PERI-OPERATIVE NURSING

Elective Surgery

preplanned, patient choice, non-urgent

Required or Urgent Surgery

Must be done reasonably soon

Emergency Surgery

Immediate to preserve life or function

Ablative

To remove a diseased body part

Curative

Removal of tumor or disease with the intention of cure

Cosmetic

Surgery to change appearance

Diagnostic/Biopsy

Used to determine whether a person has a particular disease/condition

Exploratory

Investigating area of body suspect of disease when specific diagnosis is not possible

Palliative

Alleviates symptoms of disease (pain/discomfort/blockages) (Not Curative)

Prevention

Removal of tissue that is not yet diseased to prevent disease spread

Reconstructive

Restores form, function and appearance to damaged or disfigured part of the body

Transplant

Organ or tissue from one person to another

Major Risk Surgery

Higher degree of risk, Involves major body organs, Has post-

operative risks. Likely to be performed in the hospital setting

Minor Risk Surgery

Usually outpatient, low risk. Usually elective

Pre-Operative

May be months, weeks, days, hours. Includes until client is taken to the operating room

Intra-Operative

From entering the operating room until leaving the operating room

Post-Operative

Stage 1

Types of Surgical Settings

Hospitals, Outpatient Surgical Centers, HCP (Health Care Provider) Offices, Specialty Surgical Centers

Obtaining Consent is the role of Who?

The Provider

PRE-OPERATIVE NURSING DIAGNOSES

Knowledge Deficits, Surgical procedure

Preoperative Diagnostics

Urinalysis, Blood type/Cross match, Pregnancy Test, CBC, Clotting Studies, Blood electrolyte levels, ABGs, Chest X-ray, 12-lead EKG

Education starts

At the pre-op visits

Transportation and discharge plan needs to be made when?

BEFORE procedure

Physical Preparation

Educate on NPO, When to take/stop taking meds, Voiding before going to OR, TEDs if needed

Postoperative Exercises

Deep breathing, Incentive Spirometer, Coughing, Turning, Leg exercises, Early Mobility

General Anesthesia

Sleep – no pain – no memory of event. IV or inhaled. CNS depression. 3 stages

Conscious Sedation

Can respond to verbal commands – no pain

Regional Anesthesia

Blocking nerve transmission to specific area. Awake

Local Anesthesia

Injection of anesthetic into specific body area. Minor sx

Sedative-Hypnotics

Benzodiazepines and Nonbenzodiazepines

Benzodiazepines

Depresses CNS, skeletal muscle relaxation, Monitor Vitals, usually end in -am

Nonbenzodiazepines

Used in combination with narcotics/opioids (zolpidem)

Opioids

Oral, IV or Epidural. Pain relief, Can cause respiratory depression (morphine, dilaudid, fentanyl) Safety precautions!!!

Anticholinergics

Prevent post-op nausea/vomiting. Decrease oral/resp secretions. (atropine, scopolamine) Monitor VS, I/O (retention), BMs

Antiemetics

Decrease incidence of nausea/vomiting (ondansetron, metoclopramide) Monitor nausea, BS, abdominal distension

Anti-infectives

Used prophylactically. Medications that inhibit or kill infectious organisms

Non-opioid Analgesics/Antipyretics

Reduce pain and fever (Ibuprofen, acetaminophen) Assess GI and Liver function

Anticoagulants

Stop 2-4 days before procedure (unless specified). Used after surgery for DVT prevention, Assess INR

Laxatives

Helpful when NPO, when taking narcotics and immobile. Very important part of post-op care.

Antidiabetic-Oral and Injectable

NPO 8 hours or more before procedure. These medications will be adjusted by HCP (healthcare provider.) (Insulins, metformin, glipizide) GLP1s even longer

Antihypertensives and antianginals

Help control blood pressure. BP can drop during surgery

Bronchodilators

May be given to increase respiratory effectiveness. Relax and open airways. Some may interact with anesthesia, Assess lungs

Corticosteroids

Reduce inflammation. Asthma, Assess CBC and blood sugar

Prophylactically

Preventative

Oliguria

Abnormally low urine output

Atelectasis

Lung Collapse/Alveolar collapse

-Ostomy

To form a new opening

-Ectomy

Removal of an organ

Excision

To remove

-Scopy

To examine

PACU

Post Anesthesia Care Unit

Evisceration

Protrusion of internal organs through an open wound

Dehiscence

Surgical wound accidentally opens

Reasons for Early Ambulation

Muscle Strength, Bowel movement, Prevent clots, Lessens pain, Improve lung function/prevent Atelectasis, Shortens healing time