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Peri-Operative Care NURS 2016 Stages of the Peri-Operative Period Pre-Operative From time of decision to have surgery until admitted into the OR theatre. Stages of the Peri-Operative Period Intra-Operative Time from entering the OR theatre to entering the Recovering Room or Post Anesthetic Care Unit (PACU) Stages of the Peri-Operative Period Post-Operative Time from leaving the RR or PACU until time of follow-up evaluation (often as opt-patient) Some Suffixes Ectomy Otomy Oscopy Pathy Rhage Oma Itis Logy Megaly Rhea Lysis Megaly Some Prefixes Chole Lap Dys Cyst Lith Carcin Neo Ortho Trans A Few Terms Reduction Resection Bypass Excision I&D Aspiration DVT Dehiscence Evisceration Paralytic Ileus Classifications of Surgery I II III IV V Emergency: immediately Urgent: 24-30 hours Required: need surgery in upcoming weeks Elective: Should have Optional: Not necessary – a choice Pre-Operative Period Nursing Assessment Nutritional and Fluid Status Drug and Alcohol use Respiratory Status CV Status Other system (renal, hepatic, immune Medications Psychosocial, spiritual and cultural beliefs Pre-Operative Period Nursing Interventions Teaching Physical Prep Surgical Site Nutrition and Fluids Preanesthetic Medication Psychosocial Support Reducing anxiety and addressing fears Pre-Operative Period Teaching Pain management Deep Breathing and Coughing Movement and Ambulation Pre-Operative Period Pre-Op Checklist (figure 18.3, page 413) Proper documentation complete Physical and chemical work-up complete Patient physically prepared Current condition Intra-Operative Period Nursing Roles: Patient Advocate Scrub nurse Responsible for ‘sterile’ work Monitor sterile integrity of procedure Monitors equipment (instruments, sutures, etc) Circulating nurse Protects patient safety Monitors operating room conditions Monitors surgical team activities Intra-Operative Period Stages of Anesthesia I: Beginning II: Excitement III: Surgical anesthesia IV: Medullary Depression Intra-Operative Period: Achieving Anesthesia Inhalation Halothane and methoxyflurane Administered via mask or endotracheal tube Inducation and recovery quite rapid Intravenous Tranq/Sedatives Opioids Neuroleptanalgesics Dissociative Agents Barbiturates Nonbarbiturates Intra-Operative Period Anesthesia is not always General Regional Blocks Local infiltration Intra-Operative Period Complications Nausea and vomiting Anaphylaxis Hypoxia Hypothermia Malignant Hyperthermia DIC Post-Operative Period Immediate Post-Op PACU Assist and monitor patient in post-anesthetic stage Airway, circulation, hemorrhage, nausea/vomiting Recovery Clinical Unit Discharge home Post-Operative Period: Clinical Unit Primary focus Neurological status Pain management Respiratory function Circulatory function Wound care Fluid Balance Nutritional status Post-Operative Period Immediate Assessment Level of consciousness Vital Signs (q15 x 2, q30, . . .) Wound Fluid Balance Pain Post-Operative Period: Recovery: Day 1 to Discharge Preventing Respiratory Complications Relieving Pain Promoting Cardiac Function Encouraging Activity Promoting Wound Healing Maintaining Body Temp Monitoring GI Function Managing Voiding Providing Support Post-Operative Period: Complications Deep Vein Thrombosis Hematoma Infection Wound Dehiscence Post-Operative Period Consider the list of Nursing Diagnosis provided What nursing interventions would be appropriate