PERIOPERATIVE NURSING THREE PHASES v PREOPERATIVE v INTRAOPERATIVE

PERI-OPERATIVE NURSING THREE PHASES v. PRE-OPERATIVE v. INTRA-OPERATIVE v. POST-0 PERATIVE

GENERAL INFORMATION 1. Pre-operative begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room 2. Intra-operative begins when the patient is transferred to the surgery & ends when transferred to the recovery room 3. Post-operative begins when the patient is admitted to the recovery room & ends with follow up evaluation in the clinical setting or home

PRE-OPERATIVE SURGERY Carolyn Frye-Shegog

GENERAL INFORMATION • PURPOSE OF SURGERY • SURGERY SETTINGS • INFORMED CONSENT

CLASSIFICATION OF SURGERY ACCORDING TO PURPOSE: v DIAGNOSTIC v. CURATIVE v. PALLIATIVE v. RECONSTRUCTIVE v. PREVENTIVE v. EXPLORATORY v. COSMETIC

MAJOR AND MINOR SURGERY

TERMINOLOGY Ø ECTOMY: REMOVAL OF AN ORGAN Ø RRHAPHY: SUTURE OF A PART Ø SCOPY: LOOKING INTO Ø OSTOMY : MAKING AN OPINING Ø PLASTY : REPAIR OR RESTORE Ø OTOMY: CUTTING INTO

AMBULATORY SURGERY • ADVANTAGES: • Less psychological distress associated with hospitalization • Decreased exposure to hospital infections • Economic savings • Consumer satisfaction

FACTORS AFFECTING ADAPTATION TO SURGERY • • AGE: NEUROENDOCRINE RESPONSE: SURGICAL PROCEDURE: PREVIOUS HOSPITALIZATIONS AND SURGERIES: • SPIRITUAL BELIEFS: • TYPE OF ADMISSION

PSYCHOSOCIAL REACTIONS TO SURGERY: EMOTIONAL RESPONSES TO SURGERY: Ø FEAR OF THE UNKNOWN Ø FEAR OF ANESTHESIA; Ø FEAR OF PAIN: UNIVERSAL –FEAR OF MUTILATIONS OR ALTERED BODY IMAGE Ø FEAR OF DEATH Ø FEAR OF SEPARATION AND ROLE CHANGE

NON VERBAL COMMUNICATION OF FEARS AND ANXIETIES Ø RAPID SPEECH Ø JOKING Ø MAKING LIGHT OF SITUATION Ø WITHDRAWAL

NURSES ROLE • RECOGNIZING AND UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:

PRE-OPERATIVE NURSING ASSESSMENT ü PSYCHOLOGICAL ASSESSMENT: • Social History: smoking, alcohol consumption, occupation etc. • Family health history • Past health history & home medication:

MEDICATIONS CON’T • STEROIDS-should not be stopped abruptly • Antidepressants can increase hypotensive effects of anesthesia • Antibiotics such as neomycin, kanamycin can combine with certain anesthetics & lead to respiratory paralysis • Insulin dosage may need to be adjusted-check with the physician • ASA thins blood so may increase post-op bleeding • Antihypertensives & cardiac drugs can’t be stopped abruptly • Check for the use of OTC drugs for glaucoma

PHYSIOLOGICAL ASSESSMENT v. Respiratory v. HX of dyspnea, coughing, hemoptysis v. COPD, or URI v. Smoker? v. Record baseline breath sounds v. Diagnostic tests; ; ABG’S CXR, FPT’S

CARDIOVASCULAR • HX OF CARDIO OR CEREBRAL VASCULAR DISEASE • PACEMAKER • ARTIFICIAL VALVES • ANTICOAGULANT THERAPY

CNS: (ENTRAL NERVOUS SYSTEM) • HX of stroke, TIA’S, • NEUROMUSCULAR DISORDERS SUCH AS MYASTHENIA GRAVI, • ESPECIALLY IMPORTANT TO ASSESS MENTAL STATUS • LOC

PRE-OPERATIVE NURSING CARE • PRE – OPERATIVE TEACHING o THE NURSE IS RESPONSIBLE TO: o FIND OUT WHAT PT. KNOWS o INCLUDE FAMILY o USE SIMPLE TERMS o EVALUATE PT. UNDERSTANDING o USE AUDIOVISUAL AIDS o ASK FOR RETURN DEMONSTRATION

PRE-OPERATIVE TEACHING ü USUAL TOPICS COVERED üPreoperative tests üPreoperative routines üSchedule üPACU üFAMILY DIRECTIONS üPOSTOP THERAPIES üPAIN MANAGEMENT üDIET

PRE-OPERATIVE NURSING ASSESSMENT • • PSYCHOLOGICAL ASSESSMENT SOCIAL HISTORY • FAMILY HEALTH HISTORY • PAST HEALTH HISTORY • PHYSIOLOGICAL HISTORY

PREOPERATIVE PHYSICAL PREPARATION v. PRE-OP PHYSICAL PREPARATION v. NUTRITIONAL v. NIGHT BEFORE SURGERY, LIGHT MEAL OR LIQUID DIET v. SPECIFIC IV FLUIDS v. NPO AFTER MIDNIGHT v. POSSIBILITY OF LIGHT BREAKFAST ON DAY OF

PRE-OP PHYSICAL PREP • Intestinal ØNPO ØEnemas until clear ØLaxatives ØAntibiotics to decrease intestinal flora

PRE-OP PHYSICAL PREP • Skin prep • Bathe before surgery • Shaving operative site • Scrub with betadine/other antiseptic

Three important components of consent form 1. Adequate disclosure 2. Sufficient comprehension 3. Voluntary consent