Care of the Surgical Patient CNA 2 OSBN

Care of the Surgical Patient CNA 2 OSBN Curriculum

Reasons for Surgery �Elective �Urgent Surgery �Emergency Surgery

Pre-Operative Period �Surgical Consent �Special Tests �Nutrition & Fluids �Elimination �Skin Prep �Pre-Op Meds �Transportation

Post-Operative Period �PACU to Nursing Unit �Frequent VS/policy �Dressing �Tubes ◦ Foley/IV /JP/NG �Rails Up �Call Light Handy �Family Present �Early Ambulation

Tissue Healing � Healing Process � Tissue Healing Stages ◦ ◦ ◦ Blood Clot Formation Inflammatory Phase Cellular Repair Regrowth of Bld Vessels Scar Formation �Issues w/Healing ◦ Malnutrition ◦ Wound Infection ◦ Coexisting Conditions � � � Diabetes Mellitus Advanced Age Tobacco Abuse Cancer Medication Side Effect

Wounds, Incisions, & Dressings �Wound Created �Portal of Entry �Infection a Threat �Factors Affecting Healing ◦ ◦ ◦ Type of Wound Age/General Health Nutrition Life Style Circulation �Important for Wound Healing ◦ Smoking ◦ Anticoagulants

More on Wounds �Wound Care Involves Prevention ◦ Infection ◦ Blood Loss ◦ Pain �Incision ◦ Clean/Dry ◦ Well Approximated ◦ No Edema/Irritation �Dressings ◦ Protects ◦ Absorbs ◦ Controls

Wound Closure �Sutures ◦ Stitches ◦ Stop Bleeding ◦ Speed Healing �Steri Strips ◦ Stretched Across Skin �Staples

Wound Drainage � Fluid Escapes � Variable Amt. of Drainage � Bleeding/Infections Affect �Types ◦ Serous �Clear, Watery ◦ Sanguineous �Bloody Drainage ◦ Sero-Sanguineous �Thin, Watery, Pink ◦ Purulent �Thick, �Yellow/Brown/Green

Drains �Drain Fluid ◦ From Surgical Site �Types ◦ Jackson Pratt: JP � 100 mls ◦ Hemovac � 400 mls ◦ Constavac/Stryker �>400 mls ◦ Penrose �No Container

Observation & Reporting �Location �Amount �Color CNA 2 Actions �Report Abnormals to Nurse �Maintain Integrity �Aseptic Technique to Empty

Wound Vac Drain

Preventing Complications �PRIORITY �Close Observation of Patient �Patient Safety �Activity Important After OR �Pulmonary Toilet �Emotional Support �Encouragement �Side Rails Up

Cardiovascular System �Edema: Fluid Retention �Sternal Precautions �Orthostatic Hypotension �DVT �MI

CNA 2 Actions �Report Abnormals to Nurse �Sternal Precautions ◦ Hug Pillow to Cough ◦ No Arms �C&DB, IS �TEDs/SCDs �Turning �Early Ambulation �Pain Control

Bleeding � Hemorrhage ◦ Excessive Loss in Short Period ◦ Death Can Result � Internal Hemorrhage ◦ Can’t See ◦ Bleeding Inside Body � Hematoma ◦ Check Under Things � Shock ◦ Not enough Blood Supply to Organs

CNA 2 Action �Report Abnormals to Nurse STAT �Remain w/Pt. �Assist as Requested

Observation & Reporting �Blood or Hematoma �Lg. amt. Bloody Drainage �Falling BP �Rapid/Weak Pulse �Rapid Respirations �Cool/Moist/Pale Skin �C/o Thirst �Restlessness �Decreased LOC

Capillary Refill �Extremity �How Blood Flow ◦ Pressure to Nail Bed until White ◦ Blanch Time �>2 Seconds Report

Observation & Reporting �Blanch �Pain Time > 2 -3 Sec. CNA 2 Actions �Report � Elevate Abnormals to Nurse Extremity

Digestive System �Increase Risk ◦ Paralytic Ileus ◦ Constipation CNA 2 Actions � Encourage Movement � Enemas prn � Report ◦ N/v ◦ Excessive Thirst ◦ Choking

Observation & Reporting Abdomen � Pain � Distention � Flatus � Swollen Abd. � Intestinal Gas CNA 2 Actions � Report Abnormals to Nurse � Increase Activity as Ordered � Bowel Care as Ordered

Endocrine System �Glycemic Control ◦ Hyperglycemias ◦ Increased Risk for Infection CNA 2 Actions �Report S&S ◦ Hyper/Hypoglycemia STAT ◦ Report < 75% Meal

Integumentary System �Increased ◦ ◦ Risk For Skin Breakdown Infection Dehiscence Evisceration CNA 2 Action � TCDB Q 2 Hr � Monitor Skin/Pressure Points � Pallor/Cyanosis � Bleeding

Pulmonary System �Increased Risk ◦ Atelectasis ◦ Pneumothorax ◦ Pneumonia ◦ Inflammation/Infected Lung ◦ Fluid Pooling CNA 2 Action �Report Abnormals to Nurse �C&DB Exercises �IS

Urinary System �Increased Risk For ◦ Urinary Retention ◦ Decreased UOP CNA 2 Actions �Report Abnormals to Nurse �Accurate I&O �Quality Urine

Pain �Expected �Depends ◦ ◦ ◦ ◦ On Extent of OR Site of Incision Drainage Tubes Casts Pt. “Threshold” Current Med Usage Hx Chronic Pain Hx Drug Abuse

Observation & Reporting �Painful Behaviors ◦ Moaning ◦ Grunting ◦ Crying Out ◦ Restlessness ◦ Withdrawn ◦ Furrowed Brow ◦ Grimacing ◦ Clenched Teeth ◦ Rubbing Affected Area ◦ Cursing when Repositioned

CNA 2 Actions �Report C/O Pain to Nurse �Pain Scale ◦ Compare to Familiar Pain �Can You Describe It? �Comfort Measures �Turn Frequently