Venusdonasco Final Presentation Perioperative Nursing Oct2009

Perioperative  Nursing

n

Prepared by : Venus A . Donasco , R.N.

Operating room

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Specific objectives : 1 . define related terms 2 . identify the types of surgery 3 . enumerate the phases of perioperative nursing 4 . cite the roles / responsibilities of the nurse in each phase 5 . name the members of the surgical team 6 . differentiate Ga and LA 7 . understant the principles of aseptic technique 8 . appreciate the role of a healthcare provider in caring patients undergoing surgery

We are a tradition of excellence..

Definition of terms:

PERIOPERATIVE NURSING

vRefers to the total span of surgical intervention vIncludes ward admission, anesthesia, surgery and recovery

SURGERY: any procedure

performed on the human body that uses instruments to alter tissue or organ integrity 

Perioperative nurse

ØResponsible for maintaining a safe environment for the surgical patient before, during, and immediately following surgery

Purposes of surgery Diagnostic  CURATIVE: repair or  Curative removal of a diseased  Restorative/reconstructive organ  Palliative  RESTORATIVE: correct  Cosmetic a disease process 



relieve the DIAGNOSTIC: determines the symptoms but do not origin of the presenting cure the disease symptoms  COSMETIC: improve  person’s appearance 

 PALLIATIVE:

Types of surgery A. DEGREE OF URGENCY ii. EMERGENCY iii. ELECTIVE iv. URGENT v.

immediately to preserve life

  ELECTIVE: planned for

correction of nonacute problem

REQUIRED

B. DEGREE OF RISK



i.

 EMERGENCY: performed

MAJOR

ii. MINOR

  URGENT: necessary for clients

health to prevent additional problem from developing

iii. AGE iv. NUTRITIONAL STATUS v.

MEDICATIONS

vi. MENTAL STATUS C. EXTENT OF SURGERY





i.

SIMPLE

ii. RADICAL



 REQUIRED: has to be performed

at some point, can be preschedule

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Degree of risk Minor Major surgery surgery  Involves

high degree of risk  Longer and extensive

 Involves

little risk



 Often

done with general anesthesia

3. Age

4 . NUTRITIONAL STATUS 5 . MEDICATIONS 6 . MENTAL STATUS

Phases of perioperative nursing n

1. perioperative n n

n

2. intraoperative n

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3. post-operative phase

Perioperative nursing Begins

when the patient makes the decision to have a surgery and ends when the patient has been transferred to an oR bed Important things to consider: 1.Stop ASA 7-10 days prior to surgery 2.Stop herbals 2-3 weeks before surgery 3.No smoking 4-8 weeks, stop smoking at least 24 hrs before surgery

4. Monitor immunocompromised patient closely for S / S of infection before surgery 5 . control HPN prior to surgery if possible 6 . obesity increases risk and severity of complications 7 . if patient has acute renal problems , surgery is contraindicated

Specific considerations : a . Diabetes mellitus - at risk for hyperglycemia and hypoglycemia b . Long term use of corticosteroid - adrenal insufficiency c . Uncontrolled thyroid disease - overactive : thyrotoxicosis - underactive : respiratory depression

Surgical consent:purpose and components informed consent: > a legal procedure to ensure that a patient or client knows all of the risks and costs involved in  a treatment 





> elements include informing the client of the nature of the treatment , possible alternative treatments , and the potential risks and benefits of the treatment 

Components/guidelines of informed consent v Client’s full name, surgeon, the purpose,  risks and clients signature v v in order for informed consent to be considered valid, the client must be competent and the consent should be given voluntarily.

surgeon: responsible for obtaining informed consent

nurse: serves as an advocate and a witness

Patient should not be sedated or coerced prior to obtaining the consent if client decides against the surgery , the nurse is obligated to inform the surgeon in order to prevent unwanted treatment 

COMMON ORDEr Preop 1. CLIENTS ROUTINE MEDICATIONS 2. SPECIFIC PREPARATION ORDERED BY THE DOCTOR 2.1 nebulization 2.2 I.V. Therapy 2.3 NPO status 2.4 Pre-op meds

PRE-OP CHECKLIST

Client has ID band and allergy

bracelet Informed consent is signed and witnessed Diagnostic and laboratory test results Client voided Document height and weight Vital signs before exiting the ward Pre - op meds given

Additional pre-op care: vCheck policy and procedure regarding dentures, glasses and hearing aids vProper attire includes: JEWELRY OFF, NAIL POLISH, MAKE-UP AND CONTACT LENS § MAKE SURE THAT PATIENT HAS WORN THE FOLLOWING prior to surgery: § OR gown ( hospital gown) § Hair cover

ØMake sure pre - op meds are given ensure all documentation and pre - operative procedures and orders are complete

ØSend entire medical record or chart to the Operating room with patient

Interventions for intraoperative patients Nurse’s role: SAFETY AND

STERILITY  ANESTHETIC NURSE: concerned

with ensuring that drugs are drawn up and administered safely  Checking procedures and consent

has been obtained

Intraoperative phase 

Begins when the client is transferred to the operating room bed and ends when the patient is transferred to the PACU

  Monitored ,

anesthesized , prepped , and draped

  Operation / surgery

is peformed

Members of the surgical team 1. SURGEON üHead of the surgical team üMakes the major decision 

 

2. Surgical assistant



3. ANESTHESIOLOGIST  > is a physician with at least 4 years of advanced training in anesthesia 

 

ü

4. Certified registered nurse anesthetist § Qualified health care professional who administer anesthesia

Functions : § Maintain the person airway 

§

§ Ensure that the person has an adequate O2 and CO2 exchange 

§ Infuse blood , medications and fluids as necessary

5. Circulating nurse 

ACTS AS THE MANAGER OF THE OR



Functions include: Ø Check all equipments are working properly Ø Prepares and autoclave instrument Ø Alert team members of any break in the sterile technique Ø Do skin preparation Ø Document the specific activity throughout the operation Ø Verify consent and coordinate with the team 

6. Scrub nurse § Participates directly during the procedure 

§ Setting up the OR and making certain that the environment is STERILE 

§ Maintains an accurate count of sponges, sharps and instruments on the sterile field and count the same materials together with the circulating nurse

7 . Holding area nurse



8 . Operating room technician

Operating room attire 

OR gown / scrub suits



 Masks 

 Gloves 

 Foot

socks



 Headgear / headcover

Aseptic technique 1.

STERILIZE all supplies used for sterile procedures , when in doubt , consider an object unsterile

 

2 .

When putting on sterile gloves , DO NOT TOUCH the outside of barehands , when wearing STERILE GLOVES , ONLY TOUCH STERILE ARTICLES

 

3 . The outer wrappings and edges of packs that contain sterile items are not sterile They should be opened or handled by the

person who is not wearing sterile gloves

 Open sterile packages with the edges of the wrapper directed away from your body to avoid touching your uniform or reaching over a sterile field  Touch only the outside of the sterile wrapper Once a sterile pack has been opened , use it , if it is not used , rewrap and resterilize it

Ø8. store sterile packages in dry areas  Guide to aseptic

9 . be constantly aware of techniques

need for clean surroundings



10 . hold sterile objects

and gloved hands ABOVE WAIST LEVEL or level to the sterile field



> since it cannot be

sterilized , any object that touches is is considered CONTAMINATED ! Have a special receptacle or waxed paper to receiver contaminated

4 . Avoid sneezing , coughing , or talking directly over a sterile field or object 



5 . Do not reach across or above a sterile field or wound 



6 . Avoid spilling solutions on a sterile setup 



7 . A sterile field should be away from drafts , fans and windows 

ANESTHESIA Ø Comes from a greek word 

Ø “ ANESTHESIS” Ø NEGATIVE SENSATION 

Ø INDUCED STATE OF PARTIAL OR TOTAL LOSS OF SENSATION, Ø Ø Blocks transmission of nerve impulses Ø Ø Suppresses reflexes Ø Ø Promot muscle

Anesthesia machine

Types of anesthesia Local anesthesia

General anesthesia





 Reversible loss of

anesthesia  Induced by inhibiting neuronal impulses in several areas of the CNS

Sensory nerve impulse

transmission from a specific body area or regions is briefly disrupted

 Client remains

conscious and able to follow instructions



 State can be achieved by

a single or a combination of agents

 Gag and cough reflex

remain intact



 CNS is depressed

resulting to AMNESIA, ANALGESIA, unconsciousness with

Administration of g.a § INTRAVENOUS ANESTHESIA § 

> Client experience unconscious 30 seconds after IV administration







INTRAVENOUS



INHALATION ANESTHESIA

Ø A mixture of volatile liquids or gas and oxygen is used Ø There is ease in administration and elimination Ø Can be administered thru a mask or ETT 

INHALATION

Stages of anesthesia stage

Start point

I. onset

Anesthetic administration

II. excitement

III. Surgical anesthesia IV. danger

End-point

Physical reaction

Loss of consciousness Drowsy, dizzy, possible visual & auditory hallucinations Loss of consciousness Loss of eyelid reflexes Increase in ANS activity, irreg RR

Nsg. interventions

Close OR doors, keep room quiet, be with the patient Remain quiet Assist anesthesia as needed Loss of eyelid reflexes Loss of most reflexes, Pt. Is unconscious, Begin preparation when depression of VS muscles are relaxed, no ct. Is breathing well with blink or gag reflex stable VS Functions excessively Respiratory and Client is not breathing, If arrest occurs, respond depressed circulatory failure heartbeat may or may immediately to assist in not be present establishing airways and other procedures

Complications of LA and GA Assess for CNS stimulation, CNS

and cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, N/V, seizures, increase PR, RR and BP

Treatment of complications  Establish an open

airway 



Give oxygen 



Notify the surgeon 



Fast-acting barbiturate is usual treatment 

If toxic reaction is untreated, unconsciousness, hypotension, apnea, cardiac arrest and death may result 

Post - operative phase 

Transfer of patient from the OR to the PACU/RR 

§ begins when the ward nurse assisting RR personnel in transferring the patient to the bed in his room § § continues until the patient is discharged from the care of the surgeon

Post-op patient care 1. position and safety  Spinal anesthesia: flat on bed for 8 hrs 

  Not

fully conscious: side-lying position and raise side rails

  2.

vital signs  Monitor and note any alterations  Check for any symptoms of complications

3. level of consciousness >ASSESS PTS . REACTION TO STIMULI and ability to extremities  4.

move

intravenous fluids

  Assess

the type and amount of solution

  Tubing

and the infusion rate  Check doctor’s order

5. Wound > check dressing , note the color and amount of drainage / bleeding 6. color and temperature vObserve for paleness and cyanosis v v7 . comfort ØAssess for pain , nausea and vomiting Ø ØNote duration , location and intensity 

General post - op nursing implications MONITOR VS  ADMINISTER

ANALGESICS PRN  ADMINISTER IV

FLUIDS AS ORDERED  

ENSURE PROPER

NUTRITION THERAPY OF CLIENTS  INSTRUCT PATIENT

ON TAKE HOME MEDS, WOUND CARE SUPPLIES AND APPOINTMENT

“ PERIOPERATIVE NURSING IS NOT JUST A TECHNICAL WORK ANYONE CAN DO !”

“ IF YOU CAME THROUGH YOUR SURGERY IN GOOD SHAPE , THANK A PERIOPERATIVE NURSE ” 

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THANK YOU AND HAVE A NICE DAY !!!    

PREPARED BY : VENUS DONASCO , R . N.

A.

THANK YOU!!  HAVE

A NICE DAY EVERYONE!!!!



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