Download File

Care of the Surgical Patient
Nursing Essentials
Standard
HS-NE-14:
 The student will analyze and
demonstrate nursing assistant
skills which may be performed in
an acute care setting.

Describe the psychological and physical
preparation of the preoperative
patient/client.
 Demonstrate pre and post operative care
procedures within scope of practice.

Essential Questions
What responsibilities would a nursing
assistant have in the care of preoperative and post-operative
patients?
 What procedures are required for the
CNA to perform on the surgical
patient and how does he/she go
about doing them?

Skills From This Unit





Demonstrate the technique for dressing
and undressing a patient/client/resident
with an IV catheter
Review the correct technique for making a
surgical bed
Demonstrate the use of a pulse oximeter
Size/apply/remove elasticized stockings
(Surgical Hose)
Check capillary refill
Knowledge From This Unit
Scope of practice as related to preoperative and post-operative care
 The purpose and methods for special
techniques
 Basic care and reporting guidelines for


Pulse oximetry, TED hose and sequential
compression therapy, oxygen, initial
ambulation, TCDB, chest tubes, drainage
tubes, bandages and dressings
Terms









Ambulation
Anesthesia
(General, Local,
and Spinal)
Atelectasis
Binders
Dangling
Depilatory
Nosocomial
Prosthesis
Singultus (hiccup)









Vertigo
Hypoxia
Embolus
DVT
PACU
Thrombophlebitis
Distention
Disruption
Umbilicus
Why do surgical patients worry?
Disfigurement
 Pain
 Loss of control
 What might be found
 Length and cost of recovery
 Possibility of death
 Anxiety

Anesthesia

General anesthesia



Local anesthesia



Induces patient to become unconscious
Aspiration is a risk of this type of anesthesia
Induces loss of feeling in a specific area
May be regional or spinal
The type of anesthesia used is determined
by



Location and type of surgery
Length of time
Patient’s condition
Preoperative Care

Teaching
Tests, meds, explain procedures
 Permits signed
 NPO*
 Handling of valuables*
 Skin prep and special baths*
 Removing prosthetics, jewelry and
make-up*

The CNA may be asked to assist with any of these
activities within their scope of practice
Preoperative Care

Psychological Preparation

Surgery can be scary for a patient
 Allow
patients to voice their fears
 Work in an efficient, calm manner
 Listen
 Explain all procedures
 Encourage patient participation
 Report requests for clergy
Watch body language as a cue that patient is
anxious, fearful, etc.
Preoperative Care

Physical Preparation

May be done in hospital* or at home the
night before surgery
 Surgical
bath
 Enemas
 Medications
 NPO
 Tests*
 Surgical
Prep*
 Removal of water pitcher from room*
Preoperative Care

Nosocomial Infections
Often patients are admitted to the
hospital the morning of surgery and
discharged home as soon after surgery
provided it is safe for the patient.
 This is done to prevent the possibility of
a nosocomial infection

Preoperative Care

Surgical Preps

May include:
 Cleaning
the operative site
 Shaving the operative site or using a
depilatory cream the night before surgery
The physician’s preference determines what prep is done.
Checking to see that the correct surgical site is chosen is also
done at this time-”right patient, right site”
Remember what not to shave!
Preoperative Care

Immediate Pre-op Care







Vital Signs
Valuables
Remove nail polish, makeup jewelry, hair
pins
Assist pt into a gown
Make sure patient voids (empty the
catheter if they have a Foley)
Raise side rails, remove unnecessary
equipment and prepare the room for the
stretcher
Complete surgical checklist
What should be done while the
patient is in surgery?

While the pt is in surgery, the CNA
Should prepare the surgical bed
 Remove all from bedside table except:

 Emesis
basin, tissues, vital signs equipment
Check with charge nurse for special
equipment
 Watch for your patient’s arrival
 Follow policy regarding visitors after
surgery

Post Operative Care





Identify Patient
Use universal precautions
Assist in transfer to bed
Stay with patient if unconscious (unless he
has family present)
Follow through with special instructions



Position changes
Leg exercises
TCDB
Post Operative Care
Apply TED hose and SCD’s if ordered
 Have extra blankets available
 Take Vital Signs according to policy*

Q 15 min x 4
 Q 30 min x 2
 q 1h x 1
 Q 4 hrs x 24 hrs

*This is just an example of what might
be required
Post Operative Care
Check dressings
 Check IV solutions-be careful of its
location
 Encourage TCDB exercises
 Watch for vomiting
 Check distal pulses
 Follow policy for spinal anesthesia pts
 Monitor drainage tubes for connection

Post Operative Care
Record and report first void
 Assist in dangling and initial
ambulation
 Report complaints of pain
 Report any pertinent information to
the nurse

Anesthesia affects patients differently. Use safety precautions
until patients are fully awake—side rails up, call bell in
place at bedside, use caution when giving fluids
Dressings and Bandages

These are used to cover incisions,
ulcers and injuries
Always observe for drainage and report as necessary
Drainage

May be:


Blood, pus, serous
drainage from tissue
trauma, or gastric
secretions
The drainage may be
collected via:






Catheters
T-tubes
JP drains
Hemovac drains
Penrose drains
Cigarette drains

Responsibilities





Note amt and character
each shift
Inform when dressing
needs to be changed or
reinforced
Report heavy or light
drainage
Report change in
character
Make sure tubes are
not kinked
Dealing with Tubes


Wear gloves if possible
contact with body
fluids
Check



Drainage for character
and amt
For obstructions





Keep



orifices clear of
secretions
drainage tubes below
insertion site
IV tubes above
insertion site
Never
Monitor level of
infusions
Restrain tubes if
needed to prevent
dislocation


disconnect tubes
put stress on tubes
Order needed
Report


Leakage or
disconnected tubes
Pain, discoloration,
swelling or drainage
Drains
Exercises for the Post Operative
Patient

TCDB
Turn, cough, deep breathe exercises
 Help clear air passages and prevent
pneumonia and atelectasis
 You may need to avoid this in the
patient who has had the following
surgeries

 Eye
 Nose
 Neurologic
Check with the nurse for when to begin this with these patients
TCDB Guidelines




Check to see if pain
meds are needed
10 breaths and 2
coughs
Use a pillow or binder
to splint the incision
Look at Procedure
Sheet and teach other
how to do this!
Remember universal precautions when assisting
with coughing and deep breathing
and use PPE as necessary
Pulse Ox

Turn to page 561 and let’s look at
Pulse Oximetry

Checking pulse ox is an important post
op procedure
 Many
patients are using oxygen
 This helps to make sure their oxygen levels
are being maintained
 Also helps to ensure atelectasis isn’t
occurring
Leg Exercises




Encourages circulation through the lower
extremities
Used to prevent DVT which can lead to embolus
formation
Perform them 3 to 5 times every 1-2 hours while
awake
Utilize TED hose and SCD sleeves as ordered

Look at Procedure Sheet and teach each other
how to do this!

Make sure this is not
contraindicated due to the
surgery itself. (Check orders)
TED Hose






Applied to prevent/reduce the incidence of
thrombophlebitis
May be knee length or thigh length
Must be applied smoothly, without wrinkles
Remove and reapply every 8 hours or as
often as ordered
Make sure legs are dry
Look at procedure sheet to see how to do
this. We’ll practice on each other also!
SCD Hose




Sequential Compression Devices
Used to prevent complications of blood
clots
Massages the legs using a milking,
wavelike motion
They inflate and
deflate rhythmically
to mimic the action
that occurs as
we walk