Transcript Perioperative Nursing

Perioperative Nursing
Peg Trueman RN MSN Ed.D. CNE
Meet the Patient
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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
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Respiratory
Cardiovascular
Fluid Status
Nutrition
Elimination
Activity
Wound Healing
Respiratory
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Pulmonary
assessment
data
TCDB
• C/I: CHI, eye sx
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O2 therapy
IPPB
I.S.
The real reason dinosaurs
became extinct.
Cardiovascular
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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
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Hydration status
data
Drainage amts
vital signs
daily weights!
IV therapy
Blood therapy
Nutrition
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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
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Urinary output
• retention?!!
• Dehydration
• Catheter is the
last resort!
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Bowel activity
• bowel sounds
• flatus
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Ambulation!!!!
Activity
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OOB ASAP!!
• Usually within 24
hrs
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Psychological
impact
Needs
encouragement!
Physiology of Wound
Healing
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Inflammatory Stage
• “insult”
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Proliferative Stage
• reinforcemen/framework
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Maturation Stage
• “settling in”
Wound Healing:
First Intention
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Scar formation is minimal
Properly closed
Heal with little tissue reaction
Wound Healing:
Second Intention
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Wound is left open to granulate
Resultant in scar formation
“Healing by granulation”
Wound Healing:
Third Intention
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Two opposing granulation surfaces
are brought together
Scar is deeper and wider
“Delayed closure”
Factors Affecting
Wound Healing
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Age
Hemorrhage
Hypovolemia
Local Factors
Nutritional
Deficits
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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
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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
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Common Pain Medication
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Demerol
Morphine
Dilaudid
Stadol
NSAIDs
Side Effects of Pain medication*
Managing Potential
Complications
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Shock/Hemorrhage
Deep Vein Thrombosis (DVT)
Pulmonary Embolism
Respiratory Complications
Urinary Retention
Intestinal Obstruction
Wound Complications
Surgery Specific Care
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Postoperative Uniquities and
“worries”
Remember Mr. P?
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Case Study
Review
Perioperative Nursing