Beruflich Dokumente
Kultur Dokumente
• Perioperative Nursing
-(Gk-peri-around + L operari-to
work + nutrix- nurse)
- Nursing care provided to
surgery patients during the
entire inpatient period
( preoperative, intraoperative &
postoperative) from admission
to date of discharge.
PREOPERATIVE CARE
• Preoperative Care
- the preparation and
management of patient
before surgery. Begins
at the time of the
decision for surgery.
PREOPERATIVE CARE (cont…)
• Psychologic Preparation for Surgery:
Preparation for hospital admission: includes
explanation of procedures to be done, probable
outcome, expected duration of hospitalization, cost,
length of absence from work and residual effects.
Preoperative visits.
PREOPERATIVE CARE
(cont…)
• LEGAL ASPECTS:
INFORMED CONSENT: permission
obtained from the patient to
perform specific test or procedure.
1.This is to protect the surgeon and
the hospital against claims that
unauthorized surgery has been
performed and that the patient was
unaware of the potential risks of
complications involved.
2.Protects the patient from undergoing
unauthorized surgery.
PREOPERATIVE CARE
(cont…)
• PHYSIOLOGIC PREPARATIONS:
2. Respiratory preparation – includes x-ray
ordered by the surgeon.
3. Cardiovascular preparation – ECG, Blood
test: CBC, Hgt, and others
4. Renal preparation – routine urinalysis
PREOPERATIVE CARE (cont…)
• INTRAOPERATIVE CARE
pertaining to the period during
a surgical procedure. Begins
at the moment when the
patient is anesthetized and
ends when the last stitch and
dressing is in place.
INTRAOPERATIVE CARE (CONT…)
• 2 Types of Anesthesia:
Main Classification:
c. General Anesthesia – it is a state of analgesia, amnesia and
unconsciousness characterized by the loss of reflexes and muscle
tone.
Types: Inhalation Anesthesia : surgical narcosis achieved by the
inhalation of an anesthetic gas or vapor.
Endotracheal: G.A. administered through a tube, placed
through the mouth or nose, directly into the trachea or windpipe.
Advantage: prevention of pain and anxiety.
Disadvantage: circulatory and respiratory depression. Highly
inflammable and explosive.
INTRAOPERATIVE CARE (CONT…)
Safety Rules:
b. Do not wear slips, nylons,
wool, or any material which
can set-off sparks.
c. Minimized use of cautery.
d. Do not touch the vicinity of
the breathing area to prevent
sparks.
e. Do not use bed materials that
are not conductive.
INTRAOPERATIVE CARE
(cont…)
4. Gastrointestinal Complications:
Paralytic Ileus – cessation of peristalsis due to extensive handling of GI
organs.
Nursing Management: No fluids or food are given until peristalsis has returned as
evidenced by auscultation of bowel sounds or by passing of flatus.
Vomiting – usually a result of certain anesthetics on the stomach or eating
food or drinking H2O before peristalsis returns. Psychologic factors also
contribute to vomiting.
Nursing Management:
1. Position the patient on his side to prevent aspiration.
2. When vomiting has subsided, give ice chips, sips of ginger ale, or hot tea or eating
small amounts of dry solid foods may relieve nausea.
3. Anti-emetic Drugs: Metochlopromide HCl (Pasil),
POSTOPERATIVE CARE
(cont…)
• GI complications (cont…)
Abdominal Distention: results from the accumulation of
non- absorbable gas in the intestine.
Causes:
1. Reaction to the handling of bowel during surgery.
2. Swallowing of air during recovery from anesthesia.
3. Passes of gases from the blood stream to the atonic portion of
the bowel.
4. Gas pain: results from contraction of unaffected portion of the
bowel in order to move accumulated gas in intestinal tract..
POSTOPERATIVE CARE
(cont…)
Management:
1. Aspiration of fluid or gas with a NGT.
2. Ambulation stimulates the return of peristalsis and expulsion of flatus.
3. Rectal tube insertion- inserted just past the rectal sphincter and
removal after approximately 20 mins (2-4 inches for adult, 1-3 inches
for children) prolonged stimulation of the anal sphincter may result in a
loss of neuromuscular response. It may cause pressure necrosis of the
mucous surface.
4. Fleet enema.
Constipation : due to decrease food intake and decrease activity.
Management: Drinking adequate amounts of fluid and ambulating will
have a bowel movement within 3-4 days after surgery.
POSTOPERATIVE CARE
(CONT…)
5. Urinary Complications:
Return of Urinary Function: usually after 6-8 hours. 1st voiding may not
be more than 200ml and total output may not be more than 1500ml. This
is due to the loss of fluids during surgery and to perspiration,
hyperventilation, vomiting and increase secretion of ADH.
Complications:
4. Urinary retention
Causes:
a) Prolonged recumbent position
b) Nervous tension.
c) Effect of anesthetic that interfere with bladder sensation and the ability to
void.
d) Use of narcotics that reduce the sensation of bladder distention.
e) Pain at the site or by movement.
POSTOPERATIVE CARE
(cont…)
Management (Urinary retention)
1. Force fluid intake.
2. Place patient on bed pan at regular interval.
3. Pouring warm H2O over the perineum.
4. Assuring patient’s privacy
5. Assuming proper position.
6. Catheterization if bladder is palpable over the
suprapubic bone, because pressure causes
discomfort, this is done to prevent stretching of
the vesical wall.
POSTOPERATIVE CARE
(cont…)
Complications (Urinary comp…cont….)
2. Urinary Tract Infection:
Management:
1. Instruct the patient to empty the bladder
completely each voiding.
2. Use sterile non-traumatic technique in
catheterization if necessary.
POSTOPERATIVE CARE
(cont…)
6. Post-operative discomforts:
Post-operative pain:
Management: narcotics can be given every 3-4 hours during the 1st 48
hours post-op for severe pain without the danger of addiction.
Hiccoughs: brought about by the dilation of the stomach, irritation
of the diaphragm, peritonitis and uremia cause either reflex or
CNS stimulation of the phrenic nerve.
Management:
1. Paper bag blowing.
2. CO2 inhalation, 5% CO2 and 95% O2, 5 mins every hour.
POSTOPERATIVE CARE
(cont…)
7. Wound Complications:
sutures are usually removed
about the 5-7th day post-op
with the exception of wire
retention sutures placed deep
in muscles and removed
usually 14-21 days after.
POSTOPERATIVE CARE
(cont…)
Wound complications:
Hemorrhage from the wound: most likely to occurs within the
1st hours post-op or as late as 6th or 7th post-op day.
Causes:
a. Hemorrhage occurring soon after operation: slipping of
ligature or mechanical dislodging of a blood clot or
caused by the re-established blood flow through vessel.
b. Hemorrhage after a few days: sloughing of a clot or tissue,
infection, erosion of blood vessel by a drainage tube.
Assessment:
a. Bright red blood
b. Decrease BP
c. Increase PR & RR
d. Restlessness
e. Pallor
f. Weakness
g. Cold, moist skin
POSTOPERATIVE CARE
(cont…)
2. Infection:
Causes: streptococcus, staphylococcus
Assessment:
a. From 3- 6 days after surgery, the patient begins to have low
grade fever and the wound becomes painful and swollen.
There maybe purulent drainage on dressing.
3. Dehiscence and Evisceration:
a. Dehiscence- (wound disruption) refers to a partial to complete
the separation of the wound edges.
b. Evisceration- refers to the protrusion of the abdominal viscera
through the incision and onto the abdominal wall.
POSTOPERATIVE CARE
(cont…)
Assessment:
a. Complaint of giving sensation in the incision
b. Sudden, profuse leakage of fluid from the incision
c. Dressing saturated with clear , pink drainage.
Management:
a. Position the patient to low fowler’s position; instruct not to cough,
sneeze , eat or drink, and remain quiet until the surgeon arrives.
b. Protruding viscera should be covered with warm, sterile saline
dressing.
c. Apply slight pressure on the bleeding site.
d. Dressing should be change frequently
e. Administer antibiotic as ordered