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Chapter 40
Nursing Care of the Perioperative
Client
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Surgical Interventions
• Surgery according to urgency
– Emergency
• Requires immediate intervention to sustain life
– Urgent
• Necessary to maintain health in non-life-threatening
situations
– Elective
• Convenient for client and physician
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Surgical Interventions
• Interventions based on expected
outcomes
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Diagnostic and exploratory
Reconstructive
Curative
Palliative
Transplant
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Setting
• Minor surgery
– Ambulatory care centers
– Physician offices
• Urgent or elective surgery
– Outpatient surgery areas
• One-day surgery centers
• Freestanding ambulatory clinics
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Client Safety
• The Joint Commission National
Patient Safety Goal for surgeries and
procedures:
– Prevent surgical infections
– Identify intended site
– Perform time-out
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anesthesia
• General
• Regional
• Local
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Assessment
– Nursing history
– Medical history
– Medications
• Herbs
• Allergies
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Assessment
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Age-related considerations
Social and cultural considerations
Spiritual considerations
Psychosocial status
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Assessment
– Physical assessment
• General survey
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Head and neck
Upper extremities
Anterior and posterior chest and abdomen
Lower extremities
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Diagnosis
– Deficient knowledge
– Anxiety
– Fear
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Planning and outcome identification
– Collaboration
• Surgeon
• Anesthesia provider
• Registered nurse
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Implementation
– Surgical consent form
– Preoperative checklist
– Client teaching
• Types of surgical incisions
• Postoperative exercise instruction
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Implementation
– Other devices
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Antiembolism stockings
Pneumatic compression device
Continuous passive motion device
Transcutaneous electrical nerve stimulation (TENS) unit
PCA
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Implementation
– Physical preparation
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Skin preparation
Nutrition
Gastrointestinal preparation
Urinary elimination
Safety precautions
Medications
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Preoperative Phase and the
Nursing Process
• Evaluation
– Client’s ability to verbalize and demonstrate
exercises
– Documentation
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase
• Surgical environment
• Holding area
• Occupational hazards
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase and the
Nursing Process
• Assessment
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Client’s identification band
Surgical site confirmation
Ability to position client
Preparation of operating room (OR) bed
Availability of accessories
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase and the
Nursing Process
• Diagnosis
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Risk for perioperative-positioning injury
Risk for injury
Risk for infection
Hypothermia
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase and the
Nursing Process
• Planning and outcome identification
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Meet surgeon’s needs for positioning
Alleviate or prevent client problems
Determine best mode of client transfer
Prepare equipment and positioning aids
Collaborate
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase and the
Nursing Process
• Interventions
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Surgical asepsis
Skin preparation
Positioning and draping
Electrical hazards
Heat loss
Monitoring of physiological functioning
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Intraoperative Phase and the
Nursing Process
• Evaluation
– Transfer to post-anesthesia care unit
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Assessment
– Respiratory status
• Airway
• Breathing
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Assessment
– Total assessment
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Circulation
Neurologic status
Fluid and metabolic status
Pain
Wound management
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Diagnosis
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Ineffective airway clearance
Ineffective breathing pattern
Ineffective tissue perfusion
Deficient fluid volume
Imbalanced nutrition
• Less than body requirements
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Diagnosis
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Urinary retention
Acute pain
Risk for infection
Situational low self-esteem
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Planning and outcome identification
– Post-anesthesia care unit (PACU) care
– Post-PACU care
– Prioritized according to type of anesthesia and
surgical interventions
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Interventions
– Monitor respiratory status
• Extubation
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Monitor circulatory status
Monitor neurologic status
Monitor fluid and metabolic status
Manage pain
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Evaluation and discharge from PACU
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Is conscious, oriented, and moves all extremities
Demonstrates full return of reflexes
Clears airway and coughs effectively
Exhibits stable vital signs
Has adequate intake and output
Controls body temperature
Has stable wounds
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Ongoing postoperative care
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Ineffective airway clearance
Ineffective tissue perfusion
Deficient fluid volume
Imbalanced nutrition
Urinary retention
Acute pain
Risk for infection
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Postoperative Phase and the
Nursing Process
• Evaluation
– Ongoing process
– Refer to diagnoses and outcomes
– Variable time frame
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.