Download section 8 - Bakersfield College

BAKERSFIELD COLLEGE
LICENSED VOCATIONAL NURSING PROGRAM
1ST SEMESTER FUNDAMENTALS
CLIENTS WITH SPECIAL NEEDS
CHAPTER 50 - THE SURGICAL CLIENT: PREOPERATIVE CARE
INTRODUCTION
The goal of this module is to assist you in providing adequate emotional and physical
support to clients and family members during a client’s surgical experience. The
anticipation of surgery produces considerable fear in the client who faces many
unknowns.
OBJECTIVES
Upon completion of this unit, the student will be able to:
A.
Theory
1.
Define Perioperative nursing.
2.
List four pathological processes responsible for most surgical conditions
and give an example of a surgical condition for each process.
3.
List the three major classifications for all surgical procedures.
4.
List and describe the five purposes of surgery.
5.
Describe three conditions that increase a person’s surgical risk.
6.
Identify and state the purpose of lab work and tests that might be ordered
preoperatively.
7.
List factors to include in the preoperative assessment of the surgical client.
8.
Identify who is responsible to provide information for the informed
consent.
9.
State what the nurse’s signature on a consent form means.
10.
Identify who can sign a surgical consent.
11.
Describe how fear and anxiety is expressed by the surgical client.
12.
List each step of the preoperative check list.
13.
Identify medications and their purpose that are used as preops.
B.
Laboratory
1.
Demonstrate postoperative exercises: diaphragmatic breathing, coughing,
turning, and leg exercises.
ASSIGNMENT
A.
Read Chapter 50- Potter & Perry –pgs. 1365 – 1390, omit N/G’s, Critical
Thinking Exercise # 2 and Review Questions
B.
Study Guide for Chapter 50
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Chapter 50 The Surgical Client
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Preoperative Care
o The goal of this unit is to assist you in providing adequate emotional and
physical support to clients and family members during a surgical
experience
The anticipation of surgery produces considerable fear in the client who faces
many unknowns
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History of Surgical Nursing
Nursing played a major role in disease prevention.
Early surgical nurses
o Cleaned rooms and equipment, obtained supplies, cared for clients
postoperatively
Association of Operating Room Nurses
o Established 1956
Ambulatory surgery
o Perioperative Nursing
Refers to the role of the operating nurse during the preoperative, intraoperative,
and postoperative phases of surgery
In some institutions this is the way it is done and in others different nurses care
for the client during each phase of the surgical experience
Four Pathological Processes Responsible for Surgical Conditions
Obstruction
o blocks flow of body substances
Perforation
o Rupture of body part
Erosion
o Result of continuous irritation; infection
Tumors
o Benign or malignant
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Classification of Surgery
Seriousness
o Major
 Length of procedure
 Blood loss
 Risk of post-op complications
o Minor
 Brief procedure
 Minimal risk
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Urgency
o Elective
 Performed for client’s well being
 Not absolutely necessary
o Urgent
 Necessary for client’s health
 Prevent additional problems
o Emergency
 Immediate need to save a life
 Preserve a body part
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Purpose – Why it is done
o Diagnostic
 To confirm diagnosis
o Ablative
 Excise or remove diseased body part
o Palliative
 Relieve symptoms
o Reconstructive
 Restores function or appearance
o Transplant
 Replace organs
o Constructive
 Restores function lost from congenital anomalies
- Cosmetic
 To improve appearance
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Preoperative Surgical Phase
Surgical clients enter the health care setting in different stages of health
Some enter with a planned surgery and some through the emergency department
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Assessment
History
o client age
o Past illnesses and surgeries
o Medical conditions
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Review client and family members understanding and perception of surgery
Medication history
Smoking habits
o Risk for respiratory complications
Alcohol ingestion
o Reactions to anesthesia
o Need more analgesia post-op
Family support
o Provide assistance during recovery
Occupation
o May not be able to return to former job
Review of emotional health
o Verbalize fears and feelings
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Physical exam
o Focus on body systems affected by surgery
o Monitor vital signs
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Estimation of Surgical Risk
Physical and Mental Condition
o Clients at risk
 Age
 Obesity
 Fluid or electrolyte imbalance
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Extent of Disease
Magnitude of Operation
Resources and Preparation of:
o Surgeon, nurses, hospital
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Nursing Diagnosis
Preoperative diagnoses:
o Fear
o Knowledge deficit
o Risk for ineffective airway clearance
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Planning and Implementation
o Informed consent
 Client must understand procedure and risks
 Physician responsibility to inform client
 Client must be alert and oriented
 Client signature implies he is informed
 Witnessed by member of health care team
 Nurse verifies consent with client
 Check for time limit on signed consent
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Nurse witness verifies only client signed consent
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Who can sign the consent form?
Legal age
Underage but married
Emancipated minor
Without legal guardianship
Parent or guardian of minor
Spouse or next of kin for unconscious or mentally incompetent
Telephone consent obtained by 2 witnesses – or telegram
Court order
Emergency situations the surgeon can perform without a consent
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Preoperative Teaching
Office or home setting
o Printed literature
o Video tapes
Admission or pre-admission nurses
o Educate clients and family members
Better prepared and less anxious
AORN Criteria
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Client sites reasons for each of preop instructions
o Diaphragmatic breathing
 Improves lung expansion
o Incentive spirometry
o Controlled coughing
 Removes secretions
o Turning
 Improves blood flow
o Leg exercises
 Prevents clots
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The client states the time surgery is scheduled
The client states the unit to which he will return to after surgery
The client discusses anticipated monitoring and therapeutic devices
The client describes the scheduled procedure and treatment plan
The client describes anticipated recovery steps
The client verbalizes expectations of pain and pain relief measures
The client expresses feelings regarding the surgical intervention and the expected
outcome
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Physical preparation
Maintenance of normal fluid and electrolyte balance
o NPO at midnight
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o May brush teeth and rinse without swallowing water
o Notify MD if client eats or drinks during NPO period
Minimize the risk of surgical wound infection
o Bath evening before surgery with antimicrobial soap
o Skin prep or shave
Prevent bowel and bladder incontinence
o Absence of peristalsis for 24 hrs >
Promote rest and comfort
o Provide a quiet environment
o Administer sedative-hypnotic
o Day of Surgery
pre-op checklist
Check the chart
Check and record vital signs
Provide hygiene
Check hair and cosmetics
Remove prosthetics
Void before pre-op medications
o Empty foley or insert one if ordered
Check anti-embolic stockings
Promote client dignity
Perform special procedures
o Start IV
o NG
o Foley
Safeguard valuables
Preop Medications
o Barbituates
 Decrease anxiety, BP and pulse
o Tranquilizers
 Decrease anxiety and BP
o Narcotic analgesics
 Provide sedation
 Reduce pain
 Decrease amount of anesthesia
o Anticholinergics
 Decrease mucous secretions
o “On call”
 Meds may be given on call to OR
o After administration of preops
 Side rails up
 Lights low
 Bed in low position
 Family may remain quietly with patient