Perioperative Management

PERIOPERATIVE MANAGEMENT - Used to describe functions in the total surgical experience of the px.

PHASES OF SURGERY  Pre-operative

– from the time of px’s decision for surgical intervention to the px’s tranference to the OR.  Intra-operative – px is received in the OR (with physical preparation) unto the admission in the RR.  Post-operative – px’s admission in the RR until the follow-up evaluation.

TYPES OF SURGERY  Optional  Elective  Required  Urgent  Emergency

Different Surgeries Preffixes Stomach – gastro Pylorus – pylor Liver – Hepa Gallbladder – Cholecyst CBD – Choledoch Small Intestine – Enter Colon – Col Urinary bladder – Cyst Kidney – Nephr Pelvis of kidney – Pyel Fallopian tube – Salping Ovary – Oophor Rupture – Herni Abdomen/Loin - Lapar

Suffixes itis – inflammation of Otomy – to make a cut into Ostomy – to make a mouth or an opening Ectomy – to remove Pexy – to sew up in position Orrapy – to repair a defect Plasty – to improve by changing the position of tissue (structure)

Effects of Surgery  Stress

Response Activation (SRA)  Decreased resistance to infection  Alteration in the vascular and respiratory function  Vital organ function (VOF) is altered  Psychologic effects (common fears r/t SRA)

Fx’s Influencing Sx Risk  Age  Nutrition  Fluid

and Electrolyte Balance  General Health Status  Medications:      

Anticoagulants Tranquilizers Antibiotics – aminoglycosides Diuretics Antiypertensives Long term steroid therapy

Pre-Operative Px Management  Psychologic

support and pre-op teaching  Pre-op practice  Physical preparation  Preparation immediately prior to Sx  Preaneasthetic medications  Opiates  Anticholinergics  Barbiturates  Prophylactic

antibiotics

Intra-operative Management Types of Aneasthesia  General – induces depression of CNS, produces decreased muscle stretch activity and produces LOC.  Regional – produces loss of painful sensation in one area/region of the body and does not produces LOC.

Stages of Aneasthesia Stage

From

To

Px’s status

Stage 1 – induction Administration of aneasthesia

LOC

Euporic, drowsy and dizzy

Stage 2 – LOC delirium/excitement

Relaxation

Irregular breating and excited but very susceptible to external stimulus

Stage 3 – surgical aneasthesia

Relaxation

Loss of reflexes and Regular breathing; depression of VOF (-) corneal reflex; pupillary constriction

Stage 4 – danger stage

VOF depression

Possible for CRA

(-)breathing; bradycardia; dilated pupils

Types of RA 1.

2.

Topical

Agent applied directly to the surface area Local infiltration block (LIB) Injected into subcuteneous tissue of the sx site

3.

Field block (FB)

4.

Nerve block (NB) Spinal, epidural, caudal and saddle block

5.

Method

Area surrounding the sx site Injected into nerve plexus Likely to be same; injected into subarachnoid spaces of the spinal vertebra; produces aneasthesia below diaphragm, lower abdomen, perineum and LE.

Common Aneasthetic Techniques  Conscious

Sedation  Deep Sedation  General Aneasthesia  Regional Aneasthesia

Intra-operative Complications       

Hypoventilation hypotension Oral trauma Hypothermia Cardio/Pulmonary alteration/depression Peripheral nerve damage Malignant hyperthermia    

Excessive intracellular calcium level Rare reaction to aneasthetic inhalants & muscle relaxant Theophylline, epinephrine, aminophylline and digitalis may induce & intensify this reaction Signs: tachycardia, pseudotetany, muscle rigidity, cyanosis and hyperthermia.

Post-operative Care/Management A. B.

Recovery Room (Immediate postoperative care) Care on Surgical Floor (surgical ward)         

Cardio/Respiratory status Promotion of adequate fluid and electrolytes Nutrition Monitoring of elimination Comfort measures; analgesics Encourage and promote mobilization Provide wound care Provide psychologic support Provide discharge health teachings

Post-operative Discomfort 1. 2. 3. 4. 5.

Nausea and vomiting Thirst Pain Constipation and gas cramps Bowel and urinary elimination disturbances

Post-operative Complications Shock 2. Hemorrhage 3. Deep Vein Thrombosis (DVT) 4. Wound Infection 5. Pulmonary Complications 1.

A. B. C. D. E.

Atelectasis Aspiration Pneumonia Embolism Hiccups (Singultus)

Thank you very much! MELVIN NIZEL M. ALARCA, CP, RN Instructor College of Nursing Cavite State University