Care of the Surgical Patient

Preoperative Care:

Preoperative Care- Age related risks

• Integumentary

• MSK

• renal/urinary

• neuro

• Cardio

• Respiratory

1. from the time surgery is scheduled until client is transferred to operating room

• dry fragile skin = slower healing

• inflamed joints

• kidney function/inocntinence

• delayed reactions/cognitive function

• HTN or hypotension, decreased circulation

• hypoxemia, decreased lung elasticty

What you need on the chart and why

• History & Physical, History of Anesthetic problems, Allergies:

• Pregnancy Test:

• Blood type and Cross match:

• Provide critical info on pt

• anesthesia can be toxic to fetus

• when large blood loss is expected (abdominal, vascular) & bleeding disorder pts

Preop Care- Informed Consent

1. What happens?

2. RN’s job

3. What if client unable to sign full name?

4. What if you have a pt who has had sedatives/pain meds/dementia?

1. All risks, benefits, alternatives and prognoses explained by the PROVIDER

2. ensure client understands and witness the consent

3. “X” is acceptable with two RN witnesses

4. CANNOT SIGN (8-24hrs) or signed by next of kin

Surgical Care Improvement Project

• If antibiotics are prescribed when do we give and stop them?

• Give 1 hour b4 incision and stopped within 24 hrs after

Intraoperative Phase:

begin when client is at operating table and ends when client transferred to post-anesthesiia unit

Types of sedation

1. Minimal sedation

2. Moderation sedation

3. Deep sedation

1. can respond to verbal commands; coordination may be impaired

2. Client can maintain airway; colonoscopy

3. General anesthesia; cant be awakened easily

Naloxone (Narcan)

1. Use:

2. Side effects:

3. Monitor:

1. Resipatory depression due to opioid use

2. N/V, sweating, rapid heart rate

3. RR, HR, LOC, withdrawal

Taking Action- Post-op

Ways to prevent Respiratory complication?

Deep breathing/coughing, frequent turning, suctioning, incentive spirometer

Priority Interventions for Constipation

Decreased bowel sounds Straining Decreased fluid intake Mobility decreased

Decreased bowel sounds Straining Decreased fluid intake Mobility decreased

Offer fluids at regular intervals High fiber diet Encourage ambulation/turning Admin stool softener

Priority interventions for Post-op Hemorrhage= hypovolemic SHock

Restless (early) Rapid decrease in HR,BP, O2 Decrease urine Decrease LOC Rapid swelling at site Marked drainage Cool, clammy skin

Restless (early) Rapid decrease in HR,BP, O2 Decrease urine Decrease LOC Rapid swelling at site Marked drainage Cool, clammy skin

IMMEDIATE NOTIFICATION OF HCP Infusion of fluids/blood O2 as needed PREP FOR IMMEDIATE TRANSFER BACK TO OR

Priority interventions for Venous Thromboembolism (VTE)

Tachycardia, hypoxia, hypotension, SOB, chest pain Redness, unilateral changes Delayed cap refill

Tachycardia, hypoxia, hypotension, SOB, chest pain Redness, unilateral changes Delayed cap refill

Reposition frequently SCDs or compression stockings Heparin, Enoxaparin, anticoagulants Hydration

Wound Evisceration

1. People at risk

2. Dehiscence

1. coughing/straining, obesity, poor nutrition, diabetic

2. wounds that open either half or completely along suture lines