Ppt chapter 27

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Chapter 27

Perioperative Care


•Is the following statement true or false?

Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart.

Question Question


True.

Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart.

AnswerAnswer


Introduction to Operative Care Introduction to Operative Care

• Perioperative care is care that clients receive before, during, and after surgery

• Nurses assume general responsibilities when caring for clients during the preoperative, intraoperative, and postoperative periods of perioperative care


Preoperative PeriodPreoperative Period

• Starts when client, or his family in an emergency situation, learn that surgery is necessary

• Ends when client is transported to the operating room


Types of Surgery According to Urgency

Types of Surgery According to Urgency


Preoperative Period (cont’d)Preoperative Period (cont’d)

• Inpatient surgery: procedures performed on a client who is admitted to the hospital, expected to remain at least overnight, and needs nursing care for more than 1 day after surgery

– Clients who have inpatient surgery undergo prior laboratory and diagnostic tests



• Inpatient surgery (cont’d)

– Anesthesiologist: physician who administers chemical agents that temporarily eliminate sensation and pain

– Anesthetist: nurse specialist who administers anesthesia under the direction of a physician


QuestionQuestion

•Removal of a cataract falls under which type of surgery?

a. Required

b. Emergency

c. Urgent

d. Elective


AnswerAnswer

a. Required

The type of surgery conducted for the removal of a cataract is called “required surgery.” Surgery for relieving an intestinal perforation is an example of an “emergency surgery.” Removal of a malignant tumor is an example of an “urgent surgery.” Removal of a superficial cyst is known as an “elective surgery.”



• Outpatient surgery: operative procedures performed on clients who return home the same day


Advantages and Disadvantages of Outpatient Surgery

Advantages and Disadvantages of Outpatient Surgery



• Outpatient surgery (cont’d)

– Clients remain in the outpatient surgical suite for a brief time and get discharged by midafternoon or early evening when:

o The client is awake and alert

o Vital signs are stable

o Oral fluids are retained



• Laser surgery

– Used as an alternative to many previously conventional surgical techniques such as reattaching the retina, removing skin tattoos, and revascularizing ischemic heart muscle



• Laser surgery (cont’d)

– Advantages

o Cost effectiveness

o Reduced need for general anesthesia

o Minimal blood loss

o Less time recuperating


• Laser surgery (cont’d)

– Laser technology requires unique safety precautions such as eye, fire, heat, and vapor protection

– Various safety measures are taken during laser surgery




• Informed consent

– Permission for a procedure that a client gives after an explanation of the risks, benefits, and alternatives


Surgical Consent FormSurgical Consent Form


• Preoperative blood donation

– Autologous transfusion: self-donated blood

– Directed donors: blood donors chosen from among the client’s relatives and friends

o If directed donation not used, it is available for use by other clients



QuestionQuestion

•Which of the following types of surgeries is used for removal or replacement of defective tissues to restore function?

a. Palliative

b. Exploratory

c. Curative

d. Diagnostic


AnswerAnswer

c. Curative

Curative surgery is used for the purpose of removal or replacement of defective tissues to restore function. Relief of symptoms or enhancement of function without cure is called palliative surgery. Exploratory surgery is a more extensive means to diagnose a problem. Removal and study of tissues to make a diagnosis is called diagnostic surgery.


• Immediate preoperative care

– Nursing assessment

o Surgical risk factors Low hemoglobin and red cells Cardiopulmonary disease Malnutrition Dehydration



• Immediate preoperative care (cont’d)

– Preoperative teaching

o Deep breathing

o Coughing

o Leg exercises

o Postoperative pain management




– Physical preparation

o Skin preparation

o Elimination

o Food and fluid restrictions





– Physical preparation (cont’d)

o Care of valuables

o Surgical attire

o Disposition of dentures and prostheses



– Preoperative medications

– Psychosocial preparation

– Preoperative checklist



Preoperative ChecklistPreoperative Checklist


• Receiving room

• Operating room

• Surgical waiting area

Intraoperative PeriodIntraoperative Period


Intraoperative Period (cont’d)Intraoperative Period (cont’d)

• Anesthesia– General: central nervous system – Regional: specific area of the body

o Localo Spinal, epidural, peripheral nerve blocks

– Conscious sedation: clients are sedated, a state of relaxation and emotional comfort but not unconsciousness; client can respond verbally and physically


QuestionQuestion

•Which of the following postoperative complications is a protrusion of abdominal organs through separated wounds?

a. Wound infection

b. Adynamic ileus

c. Dehiscence

d. Evisceration


AnswerAnswer

d. Evisceration

A postoperative complication in which abdominal organs protrude through separated wounds is called evisceration. A wound infection indicates proliferation of pathogens at or beneath the incision. An adynamic ileus signifies lack of bowel activity, and dehiscence indicates separation of incisional edges.


Postoperative PeriodPostoperative Period

• Immediate postoperative care

– Initial postoperative assessments

– Preparing the room

– Monitoring for complications

• Continuing postoperative care

– Food and oral fluid intake


Postoperative Period (cont’d)Postoperative Period (cont’d)

• Continuing postoperative care (cont’d)

– Promoting venous circulation

o Pneumatic compression device

o Antiembolism hose

– Wound management

– Elimination


Pneumatic Compression DevicePneumatic Compression Device


Postoperative Period (cont’d)Postoperative Period (cont’d)

• Continuing postoperative care (cont’d)

– Discharge instructions

o How to care for the incision site

o Signs of complications to report

o Which foods to consume or avoid

o When and where to return for a medical appointment


Nursing ImplicationsNursing Implications

• Applicable nursing diagnoses– Deficient knowledge, fear, acute pain

– Risk for ineffective therapeutic regimen management, infection, impaired gas exchange, deficient fluid volume

– Ineffective breathing pattern, airway clearance

– Impaired skin integrity, disturbed body image


General Gerontologic ConsiderationsGeneral Gerontologic Considerations

• Chronic health concerns in older clients may increase preoperative/postoperative periods

• Muscle atrophy occurs in older adults who have been on bed rest as little as 1 or 2 days; range-of-motion exercises can maintain mobility

• Important to assess client’s support system for care at home; client may need home rehabilitation services or extended care admission


General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Wound healing may occur more slowly due to impaired circulation and oxygenation; poor hydration and nutrition

• Postoperative signs and symptoms may be more subtle or delayed; change in mental status may be early indicator of infection

• Cardiac status of older adults is monitored carefully after surgery

Health & Medicine

Ppt chapter 27