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PERI OPERATIVE

NURSING

Presented by:
Ms. Monica L. Añonuevo, RN, MAN
Course Objectives

 To develop an understanding of the principles


of sterile and aseptic technique and the
necessity of their application in all operative
procedures or phases.
 To acquire basic knowledge and skills about
OR nursing in order to provide better and
efficient care to surgical pts.
 To develop confidence, alertness and
competence among students in meeting the
patient’s needs – physical or psychological.
Introduction

Definition of Terms

 Operating room / Operating theatre


- room in a health care facility in which patients are prepared
for surgery, undergo surgical procedures, and recover from the
anesthetic procedures required for surgery

 Surgery
- branch of medicine concerned with disease or conditions
requiring or amenable to operative or manual procedures
 Peri-operative nursing
- total surgical experience that
encompasses pre-operative, intra-
operative, and post-operative phases of
patient care

 OR nurse
- duly licensed registered nurse legally
responsible for the nature and quality of
the nursing care patients
 Surgical conscience
- awareness which develops from a
knowledge base of the importance of
strict adherence to principles of aseptic
and sterile techniques
 Asepsis
- freedom from infection or absence of
microorganism
 Sepsis
- general reaction from the action of bacteria
or their products
 Disinfection
- process of destroying all pathogenic
microorganisms except spore bearing
ones
 Aseptic technique
- methods by which contamination of
microorganism is prevented
 Antiseptic
- substance which combat sepsis and
cause bacteriostasis
 Anesthesia

- insensibility to pain and trauma with


or without loss of consciousness
Terminologies
SUFFIX MEANING
Cele - tumor, hernia
Centhesis - puncture
Ectomy - surgical excision
Itis - inflammation
Litho - stone / calculus
Ostomy - creation of a new opening
Rhapy - repair
Oscopy - examination w/ a lighted
instrument
Plasty- plastic repair
Pexy - to fix or suture in place
FOUR MAJOR TYPES OF PATHOLOGIC
PROCESSES REQUIRING SURGICAL
INTERVENTION.

O – BSTRUCTION. Impairment to the


flow of vital fluids. E.g. blood, urine,
CSF, bile.
P – ERFORATION. Rupture of an
organ
E – ROSION. Wearing off of a surface
or membrane.
T – UMOR. Abnormal new growth
Objectives of Surgery

a. Correction of deformities and defects;


b. Repair of injuries;
c. Diagnosis and cure of disease process;
d. Relief of suffering;
e. Prolongation of life
Reasons why Patients
submit to Surgical
Intervention
 To preserve life
 To maintain dynamic body
equilibrium
 To undergo diagnostic procedures
 To prevent infection and to
promote healing
 To obtain comfort and to ensure
the ability to earn a living
Conditions treated by
Surgery

CONGENITAL – inborn deformity

ACQUIRED – conditions resulting


from trauma or injury
Peri operative Care
(SURGERY)

 PERIOPERATIVE – is a term used to describe


the entire span of surgery, including before
and after the actual operation.

 SURGERY – a branch of medicine that


encompasses pre-operative care, intra
operative judgment and management and
post operative care of patients.
Perioperative Nursing or
Operating Room Nursing

 Perioperative nursing includes those activities


performed by the professional registered nurse
in the preoperative (before) , intraoperative
(during) and postoperative (after) phases of
surgery.
What is a PERIOPERATIVE
NURSE?

 A perioperative nurse is a nurse who


provides patient care, manages,
teaches and studies the care of
patients undergoing operative or
other invasive procedures
What is does a PERIOPERATIVE
NURSE do?
 Provides specialized nsg. Care to
patients before, during and after their
surgical & invasive procedure
 Helps plan, implement and evaluate
treatment of the patient
 Acts as a patient advocate for patients
undergoing surgical & invasive
procedures
 Works closely w/ all members of the
surgical team
Expected Behavior of an OR
Personnel
 Emphatic
 Conscientious
 Efficient and well organized
 Flexible and adaptable
 Sensitive and perceptive
 Understanding, supportive
 Skilled listener, keen observer and
able communicator
 Considerate
 Informative and sincere
Expected Behavior of an OR
Personnel
 Versatile
 Analytical – knows the how and the
why of surgical procedures.
 Creative / resourceful
 Humanistic
 With sense of humor
 Enduring
 Intellectually eager and curious
 Ethical – knows the ethical principles,
moral values and professional
conducts
Three Phases of
Perioperative Care
 Preoperative phase – begins with the
decision to perform surgery and continues until
the client reaches the operating area.
 Intraoperative phase – includes the entire
surgical procedure until transfer of the client to
the recovery room
 Postoperative phase – begins with admission
to the recovery area and continues until the
client receives a follow – up evaluation at home
or is discharged to a rehabilitation unit.
Abdominal Incisions
Incision Site Types of Surgery
Subcostal Gallbladder and billiary tract
surgery.
Paramedian Right side – billiary tract,
gallbladder
Left side – splenectomy,
gastrectomy, hiatal hernia repair

Transverse gastrectomy
Rectus Right side – AP, small bowel
resection
Left side – sigmoid colon
resection
Mc Burney AP
CLASSIFICATION of Surgical
Procedures
I. According to Purpose

Type of surgery Purpose Example

Diagnostic To establish the presence of a. Breast biopsy


a disease condition b. Biopsy of skin lesion
Exploratory To determine the extent of a. Exploration of
the disease condition abdomen for
unexplained pain
b. Exploratory
laparoscopy

Curative a. Ablative – involves Cholecystectomy/


removal of an organ Appendectomy
(suffix used is
‘’ectomy”)
Total Hip Replacement,
b. Constructive – involves orchipexy
repair of congenitally
defective organ
(suffixes use are
Type of surgery Purpose Example

Palliative To relieve distressing Resection of a tumor


signs and symptoms, not to relieve pressure
Diagnostic necessarily to cure the and pain
disease

Cosmetic Correction of defects, a. Rhinoplasty


improvement of b. Cleft lip repair
appearance or change to
a physical feature c. Mammoplasty
II. According to URGENCY

Classification Conditions Example


Emergency Immediate: condition is life Gunshot wound
– threatening requiring Severe bleeding
surgery at once Small bowel obstruction
Urgent Within 24 to 30 hours: Kidney stones
client requires prompt Acute gallbladder infection
attention Fractured hip
Required Planned for a few weeks Benign Prostatic Hypertrophy
or months after decision: Cataracts
client requires surgery at Hernia w/o Strangulation
some point.
Elective Client will not be harmed if Revision of scars
surgery is not performed but Vaginal repairs
will benefit if it if performed

Optional Personal preference Cosmetic surgery


III. According to LOCATION

 INTERNAL – inside the body


ex. Hysterectomy

 EXTERNAL – outside the body


ex. Skin Grafting
IV. According to DEGREE OF RISK
TO THE PERSON / PHYSIOLOGIC
HAZARD

 MAJOR – life threatening


- when major or vital organs are
involved and those surgeries that
may involve serious bleeding.

 MINOR – non life threatening, less


serious
ex. biopsy
Surgical Risks

 General Risks Factors


 Obesity
 Fluid, electrolyte and nutritional
problems
 Age
 Presence of disease
 Concurrent or prior pharmacotheraphy
(patient taking up medication for
treatment, ex. Heparin, coumadin, etc.)
 Other Factors
 Nature of condition
 Location of the condition
 Magnitude and urgency of the
surgical procedure
 Mental attitude of the person
toward surgery
 Caliber of the professional staff and
health care facilities
Effects of Surgery to the
Client

 Stress response is elicited


 Defense against infection is
lowered
 Vascular system is disrupted
 Organ functions are disturbed
 Body image may be disturbed
 Lifestyles may change
Preoperative Care

 Psychological Care
 Preoperative Teaching
 Physical Care
 Nurses Responsibility
Psychological
Preparation
Fears related to surgery
 General fear

- fear of the unknown


- what to expect and what are the
consequences of surgery
- nursing action: allay anxieties by
giving the patient opportunities to
express his/her fears
 Specific fears
- fear of destruction of body
image
- threat to sexuality
- fear of permanent disability
- fear of pain
- fear of dying
Preoperative Teaching
 Post-op exercises
 Equipment used during post-op period
- oxygen, pulse oximeter, CVP
- ventilator
- NGT
- IV medications
- foley catheter
Provide client and family teaching,
instruct the client in:
 deep breathing and coughing
exercise
 relaxation technique
 Post op Exercises of extremities
 turning and moving techniques
 pain – control techniques
 INCENTIVE SPIROMETRY USE
 Pain medication and when to
request it
- Patient-Controlled Anesthesia
(PCA)
 NPO
 Ancillary tests
Physiologic Preparation

Factors that affect surgery


 Age
 Nutrition
 Presence of disease
 Prior drug therapy
Age
 The very young
- tolerates trauma of surgery well.
- sensitive to temperature changes &
rough handling.

 The elderly
- tolerates trauma of surgery poorly.
Nutrition

 Dehydration and malnutrition cause


potential complications post-operatively.

 Obese people breathe poorly


& are prone to pulmonary
complications.
Assessment
Assess respiratory status,
including history of
pulmonary problems to
identify risk factors for
postoperative
complications

Assess cardiovascular status


Assess for and report evidence of F/E imbalance

Assess emotional status of client.

Examine the client’s record for endocrine or


metabolic problems that could affect his
response to surgery (DM).

Assess immunologic and hematologic functions


 history of allergies
 previous reactions to blood transfusions
 history of substance abuse
Assess neurologic functions

Assess integumentary system

Evaluate medication history for drugs that could


increase operative risk for affecting coagulation time
or interacting anesthetics

Assess the client for any type of prosthetic device or


metal implants.

Assess the client and his family’s knowledge base to


guide the preoperative teaching program.

Assess the laboratory and diagnostic results of the


patient (x-ray, cbc, wbc, etc.)
B. NURSING DIAGNOSIS

 Anxiety

 Deficient knowledge
C. PLANNING AND OUTCOME
IDENTIFICATION

Major goals:
1. Decreased anxiety and increased
knowledge of the surgical experience.

2. Promote measures that help decrease


anxiety for the client and his family.
 Discuss the surgical experience with
the client and his family to minimize
anxiety and increase knowledge.
Provide GI preparation as prescribed,
w/c may include:
 restricting solid food and fluid for
8 to 10 hours before surgery
 posting NPO sign
 administering an enema and inserting
a NGT as prescribed
Informed Consent (Operative
Permit/Surgical Consent)

Purposes:
 to ensure that the client understands the nature
of the treatment including the potential
complications and disfigurement (explained by
AMD)
 to indicate that the client’s decision was made
without pressure
 to protect the client against unauthorized
procedure
 to protect the surgeon and hospital against legal
action by a client who claims that an authorized
procedure was performed
Circumstances Requiring a
Permit:

 Any surgical procedure where scalpel,


scissors, suture, hemostats of
electrocoagulation may be used.

 Entrance into a body cavity – e.g.


paracentesis, bronchoscopy,
cystoscopy, colonoscopy,
proctosigmoidoscopy
Preparing the person the evening
before surgery

 PREPARING THE SKIN


 shaving the skin in and around the surgical area (most
often it is done in the operating room)
 using an electric razor
 applying scrub to the surgical area

 PREPARING THE G.I. TRACT


 PREPARING FOR ANESTHESIA
 Avoidalcohol and cigarette smoking for at least 24
hours before surgery
 PROMOTING REST AND SLEEP
PREPARING THE PERSON ON
THE DAY OF SURGERY
 Early A.M. care
 Awaken one hour before preop medications
 Morning bath, mouth wash
 Provide clean gown
 Remove hairpins, braid long hairs, cover hair
with cap
 Remove dentures, foreign materials (chewing
gum), colored nail polish, hearing aid, contact
lens (wedding ring – tie with gauze and fasten
around the wrist)
 Take baseline VS before preop medication
 Check ID band, skin prep
 Check for special orders – enema, GI tube
insertion, IV line
 Check NPO
 Have client void before preop medication
 Continue to support emotionally
 Accomplish:
 ’PREOP CARE CHECKLIST’’ (includes:)
 Assessment
 Preoperative Medications
 IV
 Preoperative Preparations
 Chart
 OTHER Information – as required by agency
policy
 Signature
PRE - OPERATIVE
MEDICATIONS
 A single drug or a combination of
various drug usually given IM, 30
– 60 mins. Before surgery
 purpose:
 to allay anxiety
 Help the patient to relax
 to minimize respiratory tract secretions
and changes in HR (heart rate)
Commonly used
Preoperative Medications

I. ANTICHOLIGERNICS
 Action:
 SIDE EFFECTS:
 EXAMPLES:
 ATROPINE SULFATE
 SCOPOLAMINE
 GLYCOPYRROLATE
II. ANTIEMETICS
 Action
 Side Effects
 EXAMPLE:
 Droperidol

 Promethazine (phenergan)
III. TRANQUILIZERS
 Action
 S/E
 EXAMPLE

- Hypnotics (diazepam)
- Valium (flurazepam)
- Dalmane torazepam,
(ativan)
IV. SEDATIVES
 Action
 S/E:
 EXAMPLE:
Midazolam
Barbiturates
Phenobarbital (Nembutal)
secobarbital (seconal)
V. OPIODS (NARCOTICS)
 ACTION
 S/E:
 EXAMPLE:
 Morphine,

 Meperidine (Demerol)
THE OPERATING ROOM
OR Furniture & Other
Equipments

 OR Table
 Instrument table or Back table
 Mayo table
 Small table
 Anesthesia table
 Anesthesia machine
 Sitting stools and foot stool
 IV stands
OR Furniture & Other
Equipments ( cont…)

 Suction machine, bottles and tubings


 Cautery machine
 Kick buckets in wheeled bases
 Basin in wheeled bases for soiled
sponges and gloves
 Communication system / Intercom
OR Furniture & Other
Equipments (cont.)

 Board for recording of sponge,


instrument and sharps counting
 Defibrillator
 Blood warmer machine attached to IV
pole
 Other monitoring machines
 Cabinets / carts
Operating Room Unit

Transition Zone
1. Semi restricted / semi
sterile area
Operating Room Unit

Semirestricted Area
OR Suite

3. Restricted / sterile area


The Surgical Team

 Surgeon
 First Assistant
 Scrub nurse
 Anesthesiologist
 Circulating Nurse

Sterile
Unsterile
The Surgeon

 Surgeon – heads the


surgical team, he or
she is a physician
Anesthesiologist

 Anesthesiologis
t – makes a
preoperative
assessment to plan the
type of anesthetic to be
administered and to
evaluate the client’s
physical status.
 Circulating nurse – managing
the overall nursing care in the
operating room and helping to
maintain a safe, comfortable
environment.
Scrub Nurse

 responsible for
scrubbing for
surgery, including
setting up sterile
tables and
equipment and
assisting the
surgeon and
surgical technicians
during the surgical
procedure.
THE INTRAOPERATIVE
PERIOD
a. ASSESSMENT
1. classify the client’s physical status for

anesthesia
Total or partial loss of sensation to
touch or pain, caused by nerve injury
or diseased, or induced intentionally,
especially by the administration of
anesthetic drugs, to provide medical
treatment
Types of Anesthesia
 GENERAL ANESTHESIA –
 (inhaled or I.V.) refers to drug – induced depression of the
CNS that produces analgesia, amnesia and unconsciousness
(affects whole body)

 Stages:
 stage I – BEGINNING
 from. Anesthetic administration to loss of consciousness
 drowsy, dizzy

 stage II – EXCITEMENT
 from Loss of consciousness to Loss of EYELID REFLEX
 Increase in autonomic activity, irregular breathing
 Stage III – surgical anesthesia
 From Loss of EYELID REFLEX to Loss of
most reflexes, depression of vital
functions

 Stage IV – danger
 FromFunctions excessively depressed
to Respiratory and circulatory failure
REGIONAL anesthesia
 is a form of local anesthesia that suspends sensation and
motion in a body region or part; the client remains
awake.
Types:
a. Local anesthetic – provides loss of sensation, used
primarily for dental, eye and minor surgeries

b. Spinal anesthetic – local anesthetic injected into the


subaracnoid space of the lumbar area (usually L4 or L5),
which contains cerebrospinal fluid) suspend sensation
and motion in the lower extremities, perineum and lower
abdomen
 e.g. lidocaine, procaine
c. Epidural block – local anesthetic injected into
the extradural space near the spinal cord

d. Peripheral nerve block – injected in a


specific body region and directed at a
particular nerve
 e.g. lidocaine
Positions During
Surgery
Nursing interventions:
 Explain purpose of position
 Strap the person to prevent falls
 Maintain adequate respiratory and
circulatory function
 Maintain good body alignment
FIVE TYPES OF SURGERY
POSITIONS
 Dorsal Recumbent – hernia repair,
mastectomy, bowel resection, cholecystectomy
 Trendelenburg – lower abdomen, pelvic
surgeries
 Lithotomy – vaginal repairs, D and C, rectal
surgery, APR – Abdomino – Perineal Resection)
 Prone – spinal surgeries, laminectomy
 Lateral – kidney, chest, hip surgeries
NURSING PROCESS OVERVIEW FOR
THE INTRAOPERATIVE PERIOD

A. ASSESSMENT
 Classify the client’s physical status for anesthesia

 Assess the client’s record for appropriate documentation

 Verify client identification and that the correct surgery is


scheduled

 Assess for surgical consideration and precautions

 Assess the client’s risk for accidental hypothermia or


malignant hyperthermia
NURSING MANAGEMENT
intra operative period
 SURGICAL ASEPSIS

 CLIENT’S FASETY AND PROTECTION FROM


SURGERY
POSSIBLE INTRAOPERATIVE
COMPLICATIONS

 Infection – strict aseptic


technique is absolutely
necessary before and during
surgery.
 Fluid volume excess or deficit
– proper recording and keeping a
running total of IV fluids
administered.
 Injury related to positioning
 Hypothermia – due to low temperature in the OR
 Malignant hyperthemia - occurs when body temp. muscle,
metabolism and heat production increase rapidly and
uncontrollable response to stress and some anesthetic agents, with
the following s/sx:
 Tachycardia
 Tachypnea, cyanosis,
 Fever, muscle rigidity
 Diaphoresis, mottled skin,
 Hypotension, irregular heart rate
 Decreased urine output and cardiac arrest).
NURSING DIAGNOSIS

 RISK FOR FLUID VOLUME DEFICIT OR EXCESS

 RISK FOR HYPOTHERMIA AND HYPERTHEMIA

 RISK FOR INFECTION AND INJURY


PLANNING

 Maintenance of fluid
balance
 Maintenance of
normothermia
 Prevention of infection
 Absence of injury
IMPLEMENTATION
 PROMOTE MEASURES THAT MAINATAIN
ADEQUATE FLUID AND ELECTROLYTE
BALANCE
 Monitor I/O accurately
 Assess for dehydration
 Assess for circulatory overload (assess
breath sounds, peripheral edema and
jugular vein distention)
 Monitor electrolyte values
 PROMOTE MEASURES THAT MAINTAIN A
CLIENT’S NORMAL TEMP.
(36.6 – 37.5)
 PROMOTE MEASURES THAT DECREASE
RISK OF INFECTION
 ENSURE THE CLEINT’S SAFETY IN THE OR
 promote measures that ensure tissue
perfusion in the client during surgery
 assess the client’s vital signs
 assess the client’s respiratory status and
assist with mechanical ventilation
 assess the client’s peripheral vascular status
minimum
Types of Surgical
Incisions

 Butterfly – for craniotomy


 Limbal – for eye surgeries
 Halstead/ elliptical – for breast surgeries
 Abdominal – for abdominal surgeries
 Mc burneys – for appendectomy
 Lumbotomy/transverse – for kidney
surgeries
POST OPERATIVE CLIENT
 PACU (POST ANESTHESIA CARE UNIT)

 2 PHASES OF CARE:

 I: IMMEDIATE RECOVERY - REQUIRES


INTENSE NURSING

 II: CLIENT PREPARED FOR


DISCHARGE HOME OR TO OTHER
CARE AREA
TRANSFER TO THE PACU

 WHO’S RESPONSIBLE ??

 ANESTHESIOLOGIST OR
ANESTHETIST

 REMAINS AT HEAD OF BED DURING


TRANSFER….THINK AIRWAY !!!
THINGS TO CONSIDER ….

 SURGICAL INCISION

 POSITIONING (DRAINS & DRAINAGE


TUBES MAY BE PRESENT)

 WARM THE CLIENT

 SIDE RAILS (ALWAYS THINK


SAFETY !!!)
TRANSFER REPORT .. WHAT
INFORMATION IS NEEDED ?

 DIAGNOSIS & TYPE OF SURGERY

 CLIENT’S GENERAL CONDITION

 PROBLEMS / PATHOLOGY
 FLUIDS / PRESENCE OF DRAINS &
TUBES

 ANY OTHER SPECIFIC INFORMATION


NURSING MANAGEMENT

 CLIENT ASSESSMENT

 VITAL SIGNS ARE VITAL !!!!


 SKIN COLOR
 LEVEL OF CONSCIOUSNESS
 INCISIONAL SITE
 AIRWAY PATENTCY
 CLIENT’S PREVIOUS HEALTH HISTORY
AIRWAY - AIRWAY - AIRWAY

 MAINTAIN PULMNORAY VENTILATION

 PREVENT HYPOXEMIA
 PREVENT HYPERCAPNIA ( EXCESS CO2)

 ASSESS RESPIRATORY RATE - O2 ORDERS


 ASSESS DEPTH / EASE OF / O2 SATS / AND
 BREATH SOUNDS
PROLONGED ANESTHESIA

 CLIENTS USUALLY UNCONSCIOUS


 ALL MUSCLES RELAXED
 TONGUE MAY OBSTRUCT AIR
PASSAGE

 SIGNS: CHOKING / NOISY &


IRREGULAR RESPIRATIONS /
CYANOSIS
AIRWAY DEVICES
 PLASTIC - MAY LEAVE TIL GAG REFLEX
RETURNS

 ENDOTRACHEAL TUBE - MECHANICAL


VENTILATION ( MAY NEED ICU
TRANSFER)
THINK SAFETY

 CLIENT VOMITS ……

 TURN CLIENT TO THE SIDE

 MAYELEVATE HEAD OF BED IF NOT


CONTRAINDICATED

 PHARYNGEAL SUCTIONING
 ASSESS:
 MENTAL STATUS (THINK HYPOXIA)
 VITAL SIGNS
 CARDIAC RHYTHM
 SKIN PARAMETERS
 URINE OUTPUT
 AMOUNT OF BLOOD LOSS
HYPOTENSION

 MAY RESULT FROM:

 LOSS OF BLOOD (> 500ML = REPLACE)


 HYPOVENTILATION
 POSITION CHANGES
 SIDE EFFECTS OF MEDS
SHOCK
 SERIOUS COMPLICATION
 CAN RESULT FROM HYPOVOLEMIA

 INADEQUATE CELLULAR
VENTILATION & INABILITY TO
EXCRETE METABOLIC WASTE
PRODUCTS
SHOCK - CLASSIC SIGNS

 PALLOR
 COOL, MOIST SKIN
 RAPID BREATHING
 CYANOSIS (LIPS/ GUMS)
 WEAK & THREADY PULSE
 ↓ PULSE
 USUALLY ↓ B/P & CONCENTRATED URINE
TREATMENT

 TREATMENTS:
 IV FLUIDS
 BLOOD
 MEDS ( ↑ B/P)
 MANAGE PAIN
 BODY TEMPERATURE
(NORMOTHERMIA)
VOLUME REPLACEMENT

 PRIMARY INTERVENTION
 LACTATED RINGERS SOLUTION

 OXYGEN

 CONTINUOUS CLIENT
ASSESSEMENT
HEMORRHAGE

 CLIENT IS APPREHENSIVE &


RESTLESS

 PULSE RATE ↑
 TEMPERATURE ↓
 AIR HUNGER (RAPID & DEEP
RESPIRATIONS)
IF HEMORRHAGE CONTINUES….

 CARDIAC OUTPUT ↓

 BLOOD PRESSURE & HEMOGLOBIN


↓ RAPIDLY

 USE SHOCK POSITION - (FLAT ON


BACK - KNEES STRAIGHT - LEGS ↑)
 ADMINISTER FLUIDS- BUT BE
CAREFUL!
HYPERTENSION &
DYSRHYTHMIAS

 HYPERTENSION: THINK PAIN /


HYPOXIA

 DYSRHYTHMIAS: THINK ELECTROLYTE


IMBALANCE / PAIN / HYPOTHERMIA /
STRESS/
GASTROINTESTINAL FUNCTION

 ASSESS GASTRIC ACTIVITY


 BOWEL SOUNDS
 NAUSEA
 PRESENCE OF NG TUBE
 SKIN: DRESSINGS / DRAINS

 GENITOURINARY: I&O / FOLEY/ AMOUNT&


COLOR OF URINE / BLADDER FULLNESS &
DISTENTION

 POSITIONING (PREVENTING CIRCULATORY


STASIS)
OLDER CLIENTS….

 THINK SAFETY .. TRANSFER GENTLY..


CAN AFFECT B/P & VENTILATION

 KEEP WARM
 CHANGE POSITION FREQUENTLY

 POSTOPERATIVE CONFUSION
SOMETIMES COMMON
MOVING OUT OF PACU
....WHEN TO TRANSFER
(PARAMETERS)
 STABLE VITAL SIGNS
 ADEQUATE PULMONARY
FUNCTION…..HOW WILL YOU KNOW?
 NEUROLOGICALLY “ADEQUATE”…
HOW WILL YOU KNOW?
 ADEQUATE URINE OUTPUT
 NAUSEA/ VOMITING & PAIN
CONTROLLED
PULMONARY COMPLICATIONS

 GOALS: PREVENT ATELECTASIS &


PNEUMONIA
 TEACH SPLINTING

 ENCOURAGE D – B – C – T exercise

 TEACH IMPORTANCE OF APPROPRIATE


PAIN CONTROL

 TEACH IMPORTANCE OF AMBULATION

 INCENTIVE SPIROMETER?
THE SURGICAL SITE

 MONITOR & OBSERVE FOR:


 BLEEDING
 TYPE & INTEGRITY OF
DRESSING
 PRESENCE OF DRAINS /
TUBES
LABEL MULTIPLE DRAINS
Nursing Interventions:
 Stay w/ patient and have some one notify surgeon
immediately
 If intestines are exposed, cover with STERILE
MOIST DRESSINGS
 Keep patient on absolute bedrest – low fowler’s
 Instruct patient to bend his knees – relieves
tension on abdomen
 Instruct not to cough, sneeze, eat, drink and
remain quiet
 Assure patient that wound will be properly taken
cared for
 Prepare for surgery and repair of wound
PAIN
 PSYCHOLOGICAL FACTORS MAY
INFLUENCE

 PAIN STIMULATES STRESS RESPONSE


… (VASOCONSTRICTION) CAN THUS
CONTRIBUTE TO COMPLICATIONS

 ASSESS ADEQUATELY
PAIN CONTROL MEASURES

 OPIODS

 PATEINT-CONTROLLED
ANALGESIC

 COMFORT MEASURES
URINARY ELIMINATION

 URINARY RETENTION:
Nursing Interventions:
ANESTHESIA/
OPIOIDS / a. assist patient to sit or
ABDOMINAL, PELVIC, stand up (if permissible)
HIP SURGERY (PAIN) b. provide privacy
c. use psychological aid of
 VOID WITHIN 6-8 running tap water
HOURS OF SURGERY ( relaxes bladder
(INCLUDE PACU TIME) sphincter spasm)
d. catheterize when all
measures are
unsuccessful
ACTIVITY

 EARLY AMBULATION: REDUCES


LIKELIHOOD OF:
 ATELECTASIS
 PNEUMONIA
 GI DISCOMFORT
 CIRCULATORY PROBLEMS
 SHORTER HOSPITAL STAYS
 MONITOR FOR ORTHOSTATIC
HYPOTENSION!
OTHER CONSIDERATIONS

 MAINTAIN SAFE ENVIRONMENT

 PROVIDE EMOTIONAL SUPPORT


CONTINUE TO MONITOR FOR
COMPLICATIONS

 RESPIRATORY: ↓ BREATH SOUNDS-


CRACKLES - FEVER - TACHYCARDIA
- COUGH

 DEEP VEIN THROMBOSIS (DVT)


positive HOMAN’S SIGN ( pain on the
calf or thigh upon dorsiflexion of the
foot)

 PULMONARY EMBOLISM
 DEHYDRATION / LOW CARDIAC OUTPUT/
 BLOOD POOLING IN EXTREMITIES / BED
REST
WOUND INFECTION

 SURGICAL WOUNDS DISRTUPT


SKIN INTEGRITY!
 MONITOR LAB VALUES…WBC
 CLASSIFIED ACCORDING TO
DEGREE OF CONTAMINATION
 OTHER RISK FACTORS: AGE/
NUTRITIONAL STATUS / SMOKING/
OBESITY/ DIABETES
PROMOTING BOWEL FUNCTION
(BM – 2nd – 3rd day post op.)

 CONSTIPATION COMMON AFTER SURGERY

 ASSESS BOWEL SOUNDS ADEQUATELY!!!

 ASSESS FOR ABDOMINAL DISTENTION

 PARALYTIC ILEUS & INTESTIONAL OBSTRUCTION


CAN OCCUR
HICCUPS or SINGULTUS
- spasmodic closure of the glottis following a
sudden involuntary intake of breath causing an
abrupt cough
Causes:
a. irritation of phrenic nerve
* distended stomach, peritonitis, surgery
performed near diaphragm
* indirect – toxemia, uremia
* reflex – exposure to cold, drinking very cold
or very hot liquids, intestinal obstruction
Abdominal Distention or PARALYTIC ILEUS:

Causes:
a. resection and handling of the bowel during
surgery
b. swallowing of air during recovery from
anesthesia
c. passing gases from the blood stream to bowel
PHASES OF WOUND
HEALING
 First Phase – ‘’INFLAMMATORY PHASE’’
blood clot formation with swelling (lasts fr.1 – 4 days).

 Second phase – ‘’ PROLIFERATIVE’’


formation granulated tissue (occurs from 5 – 20days).

 third phase – ‘’MATURATION or REMODELING


PHASE’’
lasts up to 21 days to several months and even 1 to 2 years
(remodeling of new tissue)
Three modes of wound
healing
 Primary intention – heals in 8 – 10
days, with minimal scarring
 Secondary intention – wound healing
is slow
 Tertiary intention – the resulting scar
is wider than primary intention
POSTOP PSYCHOLOGICAL
DISTURBANCES:

DELIRIUM (MENTAL ABERRATION)/ ACS


(ACUTE CONFUSIONAL STATE)
 CAUSES:
 Dehydration, insufficient oxygenation, anemia
 Hypotension, hormonal imbalances, infection
 trauma
 manifestations:
 poor memory ,restlessness, inattentiveness
 inappropriate behavior, wild excitement, hallucinations,
delusions, depression
 disoriented, sleep disturbances
 nursing interventions:
 sedatives to keep client quiet and comfortable
 explain reasons for interventions
 listen and talk to the client and significant others
 provide physical comfort
 treat the underlying cause
2 – 3 days after surgery (discharge
planning/teaching)

 Self- care activities

 Activity limitation

 Diet and medication at home

 Possible complications

 Referrals, follow – up check – up


AMBULATORY SURGERY
(OUTPATIENT SURGERY)

 A surgery that requires fewer than 24 hours of


hospitalization
Criteria for ambulatory surgery
a. the client is not critically ill
 surgical procedure is not extensive and does not
require many hours of general anesthesia
 recovery is expected to be quick
 the client or family can provide adequate
postoperative care
Surgical Handscrub

2 types of scrubbing method


a. Time method
b. Scrub/brush stroke method
15 Strokes
• 15 palmar
• 15 back of hand
• 15 interdigital space
• 15 lower forearm
• 15 upper forearm
• 15 above elbow
Gowning & Gloving

two techniques:
- Closed Method
- Open Method
Principles & Practices of
Surgical Asepsis
Principles & Practices of
Surgical Asepsis

S
T
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L
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Principles & Practices of
Surgical Asepsis
Principles & Practices of
Surgical Asepsis
4 Categories of Instruments

Sharps
• Scalpels/ Knife/
Blade holder – for
incising and #7, #3, #4
dissecting (left to right)
Sharps

• Scissors

Straight Mayo scissor - Used to cut suture


and supplies.  Also known as Suture
scissors.
Sharps

Curved Mayo scissor - Used to cut heavy


or tough tissue (fascia, muscle, uterus,
breast).  Available in regular and long sizes.
4 Categories of
Instruments

Scalpel No. 3 , 7 , 9 – blade no. 10, 11, 12, 15


Scalpel No. 4 – blade no. 20, 21, 22, 23,
Sharps

Metzenbaum scissors - Used to cut


delicate tissue. 
Sharps

IRIS STICH OPERATING


Sharps

KILNER BANDAGE – uterus /


umbilicus
Grasping & Holding
Instruments

Debakey Tissue Forcep Adson Forceps

Ferris Smith Tissue Forcep


Russian Tissue Forcep
Grasping & Holding
Instruments

Thumb Forcep – holds delicate tissues as in GIT

Toothed Tissue Forcep or Rat Tooth-for tougher tissues


Grasping & Holding
Instruments

Bobcocks- hold delicate tissues Allises-for tough tissues


Clamping & Occluding
Instruments

Crile Hemostat “aka” Stet or Tag – for shallow layers of tissue


Clamping & Occluding
Instruments

Kelly Hemostats – for deep layers of tissue or cavity


Clamping & Occluding
Instruments

Kocher Hemostats
Clamping & Occluding
Instruments

Right Angle Hemostats or Mixters


Clamping & Occluding
Instruments

Tonsil Hemostat
Retractors

• Handheld Retractors or Non self


retaining retractors

Army Navy Retractors


Retractors

Deaver Retractors
Retractors

Harrington Retractor
Retractors

Malleable Ribbon
Retractors

Richardson Retractors
Retractors

Goulet Retractor
Retractors

• Self-Retaining Retractor

Balfour abdominal Retractor Bladder Retractor


Types of needles and
Drapes
A. Needle
 Hypo needle
 Suture needle

B. DRAPES
 Towel, st. Mary’s, lap sheet, eye sheet, thyroid
sheet, breast sheet, kidney sheet
 Quarter (head/foot)
 Fenestrated
 Mayo table drape
ACRONYMS USED
DURING SURGERY
 MRM – modified radical mastectomy
 ECCE c PCIOL – extra capsular cataract
extraction w/ posterior chamber intraocular lens
 TAHUSO – total abdominal hysterectomy w/
unilateral salpingo oophorectomy
 ORIF – open reduction internal fixation
 LSCS – low segment caesarean section
 EGD – esophago gastroduodenoscopy
 CSOM – chronic suppurative otitis media
 FBE – foreign body extraction
 TURP – trans urethral resection of prostate
 BKA – below knee amputation
 OD – right eye (ocularis dexter)
 PHRA – partial hip replacement arthrplasty
 PFC – peritoneal fluid cytology
 ESS – endoscopic sinus surgery
 FNB – fine needle biopsy
FUTURE OPERATING
ROOM
RECOVERY ROOM
WARD
END OF PRESENTATION

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