Download Care of the Client Experiencing the Perioperative Cycle

UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
1. Define the terms listed in the content
I. Application of terms
column appropriate to the patient
A. Abscess
situations.
B. Anesthesia
C. Anesthesiologist
D. Anesthetist
E. Anticholinergics
F. Atelectasis
G. Biopsy
H. Hyperventilation
I. Hypovolemic shock
J. Hypoxia
K. Incentive spirometry
L. Infection
M. Inflammation
N. Informed consent
O. Intraoperative
P. Lithotomy position
Q. Medical asepsis
R. Perioperative
S. Postoperative
T. Preoperative
U. Pyogenic-pus producing
V. Pyrogenic-fever
W. Surgical asepsis
X. Surgical classifications
1. Diagnostic
2. Curative
3. Palliative
4. Reconstruction/cosmetic
5. Reparative
Y. Surgical indications
1. Emergency
2. Elective
3. Optional
4. Required
5. Urgent
Z. Endarterectomy
Clinical Objectives
Evaluate quality of care and
learning needs of self, peers,
or others.
Identify organizational
procedures for reporting/
solving patient care problems.
Inform and support health
rights of patients.
Provide nursing care to
patients and families within
limits of nursing knowledge
and experience and the legal/
ethical standards of care.
Select and carry out safe and
appropriate activities to assist
patient to meet basic physiologic needs, including:
Circulation, nutrition, oxygennation, activity, elimination,
comfort, rest and sleep.
Carry out measure to prevent
exposure to and transmission
of pathogens.
Evaluate quality of care and
learning needs of self, peers,
or others.
Assist health care providers in
reporting patient care
problems.
Learning Opportunities
Review:
Operating Room Orientation Packet in
RNSG 2561
Readings:
McKinney
Adams
Lewis
Berman & Snyder
TVCC Library – Nursing Education on
Video
http://tvcc.ent.sirsi.net/client/tvcclibraries
Aseptic Nursing Techniques at the
Bedside: Demonstrations of Aseptic
Techniques.
Aseptic Nursing Techniques at the
Bedside.
Aseptic Nursing Techniques at the
Bedside: The Sterile Field.
Aseptic Nursing Techniques at the
Bedside: Transmission of Infection.
Aseptic Nursing Techniques in the OR:
Creating and Maintaining a Sterile Field.
Aseptic Nursing Techniques in the OR:
Gowning, Gloving, and Surgical Skin
Prep.
Aseptic Nursing Techniques in the OR:
Principles of Sterile Technique.
Aseptic Nursing Techniques in the OR:
Surgical Hand Scrub.
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
2. Compare and contrast the effects of
II. Anatomy and Physiology
surgery on the normal anatomy and
A. Neurologic
physiology of major systems across
B. Respiratory
the lifespan.
C. Cardiovascular
D. Hepatic and Renal
E. Endocrine
F. Immunology
G. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
3.
Analyze factors included in the
assessment of the surgical patient,
including the developmental and
cultural considerations.
III. General Physical Assessment
A. Interview
1. Chief complaint
2. Precipitating event
3. Medical history
4. Family/social/occupational history
5. Medication history (prescription/nonprescription)
6. Knowledge of surgical procedure
7. Identify risk factors for
surgery/anesthesia
B. General Physical Assessment
1. Neurological
a. Level of consciousness (LOC)
2. Psychosocial
a. Anxieties
b. Fear
c. Mood
d. Perception of event
e. Emotional reaction/coping
Mechanisms
f. Availability of financial assistance
3. Nutritional status/chemical substance use
a. Obesity
b. Drug or alcohol
Clinical Objectives
Collaborate with other health
care providers and members of
the organization to solve
patient care problems.
Select and carry out appropriate nursing measures to
promote psychosocial wellbeing.
Administer medications and
treatments safely.
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
4. Respirations
a. Respiratory
(1) Rhythm
(2) Depth
(3) Effort
b. Breath sounds
c. Smoking
d. Infection
5. Cardiovascular
a. Blood pressure
(1) Lying
(2) Sitting
(3) Standing
b. Pulses
c. Capillary refill time (CRT)
d. Pre-existing conditions
6. Gastrointestinal (GI
a. Palpation
b. Auscultation
7. Hepatic and renal function
8. Endocrine function
a. Blood glucose (diabetes)
b. Use of steroid medications
9. Immunologic function
a. Allergies
b. Temperature
10. Previous medication therapy
11. Development considerations
a. Age Specific
(1) Sensory limitations
(2) Mouth and teeth
(3) Skin
(4) Fears
12. Special Needs Patient
C. Preoperative assessment
1. Nutrition
a. Nothing by mouth (NPO)
b. Dehydration
2. Preoperative check list
3. Baseline vital signs
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
D. Post-operative assessment
1. Airway patency
2. Vital signs
3. Neurological status
4. Tubings and drains
5. Surgical report
a. Diagnosis (DX) – pre and post
b. Medications given
c. Problems occurred
d. Pathology encountered
e. Blood loss
6. I & O
7. Other data
8.
Post anesthesia care unit (PACU) scoring guide
E. Diagnostic tests
1. Laboratory studies
a. Complete blood count (CBC)
b. Prothrombin time (PT)
c. Partial thromboplastin time (PTT)
d. Electrolytes
e. Urinalysis
f. Type and cross match (TCX)
2. Radiology
a. Chest x-ray
b. X-rays
3. Electrocardiogram (EKG/ECG)
4. Cultures
5. Frozen sections
F. Cultural influences
1. Language
2. Health beliefs/practices
3. Spiritual beliefs
4. Religious practices
G. Developmental
1. Age specific assessment data
a. Vital signs
b. Fluid/electrolytes
c. Nutritional
d. Physical changes
2. Behavioral/emotional response to health care
providers
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
4.
Discuss legal and ethical issues related
to patients undergoing a surgical
procedure.
IV. Legal/ethical issues
A. Informed consent
1. Criteria
2. Responsibilities
3. Signatures
B. Patient Rights
C. Blood administration
D. Confidentiality
E. Privacy
F. Patient advocate
5.
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected surgical
procedures.
V. Selected surgical procedures
A. Abdominal surgeries
1. Laparoscopic
a. Cholecystectomy
2. Open
a. Appendectomy
B. Tonsillectomy & adenoidectomy (T&A)
C. Myringotomy & tube insertion
D. Total knee replacement (TKR)
E. Laparoscopic knee surgeries
F. Fractures – cast care
G.
Open reduction and internal fixation (ORIF) hip
H. Total hip replacement (THR)
6.
Discuss analysis, planning,
implementation and evaluation for the
nursing management of patients
undergoing a surgical procedure.
VI. Selected nursing diagnoses/nursing
implementation
A. Knowledge deficit: Preoperative teaching
1. Independent interventions
a. Assessment
(1) Knowledge level
(2) Developmental stage
(3) Expectations
b. Pertinent information
(1) Exercises
(2) Turning
(3) Pain control
c. Teaching aids
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
2. Collaborative interventions
a. Informed consent
(1) Knowledge of surgical
procedure
(2) Information about complications
(3) Legal
b. Administer medications and monitor
for desired effects and adverse/side
effects
(1) Narcotics
(2) Analgesics
(3) Sedatives
(4) Tranquilizers
(5) Anticholinergic
c. Nutrition and fluids
d. Intestinal preparation
e. Skin preparation
3. Recognition of complications
4.
Evaluate outcome of nursing interventions:
Patient demonstrates understanding
a. Methods of evaluation
b. Patient verbalizes understanding
B. High risk for intraoperative complications
1. Independent interventions
a. Assessment
b. Age related considerations
2. Collaborate intervention
a. Roles of surgical team
b. Positioning
c. Skin care/Center for Disease Control
standards (CDC)
3. Monitor for desired effects and
adverse/side effects
a. General anesthesia
(1) Gas inhalation
(2) Intravenous agents
b. Conscious sedation
c. Regional anesthesia
(1) Topical
(2) Spinal
(3) Epidural
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
4.
Recognition of complications
a. Arrest/Dysrhythmias
b. Hypotension/hypertension
c. Hemorrhage
5. Evaluation outcome
a. Patient will return to preanesthetic
level of consciousness (LOC)
C. Ineffective airway clearance Post Anesthesia
D. Care Unit (PACU)
1. Independent interventions
a. Assessment respiratory function
(1) Age related considerations
(2) Maintain open airway
b. Promoting lung expansion
(1) Turn, cough, and deep breathe
(2) Incentive spirometry
(3) Splint incision
2. Collaborative interventions
a. Administer oxygen
b. Administer medications and monitor
for desired effects and adverse/side
effects
(1) Narcan
c. Diagnostic tests
(1) Arterial blood gases (ABG)
(2) Pulse oximeter
3. Recognizing complications
a. Arrest/Dysrhythmias
b. Hypertension/hypotension
c. Respiratory depression
d. Bronchospasms
e. Laryngospasm
f. Malignant/hyperthermia
g. Hypothermia
h. Aspiration
i. Atelectasis
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
4.
Evaluation outcome
a. Maintain patent airway with adequate
exchange
b. SaO2 94% or greater (>)
E. Fluid and electrolyte imbalance (postoperative)
1. Independent interventions
a. Assessment
b. Age related hydration status
c. Intake and output
d. Monitor pertinent diagnostic tests
e. Maintain skin integrity
2. Collaborative interventions
a. Administer replacement fluid
(1) Oral replacement solutions
(2) Intravenous therapy
b. Administration medications and
monitor for desired effects/adverse
effects
(1) Potassium chloride (KCL)
3. Recognition of complications
a. Hypovolemic shock
b. Hyper/hypokalemia
c. Hyper/Hyponatremia
d. Fluid volume excess
4.
F.
Evaluation outcome: Patient will demonstrate
adequate perfusion as exhibited by:
a. Intake & Output
b. Electrolyte balance
c. Vital signs
Pain and other postoperative discomforts
1. Independent interventions
a.
Assess coping strategies and related
factors
b.
Pain assessment
(1) Perception of pain
(2) Pain assessment scales
(3) Physiologic responses
(4) Behavioral responses
(5) Influencing factors
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
(a)
(b)
(c)
(d)
(e)
c.
d.
e.
2.
Past experience with pain
Anxiety
Culture
Age
Placebo effect
Provide physical care
Manage anxiety
Pain management strategies
(1) Theories of acute pain
management
(2) Pharmacologic interventions
(3) Nonpharmacologic measures
(a) Massage
(b) Ice and heat
(c) Transcutaneous electrical
nerve stimulation (TENS)
(d) Distraction
(e) Relaxation techniques
(f) Guided imagery
(g) Hypnosis
(h) Skin Traction
(i) Skeletal Traction
f. Teach appropriate and safe ways to
use analgesics
Collaborative interventions
a. Administer medications and monitor
for desired effects and adverse/side
effects
(1) Analgesics
(a) Preventive approach
(around the clock schedule)
(b) Individual doses
(c) Patient-controlled analgesia
(PCA)
(2) Opioids
(3) NSAIDs
(4) Routes
(a) Parenteral
(b) Oral
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
(c) Rectal
(d) Intraspinal
(5) Anticoagulants
3. Recognizing complications
a. Respiratory depression and sedation
b. Nausea and vomiting
c. Constipation
d. Inadequate pain relief
e. Addiction and tolerance
f. Impaired circulation
4. Evaluation of outcome
a. Achieves pain relief
b. Administers prescribed analgesic
medications correctly
c. Uses nonpharmacologic pain
strategies as recommended
d. Reports minimal side effects of
interventions
G. Potential other post operative complication
1. Independent interventions
a. Assessment
(1) Respiratory
(2) Circulatory
(3) Neurologic
(4) Drainage
(5) Comfort
(6) Psychologic
(7) Safety
(8) Equipment
b. Age related considerations
c. Monitor pertinent diagnostic tests
2. Collaborative interventions
a. Fluid and electrolyte replacement
b. Medications
3. Recognition of complications
a. Hypovolemia shock
b. Hemorrhage
c. Deep vein thrombosis (DVT)
d. Wound infection
e. Peritonitis
f. Evisceration
Clinical Objectives
Learning Opportunities
UNIT III – Care of the Patient Experiencing the Perioperative Cycle
Behavioral Objectives
Content Outline
g. Dehiscence
h. Urinary retention
i. Gastrointestinal dysfunction
j. Compartment Syndrome
k. Fat Emboli
4. Evaluation outcome
a. Patient will return to preanesthetic
LOC, sensory – motor activity, vital
signs 20% plus or minus.
b. Patient will be able to perform
activities of daily living.
N:ADN/Spring 09/RNSG 2504 Unit III Care of the Patient Experiencing the Perioperative Cycle
Clinical Objectives
Learning Opportunities
Revised 11/12