Operative Care Study Guide

docx

School

Saint Anthony College of Nursing *

*We aren’t endorsed by this school

Course

311

Subject

Medicine

Date

Apr 3, 2024

Type

docx

Pages

Uploaded by jimeniagarcia12

Preoperative Care Degrees of surgery:  Elective  Emergency  Urgent Surgical Risk Factors:  Smoking  Age  Nutrition  Obesity  Obstructive sleep apnea  Immunosuppression  Fluid and electrolyte imbalance  Postoperative nausea and vomiting  Venous thromboembolism Preoperative Surgical Phase: Assessment - Nursing history - Medical history - Surgical history - Smoking habits - Alcohol and substance abuse - Pregnancy - NPO STATUS: surgery delay may lead to dehydration, pt at risk may require additional fluids and electrolytes before surgery Age related risks:  Physiologic changes in older adults that put them at greater risk for complications: - Integumentary system: decreased subcutaneous fat, dry fragile skin leading to slower healing - Musculoskeletal system: inflamed joints leading to swelling and discomfort, arthritic joints - Renal and urinary system: decreased kidney function, decreased ability to excrete waste, incontinence - Neurological: impaired cognitive function, delayed reactions, sensory deficits - Cardiovascular system: hypertension and hypotension, decreased circulation - Respiratory system: SOB, decreased oxygenation blood, decreased lung elasticity Types of sedation:  Minimal sedation - can respond to verbal commands - cognitive function and coordination may be impaired

 Moderation sedation - deeper sedation - client can maintain airway  Deep sedation - general anesthesia - client cannot be awakened easily Types of Regional: Preparing the client for surgery:  Offer psychological support assess clients fears and anxieties, support system, coping mechanisms (goal- decrease the body response to stress)  Health history  Allergies  Head-toe assessment  Baseline vitals, height, weigh  Skin preparation as needed  NPO  Medication administration  Remove items prior to surgery - Jewlery, dentures, make up, nail polish, glasses/contacts, hearing aids, artificial limbs Informed consent:  Procedure to be performed with potential risks  Type of anesthesia being provided with risks  Any possible potential procedures that could take place during surgery  Postoperative plan of care and potential complications  SURGEONS RESPONSABILITY TO OBTAIN CONSENT, nurse verifies and witnesses consent SAFETY IS PRIORITY  Preventing wrong site, client marks correct surgical site verified by nurse and surgeon  Time out is performed  Verify clients ID band  Ensure informed consent is signed  Allergies are double checked  Verification H&P complete Preoperative surgical phase implementation:  Health promotion - Preoperative teaching - Postoperative activity resumption - Pain relief measures - Rest - Feelings regarding surgery

- Minimize risk for surgical wound infection - Maintain normal fluid and electrolyte balance - Preventing bowel incontinence and contamination CLIENT EDUACTION:  Explain routine process  Explain special equipment post op  Pre and post op medications  Breathing exercises (coughing, incentive spirometer)  Importance changing positions  Pain management  Special considerations related to surgery type Actions to take preoperatively:  Ensure correct procedure is verified for the correct client at the correct site  Marking the correct site  Initiate IV access/IV fluid  Perform preop and postop teaching  Administer medications  Instruct client stay in bed Evaluate and document:  Completion of informed consent  Preoperative assessment  Skin preparation  Medication administration  Initiation IV/fluids  Client teaching Intraoperative Care - Begins when client is transffered to the operating table and ends when client is transferred to PACU Preparing the OR suite - Surgical attire must be worn by all personnel - Check the equipment is functioning properly - Aseptic technique when setting up sterile field - Surgical counts Circulating nurse - Responsible for documenting, handling and transporting specimens, monitor sterile field, surgical counts instruments and dressings Scrub nurse

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

- Responsible for maintaining sterile field, surgical counts with circulating nurse, hands instruments to surgeon SAFETY CONSIDERATIONS - Time out implemented to avoid wrong person, procedure, site - Universal protocol - Surgical fires - Electrosurgery plume Why is positioning a pt critical? - Maintenance of airway - Prevents pressure on nerves, skin over bony prominences, earlobes, eyes - Prevent occlusion of arteries and veins Surgical site prevention - Scrub surgical site with antimicrobial agents - Hair may be removed with clippers - Surgical site is draped Preventing infection - If antibiotics prescribed should be given 1 hr prior to incision and stopped within 24 hrs after surgery Increased risk developing infection - over 65 - Smokers - Immunocompromised or obese - Existing infections - Chronic medical conditions - Diabetes mellitus - Alcohol use - Poor nutritional status Catastrophic events in the OR  Anaphylactic reactions - Sx masked by anesthesia, hypotension, tachycardia, bronchospasm, pulmonary edema  Malignant hyperthermia - Condition triggers severe reaction to certain drugs used as part of general anesthesia for surgery - Causes alteration in calcium activity in muscle cells - Passed down through families - Sx muscle rigidity, tachycardia, tachypnea - Late sign rise in temp 105 or higher, multiple organ failure - Occurs due to exposure to succinylcholine

- Tx cold blankets to cool down, cool fluids, 100% O2 needed, dantrolene to help relax muscles, infuse ice IV fluids Intraoperative complications - Hypoxemia low blood oxygen, caused by improper positioning, medications, aspiration - Hypothermia heat loss due to cool environment - Paresthesia numbness and tingling, monitor cap refill - Pressure ulcers - Hemorrhage, hypovolemia, hypovolemic shock Postoperative Care Modified Aldrete Scoring System - Used to assess transition from Phase I to Phase II - Discontinuation of anesthesia to return of protective reflexes and motor function - A score of 9 or 10 indicates readiness for transfer or discharge to the next phase of recovery - Scale includes activity, breathing, circulation, awareness, arterial O2 saturation Asessment - Airway and respiration - Neurological functions - Skin integrity and condition of the wound - Metabolism - Genitourinary function - Gastrointestinal function - Comfort Acute care - Maintaining respiratory function - Preventing circulatory complications - Achieving rest and comfort - Temperature regulation - Maintaining neurological function - Maintaining fluid and electrolyte balance - Promoting normal gastrointestinal function and adequate nutrition - Promoting urinary elimination - Skin and wound care - Maintaining/ enhancing self-concept Postoperative Complications

Phase I discharge criteria  Patient awake (or at baseline)  Vital signs at baseline or stable  No excess bleeding or drainage  No respiratory depression  Oxygen saturation > 90%  Pain management  Nausea and vomiting controlled  Report given  Aldrete score 8-10  Urine output 30 ml Ambulatory surgery - Same day surgery - No IV opioids in past 30 mins - Voided if appropiate to surgical procedure - Able to ambulate if not contraindicated - Responsible adult present to drive pt home - Written discharge instructions given and understood, provided to pt and caregiver, specific type of surgery and anesthesia used, care of incision and dressings - Discharge teaching includes sx to report, follow up appt, answers questions

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

- When to seek help after discharging unrelieved pain, questions about medication, wound drainage and/ or bleeding - Increased drainage - Fever >100 MOST COMMON CAUSE OF HYPOTENSION IN PACU IS LOSS OF FLUID AND BLOOD NURSE SHOULD ADMINISTER IV FLUIDS Types of anesthesia: Genral- causes loss of sensation, consciousness, reflexes, and memory of surgery (major surgery) Risks- family hx hyperthermia, respiratory disease, cardiac disease, gastric contents, alcohol use Regional- causes reduction of sensation in selected parts of the body due to blockage of peripheral nerves or spinal cord Risks- allergy, alterations in peripheral circulation Local- involves topical application of an anesthetic agent to the skin or mucous membranes Medications:  Opioids - Used for sedation, relieve postop and preop pain - Delays awakening from surgery, postop constipation and urinary retention  Benzodiazepines (diazepam, midazolam) - Reduce anxiety preop, promote amnesia, produce mild sedation - Can result in cardiac and respiratory arrest  Antiemetics (ondansetron, metoclopramide) - Decreases postop nausea and vomiting - Enhances gastric emptying - Decrease risk aspiration - Dry mouth, dizziness adverse effects  Anticholinergics (atropine) - Decrease risk bradycardia during surgery - Block muscarinic response to acetylcholine by decreasing salivation, perspiration, bowel motility, GI secretions - Decrease risk aspiration - Urinary retention, dry mouth, tachycardia adverse effects  Sedatives (pentobarbital) - Sedative effect for paranesthesia sedation or amnesia - Induction of general anesthesia  Neuromuscular blocking agents

- Skeletal muscle relaxation - Airway placement Considerations:  Ensure client has signed informed consent before giving sedatives  Have client urinate before giving medications  Monitor airway and oxygen  Once client is on surgical table, apply safety belts  If hypotension occurs after medication lower HOB administer IV fluid bolus

Operative Care Study Guide

Related Documents