Transcript Chapter 11
Chapter 12 Nursing Care of Patients Having Surgery Surgery Urgency Levels Emergency Urgent Elective Optional Purposes of Surgery Preventive Diagnostic Exploratory Curative Palliative Reconstructive Types of Surgery Open Incision Minimally Invasive Surgery “Keyhole,” “Endoscopic” Scope Robotic Laser Robotic Surgery – da VINCI Three Perioperative Phases Preoperative Decision for Surgery to Transfer to Surgery Intraoperative Transfer to Surgery to PACU Postoperative PACU to Recovery Preoperative Phase LPN/LVN Role Assist in Data Collection Reinforce Explanations/Instructions Provide Emotional/Psychological Support Factors Influencing Surgical Outcomes Emotional Responses Age Hydration/Nutrition Smoking and Alcohol Diseases Preadmission Surgical Patient Assessment Health History Risk Factors Education Discharge Planning Referrals Diagnostic Testing Preadmission Surgical Patient Assessment (cont’d) Pregnancy Test Advance Directive Preoperative Teaching Preoperative Routines Date/Time of Admission/Surgery Admission Procedures Length of Stay, Items to Bring and Wear Recovery after Surgery Family Information Discharge Criteria Preoperative Instructions NPO Medications Bowel Prep Pain Control Preoperative Instructions (cont’d) Postoperative Exercises Deep Breathing and Coughing Incentive Spirometry Leg Exercises Incentive Spirometry Preoperative Patient: Assessment Health History Medications Physical Assessment Preoperative Nursing Diagnoses Anxiety Fear Deficient Knowledge Preoperative Consent Gives Legal Permission for Surgery Informed Consent Physician’s Responsibility No Sedation When Signing Voluntary Can Withdraw at Any Time Valid 30 Days LPN/LVN Role: Witnessing Consents Ensure Patient Has Been Informed Direct Questions to Physician Signature Indicates Observed Voluntary Signing of Consent Preparation for Surgery Preoperative Preparation Checklist Preoperative Medications Preoperative Checklist Transfer to Surgery Holding Area Holding Area Verifications Patient Data Surgical Site Time Out IV Insertion IV Antibiotic Intraoperative Phase Begins Arrival in Surgery Explain What to Expect Position Safety Tubes Placed After Anesthesia Skin Prep Intraoperative Phase LPN/LVN Role Scrub Nurse Sterile Instrument Field Assists Physician Anesthesia General Anesthesia Loss of Sensation, Consciousness, Reflexes IV or Inhalation Route Local Anesthesia Loss of Sensation to Body Region Injection of a Local Agent Endotracheal Tube Malignant Hyperthermia Rare Hereditary Muscle Disease Triggered by Some Types of General Anesthesia Agents Spinal Anesthesia Anesthesia Adjunct Agents Conscious Sedation Surgery PACU Postoperative Phase PACU Nursing Diagnoses Risk for Aspiration Ineffective Breathing Pattern Ineffective Airway Clearance Deficient Fluid Volume Risk for Injury Postoperative Phase (cont’d) PACU Nursing Diagnoses (cont’d) Disturbed Sensory Perception Acute Pain Family Visitation Keep Informed Maintain Confidentiality (HIPAA) PACU Discharge Criteria Stable Vital Signs Sao2 Greater Than 90% Awake, Baseline Level of Consciousness Respirations Not Depressed Bleeding Controlled Nursing Diagnoses for Postoperative Patients Ineffective Airway Clearance Ineffective Breathing Pattern Acute Pain Deficient Fluid Volume Ineffective Tissue Perfusion Impaired Urinary Elimination Nursing Diagnoses for Postoperative Patients (cont’d) Urinary Retention Risk for Infection Impaired Skin Integrity Imbalanced Nutrition Constipation Impaired Physical Mobility Complication Prevention Complication Prevention (cont’d) Stapled Incision Healing Phases Wound Dehiscence/Evisceration Ambulatory Surgery Discharge Criteria Stable Vital Signs No Bleeding No Nausea/Vomiting Controlled Pain Voided as Indicated No Dizziness When Upright Discharge Instructions Written Instructions/Signed Teaching Wound Care Medications Complications Equipment Discharge Instructions (cont’d) Follow-up Physician’s Visit Prescriptions Discharge Teaching Home Health Care RN Assessment, Complex Nursing Care, Teaching LPN/LVN Basic Nursing Care Assistants ADLs, Chores