Download Perioperative Nursing

Perioperative Nursing
Peg Trueman RN MSN Ed.D. CNE
Meet the Patient

The experience
of surgery is a
routine event for
everyone
involved EXCEPT
for the patient!
Nursing Management
after Surgery
Postoperative Phase:
Plan of Care
System Assessments







Respiratory
Cardiovascular
Fluid Status
Nutrition
Elimination
Activity
Wound Healing
Respiratory


Pulmonary
assessment
data
TCDB
• C/I: CHI, eye sx



O2 therapy
IPPB
I.S.
The real reason dinosaurs
became extinct.
Cardiovascular




Cardiac
assessment
data
“Okay, Williams, we’ll vote…
how many here say the
heart has four
chambers?”
Leg exercises
Avoiding venous
statsis
ICD/hose
Fluid Status






Hydration status
data
Drainage amts
vital signs
daily weights!
IV therapy
Blood therapy
Nutrition





NPO status
Progression of
diet
check bowel
sounds
Feedings
TPN
“The Nurse says a trip-o’-loomin’
cow-filler is feeding Grandma.
It has three loops--one for breakfast,
one for lunch, and one for dinner!”
Elimination

Urinary output
• retention?!!
• Dehydration
• Catheter is the
last resort!

Bowel activity
• bowel sounds
• flatus

Ambulation!!!!
Activity

OOB ASAP!!
• Usually within 24
hrs


Psychological
impact
Needs
encouragement!
Physiology of Wound
Healing

Inflammatory Stage
• “insult”

Proliferative Stage
• reinforcemen/framework

Maturation Stage
• “settling in”
Wound Healing:
First Intention



Scar formation is minimal
Properly closed
Heal with little tissue reaction
Wound Healing:
Second Intention



Wound is left open to granulate
Resultant in scar formation
“Healing by granulation”
Wound Healing:
Third Intention



Two opposing granulation surfaces
are brought together
Scar is deeper and wider
“Delayed closure”
Factors Affecting
Wound Healing





Age
Hemorrhage
Hypovolemia
Local Factors
Nutritional
Deficits





Oxygen deficit
Drainage
Medications
Systemic
Disorders
Wound Stressors
Wound Care
“Just a friendly suggestion…next time you do a dressing
change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT!”
Post-op Pain Control



What is pain?
Factors affecting pain
Administration
• Preventative Approach
• PRN vs ATC
• Routes of Administration
• Intramuscular
• Intravenous
• PCA pump/Epidural lines
Post-op Pain Control

Common Pain Medication
•
•
•
•
•

Demerol
Morphine
Dilaudid
Stadol
NSAIDs
Side Effects of Pain medication*
Managing Potential
Complications







Shock/Hemorrhage
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Respiratory Complications
Urinary Retention
Intestinal Obstruction
Wound Complications
Surgery Specific Care

Postoperative Uniquities and
“worries”
Remember Mr. P?

Case Study
Review
Perioperative Nursing