NURSING 465 - Perioperative Nursing Care Med Surg Study Guide.

NURSING 465 - Perioperative Nursing Care Med Surg Study Guide.Perioperative Nursing Care Perioperative - includes pre, intraoperative, post operative care Pre operative- from the decision of surgery until patient goes ...

NURSING 465 - Perioperative Nursing Care Med Surg Study Guide.Perioperative Nursing Care Perioperative - includes pre, intraoperative, post operative care Pre operative- from the decision of surgery until patient goes into the OR Intraoperative- In the OR until their in the post ECHO Phases of Perioperative Nursing  Preoperative phase: period of time from decision for surgery until patient is transferred into operating room  Intraoperative phase: period of time from when patient is transferred into operating room to admission to postanesthesia care unit (PACU)  Postoperative phase: period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home  Sidebar: golytely- laxative and electrolytes for bowel cleansing Preadmission  Initiates initial preoperative assessment  Initiates teaching appropriate to patient’s needs  Operative processes-when, where, how, who, what  Post-operative teaching-PACU processes, monitoring, catheters  Involves family in interview if possible  Verifies completion of preoperative diagnostic testing- time frame of labs needed, radiological studies, medical clearance  Verifies understanding of surgeon-specific preoperative orders: medications and diet restrictions.  Other preparations: Bowel prep, shaving, labeling of site  Discusses, reviews advanced-directive document  Begins discharge planning by assessing patient’s need for postoperative transportation, care  Cholecystectomy- surgical removal of the gallbladder  Initiates teaching appropriate to patient’s needs- 1st thing you should ask if tell me what the doctor you about your surgery- gives you a sense of what the pt. understands, explain that the will be using an incentive spirometer Preoperative Assessment  Labs that may be need to be completed before surgery- CBC because post operative ECHO, CMP (complete metabolic panel ), renal fcn, liver fcn, coagulation panel (if they’re on Heparin, etc.)  Smokers or people over 50 or 60- need Chest X ray before surgery to see if there's respiratory compromise  Much higher risk for infection if you shave instead of clip the hair before surgery (don’t shave!)  Healthcare proxy, living wills- nurses can be a witness  Only doctors can be witnesses for advance directives Special Considerations During Preoperative Period  Patients who are obese- increase risk of infection & post-operative complications including dehiscence, post-op education  Patients with disabilities-mobility issues- post-op education  Patients undergoing ambulatory surgery- when to arrive, pre-op preparations, post-op educations  Patients undergoing emergency surgery-consent, family members, belongings, post-op education  Dehiscence vs. Evisceration  Dehiscence - opening of the surface of the wound  Evisceration- AB contents that protrude from the wound Medications That May Affect Surgical Experience  Corticosteroids-cardiovascular collapse with sudden d/c  May need IV post-op  Diuretics-affects electrolytes  Tranquilizers-seizure if d/c’d suddenly  Insulin-may be held or given IV  Antibiotics-potential for interaction with muscle relaxers (includes anesthesia)  Anticoagulants-potential for intra or postoperative bleeding. Held for pre-op duration varies  Antiseizure medications- seizure activity if not given-IV may be needed  Thyroid hormone-may need IV  Opioids-potential for interaction with anesthesia and increased need postop (has a cumulative effect)  OTC and herbals-may interact with medications  Corticosteroids- needed for Autoimmune DOs, etc.  Tranquilizers- ex. anxiolytics  Anticoagulants- 81 mg- Aspirin- prevent cardiovascular events (Ex. MI) to make the platelets more slippery Informed Consent  Should be in writing  Should contain the following:  Explanation of procedure, risks  Description of benefits, alternatives  Offer to answer questions about procedure  Instructions that patient may withdraw consent  Statement informing patient if protocol differs from customary procedure  Valid consent must be freely given, without coercion  Patient must be at least 18 years of age (unless emancipated minor)  Consent must be obtained by physician  Patient’s signature must be witnessed by professional staff member  Pelvic exenteration- for someone with recurrent endometriosis- remove vagina, rectum, bowel….give a urinary diversion with an ileostomy and all the rest of the ab contents are removed  Continent urinary diversion – rare. There’s usually a lot leakage from the stoma so a bag is used  Patient’s signature must be witnessed by professional staff member (nurse can be there ONLY for the signing- not the best thing but its allowed)