1 MS-MT - Chapter 18

1. Preoperative Care

Care ā the surgery.

1. Intraoperative Care

Care during the surgery.

1. Postoperative Care

Care p̄ the surgery.

Surgery may be performed for any of the following Purposes:

Suffixes Describing Surgical Procedures

Suffix

Meaning

Example

• ectomy

Excision or removal of

Appendectomy

• lysis

Destruction of

Electrolysis

• orrhaphy

Repair or suture of

Herniorrhaphy

• oscopy

Looking into

Endoscopy

• ostomy

Creation of opening into

Colostomy

• otomy

Cutting into or incision of

Tracheotomy

• plasty

Repair or reconstruction of

Mammoplasty

Surgical Settings

Elective Surgery (scheduled)

Emergency Surgery

Inpatient Surgery

• Pts who are going to be admitted to the hospital are usually admitted on the day of surgery (same-day admission).

Ambulatory Surgery

May be conducted in:

1. Endoscopy Clinics

2. Physician’s Office

3. Freestanding Surgical Clinics

4. Outpatient Surgery Units in Hospitals

Advantages of Ambulatory Surgery

1. Involves laboratory tests.

1. Requires fewer preoperative & postoperative.

1. Reduces the risk for health care issue infections.

To Perform the Function Effectively in Preparing, Caring, and Facilitating the pt’s Recovery p̄ surgery :

1. Know the nature of the disorder requiring surgery & any coexisting medical problems.

1. Identify the individual pt’s response to the stress of surgery.

1. Know the results of apt preoperative diagnostic tests.

1. Identify potential risks and any coexisting medical problems that should be included in the plan of care.

Primary Purposes of pt interview

1. Obtain the pt’s health information

1. Provide and clarify information about the planned surgery, including anesthesia

1. Assess the pt’s emotional state and readiness for surgery, including his or her expectations about the surgical outcomes.

Psychosocial Assessment Of Preoperative Pt

Situational Changes

• Identify support systems, including family, other caregivers, group and institutional structures, and religious and spiritual groups.

• Define current degree of personal control, decision making, and independence.

• Consider the impact of surgery and hospitalization and the possible effects on lifestyle.

• Determine the presence of hope and anticipation of positive results.

Concerns With the Unknown

• Identify specific areas and degree of anxiety and fears related to the surgery (e.g., pain).

• Identify expectations of surgery, changes in current health status, effects on daily living, and sexual activity (if appropriate).

Concerns With Body Image

• Identify current roles or relationships and view of self.

• Determine perceived or potential changes in roles or relationships and their impact on body image.

Past Experiences

• Review previous surgical experiences, hospitalizations, and treatments.

• Determine responses to those experiences (positive and negative).

• Identify current perceptions of surgical procedure in relation to the above and information from others (e.g., a friend’s view of a personal surgical experience).

Knowledge Deficit

• Identify the amount and type of preoperative information the patient wants.

• Assess understanding of the surgical procedure, including preparation, care, interventions, preoperative activities, restrictions,and expected outcomes.

• Identify the accuracy of information the patient has received from others, including health care team, family, friends, and the media.

Anxiety

• Most people are anxious when facing surgery because of the unknown.

• This is normal and is an inborn survival mechanism.

• If the anxiety level is ⬆, cognition, decision making, and coping abilities are reduced.

• The patient may experience anxiety when surgery is in conflict with his or her religious and cultural beliefs. In particular, identify, document, and communicate the patient’s religious and cultural beliefs about the possibility of blood transfusions.

• For example, Jehovah’s Witnesses may choose to refuse blood or blood products.

Common Fears

Pts fear surgery for a number of reasons. The most common is the risk of death or permanent disability resulting from surgery.

• Fear of death

• Fear of pain and discomfort

• Fear of mutilation or alteration in body image

• Fear of anesthesia

• Fear of disruption of life functioning

Hope

Assess and support the presence of hope and the pt’s anticipation of positive results.

• Past Health History

  • Pt’s any previous medical problems and surgeries.

  • In women about their menstrual and obstetric hx.

  • Obtain information about the pt’s family hx of adverse reactions to or problems with anesthesia

• Medications

  • All current routine and intermittent medication use.

Preoperative Preparation

Sensory Information

• Preoperative holding area may be noisy.

• Drugs and cleaning solutions may be cold and odorous.

• Operating room (OR) can be cold. Warm blankets are available and can be requested.

• Talking may be heard in the OR but may be distorted because of masks. Ask questions if something is not understood.

• OR bed will be narrow. A safety strap will be applied over the thighs.

• Lights in the OR may be bright.

Monitoring machines may be heard (e.g., ticking and beeping noises) when awake.

Procedural Information

• What to bring and what type of clothing to wear to the surgery center.

• Any changes in time of surgery.

• Fluid and food restrictions.

• Physical preparation required (e.g., bowel or skin preparation).

• Purpose of frequent vital signs assessment.

• Pain control and other comfort measures.

• Why turning, coughing, and deep breathing postoperatively are

• important. Practice sessions need to be done preoperatively.

• Insertion of IV lines.

• Procedure for anesthesia administration.

• Expect surgical site and/or side to be marked with indelible ink or marker.

Process Information

Information About General Flow of Surgery

• Admission area.

• Preoperative holding area, OR, and recovery area.

• Caregivers can usually stay in preoperative holding area until surgery.

• Caregivers will be able to see the patient after discharge from the recovery area or possibly in the recovery area once the patient is awake.

• Identification of any technology that may be present on awakening, such as monitors and central lines.

Common Preoperative Laboratory And Diagnostic Tests

Test

Assessment

Blood Test

Blood glucose

Metabolic status, diabetes

mellitus

Blood urea nitrogen,

creatinine

Renal function

Complete blood count: RBCs, Hgb, Hct, WBCs, WBC differential

Anemia, immune status, infection

Prothrombin Test (PT), Partial Prothrombin Test (PTT) ,Int'l Normalized Ratio (INR) , platelet count

Coagulation status

Electrolytes

Metabolic status, renal function, diuretic side effects

Human chorionic gonadotropin (hCG)

Pregnancy status

Liver function tests

Liver status

Serum albumin

Nutritional status

Type and crossmatch

Blood available for replacement (elective surgery patients may have own blood available)

Cardio-Pulmonary Clearance (CP)

Electrocardiogram

Cardiac disease, dysrhythmias

Chest x-ray

Pulmonary disorders, cardiac enlargement, heart failure

Pulmonary function studies

Pulmonary status

Urinalysis

Renal status, hydration, urinary tract infection

ABGs, pulse oximetry

Respiratory and metabolic

function, oxygenation status

Consent For Surgery

• P̄ nonemergency surgery can be legally performed, the pt must voluntarily sign an informed consent form in the presence of a witness.

Informed consent

• An active, shared decision-making process between the health care provider and the recipient of care.

Emancipated Minor

• The one who is younger than the legal age of consent but is recognized as having the legal capacity to provide consent.

Liquid and Food Intake

Minimum Fasting Period (Hr)

Clear liquids (e.g., water, clear tea, black coffee, carbonated beverages, fruit juice without pulp)

2

Breast milk

4

Nonhuman milk, including infant formula

6

Light meal (e.g., toast and clear liquids)

6

Regular meal (may include fried or fatty food, meat)

8 or more

1 - 3 days prior to admission.

Day of the surgery

Class

Drug

Purpose

Antibiotics

Cefazolin (Ancef)

Prevent post- operative infection

Action: Inhibit bacterial cell-wall synthesis and produce a bactericidal action.

Anticholinergics

Tropine (Isopto Atropine) Glycopyrrolate (Robinul)

⬇ Oral and respiratory secretions

Scopolamine (Transderm-Scōp)

Prevent nausea and vomiting

Provide sedation

Action: Block acetylcholine from binding to its receptors on certain nerve cells, thus inhibit actions called parasympathetic nerve impulses.

Antidiabetics

Insulin (Humulin R)

Stabilize blood glucose

Action: Decreasing hepatic glucose production and the intestinal absorption of glucose.

Antiemetics

Metoclopramide (Reglan

⬆ Gastric emptying

Ondansetron (Zofran)

Prevent nausea and vomiting

Action: Work by blocking neurotransmitters, which send information about nausea and vomiting to the brain.

Benzodiazepines

Midazolam (Versed) Diazepam (Valium) Lorazepam (Ativan)

⬇ Anxiety, induce sedation, amnesic effects

Action: Work by enhancing a very important neurotransmitter called GABA (gamma-aminobutyric acid) at the GABA A receptor.

β-Blockers

Labetalol (Normodyne)

Manage hypertension

Action: Decrease the effects of the SNS by blocking the action of the catecholamines, epinephrine and norepinephrine, thereby decreasing the HR and BP.

Histamine (H2)-receptor antagonists

Famotidine (Pepcid) Ranitidine (Zantac)

⬇ HCl acid secretion, ⬆ pH, ⬇ gastric volume

Action: Block the H2 receptors of the parietal cells in the stomach thus reducing gastric acid secretion and concentration.

Opioids

Morphine (Duramorph) Fentanyl (Sublimaze)

Relieve pain during preoperative procedures

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