SlideShare ist ein Scribd-Unternehmen logo
1 von 135
JOFRED M. MARTINEZ, RN
Perioperative Nursing Lecture
ORRECTION OF DEFECTS
ALTERATION OF FORM
ESTORATION OF FUNCTION
IAGNOSIS AND TREATMENT
INPATIENT SETTINGS:
• hospitals
OUTPATIENT SETTINGS:
• hospital based ambulatory surgical centers
• free-standing surgical centers
• physicians' offices
• ambulatory care centers
URPOSE / REASON
RGENCY
ISK, DEGREE OF
XTENT
• DIAGNOSTIC
e.g. BREAST BIOPSY, EXPLORATORY LAPAROTOMY
• ABLATIVE
e.g. MASTECTOMY, HYSTERECTOMY
• CONSTRUCTIVE
e.g. CHEILOPLASTY, PALATOPLASTY
• RECONSTRUCTIVE
e.g. ORIF
• PALLIATIVE
e.g. COLOSTOMY, NERVE ROOT RESECTION
• COSMETIC
e.g. REVISION OF SCARS, RHINOPLASTY
• EMERGENCY
e.g. GUNSHOT WOUND, SEVERE BLEEDING
• URGENT
e.g. KIDNEY OR URETHRAL STONES
• ELECTIVE
e.g. CATARACT REMOVAL, HERNIA REPAIR
• OPTIONAL
e.g. CIRCUMCISION
• MAJOR
e.g. EXPLORATORY LAPAROTOMY, CESAREAN SECTION
• MINOR
e.g. INCISION AND DRAINAGE
• SIMPLE
e.g. SIMPLE MASTECTOMY
• RADICAL
e.g. RADICAL MASTECTOMY
Perioperative Nursing Lecture
REOPERATIVE PHASE
NTRAOPRATIVE PHASE
OSTOPRATIVE PHASE
Perioperative Nursing Lecture
• NURSING HISTORY
e.g. BLEEDING DISORDERS, CARDIOVASCULAR DSE.,
RESPIRATORY DSE., LIVER DSE., RENAL DSE.,
DIABETES MELLITUS
• PAST SURGICAL HISTORY
• ALLERGIES
• SMOKING AND ALCOHOL HABITS
• OCCUPATION
• EMOTIONAL HEALTH
• SIGNIFICANT OTHER’S SUPPORT
• PATIENT’S AND SIGNIFICANT OTHER’S
UNDERSTANDING OF SURGERY
GE
UTRITIONAL STATUS
ENERAL HEALTH
EDICATIONS
ENTAL STATUS
P 1. A NORMALLY HEALTHY PATIENT
P 2. A PATIENT WITH MILD SYSTEMIC DISEASE
P 3. A PATIENT WITH SEVERE SYSTEMIC DISEASE THAT
IS NOT INCAPACITATING
P 4. A PATIENT WITH AN INCAPACITATING SYSTEMIC
DISEASE THAT IS A CONSTANT THREAT TO LIFE
P 5. A MORIBUND PATIENT WHO IS NOT EXPECTED TO
SURVIVE FOR 24 HOURS WITH OR WITHOUT
OPERATION
• MUST BE BRIEF AND COMPLETE
• DETERMINE THE FOLLOWING:
 NUTRITIONAL STATUS
 HEIGHT AND WEIGHT
 BODY MASS INDEX (BMI)
 SERUM PROTEIN LEVEL
 NITROGEN BALANCE
T• ASSESS FOR OBESITY, WEIGHT LOSS,
MALNUTRITION, METABOLIC ABNORMALITIES,
AND THE EFFECTS OF MEDICATIONS ON
NUTRITION
• OBTAIN BMI AND WAIST CIRCUMFERENCE
T
• ADVISE PATIENT TO STOP SMOKING 6 MONTHS
PRIOR TO SURGERY
• TEACH BREATHING AND COUGHING EXERCISES
• IF PATIENT HAS RESPIRATORY INFECTIONS,
POSTPONE THE SURGERY.
T
• IF PATIENT IS HYPERTENSIVE, POSTPONE THE
SURGERY.
• AVOID SUDDEN CHANGES IN POSITION,
PROLONGED IMMOBILIZATION, HYPOTENSION,
HYPOXIA AND OVERLOADING THE CV SYSTEM.
T
• OPTIMAL LIVER FUNCTION IS ESSENTIAL.
• SURGERY IS CONTRAINDICATED IN PATIENTS
WITH ACUTE
• NEPHRITIS, ACUTE RENAL INSUFFICIENCY AND
OLIGURIA OR ANURIA OR OTHER ACUTE RENAL
PROBLEMS.
T
• PATIENTS WITH DM ARE PRONE TO
HYPOGLYCEMIA AND HYPERGLYCEMIA.
• PERFORM CBG TEST BEFORE, DURING AND
AFTER SURGERY. MAINTAIN BLOOD GLUCOSE
BELOW 200 mg/dL.
• USE OF CORTICOSTERIODS PLACES THE
PATIENT AT RISK FOR ADRENAL INSUFFICIENCY.
• PATIENTS WITH THYROID DISORDERS ARE AT
RISK FOR THYROTOXICOSIS OR RESPIRATORY
FAILURE.
T• DETERMINE PRESENCE OF ALLERGIES
• DOCUMENT ANY SENSITIVITY TO MEDICATIONS
AND PAST ADVERS REACTIONS TO THESE
AGENTS.
• STRICT ASEPSIS ON IMMUNOSUPRESSED
SURGICAL PATIENTS.
T
ADRENAL
CORTICOSTERIODS
DO NOT DISCONTINUE ABRUPTLY, CV
COLLAPSE MAY OCCUR
DIURETICS THIAZIDE DIURETICS MAY CAUSE
EXCESSIVE RESPIRATORY DEPRESSION
CHLORPROMAZINE INCREASES HYPOTENSIVE EFFECTS
OF ANESTHETICS
DIAZEPAM MAY CAUSE ANXIETY, TENSION AND
SEIZURES IF WITHDRAWN SUDDENLY
ERYTHROMYCIN
IF COMBINED WITH CURARIFORM
MUSCLE RELAXANT,
RESPIRATORY PARALYSIS
TWARFARIN SHOULD BE DISCONTINUED, INCREASES
THE RISK OF BLEEDING
PHENELZINE
SULFATE
INCREASES HYPOTENSIVE EFFECTS
OF ANESTHETICS
LEVOTHYROXINE
SODIUM
ADMINISTER IV TO KEEP PATIENT
IN EUTHYROID
• LABORATORY SCREENING
e.g. CBC, SERUM ELECTROLYTES, COAGULATION STUDIES,
SERUM CREATININE, BUN, URINALYSIS, BLOOD TYPING
& CROSS MATCHING
• RADIOLOGIC SCREENING
e.g. X-RAY, MRI, CT SCAN
• OTHER DIAGNOSTIC SCREENING
e.g. ECG
Perioperative Nursing Lecture
ADIATION
NESTHESIA
ONSURGICAL INVASIVE PROCEDURES
URGICAL INVASIVE PROCEDURES
 WHAT DO YOU PLAN TO DO TO ME?
 WHY DO YOU WANT TO DO THIS PROCEDURE?
 WHAT ARE ALTERNATIVES TO THIS PLAN?
 WHAT THINGS SHOULD I WORRY ABOUT?
 WHAT ARE THE GREATEST RISKS OR WORST
THAT COULD HAPPEN?
AMERICAN COLLEGE OF SURGEONS (ACS)
If the patient is:
• A minor, a parent or legal guardian should sign.
• An emancipated minor, or independently earning
a living, he or she may sign.
• A minor who is the parent of infant or child who is
having the procedure, he or she may sign for the
child.
• Illiterate, he or she may sign with an X, after
which the patient‟s writes “patient‟s mark”.
If the patient is:
• Unconscious, a responsible relative or guardian
may sign.
• Mentally incapacitated by alcohol or other
chemical substance, a responsible relative or
guardian may sign when the urgency of the
procedure does not allow time for the patient to
regain mental competence.
T
• DIET ORDERS: NPO 6 – 12 HOURS PTOR
• MONITOR INPUT AND OUTPUT
• CATHETER INSERTION
• BOWEL PREPARATION (i.e. ENEMA, USE OF LAXATIVES)
T
• HYGIENE
• BATH
• REMOVE COSMETICS AND NAILPOLISH
• REMOVE ALL HAIRPINS AND CLIPS
• REMOVE DENTURES
• PROVIDE AN OR GOWN
T
• DISCONTINUE MEDICATIONS THAT ARE ADVISED
TO BE DISCONTINUED.
• ADMINISTER PREOPERATIVE MEDICATIONS
• INSERTION OF NGT
• SPECIAL SKIN PREPARATION
• TAKE CARE OF PT.’S BELONGINGS AND REMOVE
ALL BODY PROSTHESIS
• PROMOTE POSITIVE COPING STRATEGIES
 IMAGERY
 DISTRACTION
• PROVIDE PREOPERATIVE TEACHING
• PROVIDE OPPORTUNITY FOR VISITS
FROM FAMILY AND FRIENDS
Perioperative Nursing Lecture
CONTENT OF PREOPERATIVE TEACHING:
• SURGICAL PROCEDURE
• PREOPERATIVE ROUTINES
• INTRAOPERATIVE ROUTINES
• POSTOPERATIVE ROUTINES
• PAIN RELIEF
• POSTOPERATIVE EXERCISES
• ACCESS DEVICES
• DEEP BREATHING
• COUGHING
• INCENTIVE SPIROMETRY
Perioperative Nursing Lecture
Perioperative Nursing Lecture
• LEG EXERCISES
• TURNING-TO-SIDES EXERCISES
• GETTING-OUT-OF-BED EXERCISES
Perioperative Nursing Lecture
Perioperative Nursing Lecture
RESPECTING SPIRITUAL AND RELIGIOUS BELIEFS:
• PROVIDE TIME FOR PRAYER
• ARRANGE FOR VISIT FROM A SPIRITUAL
ADVISER / CLERGYMAN AS DESIRED
• TAKE INTO CONSIDERATION RELIGIOUS BELIEFS
IN THE OPERATIVE CARE
• ORAL LAXATIVES
e.g. CASTOR OIL, BISACODYL (DULCOLAX)
• CLEAR LIQUID DIET THE EVENING BEFORE
SURGERY
• NPO AFTER MIDNIGHT
• MULTIPLE-POSITION TAP-WATER ENEMAS THE
EVENING BEFORE SURGERY
• ORAL ANTIBIOTICS 24 HOURS BEFORE SURGERY
e.g., NEOMYCIN, ERYTHROMYCIN
• CLEANING THE SKIN OVER THE SURGICAL SITE
WITH ANTIMICROBIAL SOLUTION
e.g., POVIDONE-IODINE (BETADINE)
• REMOVING HAIR OVER THE SURGICAL SITE
e.g., SHAVING HAIR, CLIPPING HAIR
• APPLY ANTIMICROBIAL SOLUTION TO THE SKIN
OVER THE SURGICAL SITE
e.g., POVIDONE-IODINE (BETADINE)
REASONS FOR PREOPERATIVE MEDICATION:
 REDUCE ANXIETY
 PROMOTE RELAXATION
 REDUCE PHARYNGEAL SECRETIONS
 PREVENT LARYNGOSPASM
 INHIBIT GASTRIC SECRETIONS
 DECREASE THE AMOUNT OF ANESTHETIC
REQUIRED FOR INDUCTION AND MAINTENANCE
OF ANESTHESIA
• SEDATIVES AND HYPNOTICS
e.g.,pentobarbitol sodium (Nembutal), secobarbitol sodium
(Secobarbitol), chloral hydrate
• TRANQUILIZERS
e.g.,chlorpromazine hydrochloride (Thorazine), hydroxine
hydrochloride (Vistaril), diazepam (Valium)
• OPIOID ANALGESICS
e.g.,meperidine hydrochloride (Demerol), morphine sulphate,
hydromorphone hydrochloride (Dilaudid)
• ANTICHOLINERGICS
e.g.,atropine sulphate, scopolomine (Hycosine)
• H2-RECEPTOR ANTAGONISTS
e.g.,cimetidine (Tagamet), rantidine hydrochloride (Zantac),
famotidine (Pepcid)
• ANTIEMETICS
e.g.,metrochlopromide (Reglan), droperidol (Inapsine),
promethazine hyrdrochloride (Phenergan)
Perioperative Nursing Lecture
1. Morning bath and mouth care
2. Provide a clean gown
3. Remove hair pins, braid long hair, and cover hair with
cap.
4. Remove dentures, foreign materials, colored nail
polish, hearing aids, glasses and contact lens.
5. Take baseline vital signs before pre-op meds.
6. Check ID band
7. Check for special orders: enema , gastric tube, IV line
8. Have client void before pre-operative medications.
9. Continue to support emotionally
10.Accomplish the Pre-op Checklist
• Provision of a comfortable stretcher
• Provision of sufficient blankets
• Provision of safety measures
• Proper identification of surgical patient
• Proper greeting of patient
• Provision of a quiet environment
 Informed consent
 Surgeon / nurse conference
 Laboratory tests
 Skin preparation
 Bowel preparation
 Iv fluids
 Preoperative medications, sedation and antibiotics
 Removal of dentures, nail polish and jewelries
 Npo status
Perioperative Nursing Lecture
Perioperative Nursing Lecture
1. ONLY STERILE ITEMS ARE USED WITHIN THE STERILE
FIELD.
2. STERILE PERSONS ARE GOWNED AND GLOVED.
3. TABLES ARE STERILE ONLY AT TABLE LEVEL.
4. STERILE PERSONS TOUCH ONLY STERILE ITEMS OR
AREAS, WHILE UNSTERILE PERSONS TOUCH ONLY
UNSTERILE ITEMS OR AREAS.
5. UNSTERILE PERSONS AVOID REACHING OVER THE
STERILE FIELD, WHILE STERILE PERSONS AVOID LEANING
OVER AN UNSTERILE FIELD.
6. THE EDGES OF ANYTHING THAT ENCLOSES STERILE
CONTENTS ARE CONSIDERED UNSTERILE.
7. THE STERILE FIELD IS CREATED AS CLOSE AS POSSIBLE
TO THE TIME OF USE.
8. STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW.
9. STERILE PERSONS KEEP WELL WITHIN THE STERILE
FIELD.
10. STERILE PERSONS KEEP CONTACT WITH STERILE
AREAS TO A MINIMUM.
11. UNSTERILE PERSONS AVOID STERILE AREAS.
12. DESTRUCTION OF THE INTEGRITY OF THE MICROBIAL
BARRIER LEADS TO CONTAMINATION.
13. MICROORGANISM MUST BE KEPT TO AN IRREDUCIBLE
MINIMUM.
THE OPERATING ROOM
• Should be free from contaminating particles, dusts,
pollutants, radiation and noise
THREE ZONES:
• UNRESTRICTED – street clothes are allowed
• SEMI-RESTRICTED – scrubs, shoe covers, caps and
masks
• RESTRICTED – scrubs, shoe covers, caps, masks, OR
gowns and gloves
OPERATING ROOM ATTIRE
• SCRUB SUIT
• STERILE GOWN
• HEAD COVER
• SHOES
PERSONAL PROTECTIVE DEVICES
• SURGICAL EYE PROTECTIVE
DEVICES
• SURGICAL FACE MASK
• STERILE GLOVES
1. SURGEON
• Perform the operative procedure safely and correctly and
heads the surgical team.
• Assumes responsibility for all medical acts of judgement and
management.
2. ANESTHESIOLOGIST
• Assesses patient before surgery and an hour prior to induction
of anesthetics.
• Administers the anesthetic agent and monitors the patient„s
physical status throughout the surgery.
• Intubate the patient if necessary.
• Manage any technical problems related to administration of the
anesthetic agent.
• Supervise the patient condition throughout the surgical
procedure.
3. CERTIFIED REGISTERED NURSE ANESTHETIST
• assist in the administration of anesthetic drugs to induce and
maintain anesthesia
• administers other medications as indicated to support the
patient's physical status during surgery
4. CIRCULATING NURSE
• sets up the operating room
• ensures that necessary supplies and equipment are readily
available, safe and functional
• makes up the operating room bed with gel and heating pads
• greets the patient
• assists the operating room team in transferring the client onto
the operating room bed
• positions the patient on the operating room bed
4. CIRCULATING NURSE
• performs the surgical skin preparation
• drapes the surgical site with sterile drapes
• opens and dispenses sterile supplies during surgery
• manages catheters, tubes, drains and specimens
• administers medications and solutions to the sterile field
• assesses the amount of urine and blood loss and reports these
findings to the surgeon and anesthesia personnel
• reviews the results of any diagnostic tests or lab studies
• maintains a safe, aseptic environment
• monitors traffic in the operating room
• performs "sharps", sponge, and instrument count
• documents all care, events, findings, and patient's responses
5. SCRUB NURSE
• helps set up the sterile field
• helps assist draping the client
• hand instruments to the surgeon
• performs "sharps", sponge, and instrument count
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
Perioperative Nursing Lecture
GENERAL ANESTHESIA
• produces total loss of consciousness by blocking awareness
centers in the brain, amnesia, analgesia, hypnosis, and relaxation
INDUCTION
 Patient fells warmth, dizzy and feeling of detachment
 Ringing, roaring or buzzing in the ears
 Aware of being unable to move the extremities, noises are
exaggerated
EXCITEMENT
 Pupil dilates but constricts in light
 PR is rapid, RR is irregular
 Restraints are applied
OPERATIVE OR SURGICAL ANESTHESIA
 Pupils are small but reactive
 Patient is unconscious
 RR is irregular, PR is normal
MEDULLARY DEPRESSION / DANGER
 Occurs when too much anesthesia is given
 RR is shallow, pulse is weak and thready
 Pupils are widely dilated and non reactive
 Cyanosis occurs and eventually death
1. Inhalation of gases and/or volatile agents through an
endotracheal tube or face mask
a. Gases e.g., nitrous oxide (N20)
b. Volatile agents
e.g., halothane (Fluothane), isoflurane (Forane)
2. Intravenous infusion of barbiturates or nonbarbiturates
a. Barbiturates e.g., thiopental sodium (Pentothal)
b. Non-barbiturates
e.g., ketamine (Ketalar), propolol (Diprivan), fentanyl citrate
with droperidol (Innovar)
Perioperative Nursing Lecture
Perioperative Nursing Lecture
A. HYPNOTICS
e.g., midazolam (Versed),, diazepam (Valium)
B. OPIOID ANALGESICS
e.g., morphine sulphate, meperidine hydrochloride (Demerol),
fentanyl citrate (Sublimaze)
C. NEUROMUSCULAR BLOCKING AGENTS
• NON-DEPOLARIZING AGENTS
e.g., pancuronium (Pavulon), atacurium (Tracium), vecuronium
(Norcuron)
• DEPOLARIZING AGENTS
e.g., succinycholine (Anectine)
A. MALIGNANT HYPERTHERMIA
Signs/Symptoms:
tachycardia, dysrthymias, muscle rigidity (especially jaw and
upper chest), hypotension, tachypnea, cola-colored urine,
extreme hyperthermia (late sign)
Treatment: DANTROLENE (DANTRIUM)
B. OVERDOSE
C. COMPLICATIONS TO ANESTHETIC AGENTS
e.g., hypotension, bradycardia, dysrthymias, respiratory
depression, decreased seizure threshold
D. COMPLICATIONS OF ET INTUBATION
e.g., broken caps, teeth, swollen lip, trauma to the vocal cords,
improper neck extension
• Injection of an anesthetic agent into or around a
specific nerve, nerve trunk, or several nerve trunks
supplying the tissue to be anesthetized
USES OF NERVE BLOCK ANESTHESIA:
a. prior to dental procedures
b. control of pain during plastic surgery
c. control of pain during surgery in an area supplied by
that specific nerve, nerve trunk, or nerve trunk(s)
d. to diagnose and treat chronic pain conditions
e. to increase circulation in some vascular disorders
• Injection of an anesthetic agent into the cerebrospinal
fluid in the subarachnoid space around the nerve roots
supplying the tissue to be anesthetized
USES OF SPINAL REGIONAL ANESTHESIA
• Control of pain during surgery of the lower abdomen
below the umbilicus, the groin, or the lower extremities
Perioperative Nursing Lecture
A. HYPOTENSION
INTERVENTIONS:
• administer O2 as ordered
• administer vasoactive drugs as ordered
• trendelenburg position if level of anesthesia is fixed
B. NAUSEA AND VOMITING
C. RESPIRATORY PARALYSIS
INTERVENTIONS:
• artificial respiration
D. NEUROLOGIC COMPLICATIONS
e.g., paraplegia, severe muscle weakness in legs
• Injection of an anesthetic agent into the epidural space
surrounding the dura mater around the nerve roots
supplying the tissue to be anesthetized.
USES OF EPIDURAL REGIONAL ANESTHESIA
• control of pain during surgery of the lower abdomen
below the umbilicus, the groin, or the lower extremities
• control of pain during labor and delivery
• SHORT (1/2- 1 HOUR)
 Procaine (Novocaine)
 Chloroprocaine (Nesacaine)
• INTERMEDIATE (1-3 HOURS)
 Lidocaine (Xylocaine)
 Mepivacaine (Carbocaine)
• LONG (3-10 HOURS)
 Bupivacaine (Marcaine)
 Dibucaine (Nupercaine)
 Etiodocaine (Duranest)
• Application of an anesthetic agent directly to the
surface of the tissue to be anesthetized
e.g. the skin or the mucosal surfaces of the mouth, throat, nose,
cornea
USES OF TOPICAL LOCAL ANESTHESIA
a. prior to injection of regional anesthesia
b. prior to endotracheal intubation
c. prior to various diagnostic procedures:
e.g. laryngoscopy, bonchoscopy, cystoscopy, endoscopy
• Injection of an anesthetic agent intracutaneously and
subcutaneously directly into the tissue to be
anesthetized
USES OF LOCAL INFILTRATION ANESTHESIA
• prior to injection of regional anesthesia
• prior to suturing of superficial lacerations at the end of
surgery into the incision for postoperative pain relief
• prior to dental procedures
• prior to minor surgical procedures
• excision of skin lesions or wound debridement
• repair of an episiotomy
• RETRACTING AND EXPOSING INSTRUMENTS
 Handheld retractors
 Self-retaining retractors
• CUTTING AND DISSECTING INSTRUMENTS
 Scalpels
 Knives
 Scissors
 Bone cutters
• Clamping and Occluding Instruments
 Hemostatic forceps
 Noncrushing vascular clamps
• Grasping and Holding Instruments
 Forceps
 Needle holders
 Bone holders
TYPES OF SUTURE MATERIALS
1. ABSORBABLE SUTURES
a. Surgical Gut e.g. Plain, Chromic, Collagen Sutures
b. Synthetic Absorbable Polymers
e.g. Polydiaxanone Suture (PDS), Poliglecaprone 25
(Monocryl), Polyglyconate (Maxon), Polyglactin 910
(Vicryl) , Polyglycolic Acid (Dexon)
2. NONABSORBABLE SUTURES
a. Surgical Silk
b. Surgical Nylon
METHODS OF SUTURING
• Simple Continuous
• Simple Interrupted
• Continuous Interlocking
• Mattress
ASSESSMENT OF SUTURE LINE
• Stitched too tight or too loose
• Too many or too few stitches
• Suture holes are not equidistant from the edges so that
the bite is not even, or there is uneven spacing between
sutures
• There is inversion or eversion of tissue edges
• The edges of tissues are overlapping and heaped on
each other
Perioperative Nursing Lecture
Perioperative Nursing Lecture
A – Airway
B – Breathing
C – Circulatory
C – Consciousness
S – Safety/comfort
D – Dressing
D – Drainage
D – Drugs
E – Elimination
F – Fluids
F - Food
THE FIVE PHYSIOLOGICAL PARAMETERS:
1. ACTIVITY
2. RESPIRATION
3. CIRCULATION
4. CONSCIOUSNESS
5. COLOR
AREA OF ASSESSMENT Point
Score
1
hour
2
hours
3
hours
MUSCLE ACTIVITY
Ability to move all extremities
Ability to move 2 extremities
Unable to control any extremity
2
1
0
RESPIRATION
Ability to breath deeply and cough
Limited respiratory effort
No spontaneous effort
2
1
0
AREA OF ASSESSMENT Point
Score
1
hour
2
hours
3
hours
CIRCULATION
BP +/- 20% of pre-anesthetic level
BP +/- 20%-40% of pre-anesthetic level
BP +/- 50% pre-anesthetic level
2
1
0
CONSCIOUSNESS LEVEL
Fully awake
Arousal on calling
Not responding
2
1
0
AREA OF ASSESSMENT Point
Score
1
hour
2
hours
3
hours
O2 SATURATION
Unable to maintain O2 sat >92% on room air
Needs O2 inhalation to maintain O2 sat >90%
O2 sat <90% even with O2 supplement
2
1
0
REQUIRED FOR DISCHARGE FROM PACU: 7 - 8
ASSESSMENT:
 respiratory rate, rhythm, depth
 patency of airway
 presence of oral airway
 breath sounds
 use of accessory muscles
 skin color
 ability to cough
 ABG'S
 O2 saturation
INTERVENTIONS:
 position patient on side to prevent aspiration
 suction artificial airways and oral cavity as
necessary
 ask patient to perform respiratory exercises
 administer O2 as needed
ASSESSMENT:
 heart rate
 blood pressure
 skin color
 heart sounds
 peripheral pulses
 capillary refill
 edema
 skin temperature
 urine output
 Homan's sign
 changes in vital signs
symbolizing shock
 type, amount, color, odor,
and character of
drainage from tubes,
drains, catheters or
incision
INTERVENTIONS:
 check under patient for pooling of blood
 check dressings, tubes, drains, and catheters for
blood
 monitor changes in heart rate and blood pressure
ASSESSMENT:
 temperature
 shivering
INTERVENTIONS:
 apply warming blankets
ASSESSMENT:
 LOC
 mental status
 movement and sensation in extremities
 presence of gag and corneal reflexes
INTERVENTIONS:
 orient patient to PACU environment
 protect eyes if corneal reflex absent
 protect airway if gag reflex absent
TYPES OF WOUND HEALING
• FIRST INTENTION
• SECONDARY INTENTION
• THIRD INTENTION
1. CLEAN WOUND
• No break in sterile technique during the procedure
2. CLEAN – CONTAMINATED WOUND
• Minor break in sterile technique
• Alimentary, respiratory, genitourinary tract or oropharyngeal
cavity not entered
3. CONTAMINATED WOUND
• Open, fresh traumatic wound of less than 4 hours duration
• Gross contamination from GI tract
4. DIRTY AND INFECTED WOUND
• Old traumatic wound for more than 4 hours from dirty source
or with retrained necrotic tissue, foreign body or fecal
contamination
Perioperative Nursing Lecture
• DRY TO DRY – trap necrotic debris and exudates
• WET TO DRY – softens debris as it dries
• WET TO DAMP – wound debridement
• WET TO WET – moisture dilute exudates
 warmth, swelling, tenderness or pain around incision
 type, amount, color, odor, and character of drainage
on dressings
 amount, consisency, color of drainage
 dependent areas (e.g., underneath the patient)
 drains and tubes and be sure they are intact, patent,
and properly connected to drainage systems
INTERVENTIONS:
• reinforce dressings as necessary
ASSESSMENT:
 bladder distention
 amount, color, odor, and character of urine from
foley catheter if present
INTERVENTIONS:
 catheterize if necessary
 notify MD if urinary output is less than 30 cc/hr
ASSESSMENT:
 abdominal distention
 N & V
 bowel sounds
 passage of flatus
 type, amount, color, odor, and character of drainage
from nasogastric tube if present
ASSESSMENT:
 I & O
 color and appearance of mucus membranes
 skin turgor, tenting, and texture
 status of IV's
 type, amount, color, odor, and character of drainage
from tubes, drains, catheters, and incision
 type, amount of solultion, flow rate, tubing, infusion
site
PREDISPOSING FACTORS:
• diabetes, uremia, obesity, malnutrition, corticosteroid therapy
MAJOR CLINICAL MANIFESTATIONS:
• fever, foul-smelling, greenish-white drainage from wound,
persistent edema, redness
TREATMENT:
• antibiotics on basis of wound culture and sensitivity
• preventive nursing interventions:
• strict aseptic technique in the operating room and during
postoperative dressing changes
MAJOR CLINICAL MANIFESTATIONS:
• discharge of serosanguineous drainage from the wound
• sensation that something gave or let go
TREATMENT:
• lay patient down
• cover wound with sterile saline-soaked gauze or towels
• prepare to return patient to operating room for repair
• monitor for shock
PREVENTIVE NURSING INTERVENTIONS:
• splint wound when patient coughs
• medicate for nausea and vomiting
• highest risk during 5th to 8th postoperative days, so teach
patient s/s as they may already be discharged
Perioperative Nursing Lecture
PREDISPOSING FACTORS:
• infection
• dehydration
• response to stress and trauma
• prolonged hypotension
• transfusion reaction
• respiratory congestion
• thrombophlebitis
MAJOR CLINICAL MANIFESTATIONS:
• temperature elevated above 99.5° (37.5° C)
• elevated pulse and respiratory rates
• diaphoresis
• lethargy
TREATMENT:
• antipyretics
• cooling sponge baths
• increasing fluids
MAJOR CLINICAL MANIFESTATIONS:
• little or no output or frequent small amounts
• palpably distended bladder
• restlessness
• discomfort
TREATMENT:
• measures to promote voiding (privacy, running water, sitting
patient up
• catheterization if above methods fail
PREVENTIVE NURSING INTERVENTIONS
• adequate hydration
• early ambulation
MAJOR CLINICAL MANIFESTATIONS:
• mild fever
• dysuria
• hematuria
• malaise
TREATMENT:
• adequate hydration
• maintenance of good bladder drainage
• antibiotics on basis of urine culture and sensitivity
PREVENTIVE NURSING INTERVENTIONS:
• encourage fluid intake
• early ambulation
• avoid catheterization or remove within 2 days
MAJOR CLINICAL MANIFESTATIONS:
• bowel obstruction
• pain
TREATMENT:
• surgery for lysis of adhesions
PREVENTIVE NURSING INTERVENTIONS:
• aseptic technique in operating room and during
dressing changes
MAJOR CLINICAL MANIFESTATIONS:
• increased temperature
• chills
• cough productive of purulent or rusty sputum
• crackles
• wheezes
• dyspnea
• chest pain
• tachypnea
• increased secretions
TREATMENT:
• promote full aeration of lungs by positioning in semi-
Fowlers or Fowlers
• administer O2 as ordered
• maintain fluid status
• administer antibiotics on basis of sputum culture and
sensitivity
• administer expectorants and analgesics as ordered
• chest physiotherapy
PREVENTIVE NURSING INTERVENTIONS:
• turn, coughing and deep breathing
• frequent position changes
• early ambulation
MAJOR CLINICAL MANIFESTATIONS:
• decreased lung sound over affected area
• dyspnea
• cyanosis
• crackles
• restlessness
• apprehension
• fever
• tachypnea
Perioperative Nursing Lecture
TREATMENT:
• position in semi-Fowler’s or Fowler’s
• administer O2 as ordered
• maintain hydration
• administer analgesics as ordered
• chest physiotherapy
• suctioning
• administer brochodilators and mucolytics via nebulizer
PREVENTIVE NURSING INTERVENTIONS:
• early ambulation
• turn, cough, and deep breathing
• incentive spirometry
MAJOR CLINICAL MANIFESTATIONS:
• absent bowel sounds
• no passage of flatus or feces
• abdominal distention
TREATMENT:
• nasogastric suction
• IV fluids
• rectal tube
• ambulate
PREVENTIVE NURSING INTERVENTIONS:
• early ambulation
• abdominal tightening exercises
• keep NPO if inactive bowel sounds
MAJOR CLINICAL MANIFESTATIONS:
• similar to paralytic ileus although bowel movement
may occur before obstruction
TREATMENT:
• bowel decompression with a Miller-Abbot tube
• surgical correction
MAJOR CLINICAL MANIFESTATIONS:
• dyspnea
• sudden severe chest pain or tightness
• cough
• pallor or cyanosis
• increased respirations
• tachycardia
• anxiety
• bradycardia
• hypotension
• restlessness
Perioperative Nursing Lecture
TREATMENT:
• contact physician stat
• maintain bedrest with HOB in semi-Fowler’s
• maintain fluid balance
• administer O2 as ordered
• administer anticoagulants as ordered
• administer analgesics as ordered
PREVENTIVE NURSING INTERVENTIONS:
• passive and active range of motion exercises to legs
• antiembolic stockings
• low-dose heparin administration if predisposing factors
present
• early ambulation
MAJOR CLINICAL MANIFESTATIONS:
• active bleeding
• elevation and discoloration of wound edges
TREATMENT:
• if small, may reabsorb; otherwise surgical evacuation
MAJOR CLINICAL MANIFESTATIONS:
• decreased blood pressure
• cold, clammy skin
• weak, rapid, thready pulse
• deep, rapid respirations
• decreased urinary output
• thirst
• apprehension
• restlessness
TREATMENT:
• position flat with legs elevated 45 degrees
• administer fluid resuscitation as well as whole blood
or its components as ordered
• administer O2 as ordered
• place extra covering to maintain warmth
• prepare for OR
MAJOR CLINICAL MANIFESTATIONS:
• pain and cramping in the calf of the involved
extremity
• redness, swelling in the affected area of the involved
extremity
• increased temperature of the involved extremity
• increased diameter of the involved extremity
Perioperative Nursing Lecture
TREATMENT:
• administer analgesics as ordered
• measure bilateral calf or thigh circumferences
• administer anticoagulants as ordered
• elevate affected extremity to heart level
• maintain bedrest
• apply moist heat on affected extremity as ordered
PREVENTIVE NURSING INTERVENTIONS:
• antiembolic stockings or sequential pneumatic
compressions stockings
• postoperative leg exercises
• early ambulation

Weitere ähnliche Inhalte

Was ist angesagt?

Peri operative nursing
Peri operative nursingPeri operative nursing
Peri operative nursingOther Mother
 
Disturbed sleeping pattern
Disturbed sleeping patternDisturbed sleeping pattern
Disturbed sleeping patternMj Hernandez
 
Scrub and circulating nurse
Scrub and circulating nurseScrub and circulating nurse
Scrub and circulating nurseProf Vijayraddi
 
Pre operative and post operative care
Pre operative and post operative carePre operative and post operative care
Pre operative and post operative careMahesh Chand
 
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptx
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptxMCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptx
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptxanjalatchi
 
11 key areas of responsibility
11 key areas of responsibility11 key areas of responsibility
11 key areas of responsibilityznel
 
surgery types - classification
surgery types - classificationsurgery types - classification
surgery types - classificationSiva Nanda Reddy
 
Peri-operative nursing PPT
 Peri-operative nursing PPT Peri-operative nursing PPT
Peri-operative nursing PPTpooja chauhan
 
Care-of-clients-with-problems-in-oxygenation-part-1
 Care-of-clients-with-problems-in-oxygenation-part-1 Care-of-clients-with-problems-in-oxygenation-part-1
Care-of-clients-with-problems-in-oxygenation-part-1Nursing Path
 
Scrub nurse
Scrub nurseScrub nurse
Scrub nurseHIRANGER
 

Was ist angesagt? (20)

Preoperative care
Preoperative carePreoperative care
Preoperative care
 
Peri operative nursing
Peri operative nursingPeri operative nursing
Peri operative nursing
 
Disturbed sleeping pattern
Disturbed sleeping patternDisturbed sleeping pattern
Disturbed sleeping pattern
 
Scrub and circulating nurse
Scrub and circulating nurseScrub and circulating nurse
Scrub and circulating nurse
 
Pre operative and post operative care
Pre operative and post operative carePre operative and post operative care
Pre operative and post operative care
 
Perioperative Care
Perioperative CarePerioperative Care
Perioperative Care
 
Pre operative care
Pre operative carePre operative care
Pre operative care
 
Post operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, Silvassa
Post operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, SilvassaPost operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, Silvassa
Post operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, Silvassa
 
Preoperative nursing
Preoperative nursingPreoperative nursing
Preoperative nursing
 
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptx
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptxMCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptx
MCQ ON POSITION USED IN NURSING CARE OF PATIENTS.pptx
 
11 key areas of responsibility
11 key areas of responsibility11 key areas of responsibility
11 key areas of responsibility
 
Surgical draping
Surgical drapingSurgical draping
Surgical draping
 
surgery types - classification
surgery types - classificationsurgery types - classification
surgery types - classification
 
Nursing Care Plan Guide
Nursing Care Plan GuideNursing Care Plan Guide
Nursing Care Plan Guide
 
Peri-operative nursing PPT
 Peri-operative nursing PPT Peri-operative nursing PPT
Peri-operative nursing PPT
 
Care-of-clients-with-problems-in-oxygenation-part-1
 Care-of-clients-with-problems-in-oxygenation-part-1 Care-of-clients-with-problems-in-oxygenation-part-1
Care-of-clients-with-problems-in-oxygenation-part-1
 
Post operative care
Post operative carePost operative care
Post operative care
 
Scrub nurse
Scrub nurseScrub nurse
Scrub nurse
 
Post op care
Post op carePost op care
Post op care
 
Care of surgical patient
Care of surgical patientCare of surgical patient
Care of surgical patient
 

Andere mochten auch

Andere mochten auch (10)

Ppt. perioperative nursing
Ppt. perioperative nursingPpt. perioperative nursing
Ppt. perioperative nursing
 
perioperative nursing care
perioperative nursing careperioperative nursing care
perioperative nursing care
 
Perioperative Nursing
Perioperative NursingPerioperative Nursing
Perioperative Nursing
 
Preanesthetic evaluation
Preanesthetic evaluationPreanesthetic evaluation
Preanesthetic evaluation
 
Preoperative assessment
Preoperative  assessmentPreoperative  assessment
Preoperative assessment
 
Preoperative preparation
Preoperative preparationPreoperative preparation
Preoperative preparation
 
Preoperative evaluation
Preoperative evaluation Preoperative evaluation
Preoperative evaluation
 
Principles of preoperative assessment
Principles of preoperative assessmentPrinciples of preoperative assessment
Principles of preoperative assessment
 
Preoperative Surgical Preparation
Preoperative Surgical PreparationPreoperative Surgical Preparation
Preoperative Surgical Preparation
 
Preoperative Evaluation
Preoperative EvaluationPreoperative Evaluation
Preoperative Evaluation
 

Ähnlich wie Perioperative Nursing Lecture

Preparation of patient before ICU ON 13.11.22.pptx
Preparation of patient before ICU ON 13.11.22.pptxPreparation of patient before ICU ON 13.11.22.pptx
Preparation of patient before ICU ON 13.11.22.pptxanjalatchi
 
Medical emergencies in dentistry phd
Medical emergencies in dentistry phdMedical emergencies in dentistry phd
Medical emergencies in dentistry phdcyriacjohn
 
Anaesthesia in robotic surgery
Anaesthesia in robotic surgeryAnaesthesia in robotic surgery
Anaesthesia in robotic surgerypankaj bhosale
 
Anaesthesia in robotic surgery
Anaesthesia in robotic surgeryAnaesthesia in robotic surgery
Anaesthesia in robotic surgerypankaj bhosale
 
Power Point Chapter 15 and 19.ppturinary
Power Point Chapter 15 and 19.ppturinaryPower Point Chapter 15 and 19.ppturinary
Power Point Chapter 15 and 19.ppturinaryAshuAshu95
 
Maintenance of therapeutic environment in OT
Maintenance of therapeutic environment in OTMaintenance of therapeutic environment in OT
Maintenance of therapeutic environment in OTFortis Hospitals Limited
 
COPD COMPLETE POWER POINT AS PER GOLD....
COPD COMPLETE POWER POINT AS PER GOLD....COPD COMPLETE POWER POINT AS PER GOLD....
COPD COMPLETE POWER POINT AS PER GOLD....V467
 
Day care surgery BY DR.HARSHENDRA.VEGUNTA
Day care surgery BY DR.HARSHENDRA.VEGUNTADay care surgery BY DR.HARSHENDRA.VEGUNTA
Day care surgery BY DR.HARSHENDRA.VEGUNTAVegunta Harshendra
 
Pre & post operative nursing care
Pre & post operative nursing carePre & post operative nursing care
Pre & post operative nursing careABHIJIT BHOYAR
 
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdfMakspeyndelValleMoon
 
Perioperative Nursing Care
Perioperative Nursing CarePerioperative Nursing Care
Perioperative Nursing CareProf Vijayraddi
 
MANAGEMENT OF TRAUMA
MANAGEMENT OF TRAUMAMANAGEMENT OF TRAUMA
MANAGEMENT OF TRAUMAannaselvabai
 
Dengue Fever, epidemiology, diagnosis and management
Dengue Fever, epidemiology, diagnosis and managementDengue Fever, epidemiology, diagnosis and management
Dengue Fever, epidemiology, diagnosis and managementWasantha13
 

Ähnlich wie Perioperative Nursing Lecture (20)

Preparation of patient before ICU ON 13.11.22.pptx
Preparation of patient before ICU ON 13.11.22.pptxPreparation of patient before ICU ON 13.11.22.pptx
Preparation of patient before ICU ON 13.11.22.pptx
 
PERIOPERATIVE-
PERIOPERATIVE- PERIOPERATIVE-
PERIOPERATIVE-
 
Pharmacological methods of behavioural management 1
Pharmacological methods of behavioural management   1Pharmacological methods of behavioural management   1
Pharmacological methods of behavioural management 1
 
Medical emergencies in dentistry phd
Medical emergencies in dentistry phdMedical emergencies in dentistry phd
Medical emergencies in dentistry phd
 
Anaesthesia in robotic surgery
Anaesthesia in robotic surgeryAnaesthesia in robotic surgery
Anaesthesia in robotic surgery
 
Anaesthesia in robotic surgery
Anaesthesia in robotic surgeryAnaesthesia in robotic surgery
Anaesthesia in robotic surgery
 
Power Point Chapter 15 and 19.ppturinary
Power Point Chapter 15 and 19.ppturinaryPower Point Chapter 15 and 19.ppturinary
Power Point Chapter 15 and 19.ppturinary
 
Clinical patients rai
Clinical patients raiClinical patients rai
Clinical patients rai
 
Maintenance of therapeutic environment in OT
Maintenance of therapeutic environment in OTMaintenance of therapeutic environment in OT
Maintenance of therapeutic environment in OT
 
Pharmacological methods of behavioural management 2
Pharmacological methods of behavioural management  2Pharmacological methods of behavioural management  2
Pharmacological methods of behavioural management 2
 
COPD COMPLETE POWER POINT AS PER GOLD....
COPD COMPLETE POWER POINT AS PER GOLD....COPD COMPLETE POWER POINT AS PER GOLD....
COPD COMPLETE POWER POINT AS PER GOLD....
 
Day care surgery BY DR.HARSHENDRA.VEGUNTA
Day care surgery BY DR.HARSHENDRA.VEGUNTADay care surgery BY DR.HARSHENDRA.VEGUNTA
Day care surgery BY DR.HARSHENDRA.VEGUNTA
 
Pre & post operative nursing care
Pre & post operative nursing carePre & post operative nursing care
Pre & post operative nursing care
 
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf
2. Pulse Oximeter, Incentive Spirometry, Nebulization, CPT.pdf
 
Operative gynaecology
Operative gynaecologyOperative gynaecology
Operative gynaecology
 
6 minute walk test
6 minute walk test6 minute walk test
6 minute walk test
 
Asthma
AsthmaAsthma
Asthma
 
Perioperative Nursing Care
Perioperative Nursing CarePerioperative Nursing Care
Perioperative Nursing Care
 
MANAGEMENT OF TRAUMA
MANAGEMENT OF TRAUMAMANAGEMENT OF TRAUMA
MANAGEMENT OF TRAUMA
 
Dengue Fever, epidemiology, diagnosis and management
Dengue Fever, epidemiology, diagnosis and managementDengue Fever, epidemiology, diagnosis and management
Dengue Fever, epidemiology, diagnosis and management
 

Mehr von Jofred Martinez

Nursing Leadership & Management
Nursing Leadership & ManagementNursing Leadership & Management
Nursing Leadership & ManagementJofred Martinez
 
Musculoskeletal System Trauma
Musculoskeletal System TraumaMusculoskeletal System Trauma
Musculoskeletal System TraumaJofred Martinez
 
Musculoskeletal System Anatomy and Assessment
Musculoskeletal System Anatomy and AssessmentMusculoskeletal System Anatomy and Assessment
Musculoskeletal System Anatomy and AssessmentJofred Martinez
 
Health Implications of Disasters in the Philippines
Health Implications of Disasters in the PhilippinesHealth Implications of Disasters in the Philippines
Health Implications of Disasters in the PhilippinesJofred Martinez
 
RA 7877 Sexual Harassment Act
RA 7877 Sexual Harassment ActRA 7877 Sexual Harassment Act
RA 7877 Sexual Harassment ActJofred Martinez
 
NGRTCI Endocrine System Disorders Lecture
NGRTCI Endocrine System Disorders LectureNGRTCI Endocrine System Disorders Lecture
NGRTCI Endocrine System Disorders LectureJofred Martinez
 
NGRTCI Endocrine System Anatomy Lecture
NGRTCI Endocrine System Anatomy LectureNGRTCI Endocrine System Anatomy Lecture
NGRTCI Endocrine System Anatomy LectureJofred Martinez
 
MS Hearing and Equilibrium Disorders
MS Hearing and Equilibrium DisordersMS Hearing and Equilibrium Disorders
MS Hearing and Equilibrium DisordersJofred Martinez
 
MS Eye and Vision Disorders
MS Eye and Vision DisordersMS Eye and Vision Disorders
MS Eye and Vision DisordersJofred Martinez
 
Nursing Healthcare Systems
Nursing Healthcare SystemsNursing Healthcare Systems
Nursing Healthcare SystemsJofred Martinez
 
Nursing Emergency and Disaster Preparedness
Nursing Emergency and Disaster PreparednessNursing Emergency and Disaster Preparedness
Nursing Emergency and Disaster PreparednessJofred Martinez
 
Nursing Curriculum Development
Nursing Curriculum DevelopmentNursing Curriculum Development
Nursing Curriculum DevelopmentJofred Martinez
 
Bioethics Behavior Control
Bioethics Behavior ControlBioethics Behavior Control
Bioethics Behavior ControlJofred Martinez
 
Bioethics Patient's Rights
Bioethics Patient's RightsBioethics Patient's Rights
Bioethics Patient's RightsJofred Martinez
 

Mehr von Jofred Martinez (20)

Hygiene and Grooming
Hygiene and GroomingHygiene and Grooming
Hygiene and Grooming
 
Sports Injury
Sports InjurySports Injury
Sports Injury
 
Nursing Leadership & Management
Nursing Leadership & ManagementNursing Leadership & Management
Nursing Leadership & Management
 
Musculoskeletal System Trauma
Musculoskeletal System TraumaMusculoskeletal System Trauma
Musculoskeletal System Trauma
 
Musculoskeletal System Anatomy and Assessment
Musculoskeletal System Anatomy and AssessmentMusculoskeletal System Anatomy and Assessment
Musculoskeletal System Anatomy and Assessment
 
Health Implications of Disasters in the Philippines
Health Implications of Disasters in the PhilippinesHealth Implications of Disasters in the Philippines
Health Implications of Disasters in the Philippines
 
RA 7877 Sexual Harassment Act
RA 7877 Sexual Harassment ActRA 7877 Sexual Harassment Act
RA 7877 Sexual Harassment Act
 
Nursing Research
Nursing ResearchNursing Research
Nursing Research
 
NGRTCI Endocrine System Disorders Lecture
NGRTCI Endocrine System Disorders LectureNGRTCI Endocrine System Disorders Lecture
NGRTCI Endocrine System Disorders Lecture
 
NGRTCI Endocrine System Anatomy Lecture
NGRTCI Endocrine System Anatomy LectureNGRTCI Endocrine System Anatomy Lecture
NGRTCI Endocrine System Anatomy Lecture
 
Neurologic Nursing 1
Neurologic Nursing 1Neurologic Nursing 1
Neurologic Nursing 1
 
MS Hearing and Equilibrium Disorders
MS Hearing and Equilibrium DisordersMS Hearing and Equilibrium Disorders
MS Hearing and Equilibrium Disorders
 
MS Eye and Vision Disorders
MS Eye and Vision DisordersMS Eye and Vision Disorders
MS Eye and Vision Disorders
 
Nursing Healthcare Systems
Nursing Healthcare SystemsNursing Healthcare Systems
Nursing Healthcare Systems
 
Nursing Informatics
Nursing InformaticsNursing Informatics
Nursing Informatics
 
Nursing Emergency and Disaster Preparedness
Nursing Emergency and Disaster PreparednessNursing Emergency and Disaster Preparedness
Nursing Emergency and Disaster Preparedness
 
Nursing Curriculum Development
Nursing Curriculum DevelopmentNursing Curriculum Development
Nursing Curriculum Development
 
Bioethics Behavior Control
Bioethics Behavior ControlBioethics Behavior Control
Bioethics Behavior Control
 
Bioethics Patient's Rights
Bioethics Patient's RightsBioethics Patient's Rights
Bioethics Patient's Rights
 
Bioethics Paternalism
Bioethics PaternalismBioethics Paternalism
Bioethics Paternalism
 

Kürzlich hochgeladen

Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 

Kürzlich hochgeladen (20)

Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 

Perioperative Nursing Lecture

  • 3. ORRECTION OF DEFECTS ALTERATION OF FORM ESTORATION OF FUNCTION IAGNOSIS AND TREATMENT
  • 4. INPATIENT SETTINGS: • hospitals OUTPATIENT SETTINGS: • hospital based ambulatory surgical centers • free-standing surgical centers • physicians' offices • ambulatory care centers
  • 5. URPOSE / REASON RGENCY ISK, DEGREE OF XTENT
  • 6. • DIAGNOSTIC e.g. BREAST BIOPSY, EXPLORATORY LAPAROTOMY • ABLATIVE e.g. MASTECTOMY, HYSTERECTOMY • CONSTRUCTIVE e.g. CHEILOPLASTY, PALATOPLASTY • RECONSTRUCTIVE e.g. ORIF • PALLIATIVE e.g. COLOSTOMY, NERVE ROOT RESECTION • COSMETIC e.g. REVISION OF SCARS, RHINOPLASTY
  • 7. • EMERGENCY e.g. GUNSHOT WOUND, SEVERE BLEEDING • URGENT e.g. KIDNEY OR URETHRAL STONES • ELECTIVE e.g. CATARACT REMOVAL, HERNIA REPAIR • OPTIONAL e.g. CIRCUMCISION
  • 8. • MAJOR e.g. EXPLORATORY LAPAROTOMY, CESAREAN SECTION • MINOR e.g. INCISION AND DRAINAGE
  • 9. • SIMPLE e.g. SIMPLE MASTECTOMY • RADICAL e.g. RADICAL MASTECTOMY
  • 13. • NURSING HISTORY e.g. BLEEDING DISORDERS, CARDIOVASCULAR DSE., RESPIRATORY DSE., LIVER DSE., RENAL DSE., DIABETES MELLITUS • PAST SURGICAL HISTORY • ALLERGIES • SMOKING AND ALCOHOL HABITS • OCCUPATION • EMOTIONAL HEALTH • SIGNIFICANT OTHER’S SUPPORT • PATIENT’S AND SIGNIFICANT OTHER’S UNDERSTANDING OF SURGERY
  • 15. P 1. A NORMALLY HEALTHY PATIENT P 2. A PATIENT WITH MILD SYSTEMIC DISEASE P 3. A PATIENT WITH SEVERE SYSTEMIC DISEASE THAT IS NOT INCAPACITATING P 4. A PATIENT WITH AN INCAPACITATING SYSTEMIC DISEASE THAT IS A CONSTANT THREAT TO LIFE P 5. A MORIBUND PATIENT WHO IS NOT EXPECTED TO SURVIVE FOR 24 HOURS WITH OR WITHOUT OPERATION
  • 16. • MUST BE BRIEF AND COMPLETE • DETERMINE THE FOLLOWING:  NUTRITIONAL STATUS  HEIGHT AND WEIGHT  BODY MASS INDEX (BMI)  SERUM PROTEIN LEVEL  NITROGEN BALANCE
  • 17. T• ASSESS FOR OBESITY, WEIGHT LOSS, MALNUTRITION, METABOLIC ABNORMALITIES, AND THE EFFECTS OF MEDICATIONS ON NUTRITION • OBTAIN BMI AND WAIST CIRCUMFERENCE
  • 18. T • ADVISE PATIENT TO STOP SMOKING 6 MONTHS PRIOR TO SURGERY • TEACH BREATHING AND COUGHING EXERCISES • IF PATIENT HAS RESPIRATORY INFECTIONS, POSTPONE THE SURGERY.
  • 19. T • IF PATIENT IS HYPERTENSIVE, POSTPONE THE SURGERY. • AVOID SUDDEN CHANGES IN POSITION, PROLONGED IMMOBILIZATION, HYPOTENSION, HYPOXIA AND OVERLOADING THE CV SYSTEM.
  • 20. T • OPTIMAL LIVER FUNCTION IS ESSENTIAL. • SURGERY IS CONTRAINDICATED IN PATIENTS WITH ACUTE • NEPHRITIS, ACUTE RENAL INSUFFICIENCY AND OLIGURIA OR ANURIA OR OTHER ACUTE RENAL PROBLEMS.
  • 21. T • PATIENTS WITH DM ARE PRONE TO HYPOGLYCEMIA AND HYPERGLYCEMIA. • PERFORM CBG TEST BEFORE, DURING AND AFTER SURGERY. MAINTAIN BLOOD GLUCOSE BELOW 200 mg/dL. • USE OF CORTICOSTERIODS PLACES THE PATIENT AT RISK FOR ADRENAL INSUFFICIENCY. • PATIENTS WITH THYROID DISORDERS ARE AT RISK FOR THYROTOXICOSIS OR RESPIRATORY FAILURE.
  • 22. T• DETERMINE PRESENCE OF ALLERGIES • DOCUMENT ANY SENSITIVITY TO MEDICATIONS AND PAST ADVERS REACTIONS TO THESE AGENTS. • STRICT ASEPSIS ON IMMUNOSUPRESSED SURGICAL PATIENTS.
  • 23. T ADRENAL CORTICOSTERIODS DO NOT DISCONTINUE ABRUPTLY, CV COLLAPSE MAY OCCUR DIURETICS THIAZIDE DIURETICS MAY CAUSE EXCESSIVE RESPIRATORY DEPRESSION CHLORPROMAZINE INCREASES HYPOTENSIVE EFFECTS OF ANESTHETICS DIAZEPAM MAY CAUSE ANXIETY, TENSION AND SEIZURES IF WITHDRAWN SUDDENLY ERYTHROMYCIN IF COMBINED WITH CURARIFORM MUSCLE RELAXANT, RESPIRATORY PARALYSIS
  • 24. TWARFARIN SHOULD BE DISCONTINUED, INCREASES THE RISK OF BLEEDING PHENELZINE SULFATE INCREASES HYPOTENSIVE EFFECTS OF ANESTHETICS LEVOTHYROXINE SODIUM ADMINISTER IV TO KEEP PATIENT IN EUTHYROID
  • 25. • LABORATORY SCREENING e.g. CBC, SERUM ELECTROLYTES, COAGULATION STUDIES, SERUM CREATININE, BUN, URINALYSIS, BLOOD TYPING & CROSS MATCHING • RADIOLOGIC SCREENING e.g. X-RAY, MRI, CT SCAN • OTHER DIAGNOSTIC SCREENING e.g. ECG
  • 28.  WHAT DO YOU PLAN TO DO TO ME?  WHY DO YOU WANT TO DO THIS PROCEDURE?  WHAT ARE ALTERNATIVES TO THIS PLAN?  WHAT THINGS SHOULD I WORRY ABOUT?  WHAT ARE THE GREATEST RISKS OR WORST THAT COULD HAPPEN? AMERICAN COLLEGE OF SURGEONS (ACS)
  • 29. If the patient is: • A minor, a parent or legal guardian should sign. • An emancipated minor, or independently earning a living, he or she may sign. • A minor who is the parent of infant or child who is having the procedure, he or she may sign for the child. • Illiterate, he or she may sign with an X, after which the patient‟s writes “patient‟s mark”.
  • 30. If the patient is: • Unconscious, a responsible relative or guardian may sign. • Mentally incapacitated by alcohol or other chemical substance, a responsible relative or guardian may sign when the urgency of the procedure does not allow time for the patient to regain mental competence.
  • 31. T • DIET ORDERS: NPO 6 – 12 HOURS PTOR • MONITOR INPUT AND OUTPUT • CATHETER INSERTION • BOWEL PREPARATION (i.e. ENEMA, USE OF LAXATIVES)
  • 32. T • HYGIENE • BATH • REMOVE COSMETICS AND NAILPOLISH • REMOVE ALL HAIRPINS AND CLIPS • REMOVE DENTURES • PROVIDE AN OR GOWN
  • 33. T • DISCONTINUE MEDICATIONS THAT ARE ADVISED TO BE DISCONTINUED. • ADMINISTER PREOPERATIVE MEDICATIONS • INSERTION OF NGT • SPECIAL SKIN PREPARATION • TAKE CARE OF PT.’S BELONGINGS AND REMOVE ALL BODY PROSTHESIS
  • 34. • PROMOTE POSITIVE COPING STRATEGIES  IMAGERY  DISTRACTION • PROVIDE PREOPERATIVE TEACHING • PROVIDE OPPORTUNITY FOR VISITS FROM FAMILY AND FRIENDS
  • 36. CONTENT OF PREOPERATIVE TEACHING: • SURGICAL PROCEDURE • PREOPERATIVE ROUTINES • INTRAOPERATIVE ROUTINES • POSTOPERATIVE ROUTINES • PAIN RELIEF • POSTOPERATIVE EXERCISES • ACCESS DEVICES
  • 37. • DEEP BREATHING • COUGHING • INCENTIVE SPIROMETRY
  • 40. • LEG EXERCISES • TURNING-TO-SIDES EXERCISES • GETTING-OUT-OF-BED EXERCISES
  • 43. RESPECTING SPIRITUAL AND RELIGIOUS BELIEFS: • PROVIDE TIME FOR PRAYER • ARRANGE FOR VISIT FROM A SPIRITUAL ADVISER / CLERGYMAN AS DESIRED • TAKE INTO CONSIDERATION RELIGIOUS BELIEFS IN THE OPERATIVE CARE
  • 44. • ORAL LAXATIVES e.g. CASTOR OIL, BISACODYL (DULCOLAX) • CLEAR LIQUID DIET THE EVENING BEFORE SURGERY • NPO AFTER MIDNIGHT • MULTIPLE-POSITION TAP-WATER ENEMAS THE EVENING BEFORE SURGERY • ORAL ANTIBIOTICS 24 HOURS BEFORE SURGERY e.g., NEOMYCIN, ERYTHROMYCIN
  • 45. • CLEANING THE SKIN OVER THE SURGICAL SITE WITH ANTIMICROBIAL SOLUTION e.g., POVIDONE-IODINE (BETADINE) • REMOVING HAIR OVER THE SURGICAL SITE e.g., SHAVING HAIR, CLIPPING HAIR • APPLY ANTIMICROBIAL SOLUTION TO THE SKIN OVER THE SURGICAL SITE e.g., POVIDONE-IODINE (BETADINE)
  • 46. REASONS FOR PREOPERATIVE MEDICATION:  REDUCE ANXIETY  PROMOTE RELAXATION  REDUCE PHARYNGEAL SECRETIONS  PREVENT LARYNGOSPASM  INHIBIT GASTRIC SECRETIONS  DECREASE THE AMOUNT OF ANESTHETIC REQUIRED FOR INDUCTION AND MAINTENANCE OF ANESTHESIA
  • 47. • SEDATIVES AND HYPNOTICS e.g.,pentobarbitol sodium (Nembutal), secobarbitol sodium (Secobarbitol), chloral hydrate • TRANQUILIZERS e.g.,chlorpromazine hydrochloride (Thorazine), hydroxine hydrochloride (Vistaril), diazepam (Valium) • OPIOID ANALGESICS e.g.,meperidine hydrochloride (Demerol), morphine sulphate, hydromorphone hydrochloride (Dilaudid)
  • 48. • ANTICHOLINERGICS e.g.,atropine sulphate, scopolomine (Hycosine) • H2-RECEPTOR ANTAGONISTS e.g.,cimetidine (Tagamet), rantidine hydrochloride (Zantac), famotidine (Pepcid) • ANTIEMETICS e.g.,metrochlopromide (Reglan), droperidol (Inapsine), promethazine hyrdrochloride (Phenergan)
  • 50. 1. Morning bath and mouth care 2. Provide a clean gown 3. Remove hair pins, braid long hair, and cover hair with cap. 4. Remove dentures, foreign materials, colored nail polish, hearing aids, glasses and contact lens. 5. Take baseline vital signs before pre-op meds. 6. Check ID band 7. Check for special orders: enema , gastric tube, IV line 8. Have client void before pre-operative medications. 9. Continue to support emotionally 10.Accomplish the Pre-op Checklist
  • 51. • Provision of a comfortable stretcher • Provision of sufficient blankets • Provision of safety measures • Proper identification of surgical patient • Proper greeting of patient • Provision of a quiet environment
  • 52.  Informed consent  Surgeon / nurse conference  Laboratory tests  Skin preparation  Bowel preparation  Iv fluids  Preoperative medications, sedation and antibiotics  Removal of dentures, nail polish and jewelries  Npo status
  • 55. 1. ONLY STERILE ITEMS ARE USED WITHIN THE STERILE FIELD. 2. STERILE PERSONS ARE GOWNED AND GLOVED. 3. TABLES ARE STERILE ONLY AT TABLE LEVEL. 4. STERILE PERSONS TOUCH ONLY STERILE ITEMS OR AREAS, WHILE UNSTERILE PERSONS TOUCH ONLY UNSTERILE ITEMS OR AREAS. 5. UNSTERILE PERSONS AVOID REACHING OVER THE STERILE FIELD, WHILE STERILE PERSONS AVOID LEANING OVER AN UNSTERILE FIELD. 6. THE EDGES OF ANYTHING THAT ENCLOSES STERILE CONTENTS ARE CONSIDERED UNSTERILE.
  • 56. 7. THE STERILE FIELD IS CREATED AS CLOSE AS POSSIBLE TO THE TIME OF USE. 8. STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW. 9. STERILE PERSONS KEEP WELL WITHIN THE STERILE FIELD. 10. STERILE PERSONS KEEP CONTACT WITH STERILE AREAS TO A MINIMUM. 11. UNSTERILE PERSONS AVOID STERILE AREAS. 12. DESTRUCTION OF THE INTEGRITY OF THE MICROBIAL BARRIER LEADS TO CONTAMINATION. 13. MICROORGANISM MUST BE KEPT TO AN IRREDUCIBLE MINIMUM.
  • 57. THE OPERATING ROOM • Should be free from contaminating particles, dusts, pollutants, radiation and noise THREE ZONES: • UNRESTRICTED – street clothes are allowed • SEMI-RESTRICTED – scrubs, shoe covers, caps and masks • RESTRICTED – scrubs, shoe covers, caps, masks, OR gowns and gloves
  • 58. OPERATING ROOM ATTIRE • SCRUB SUIT • STERILE GOWN • HEAD COVER • SHOES PERSONAL PROTECTIVE DEVICES • SURGICAL EYE PROTECTIVE DEVICES • SURGICAL FACE MASK • STERILE GLOVES
  • 59. 1. SURGEON • Perform the operative procedure safely and correctly and heads the surgical team. • Assumes responsibility for all medical acts of judgement and management. 2. ANESTHESIOLOGIST • Assesses patient before surgery and an hour prior to induction of anesthetics. • Administers the anesthetic agent and monitors the patient„s physical status throughout the surgery. • Intubate the patient if necessary. • Manage any technical problems related to administration of the anesthetic agent. • Supervise the patient condition throughout the surgical procedure.
  • 60. 3. CERTIFIED REGISTERED NURSE ANESTHETIST • assist in the administration of anesthetic drugs to induce and maintain anesthesia • administers other medications as indicated to support the patient's physical status during surgery 4. CIRCULATING NURSE • sets up the operating room • ensures that necessary supplies and equipment are readily available, safe and functional • makes up the operating room bed with gel and heating pads • greets the patient • assists the operating room team in transferring the client onto the operating room bed • positions the patient on the operating room bed
  • 61. 4. CIRCULATING NURSE • performs the surgical skin preparation • drapes the surgical site with sterile drapes • opens and dispenses sterile supplies during surgery • manages catheters, tubes, drains and specimens • administers medications and solutions to the sterile field • assesses the amount of urine and blood loss and reports these findings to the surgeon and anesthesia personnel • reviews the results of any diagnostic tests or lab studies • maintains a safe, aseptic environment • monitors traffic in the operating room • performs "sharps", sponge, and instrument count • documents all care, events, findings, and patient's responses
  • 62. 5. SCRUB NURSE • helps set up the sterile field • helps assist draping the client • hand instruments to the surgeon • performs "sharps", sponge, and instrument count
  • 73. GENERAL ANESTHESIA • produces total loss of consciousness by blocking awareness centers in the brain, amnesia, analgesia, hypnosis, and relaxation INDUCTION  Patient fells warmth, dizzy and feeling of detachment  Ringing, roaring or buzzing in the ears  Aware of being unable to move the extremities, noises are exaggerated EXCITEMENT  Pupil dilates but constricts in light  PR is rapid, RR is irregular  Restraints are applied
  • 74. OPERATIVE OR SURGICAL ANESTHESIA  Pupils are small but reactive  Patient is unconscious  RR is irregular, PR is normal MEDULLARY DEPRESSION / DANGER  Occurs when too much anesthesia is given  RR is shallow, pulse is weak and thready  Pupils are widely dilated and non reactive  Cyanosis occurs and eventually death
  • 75. 1. Inhalation of gases and/or volatile agents through an endotracheal tube or face mask a. Gases e.g., nitrous oxide (N20) b. Volatile agents e.g., halothane (Fluothane), isoflurane (Forane) 2. Intravenous infusion of barbiturates or nonbarbiturates a. Barbiturates e.g., thiopental sodium (Pentothal) b. Non-barbiturates e.g., ketamine (Ketalar), propolol (Diprivan), fentanyl citrate with droperidol (Innovar)
  • 78. A. HYPNOTICS e.g., midazolam (Versed),, diazepam (Valium) B. OPIOID ANALGESICS e.g., morphine sulphate, meperidine hydrochloride (Demerol), fentanyl citrate (Sublimaze) C. NEUROMUSCULAR BLOCKING AGENTS • NON-DEPOLARIZING AGENTS e.g., pancuronium (Pavulon), atacurium (Tracium), vecuronium (Norcuron) • DEPOLARIZING AGENTS e.g., succinycholine (Anectine)
  • 79. A. MALIGNANT HYPERTHERMIA Signs/Symptoms: tachycardia, dysrthymias, muscle rigidity (especially jaw and upper chest), hypotension, tachypnea, cola-colored urine, extreme hyperthermia (late sign) Treatment: DANTROLENE (DANTRIUM) B. OVERDOSE C. COMPLICATIONS TO ANESTHETIC AGENTS e.g., hypotension, bradycardia, dysrthymias, respiratory depression, decreased seizure threshold D. COMPLICATIONS OF ET INTUBATION e.g., broken caps, teeth, swollen lip, trauma to the vocal cords, improper neck extension
  • 80. • Injection of an anesthetic agent into or around a specific nerve, nerve trunk, or several nerve trunks supplying the tissue to be anesthetized USES OF NERVE BLOCK ANESTHESIA: a. prior to dental procedures b. control of pain during plastic surgery c. control of pain during surgery in an area supplied by that specific nerve, nerve trunk, or nerve trunk(s) d. to diagnose and treat chronic pain conditions e. to increase circulation in some vascular disorders
  • 81. • Injection of an anesthetic agent into the cerebrospinal fluid in the subarachnoid space around the nerve roots supplying the tissue to be anesthetized USES OF SPINAL REGIONAL ANESTHESIA • Control of pain during surgery of the lower abdomen below the umbilicus, the groin, or the lower extremities
  • 83. A. HYPOTENSION INTERVENTIONS: • administer O2 as ordered • administer vasoactive drugs as ordered • trendelenburg position if level of anesthesia is fixed B. NAUSEA AND VOMITING C. RESPIRATORY PARALYSIS INTERVENTIONS: • artificial respiration D. NEUROLOGIC COMPLICATIONS e.g., paraplegia, severe muscle weakness in legs
  • 84. • Injection of an anesthetic agent into the epidural space surrounding the dura mater around the nerve roots supplying the tissue to be anesthetized. USES OF EPIDURAL REGIONAL ANESTHESIA • control of pain during surgery of the lower abdomen below the umbilicus, the groin, or the lower extremities • control of pain during labor and delivery
  • 85. • SHORT (1/2- 1 HOUR)  Procaine (Novocaine)  Chloroprocaine (Nesacaine) • INTERMEDIATE (1-3 HOURS)  Lidocaine (Xylocaine)  Mepivacaine (Carbocaine) • LONG (3-10 HOURS)  Bupivacaine (Marcaine)  Dibucaine (Nupercaine)  Etiodocaine (Duranest)
  • 86. • Application of an anesthetic agent directly to the surface of the tissue to be anesthetized e.g. the skin or the mucosal surfaces of the mouth, throat, nose, cornea USES OF TOPICAL LOCAL ANESTHESIA a. prior to injection of regional anesthesia b. prior to endotracheal intubation c. prior to various diagnostic procedures: e.g. laryngoscopy, bonchoscopy, cystoscopy, endoscopy
  • 87. • Injection of an anesthetic agent intracutaneously and subcutaneously directly into the tissue to be anesthetized USES OF LOCAL INFILTRATION ANESTHESIA • prior to injection of regional anesthesia • prior to suturing of superficial lacerations at the end of surgery into the incision for postoperative pain relief • prior to dental procedures • prior to minor surgical procedures • excision of skin lesions or wound debridement • repair of an episiotomy
  • 88. • RETRACTING AND EXPOSING INSTRUMENTS  Handheld retractors  Self-retaining retractors • CUTTING AND DISSECTING INSTRUMENTS  Scalpels  Knives  Scissors  Bone cutters • Clamping and Occluding Instruments  Hemostatic forceps  Noncrushing vascular clamps • Grasping and Holding Instruments  Forceps  Needle holders  Bone holders
  • 89. TYPES OF SUTURE MATERIALS 1. ABSORBABLE SUTURES a. Surgical Gut e.g. Plain, Chromic, Collagen Sutures b. Synthetic Absorbable Polymers e.g. Polydiaxanone Suture (PDS), Poliglecaprone 25 (Monocryl), Polyglyconate (Maxon), Polyglactin 910 (Vicryl) , Polyglycolic Acid (Dexon) 2. NONABSORBABLE SUTURES a. Surgical Silk b. Surgical Nylon
  • 90. METHODS OF SUTURING • Simple Continuous • Simple Interrupted • Continuous Interlocking • Mattress ASSESSMENT OF SUTURE LINE • Stitched too tight or too loose • Too many or too few stitches • Suture holes are not equidistant from the edges so that the bite is not even, or there is uneven spacing between sutures • There is inversion or eversion of tissue edges • The edges of tissues are overlapping and heaped on each other
  • 93. A – Airway B – Breathing C – Circulatory C – Consciousness S – Safety/comfort D – Dressing D – Drainage D – Drugs E – Elimination F – Fluids F - Food
  • 94. THE FIVE PHYSIOLOGICAL PARAMETERS: 1. ACTIVITY 2. RESPIRATION 3. CIRCULATION 4. CONSCIOUSNESS 5. COLOR
  • 95. AREA OF ASSESSMENT Point Score 1 hour 2 hours 3 hours MUSCLE ACTIVITY Ability to move all extremities Ability to move 2 extremities Unable to control any extremity 2 1 0 RESPIRATION Ability to breath deeply and cough Limited respiratory effort No spontaneous effort 2 1 0
  • 96. AREA OF ASSESSMENT Point Score 1 hour 2 hours 3 hours CIRCULATION BP +/- 20% of pre-anesthetic level BP +/- 20%-40% of pre-anesthetic level BP +/- 50% pre-anesthetic level 2 1 0 CONSCIOUSNESS LEVEL Fully awake Arousal on calling Not responding 2 1 0
  • 97. AREA OF ASSESSMENT Point Score 1 hour 2 hours 3 hours O2 SATURATION Unable to maintain O2 sat >92% on room air Needs O2 inhalation to maintain O2 sat >90% O2 sat <90% even with O2 supplement 2 1 0 REQUIRED FOR DISCHARGE FROM PACU: 7 - 8
  • 98. ASSESSMENT:  respiratory rate, rhythm, depth  patency of airway  presence of oral airway  breath sounds  use of accessory muscles  skin color  ability to cough  ABG'S  O2 saturation
  • 99. INTERVENTIONS:  position patient on side to prevent aspiration  suction artificial airways and oral cavity as necessary  ask patient to perform respiratory exercises  administer O2 as needed
  • 100. ASSESSMENT:  heart rate  blood pressure  skin color  heart sounds  peripheral pulses  capillary refill  edema  skin temperature  urine output  Homan's sign  changes in vital signs symbolizing shock  type, amount, color, odor, and character of drainage from tubes, drains, catheters or incision
  • 101. INTERVENTIONS:  check under patient for pooling of blood  check dressings, tubes, drains, and catheters for blood  monitor changes in heart rate and blood pressure
  • 103. ASSESSMENT:  LOC  mental status  movement and sensation in extremities  presence of gag and corneal reflexes INTERVENTIONS:  orient patient to PACU environment  protect eyes if corneal reflex absent  protect airway if gag reflex absent
  • 104. TYPES OF WOUND HEALING • FIRST INTENTION • SECONDARY INTENTION • THIRD INTENTION
  • 105. 1. CLEAN WOUND • No break in sterile technique during the procedure 2. CLEAN – CONTAMINATED WOUND • Minor break in sterile technique • Alimentary, respiratory, genitourinary tract or oropharyngeal cavity not entered 3. CONTAMINATED WOUND • Open, fresh traumatic wound of less than 4 hours duration • Gross contamination from GI tract 4. DIRTY AND INFECTED WOUND • Old traumatic wound for more than 4 hours from dirty source or with retrained necrotic tissue, foreign body or fecal contamination
  • 107. • DRY TO DRY – trap necrotic debris and exudates • WET TO DRY – softens debris as it dries • WET TO DAMP – wound debridement • WET TO WET – moisture dilute exudates
  • 108.  warmth, swelling, tenderness or pain around incision  type, amount, color, odor, and character of drainage on dressings  amount, consisency, color of drainage  dependent areas (e.g., underneath the patient)  drains and tubes and be sure they are intact, patent, and properly connected to drainage systems INTERVENTIONS: • reinforce dressings as necessary
  • 109. ASSESSMENT:  bladder distention  amount, color, odor, and character of urine from foley catheter if present INTERVENTIONS:  catheterize if necessary  notify MD if urinary output is less than 30 cc/hr
  • 110. ASSESSMENT:  abdominal distention  N & V  bowel sounds  passage of flatus  type, amount, color, odor, and character of drainage from nasogastric tube if present
  • 111. ASSESSMENT:  I & O  color and appearance of mucus membranes  skin turgor, tenting, and texture  status of IV's  type, amount, color, odor, and character of drainage from tubes, drains, catheters, and incision  type, amount of solultion, flow rate, tubing, infusion site
  • 112. PREDISPOSING FACTORS: • diabetes, uremia, obesity, malnutrition, corticosteroid therapy MAJOR CLINICAL MANIFESTATIONS: • fever, foul-smelling, greenish-white drainage from wound, persistent edema, redness TREATMENT: • antibiotics on basis of wound culture and sensitivity • preventive nursing interventions: • strict aseptic technique in the operating room and during postoperative dressing changes
  • 113. MAJOR CLINICAL MANIFESTATIONS: • discharge of serosanguineous drainage from the wound • sensation that something gave or let go TREATMENT: • lay patient down • cover wound with sterile saline-soaked gauze or towels • prepare to return patient to operating room for repair • monitor for shock PREVENTIVE NURSING INTERVENTIONS: • splint wound when patient coughs • medicate for nausea and vomiting • highest risk during 5th to 8th postoperative days, so teach patient s/s as they may already be discharged
  • 115. PREDISPOSING FACTORS: • infection • dehydration • response to stress and trauma • prolonged hypotension • transfusion reaction • respiratory congestion • thrombophlebitis MAJOR CLINICAL MANIFESTATIONS: • temperature elevated above 99.5° (37.5° C) • elevated pulse and respiratory rates • diaphoresis • lethargy
  • 116. TREATMENT: • antipyretics • cooling sponge baths • increasing fluids
  • 117. MAJOR CLINICAL MANIFESTATIONS: • little or no output or frequent small amounts • palpably distended bladder • restlessness • discomfort TREATMENT: • measures to promote voiding (privacy, running water, sitting patient up • catheterization if above methods fail PREVENTIVE NURSING INTERVENTIONS • adequate hydration • early ambulation
  • 118. MAJOR CLINICAL MANIFESTATIONS: • mild fever • dysuria • hematuria • malaise TREATMENT: • adequate hydration • maintenance of good bladder drainage • antibiotics on basis of urine culture and sensitivity PREVENTIVE NURSING INTERVENTIONS: • encourage fluid intake • early ambulation • avoid catheterization or remove within 2 days
  • 119. MAJOR CLINICAL MANIFESTATIONS: • bowel obstruction • pain TREATMENT: • surgery for lysis of adhesions PREVENTIVE NURSING INTERVENTIONS: • aseptic technique in operating room and during dressing changes
  • 120. MAJOR CLINICAL MANIFESTATIONS: • increased temperature • chills • cough productive of purulent or rusty sputum • crackles • wheezes • dyspnea • chest pain • tachypnea • increased secretions
  • 121. TREATMENT: • promote full aeration of lungs by positioning in semi- Fowlers or Fowlers • administer O2 as ordered • maintain fluid status • administer antibiotics on basis of sputum culture and sensitivity • administer expectorants and analgesics as ordered • chest physiotherapy PREVENTIVE NURSING INTERVENTIONS: • turn, coughing and deep breathing • frequent position changes • early ambulation
  • 122. MAJOR CLINICAL MANIFESTATIONS: • decreased lung sound over affected area • dyspnea • cyanosis • crackles • restlessness • apprehension • fever • tachypnea
  • 124. TREATMENT: • position in semi-Fowler’s or Fowler’s • administer O2 as ordered • maintain hydration • administer analgesics as ordered • chest physiotherapy • suctioning • administer brochodilators and mucolytics via nebulizer PREVENTIVE NURSING INTERVENTIONS: • early ambulation • turn, cough, and deep breathing • incentive spirometry
  • 125. MAJOR CLINICAL MANIFESTATIONS: • absent bowel sounds • no passage of flatus or feces • abdominal distention TREATMENT: • nasogastric suction • IV fluids • rectal tube • ambulate PREVENTIVE NURSING INTERVENTIONS: • early ambulation • abdominal tightening exercises • keep NPO if inactive bowel sounds
  • 126. MAJOR CLINICAL MANIFESTATIONS: • similar to paralytic ileus although bowel movement may occur before obstruction TREATMENT: • bowel decompression with a Miller-Abbot tube • surgical correction
  • 127. MAJOR CLINICAL MANIFESTATIONS: • dyspnea • sudden severe chest pain or tightness • cough • pallor or cyanosis • increased respirations • tachycardia • anxiety • bradycardia • hypotension • restlessness
  • 129. TREATMENT: • contact physician stat • maintain bedrest with HOB in semi-Fowler’s • maintain fluid balance • administer O2 as ordered • administer anticoagulants as ordered • administer analgesics as ordered PREVENTIVE NURSING INTERVENTIONS: • passive and active range of motion exercises to legs • antiembolic stockings • low-dose heparin administration if predisposing factors present • early ambulation
  • 130. MAJOR CLINICAL MANIFESTATIONS: • active bleeding • elevation and discoloration of wound edges TREATMENT: • if small, may reabsorb; otherwise surgical evacuation
  • 131. MAJOR CLINICAL MANIFESTATIONS: • decreased blood pressure • cold, clammy skin • weak, rapid, thready pulse • deep, rapid respirations • decreased urinary output • thirst • apprehension • restlessness
  • 132. TREATMENT: • position flat with legs elevated 45 degrees • administer fluid resuscitation as well as whole blood or its components as ordered • administer O2 as ordered • place extra covering to maintain warmth • prepare for OR
  • 133. MAJOR CLINICAL MANIFESTATIONS: • pain and cramping in the calf of the involved extremity • redness, swelling in the affected area of the involved extremity • increased temperature of the involved extremity • increased diameter of the involved extremity
  • 135. TREATMENT: • administer analgesics as ordered • measure bilateral calf or thigh circumferences • administer anticoagulants as ordered • elevate affected extremity to heart level • maintain bedrest • apply moist heat on affected extremity as ordered PREVENTIVE NURSING INTERVENTIONS: • antiembolic stockings or sequential pneumatic compressions stockings • postoperative leg exercises • early ambulation