Download - Treatment Aspects in Perioperative Nursing
-
7/31/2019 Treatment Aspects in Perioperative Nursing
1/51
G U I D EM R . A B H I S H E K N A I R S I R L E C T U R E R S S C N
P R E S E N T E D B Y S H I B I N J A C O BM . S C N U R S I N G 1 S T Y E A R
TREATMENT ASPECTS INPERIOPERATIVE NURSING
-
7/31/2019 Treatment Aspects in Perioperative Nursing
2/51
INTRODUCTION
Perioperative nursing includemajor three phases
PreoperativeIntraoperative
Postoperative
-
7/31/2019 Treatment Aspects in Perioperative Nursing
3/51
Preoperative phase
From the time of decisionmaking of surgical interventionto the transfer of patient to theoperation room
-
7/31/2019 Treatment Aspects in Perioperative Nursing
4/51
Intra operative phase
From the time of the patient isreceived in the operating roomuntil admitted to the postanesthesia care units (PACU )
-
7/31/2019 Treatment Aspects in Perioperative Nursing
5/51
Post operative phase
From the time of admission toPACU to the follow-up evaluation
until the discharge
-
7/31/2019 Treatment Aspects in Perioperative Nursing
6/51
Surgery
The treatment of injury disease or deformity through a invasive operative procedure
Major presenting little risk to life
Minor possibility of involving risk to the life View of a client vantage point
Surgery is a major stressor for all clientsFear of the unknown is the most prevalent fear prior tosurgery and is to assist nure to help client to overcome
-
7/31/2019 Treatment Aspects in Perioperative Nursing
7/51
Types of surgeries Optional: - surgery is scheduled completely at the preferenceof a patients (E.g. cosmetic surgery)Elective: - the appropriate time of surgery is at theconvenience of the patient. Failure of the surgery iscatastrophic (E.g. superficial cysts)Required the condition requires surgery within few weeks(E.g. cataract)Urgent the surgical intervention required attention within24-48 hours (cancer)
Emergency the situation requires immediate surgicalattention without delay (E.g. accidents, gunshot injuries)
Ambulatory surgeries -the surgery plans and done and thepatient discharged on the day same day (EG cystoscopy)
-
7/31/2019 Treatment Aspects in Perioperative Nursing
8/51
PERI OPERATIVE NURSING
Has a continuous goalTo provide a standard of excellence in the care of theclient before during and after surgery
Perioperative nursing is a client oriented and must be generated to meet the clients needs and psychosocial need as the immediate physical needs
-
7/31/2019 Treatment Aspects in Perioperative Nursing
9/51
1)
PREOPERATIVE
NURSING
-
7/31/2019 Treatment Aspects in Perioperative Nursing
10/51
PREOPERATIVE NURSING
Role of nursenursing baseline data evaluation of the patient before one day of surgery by carried out a postoperative interview it includenot only a physical but only also an emotional; assessment
previous anesthetic history and identification of knownallegories or genetic problems may affect the surgical outcomeEnsuring the preadmission testsarranging the appropriate consulting services providing a
preoperative education
-
7/31/2019 Treatment Aspects in Perioperative Nursing
11/51
PREOPERATIVE PHYSIOLOGIC ASSESSMENT
Informed consent assessment AgeNutritional statusFluid and electrolyte balanceRespiratory statusMedications (previous use)Cardiovascular status
Renal & hepatic status Alcohol or drug abuseNeurological, musculoskeletal and integlumetary statusEndocrine and immunological status
-
7/31/2019 Treatment Aspects in Perioperative Nursing
12/51
Common laboratory tests
Hemoglobin & hematocrit / complete CBCBlood typing and cross matchingRFT (renal function tests)
LFT (Liver function tests)Coagulation profile including PT & APTT (prothrombine time & activated partialthromboplastin time
Urine analysisX RAY VIRAL MARKERS (HIV, HbSCG & HCV
-
7/31/2019 Treatment Aspects in Perioperative Nursing
13/51
Assessment of client psychologicalcondition
The psychological condition of a client can havestronger influence than does the physical condition,Encourage the client to express their feelings and
fears about the surgery and receiving anesthesiaObserve the client for nonverbal clues indicatinganxiety To reduce the anxiety explain the client what will behappening throughout the surgical experience
-
7/31/2019 Treatment Aspects in Perioperative Nursing
14/51
Psychosocial health assessment
Cultural beliefs can influence persons perception of surgery The client should be provided the opportunity to
express their spiritual values and beliefsPatient education
Purpose of pre operative teaching To answer questions and concerns about the surgery
To ascertain the needs or desire for additional informationTo provide information in a manner of conductive to learning
-
7/31/2019 Treatment Aspects in Perioperative Nursing
15/51
General instructions
Preoperatively the patient will be instructed in thefollowing postoperative activities this will allows achance for practice and familiarity
Incentive spirometry CoughingTurningFoot and leg exercises
-
7/31/2019 Treatment Aspects in Perioperative Nursing
16/51
Physical preparation
Identifying the client and verifying the operativeprocedurePreparing the operative site
Checking and recording the vitals Assisting in bath and gowning Verifying allergies and reordered
NPOIdentifying sensory defects of the client
-
7/31/2019 Treatment Aspects in Perioperative Nursing
17/51
PHARMACOLOGICAL ASPECTS INPREOPERATIVE
Preoperative medications Opiates- such as morphine(ROXONOL)and meperidine aregiven to relax the patient and potentiate the anesthesia Anticholernegics - atropine, glycopyrolate given to reduceprimary top reduce respiratory tract secretions and to preventsevere reflexes slowing of heart doing the anesthesiaBarbiturate/ tranquilizers given in the night for a peacefulsleep
Prophylactic antibiotics _ administered just before the surgery ST skin test
-
7/31/2019 Treatment Aspects in Perioperative Nursing
18/51
Final check list
Identification and verificationReview of patient recordConsent form
Patient preparationTransporting patient to operation roomPreoperative medicines
Psychological support to patients family
-
7/31/2019 Treatment Aspects in Perioperative Nursing
19/51
2) INTRA
OPERATIVE
PHASE
-
7/31/2019 Treatment Aspects in Perioperative Nursing
20/51
Sterile Members
1) SurgeonFirst assistant (physician or registered nurse who assistsurgeon in performing homeostasis, tissue retraction and wound closureScrub nurse ( An LP/VN/RN or a surgical technologist who preparers and maintains integetery safety andefficiency of sterile fields throughout the operation
Nonsterile members Anesthesia providerCirculating nurse R N responsibility for management of personal, equipment supplies, environment andcommunication throughout the procedure
-
7/31/2019 Treatment Aspects in Perioperative Nursing
21/51
Sterile field Asepsis Elements of aseptic techniques
Sterile gowns and glowsSterile drapesSterilization of items used in sterile tables
-
7/31/2019 Treatment Aspects in Perioperative Nursing
22/51
Intraoperative nursing care
1. Risk of infection related to invasive procedure andexposure to pathogens
2. Risk of injury related to possibility of positioningduring surgery
3. Risk of injury related to foreign bodies in adversely leftin the wound
4. Risk of injury related to chemical physical andelectrical hazards
5. Risk of impaired tissue integrity 6. Risk of alteration in fluid electrolyte balance related to
abnormal blood loss and NPO status
-
7/31/2019 Treatment Aspects in Perioperative Nursing
23/51
Anesthesia
Conscious sedationgeneral anesthesia
Four stagesInductionMaintenanceEmergenceRecovery
Regional anesthesia
LocalNerve block Spinal or epidural
-
7/31/2019 Treatment Aspects in Perioperative Nursing
24/51
Local anesthesia Consists of local volume of fluid is administered in the skin for
minimal procedures it will become the patient senseless for sometimeE.g. xylocine, lignocane, loxicard bupivaccineSpinal anesthesia
Local anesthesia is injected to lumbar or intrathecal space. Anesthesia blocks conduction in spinal nerve roots and dorsal ganglia,paralysis and analgesia occur below the level of injection. Agents usedprocaine, tetracaine, lidocine, and bupivacaineEpidural anesthesia
Achieved by injecting the local anesthesia in to the epidural space by the way of lumbar puncture
Agents used are chloroprocaine, lidocaine and bupivacinePeripheral nerve block
Achieved by injecting a local anesthesia or anesthetize n to thesurgical site
-
7/31/2019 Treatment Aspects in Perioperative Nursing
25/51
Complications
Hypo ventilationInadequate ventilator support to the after paralyzing of respiratory
muscles and ensuring comaOral trauma
Broken teeth, oropharyngeal or laryngeal trauma due to difficultintubation
Hypotension Due to the blood loss or effect of anesthesiaCardiac dysarythemia
Due to the pre exposing cardio vascular compromise electrolyteimbalance, or untoward reactions to anesthetic agentsHypothermia
Due to the exposure to the cool atmosphere in the Operation Theater and tableDue to loss of thermoregulation capability due to anesthetic agentsPeripheral nerve damages
Due to the improper positioning of the patientMalignant hyperthermia
-
7/31/2019 Treatment Aspects in Perioperative Nursing
26/51
Malignant hyperthermia
This is a rare reaction to anesthetic agents likeenflurane, fluroxene, and halothaneSuch drugs like theophylline, aminophylline,epinerphine, and digoxinInherited muscle disorder (muscle dystrophy) or ahistory clinical manifestations
TachycardiaPseudotetany Muscle rigidity High feverCyanosisHeart failureCNS damage
-
7/31/2019 Treatment Aspects in Perioperative Nursing
27/51
management
Discontinue the inhalant anesthesiaDantroline (dantrium) + oxygen + dextrose 50,diuretics, antiarrhythics, sodium bi carbonate, and
hypothermic measures (cooling blanket, iced salinesolution, iced saline lavage of stomach, bladder, orrectum
-
7/31/2019 Treatment Aspects in Perioperative Nursing
28/51
Nursing process
InterventionsSafety Advocacy Verification
Counting instruments sponges needlesEvaluation
ExpectedUnexpected
DocumentedInforming client family Surgical waiting roomOngoing update by OR team
-
7/31/2019 Treatment Aspects in Perioperative Nursing
29/51
3)
POSTOPERATIVEPHASE
-
7/31/2019 Treatment Aspects in Perioperative Nursing
30/51
ensure the continuity of care from Intraoperative phase to theimmediate postoperative phase in circulating nurse anestheologistor nurse anesthesia with a through report to PACU nurseIT include
Type of surgery performed & Intraoperative complicationsType of anesthesiaDrains and type of dressingNo of suturing & typePresence of ET tube and type of oxygen to be administeredPresence of lines and locations (central, peripheral, arterial line)Catheterization & tubes
Administration of colloids blood crystalloids and electrolyte balance
Drug allergiesPreexisting medical conditionsPost op investigations
-
7/31/2019 Treatment Aspects in Perioperative Nursing
31/51
Nursing assessment
Before receiving the patients itself the nurse shouldensure his/her unit should ready to receive thepatient
Checklist Functioning of oxygen and ventilatorFunctioning of suction apparatusCardiac monitor should be ready or not
I V access are preparedCheck for a crash cart
-
7/31/2019 Treatment Aspects in Perioperative Nursing
32/51
Assessment after receiving patient
Verify the patient identity The operative procedure and the surgeon whoperformed the procedureEvaluate the following signs and verify their level of stability with the anestheolgist
Respiratory status (airway)BreathingCirculation
Temperature, pulse, respirationOxygen saturation of the bloodHemodynamic status
-
7/31/2019 Treatment Aspects in Perioperative Nursing
33/51
Determine the swallowing gag reflexes and LOCincluding patients response to stimuliEvaluate lines, tubes, drains, estimated blood losscondition of wound (open closed packed )
Medications used , infusions, including thetransfusions, and output)Evaluate the level of consciousness and comfort andsafety measures such as pain protective reflexes
Perform safety checks to verify that side rails are inplaced and restrains are properly appliedEvaluate activity status, movements extremitiesRevise physician orders
-
7/31/2019 Treatment Aspects in Perioperative Nursing
34/51
Nursing diagnosis
Ineffective airway clearance related to effect of anesthesiaImpaired gas exchange related to ventilation perforationimbalanceIneffective tissue perforation related to cardiopulmonary (hypertension)Risk of imbalanced body temperature related to medicationssedation and cool environmentRisk of fluid imbalance related to related to blood loss NPOstatus and vomiting and indwelling tubesPain related to surgery incision and traumaRisk of injury related to sensory dysfunction and physicalenvironmentDisturbed sensory participation related to effects of medications and anesthesia
-
7/31/2019 Treatment Aspects in Perioperative Nursing
35/51
Evaluation or expected outcomes
Breath easily Lung sound clear Vital signs stable
Thermoregulation stableIntake output balanceReport of adequate pain control
Wound edges intact without drainagePosition comfortably and carefully Quiet reassuring environment maintained
-
7/31/2019 Treatment Aspects in Perioperative Nursing
36/51
Post operative complications
Nausea vomitingPainConstipation and gas crampsThirstShock HemorrhageDeep vein thrombosisPulmonary embolismUrinary retentionIntestinal obstructionHiccups Wound infection Wound dehiscence and eviscerationPsychological disturbances
DepressionDelirium
-
7/31/2019 Treatment Aspects in Perioperative Nursing
37/51
NAUSEA AND VOMITING
Causes Occurs due to thecomplication of in halationanesthesia
Result from anaccumulation of fluids instomach before peristalticmovements returnDue to the abdominaldistentionPsychological induction Adverse effects of opiods
-
7/31/2019 Treatment Aspects in Perioperative Nursing
38/51
THIRST
Inhibitions of secretions by preoperativemedications likeglycopyrolate
fluid loss, blood loss,dehydration due to theNBM
-
7/31/2019 Treatment Aspects in Perioperative Nursing
39/51
CONSTIPATION AND GAS CRAMPS
trauma andmanipulation of the bowel during the surgery local inflammation,
peritonitis, abscesslong standby bowelproblem this may leads bowel impaction
-
7/31/2019 Treatment Aspects in Perioperative Nursing
40/51
PAIN
This is the most important and common symptoms in which patients exhibits afeeling of distress stimulation of or trauma to certain nerve ending as a resultcausing painManagement
Reduce the anxiety due to anticipation of painTeach the patient about pain managementReview analagics with patient and reassure the relief with available quickly Establish a trusting relationship with the patient
Pharmacological management Parental analgesia for 2-4 days initially and later the dose decreased to oralanalgesicThe nurses responsibility to make ensure the drug is given safely andassessed efficiency
Other type of pain management Patient controlled analgesiaEpidural analgesia
-
7/31/2019 Treatment Aspects in Perioperative Nursing
41/51
SHOCK
It is a response of the body to a decrease in circulatory volume of blood, tissue perforation is impairedculminating eventually in the cellular hypoxia and deathManagement
Arrange and transfusion of blood if necessary Accurately measure any blood loss and monitor all fluid intake andoutput
Anticipitate the progression of symptoms in earliest manifestationMonitor vital signs as per institutional policy until they are stable
-
7/31/2019 Treatment Aspects in Perioperative Nursing
42/51
HEMORRHAGE
Hemorrhage is a copious escape of blood from a blood vesselClassified as 1) general 2) according to blood vessel 3)according to location
General
Primary occurs in the time of operation Intermediately with in the first few hours of the operation after the surgery immediately after the blood pressure comes normal
Secondary occurs some times after the surgery due to ligatures slip from the blood vessel and erosion of the blood vessel
According to blood vessel Capillary slow general oozing from the capillaries Venous - bleeding in dark color blood Artery bleeding that sprats and bright red in colour
According to location External - visible bleeding present in surface Internal (concealed)- bleeding cannot seen
-
7/31/2019 Treatment Aspects in Perioperative Nursing
43/51
DEEP VEIN THROMBOSIS
DVT occurs in the pelvic veins and deep vein of lower extremities in postoperative patients most
common in hip surgeriesand abdominal surgeries
-
7/31/2019 Treatment Aspects in Perioperative Nursing
44/51
PULMONARY COMPLICATIONS
Atelectasis -incomplete expansion of the lungs or aportion of lung with in 48 hours of the surgery
Aspiration caused by the inhalation of foods or
gastric contents or blood to the trachea bronchialsystemPneumonia this is a inflammatory response in which cellular materials replaces alveolar gases
Pulmonary embolism caused by theobstruction of one or more arterioles by an embolousoriginating in some ware in the venous system
-
7/31/2019 Treatment Aspects in Perioperative Nursing
45/51
URINARY RETENTIONINTESTINAL OBSTRUCTION
Bowel obstructs result in partial or completeimpairment to forward flow of intestinal contents
HICCUPS Due to intermittent spasm of diaphragm causing hicthat resulting from vibration of closed vocal cord as airrushes suddenly in to the lungs
WOUND INFECTION
It is the second most nosocomial infections theinfection may limited to the surgicial site 60% to 80% oraffect systematically w
-
7/31/2019 Treatment Aspects in Perioperative Nursing
46/51
Due to the inadequate
sutures or excessively tight sutures therupture of skin andabdominal organs are
protududed outthrough the rupturedskin
WOUND DEHISCENCE & EVISCERATION
-
7/31/2019 Treatment Aspects in Perioperative Nursing
47/51
WOUND CARE (DRESSING)
The management of the wound is done by thephysician or his assistant by strict sterile and aseptictechniquesPurpose
To protect the wound from the infectionTo splint or immobilize the woundTo protect the wound from mechanical injury To prevent contaminationTo absorbe drainageTo inhibit or kill microorganisms by using dressing withantiseptic r anti microbial properties
-
7/31/2019 Treatment Aspects in Perioperative Nursing
48/51
Drains
The drains are the tubesthat kept collecting thedischarges from in wound or surgical site
Purpose Drains are placed only when abnormal fluidcollection is present orexpectedCollection of fluids thatcause harmful to the wound
-
7/31/2019 Treatment Aspects in Perioperative Nursing
49/51
PATIENT EDUCATION
Before the discharge of the patient he shouldthoroughly teach the techniques of wound careReport immediately to the health care provider if thefollowing signs will occurReduces or marked swelling surrounding the tissuesPus or usual dischargeChills or fever more than 100Keep suture line clean and neat never vigorously rubnear the incision site
POST OPERATIVE DISCHARGE
-
7/31/2019 Treatment Aspects in Perioperative Nursing
50/51
POST OPERATIVE DISCHARGEINSTRUCTION
Rest and activity eatingsleeping wound healing bowels bathingclothing
driving bending and lifting
-
7/31/2019 Treatment Aspects in Perioperative Nursing
51/51
SUMMARY