Perioperative Nursing Peg Trueman RN MSN Ed D

Perioperative Nursing Peg Trueman RN MSN Ed. D. CNE

Meet the Patient l The experience of surgery is a routine event for everyone involved EXCEPT for the patient!

Nursing Management after Surgery

Postoperative Phase: Plan of Care

System Assessments l l l l Respiratory Cardiovascular Fluid Status Nutrition Elimination Activity Wound Healing

Respiratory l l Pulmonary assessment data TCDB • C/I: CHI, eye sx l l l O 2 therapy IPPB I. S. The real reason dinosaurs became extinct.

Cardiovascular l l Cardiac assessment data “Okay, Williams, we’ll vote… how many here say the heart has four chambers? ” Leg exercises Avoiding venous statsis ICD/hose

Fluid Status l l l Hydration status data Drainage amts vital signs daily weights! IV therapy Blood therapy

Nutrition l l l NPO status Progression of diet check bowel sounds Feedings TPN “The Nurse says a trip-o’-loomin’ cow-filler is feeding Grandma. It has three loops--one for breakfast, one for lunch, and one for dinner!”

Elimination l Urinary output • retention? !! • Dehydration • Catheter is the last resort! l Bowel activity • bowel sounds • flatus l Ambulation!!!!

Activity l OOB ASAP!! • Usually within 24 hrs l l Psychological impact Needs encouragement!

Physiology of Wound Healing l Inflammatory Stage • “insult” l Proliferative Stage • reinforcemen/framework l Maturation Stage • “settling in”

Wound Healing: First Intention l l l Scar formation is minimal Properly closed Heal with little tissue reaction

Wound Healing: Second Intention l l l Wound is left open to granulate Resultant in scar formation “Healing by granulation”

Wound Healing: Third Intention l l l Two opposing granulation surfaces are brought together Scar is deeper and wider “Delayed closure”

Factors Affecting Wound Healing l l l Age Hemorrhage Hypovolemia Local Factors Nutritional Deficits l l l Oxygen deficit Drainage Medications Systemic Disorders Wound Stressors

Wound Care “Just a friendly suggestion…next time you do a dressing change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”

Post-op Pain Control l What is pain? Factors affecting pain Administration • Preventative Approach • PRN vs ATC • Routes of Administration • Intramuscular • Intravenous • PCA pump/Epidural lines

Post-op Pain Control l Common Pain Medication • Demerol • Morphine • Dilaudid • Stadol • NSAIDs l Side Effects of Pain medication*

Managing Potential Complications l l l l Shock/Hemorrhage Deep Vein Thrombosis (DVT) Pulmonary Embolism Respiratory Complications Urinary Retention Intestinal Obstruction Wound Complications

Surgery Specific Care l Postoperative Uniquities and “worries”

Remember Mr. P? l Case Study Review

Perioperative Nursing