scrubbed person.

5. Rigid container systems should be opened on a separate surface.

When dispensing solutions, the solution receptacle on the sterile field should be placed near the table’s edge, or held by scrubbed person.

Strike- through - contamination of sterile surface by moisture that has originated from a non-sterile surface and penetrated the protective covering of the sterile item

Medications should be delivered to the sterile field in an aseptic manner.

Recommended practice VA sterile field should be maintained and

monitored constantly.1. A sterile field should be prepared in the

location in which it will be used.2. For unsterile personnel, movement around

the sterile field should maintain a distance of at least 12 inches from the sterile field.

3. Sterile fields should be prepared as close as possible to the time of use.

4. Sterile field should not be covered.5. Conversations in the presence of a sterile

field should be kept to a minimum.

RECOMMENDED PRACTICE VIAll personnel moving within or around a sterile field should

do so in a manner that maintains the sterile field.Unscrubbed personnel - should face sterile fields on approach - should not walk between two sterile fieldsScrubbed personnel - should keep their arms and hands above the level of the

waist at all times. - arms should not be folded with the hands in the armpits - should avoid changing levels.The number and movements of the surgical team should be

kept to a minimum.When a break in the sterile technique occurs, corrective

action should be taken immediately.

RECOMMENDED PRACTICES FOR TRAFFIC PATTERNS IN THE PERIOPERATIVE PRACTICE SETTINGNon- Restricted Area

Semi-Restricted Area

Restricted Area

Transition Zone

RECOMMENDED PRACTICES FOR SURGICAL ATTIRE

Surgical Attire

Helps contain bacterial shedding and promotes environmental control.

If a two-piece pantsuit is worn, the top of the scrubsuit should be secured at the waist or fit close to the body.

Should be changed daily or whenever it becomes visibly soiled, contaminated or wet.

Lab coats/cover gowns should be removed before entering a semi- restricted/restricted area

Non-scrubbed personnel should wear long-sleeved jackets that are buttoned/snapped closed during use.

HEAD COVERHeadgear should be donned before the scrub attire to prevent fall-

out from the hair collecting on the scrub attire.Personnel should cover head and facial hair, including sideburns and

necklines, when in the semi-restricted and restricted areas of the surgical suit.

Contaminated headgear must be removed and laundered by the facility.

SURGICAL MASKShould fully cover both mouth and nose and be secured in a manner

that prevents venting.Double mask is unacceptable, doesn’t increase filtration.Should be removed by handling only the ties, should be discarded

immediately.Should not be saved by hanging them around the neck or tucking

them into a pocket for future use

GLOVESSterile gloves must be worn when performing sterile procedure.Medical, non sterile gloves are recommended for non-sterile

activities.Should be changed between patient contacts/contaminated items.Hand hygiene should be performed after gloves are removed.

RECOMMENDED PRACTICES FOR STANDARD AND TRANSMISSION –BASED PRECAUTIONS IN THE PERIOPERATIVE PRACTICE SETTING

Standard Precautions to prevent pathogen transmission should be used during all invasive procedures.

Standard Precautions should include use of protective barriers and frequent hand washing to reduce risk of exposure to potentially infectious materials.

Personnel should take precautions to prevent injuries caused by scalpels and other sharp instruments.

Personnel should handle specimens as potentially infectious material.

Work practices should be designed to minimize risk of occupational exposure to bloodborne and other potentially infectious pathogens.

Transmission –based precautions should be used in addition to standard precautions for patients who are known or suspected to be infected with highly transmissible pathogens.

1. Airborne precautions - examples: rubeola, varicella, tuberculosis - respiratory protection to be worn by susceptible

persons - placing surgical mask on patients during transport - elective surgical procedures on TB patients should be

delayed until patient is no longer infectious.2. Droplet precautions - examples: diptheria,pertussis,influenza,mumps - wearing a mask when within three feet of patients - positioning patients at a distance of at least three

feet from other patients

3. Contact Precautions - wearing gloves when caring for patients/coming in contact with

items that may contain high concentrations of microbes. - wearing gowns when it is anticipated that clothing will have

substantial contact with patients/items in aegs. environment - precautions are maintained during transport. - adequately cleaning and disinfecting patient care equipment and

items before use w/ each patient.

SURGICAL HAND SCRUB

Goals:Mechanical removal of soil and transient

microbes from the hands and forearmsChemical reduction of the resident microbial

count to as low a level as possibleReduction of potential of rapid rebound growth

of microbes. Antimicrobial Agents Iodophors Chlorhexidine gluconate

Anatomic Hand Scrub Technique

Sequence in Removing Soiled Gowns and Gloves at the End of the Procedure

PREPARATION OF SURGICAL SUPPLIES

Decontamination – contaminates are removed either by hand cleaning or mechanical methods using specific solutions.

Disinfection-to used to destroy/kill/inhibit growth of microbes thru application of antiseptic solution.

Sterilization- rendering an item totally free of all living microorganisms including spores.

SurgeonAnesthesiologi

stScrub NurseCirculating

Nurse

MEMBERS OF THE SURGICAL TEAM

CIRCULATING NURSE/SCRUB NURSE

CIRCULATING NURSESets up the Operating roomEnsures that necessary supplies and equipment are readily available,

safe and functionalReceives patient endorsementAssists in the transferring of client in the OR bedPositions patient in the OR bedPerforms surgical skin preparationOpens and dispenses additional needed supplies /medications during

surgeryManages catheters, tubes, drains and specimensReviews the results of any diagnostic tests or lab studies

Ensures that the surgical team maintains sterile technique and a sterile field.

Monitors traffic in the ORManages the flow of information to and from the surgical team members

scrubbed at the fieldManages personnel, equipment, supplies and the environment during

surgeryPerforms “sharps”, sponge and instrument count at appropriate timeDocuments all care, events, findings and patient’s responses intra-opDressing of wound and drainageCare of the tissue specimen

Scrub NursePerforms scrubbing, gowning and glovingPrepares sterile field for scheduled/emergency surgeryAssists with instrumentation, sponges and suture presentationAnticipate needs for surgical teamPerforms “sharps”, sponge, and instrument countPrepares sterile dressing w/c will be applied when surgery is completedAftercare of instruments and other materials Care of tissue specimen

PARAPROFESSIONALS/ANCILLARY POSITIONSPrepares and maintains supplies, equipment and environmentAssists nursing staff before, during and after surgical procedure

ANESTHESIA AND RELATED COMPLICATIONSCommon Anesthetic Technique Minimal SedationPatient remains consciousProtective reflexes remain intactCan respond to verbal commandsModerate Sedation -state of depressed level of consciousness that does

not impair patient’s ability to maintain a patent airway and to respond to physical stimulation and verbal commands.

Deep Sedation- Drug induced state during which the patient cant be

easily aroused but can respond purposefully after repeated stimulation

GENERAL ANESTHESIA

Complete loss of consciousnessA reversible state that provides

analgesia, muscle relaxation and sedation

It depresses the cerebral cortex where conscious interpretation of pain takes place

Protective reflexes are lostProduced by IV/inhaled anesthetics

NITROUS OXIDEColorless, odorless non-explosive gasIs rarely used alone When combined with other agents and oxygen----it already serves as

“potentiator for other inhalation agents”High concentration nitrous oxide can produce hypoxiainduction agent given with oxygenused alone for short proceduresused as inhalation analgesic

INHALATION ANESTHESIAVolatile agents 1. Halothane - safe to use - producing rapid smooth induction - non-flammable/non-explosive - very potent - seldom causes nausea and vomiting - non-irritating to mucous membranes -excellent bronchodilator - hepatotoxic -decreases bp - causes malignant hyperthermia

FORANE (ISOFLOURANE)Provides rapid induction, rapid emergenceLow incidence of nausea and vomitingDoes not stimulate excessive secretionsNon-hepatotoxic/non-nephrotoxicExcellent choice for neurosurgeryNot recommended for children under 2 years of age------due to longer

airway irritation

ENFLURANEHas similar effects to halothaneMuscle relaxation is strongerHepatotoxicity is not a problemInduces electroencephalographic changes causing seizure.

COMPLICATIONS OF GENERAL ANESTHESIA1. Aspiration2. Oral trauma3. Hypoventilation4. Cardiac dysrrythmias5. Hypothermia6. Malignant Hyperthermia

From To Patient’s response Patient care consideration

Induction of general anesthesia

Beginning to lose consciousness

Drowsy, dizzy, hearing becomes exagerrated, pain sensation is decreased

Close OR doors, keep room quiet

Loss of conciousness,excitement phase

Relaxation,light hypnosis

Loss of consciousness,loss of lid reflexes.incresed muscle tone and involuntary motor response

Lightly restrain patient, remain at patient’s side but ready to assist

Regular pattern of respiration

Total paralysis of intercostal muscles and cessation of voluntary respiration

Regular respiration,contracted pupils reflexes disappear

Position patient and prepare skin

Danger stage, vital functions too depressed

Respiratory failure,possible cardiac arrest

Not breathing,little or no pulse or heart beat

Prepare for cardiopulmonary resuscitation

OXYGEN TANK COMPRESSED AIR

NITROUS OXIDE

REGIONAL ANESTHESIAProduction of anesthesia in a specific body partInjecting local anesthetics in close proximity to appropriate nervesSpinal AnesthesiaLocal anesthetic is injected into lumbar intrathecal space/sub

arachnoid spaceAnesthetic blocks conduction in spinal nerve roots and dorsal gangliaParalysis and analgesia occur below level of injectionProduces excellent analgesia and relaxation to abdominal and pelvic

procedures

Positioning Surgical Patient (Spinal Anesthesia)

Sitting PositionLateral Position

EPIDURAL ANESTHESIA

Injecting local anesthetic into epidural space by way of a lumbar puncture

Associated with obstetric surgery; anorectal and perineal procedure

Administered via bolus

Peripheral Nerve BlocksAnesthetic is injected around a nerve that supplies sensation

to a small area of the body

INTRAVENOUS BLOCK Involves IV injection of a local agent and the use of an occlusion

tourniquetProcedures involving the arm, wrist and hand

Local Anesthesia (Infiltration)Used for minors and superficial proceduresThe agent is injected in the surgical site

Topical AnesthesiaAnesthetic agent is directly applied to the skin and mucous

membranes

COMPLICATIONS OF SPINAL ANESTHESIA

Hypotension

Nausea and vomiting

Urinary retention

Post spinal headache

Quadrants Of the Abdomen Regions of the Abdomen

Abdominal Incisions

 POSITIONING SURGICAL PATIENT

Positioning: A Team Concept  5 Factors to be considered when positioning a surgical patient

 Anatomy involved with the procedureSurgical Approach/surgeon’s preferencePatient comfortPatient and staff safetyRespiratory and circulatory freedom 

Supine (Dorsal Recumbent)

Procedures:

• Abdominal• Extremity• Vascular• Chest • Neck• Facial• Ear

• BreastLithotomy

Procedures:

• Perineal• Vaginal

• Combined abdominal-vaginal

Lateral Recumbent

Procedures:

ChestKidney

Kraske (Jacknife)

Procedures:

• Rectal Procedures

• Sigmoidoscopy• Colonoscopy

Trendelenburg

Procedures:

• Lower abdominal• Pelvic Organs

Prone

Procedures:

• Surgeries involving the posterior surface of the body• Spine• Neck

• Buttocks• Lower extremities

WHAT IS SURGICAL SKIN PREP? an aseptic procedure that is used to reduce the resident

and transient flora naturally present on the skin surface.

Accomplished by application of anti-microbial agents.

Rendering the skin “surgically clean”

Is performed by the circulating nurse

Prior to draping

1. Povidone /Iodine Betadine

2. Chlorhexidine Gluconate

o Rapid actingo Have a broad

spectrum of activityo Have minimal harsh

effect on skino Inhibit rapid

rebound of microbeso Economical to useo Based on

documentation in scientific literature

ANTIMICROBIAL SOLUTIONS

SPECIAL AREAS OF CONSIDERATIONo Eyeso Traumatic open woundso Fractureso Tumors, Aneurysm and Ovarian Cysto Dirty Contaminated Areaso Emergency Preps

Breastline to upper 3rd of thigh

Table line to table line when in supine position

ABDOMINAL PREP

Shoulders Upper arm –

elbow Axilla Chest wall to

table-line and 2 inches beyond the sternum to the opposite shoulder

CHEST AND BREAST

Axilla Chest Abdominal-

from neck to iliac crest

Area should extend beyond the midline anteriorly and posteriorly

LATERAL/THORACOTOMY

Entire circumference of affected leg

Extends from the foot to upper part of thigh

KNEE/ LOWER LEG

Abdomen on the affected side

Thigh- knee Buttocks –

table –line Groin pubis

HIP/ LOWER EXTREMITY

Rectoperineal / Vaginal

SUTURESAbsorbable suturesExamples: Chromic, Plain,Polydiaxone (PDS), Polyglactin 910

(Vicryl),Polyglycolic Acid(Biovek)- Used for those who cant return for suture removal/in internal body

tissuesNon-Absorbable suturesExamples: Silk,Nylon,Prolene (Polypropylene)- Used either on skin wound closure/in stressful internal

environments where absorbable sutures will not suffice- Less scarring because they provoke less immune response

SUTURESIs a medical device used to hold tissue together after an injury or

surgery till healing takes place.

Absorbable Sutures – material is digested by body cells and fluids during the healing period.

Plain – dissolves within 5-10 days, YellowChromic- dissolves within 1 month, BrownVicryl/Safil- dissolves within 60-90 days, LavenderPDS (Polydioxone)- dissolves 2 times longer than the other

absorbable sutures, White

NON – ABSORBABLE SUTURESMaterial is not absorbed or digested by tissues during healing periodTypes:

Silk- is an animal product from silk worm cocoons. (Black)Cotton- made from long staple cotton, treated to make it smooth,

(White)Prolene- biosynthetic, non-absorbable suture material, as substitute

to silkWire- gives the greatest strength to any suture material

Different Types Of Needles

Skin

Subcutaneous

Fascia

Muscle

Peritoneum

Organ

Surgical Blades

10 1112 15

20

The Basic Surgical Instruments

Cutting and Dissecting Grasping and Holding Retracting and Exposing Clamping and Occluding Miscellaneous

CUTTING AND DISSECTING INSTRUMENTS

Scalpel holderCurved and Straight Mayo

Scissors Metzenbaum

Lister/Bandage Scissors Suture Scissors Stitch Scissors

BLADE HANDLE

CURVE AND STRAIGHT SCISSORS

METZENBAUM

GRASPING AND HOLDING INSTRUMENTS

(TISSUE FORCEPS)

DeBakey Tissue Forceps Adson Tissue

Forceps

Russian Tissue Forceps

These are available in various lengths, with or without teeth, and smooth or serrated jaws.

GRASPING AND HOLDING INSTRUMENTS

RUSSIAN TISSUE FORCEPS

They have serration up to the tips, allowing better grasp of tissue with minimum trauma.

GRASPING AND HOLDING INSTRUMENTS

Randall Stone Forceps

Tenaculum

Babcock Clamp Foester / Ovum Sponge Forceps

Backhaus Towel Clamp

Allis Clamp

Kocher/ Oschsner Clamp

They Are used to hold tissue, drapes or sponges.

HOOK AND DISSECTOR

GRASPING AND HOLDING INSTRUMENTS

RANDALL STONE FORCEPS

To hold/remove kidney stones

RETRACTING AND EXPOSING INSTRUMENTS

Senn

Volkmann Rake

US Army Navy Deaver

Malleable Vein Retractor Green Goiter

Weitlaner Langenbeck Skin Hooks Vaginal Speculum

Richardson

RICHARDSON RETRACTOR

VEIN RETRACTOR

SENN RETRACTOR

CLAMPING AND OCCLUDING INSTRUMENTS

They are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents.

Straight Mosquito

Kelly Clamp

Pean (Rochester-Pean) Clamp

Crile Clamp

Right-Angled (Mixter /Dissector) Forceps

Suturing Instruments

POSTOPERATIVE PHASE3 Stages

Immediate Stage - (1-4hrs) after surgeryIntermediate Stage - (4 -24hrs) after surgery

Extended Stage - (1-4days) after surgery/last follow-up visit with

the attending physician

IMMEDIATE POSTOPERATIVE PERIOD RespiratoryPosition - left lateral with neck extended and upper arm supported on a

pillow. - supine with head to side and chin extended forwardCheck presence of gag reflexMaintain artificial airway until gag reflex returnedOxygenAssess rate and depth of respirationAssess breath soundsMonitor for signs of atelectasis, pneumonia, pulmonary embolism

CARDIOVASCULARCardiovascularAssess skin and check capillary refillAssess peripheral edemaMonitor for bleedingAssess pulse rate and rhythmMonitor for hypo/hypertensionMonitor for cardiac dysrhythmiasAssess for Homan’s Sign

INTERMEDIATE POST –OP PERIODMonitor Respiratory Status - coughing/deep breathing q 1-2 hrs - turning in bed q 2hrs - early ambulation - auscultate lungs q 4hrsMonitor Cardiovascular Status - leg exercises q 2hrs - apply anti-embolic stockings - vital signs, color, temp of skin

PROMOTE FLUID AND ELECTROLYTE BALANCE

Measure I and O

Promote Optimum Nutrition - maintain IV infusion as ordered - Assess return of peristalsis -Progressive increase in diet

Promote Return of Urinary Function - Assess ability to void/ bladder distention - Report to surgeon if client has not voided after8hrs post-op

TRANSFERRING THE PATIENT FROM THE PACUTransfer Criteria:Patient coming out of General AnesthesiaVital signs are stable for at least 30mins and are

within normal rangePatient is breathing easilyReflexes has returned to normalPatient is responsive and oriented to time and place

PATIENT WHO HAD REGIONAL ANESTHESIA

Sensation is restored and circulation is intactReflexes has returnedVital signs have stabilized for at least 30mins Adequate urine outputControl of painControl or absence of vomiting 

POST-OPERATIVE COMPLICATIONS

 POST-OPERATIVE COMPLICATIONS

 Atelectasis - a collapse of the alveoli with retained mucus secretions - Usually develop 1-2days post-op Aspiration - caused by inhalation of food, gastric contents, water or

blood into the tracheobronchial system. - anesthetics and narcotics depress the CNS,causing

inhibition of cough and gag reflex

3. PNEUMONIA

- an inflammatory response in which cellular material replaces alveolar gas.

- may develop 3-5days post-op Assessment:Dyspnea, increased RRCrackles over involved lung areaElevated tempProductive cough and chest painHypotensionDecreased breath sounds

PULMONARY EMBOLISM

-An embolus blocking the pulmonary artery disrupting blood flow to one or more lobes of the lungs

Assessment:DyspneaSudden sharp chest/upper abdominal painCyanosisTachycardiaA drop in blood pressure

CARDIOVASCULAR COMPLICATIONSThrombophlebitisInflammation of the vein, often accompanied by clot formation 7-14 days post-op

Assessment:Vein inflammationAching or cramping painVein feels hard and cordlike and is tender to touchElevated temperaturePositive Homan’s sign

INTERVENTION hydrate patient adequately Avoid massaging to calves or thighs Avoid standing or sitting in one pace or crossing legs Avoid inserting IV’s into legs Assess for Homan’s Sign

CIRCULATORY COMPLICATIONSHemorrhage -The loss of a large amount of blood externally/internally for a

short period of timeShock-Loss of circulatory fluid volume caused by hemorrhage Assessment:RestlessnessWeak rapid pulseHypotensionTachypneaCool clammy skinReduced urine output

9. CONSTIPATION10. Paralytic Ileus - paralysis of intestinal peristalsis11. Wound Infection - occurs 3-6 days post op12. Wound Dehiscence - Separation of wound edges on the suture line - occurs between 5th and 8th day post op13. Wound Evisceration - Protrusion of the internal organs and tissues through an opening

in the wound edges

URINARY RETENTION

-Involuntary accumulation of urine in the bladder as a result of loss of muscle tone

- Due to effects of anesthetics/narcoticsAssessment:Inability to voidRestlessness and diaphoresisLower abdominal pain, distended bladderElevated BP  

POSTOPERATIVE DISCHARGE TEACHING

Focus on:Proper wound dressingMedicationsDietFollow-up visit – removal of sutures in 7-10 days/ removal of staples

in7-14 daysActivity levels-no lifting for 6 weeks - not to lift anything (>10lbs) Return to work in 6-8 weeksSigns and symptoms of complications  

POST CHEST OR LUNG SURGERY(PNEUMONECTOMY)DISCHARGE INSTRUCTION

Breathing exercises – for 3 wksArm and shoulder exercise -5times a day(10-20 repetitions /exercisePractice standing straight with shoulders even on the affected sideNo heavy lifting of more than 20lbs for 3-6mosStop any activity that causes dypnea,chest pain,excessive fatigueObtain influenza and pneumonia vaccineReport intermittent cough with sputum

DRAINS are placed in wounds only when abnormal

fluid collections are present/expected Are placed near the incision site: In compartments that are intolerant to fluid

accumulation In areas with large blood supply In infected draining wounds Areas that have sustained large superficial

tissue dissection Greatest amt is expected during the first

24 hrs are removed when amount of drainage

decreases

TYPES OF DRAINS

G R A V I T Y

1. Penrose Drain 2. T-Tube

M E C H A N I C

1. Jackson-Pratt Drain

2. Hemovac

B. MECHANICAL - these are portable self contained closed wound

mechanical devices that suction fluid after collapsing them and closing the valve thus forcing the fluid to be pulled into the collection chamber.

examples: Hemovac Jackson- Pratt

Types of Wound Healing

First Intention Healing- Wounds are made aseptic by minor

debridement and irrigation- with a minimum tissue damage and tissue

reaction- Wound edges are properly approximated with

suture- Granulation tissue is not visible/scar formation

minimal

Secondary Intention Healing

- Wounds are left open to heal spontaneously or surgically closed at a later date

- Examples include burns, traumatic injuries, ulcers and suppurative infected wounds

- Cavity of the wound fills with a red, soft, sensitive tissue (granulation tissue), which bleeds easily, a scar eventually forms.

- In infected wounds, drainage may be accomplished by use of special dressings and drains.

- Produces deeper wider scar

CARE AND HANDLING OF SURGICAL SPECIMENSTypes of Surgical Specimen1. Routine specimen -specimen that doesn’t require immediate attention -placed in a preservation fluid -labeled and sent to Pathology Department ff

conclusion of the procedure - scrub nurse should separate like specimens from

different locations -specimens not immediately passed off the field

should be kept moist in saline -calculi should not be placed in formalin, same with

foreign bodies - amputated extremities are wrapped before sending

them to the pathology/morgue

2.DIAGNOSTIC SPECIMEN

Frozen Section- Requires special handling and immediate examination by the

pathologist- With verbal report of the findings communicated to the surgeon

during the surgical procedure- Examples include breast biopsy/any organ, tumor or lesion- Specimen is sent dry and is properly labeled.

CULTURESAre taken on a patient who comes to the OR with a known/suspected

infection2 types: aerobic and anaerobic, requires different medium for growthThis will determine the antibiotic that will specifically affect the

microbesAre obtained under sterile condition, using appropriate collection

tube.Exact procedure for collecting cultures for specific test will vary from

each institutionMust be sent to the lab immediately for accurate processing