MANAGEMENT and TREATMENT of the

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• MANAGEMENT and TREATMENT of the
• PERI-OPERATIVE CLIENT
• Madeline Gervase RN,MSN,CCRN,FNP
• Union County College

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Hospital / Surgery
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Definitions

• Surgery
• Nurses

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Three Perioperative Phases

• Preoperative
• Intraoperative
• Postoperative

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INTERVENTIONSforPRE-OPERATIVE CLIENTS
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Types of Surgery

• Diagnostic
• Curative
• Palliative
• Reconstructive
• Cosmetic
• Transplant

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Continue Types of Surgery

• Urgency
• Emergent
• Urgent
• Elective
• Inpatient
• Outpatient

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Types of Surgical Facilities

• Hospitals (Large Small)
• Ambulatory Care
• Free-standing Surgical Centers
• Doctors Offices

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Surgeon Responsibilities

• Primary Physician
• Surgical Intervention
• Setting
• Diagnostic Tests
• Consent
• Outcomes and Risk

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Major role of the Surgeon

• The surgeon must explain and document evidence
  that the client understands the nature of the
  surgical procedure, the risk factors and the
  expected outcomes of the surgery.

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Preoperative Nursing Care

• The primary goal of preoperative nursing care
  is to place the client in the best possible
  condition for surgery through careful assessment
  and through preparation

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Pre-op Assessment

• Health History

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Pre-Op Assessment

• Psychosocial Aspects
• Coping ability
• Anxiety level
• Support system
• Common fears

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• Physiological Aspects
• Purpose
• Lab data
• Radiographic assessment
• Other diagnostic
• assessments
• Factors which influence
• risk

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Nursing Management

• Surgical Consent Forms
• Purpose
• Components

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Common Orders

• Clients routine medications
• Specific Preparations ordered by
• Physician
• NPO Status
• Preoperative Medication

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Pre-Operative Phase

• ALL OTHER PREPARATIONS MUST BE COMPLETED BEFORE
  GIVING PRE-OP MEDS!

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Pre-Op Medications

• 1. Routine meds usually held
• 2. Routine meds usually given
• 3. Pre-op meds
• a. Common meds
• Narcotics
• Sedatives - Hypnotic
• Anti- cholinergics
• Amnesics

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Pre-Op - Checklist

• Nurse completes check - list
• for inpatient or outpatient surgery
• Nurse signs off to
• Anesthesia/Circulator
• Nurse places documentation on chart
• and includes

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INTERVENTIONS forINTRA-OPERATIVE PATIENTS
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Intra-operative

• Holding Area
• Operating Room (OR)
• Nurses Roles

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Surgical Team Members

• Surgeon
• Surgical Assistant
• Anesthesiologist
• Certified Registered Nurse
• Anesthetist (CRNA)
• Circulating Nurse
• Scrub Nurse
• Specialty Team

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• Types of Anesthesia
• General
• Given inhalation and intravenous
• CNS depressed
• Risk for Cardiac and respiratory
• Phases
• Induction
• Maintenance
• Emergency

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Types of Anesthesia

• Regional
• Conscious Sedation

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Anesthesia

• Medication
• Unconsciousness
• Analgesia
• Reflex loss
• Muscle relaxation
• amnesia

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Care of Client (Elderly)

• ? Circulatory function
• ? Renal perfusion
• Sensory losses
• ? Skin elasticity
• Fragile bones ? Respiratory
• protective reflexes

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INTERVENTIONS forPOST-OPERATIVE PATIENTS
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Post-operative

• Transfer from OR to PACU
• PACU
• Report to PACU nurse
• Assessment

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Complications Cardiovascular

• Hemorrhage, Hypovolemic Shock
• Deep Venous Thrombosis (DVT)
• Pulmonary Embolism

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Complications Respiratory

• Atelectasis
• Prevention
• Aspiration

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ComplicationsElimination

• Problems
• Urine Elimination
• Bowel Elimination

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Discharge from PACU

• Based on
• Respirations
• Energy
• Alertness
• Circulation
• Temperature

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PACU nurse . . .

• Discharge from PACU to
• Ambulatory Surgical Unit
• Discharge from PACU to
• General Surgical Unit

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Complications General Post-Op

• AMBULATION
• the single most significant measure to prevent
  complications

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Stress Related to SurgeryGeneral Adaptation
Syndrome

• Sympathetic Effects
• 1. Manifestations
• ? BP, ? P, ? R
• skin cool and pale
• tendency for ? blood clotting

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Continue (GAS)

• bronchial dilation
• ? blood sugar
• Temperature alterations

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Effects of ? ADH ? Aldosterone

• ? water and sodium retention
• After 24 hours, post-op diuresis
• ? ADH ? fluid retention
• Electrolyte imbalances

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Effects of ? Cortisol

• ? protein catabolism
• ? immune response
• ? platelets

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Discharge

• Home care preparation
• Health teaching
• Psychosocial preparation
• Health care resources

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Wound Healing

• Healing
• Wound Drainage
• Wound Disruptions
• Sutures
• Acute Pain

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Types of Drains

• Penrose
• T-Tube
• Jackson-Pratt
• Hemo-vac
• Recording
• Communication

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Healing

• Primary Intention
• Secondary Intention
• Tertiary Intention

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Wound Drainage

• Serous
• Sanguineous
• Purulent

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Wound Disruption

• Dehiscence
• Evisceration

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• Types of Skin Closures
• a. Sutures
• Interrupted

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• Continuous Sutures

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• Staples

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• Steri-strips

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• Retention Sutures

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• Retention Bridge

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Acute Pain

• Adequate Pain Control
• Client participation in pain control

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Promotion of Recovery

• Discharge Instructions
• Follow-up plans
• Home Care
• Wound Care
• Prescriptions
• Contact Person
• Follow-up Appointment

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• Questions ?????