surgery 6th year, tutorial (dr. abdulwahid)

Preoperative phasePreoperative phase

Intraoperative phaseIntraoperative phase

Postoperative phasePostoperative phase

EMERGENTEMERGENT –Severe –Severe bleedingbleeding

URGENTURGENT 24-30 24-30

ELECTIVEELECTIVE

OPTIONALOPTIONAL

MAJORMAJOR

MINORMINOR

CLASSIFICATIONS CLASSIFICATIONS OF SURGERYOF SURGERY

Accdg. To Purpose Accdg. To Purpose ::

1.1. DIAGNOSTICDIAGNOSTIC

2.2. EXPLORATORYEXPLORATORY

3.3. CURATIVECURATIVE

4.4. ABLATIVE ABLATIVE

5.5. PALLIATIVEPALLIATIVE

5.5. RECONSTRUCTIVERECONSTRUCTIVE

Accdg. To Location Accdg. To Location ::

1.1. INTERNALINTERNAL – –

2.2. EXTERNAL EXTERNAL – –

FOUR BASIC FOUR BASIC PATHOLOGIC PATHOLOGIC

CONDITIONS THAT CONDITIONS THAT REQUIRE SURGERY:REQUIRE SURGERY:

1)1) OBSTRUCTIONOBSTRUCTION

2)2) PERFORATIONPERFORATION

3)3) EROSIONEROSION

4)4) TUMORSTUMORS

SURGICAL RISK SURGICAL RISK PATIENTSPATIENTS

Extremes of age ( very young & very old )Extremes of age ( very young & very old ) Extremes of weight (emaciation, obesity)Extremes of weight (emaciation, obesity) Dehydrated pts.Dehydrated pts. Nutritional deficitsNutritional deficits Pts. with severe trauma or injury, Pts. with severe trauma or injury,

infection/sepsisinfection/sepsis Pts. with cardiovascular diseasePts. with cardiovascular disease Endocrine dysfunction (diabetes mellitus) Endocrine dysfunction (diabetes mellitus) Hypertensive & hypotensive pts.Hypertensive & hypotensive pts. Hepatic diseaseHepatic disease Preexisting mental or physical disabilityPreexisting mental or physical disability

PHASES OF O.R. PHASES OF O.R. NURSING :NURSING :

I.I. PREOPERATIVE PHASEPREOPERATIVE PHASE

PREPARATION FOR SURGERYPREPARATION FOR SURGERY

Day of surgery : Day of surgery :

History.History.Head-to-toe assessmentHead-to-toe assessmentInformed consentInformed consentPt.’S identity & surgical site Pt.’S identity & surgical site verifiedverified

Ivf started.Ivf started.Necessary tests.Necessary tests.

Psychological Support :Psychological Support :n Fears, anxieties, Fears, anxieties, n Trusting relationship with Trusting relationship with

client.client.n Explain pre- ,operative & Explain pre- ,operative &

post-op procedures post-op procedures n Allow client to ask questions.Allow client to ask questions.n Demonstrate confidence in Demonstrate confidence in

surgeon & staff.surgeon & staff.n Provide for spiritual care.Provide for spiritual care.

PREOPERATIVE PREOPERATIVE TEACHINGTEACHING

Preoperative medication Preoperative medication Breathing exercises, coughing, Breathing exercises, coughing, incentive spirometerincentive spirometer

Leg exercises Leg exercises Position changes and movementPosition changes and movementPain managementPain management

Diaphragmatic Breathing Diaphragmatic Breathing and Splinting When and Splinting When

CoughingCoughing

Leg Exercises and Foot Leg Exercises and Foot ExercisesExercises

Ensure the diagnosticEnsure the diagnostic

1.1. CBCCBC

2.2. ElectrolytesElectrolytes

3.3. PT/PTT (Prothrombin PT/PTT (Prothrombin Time;Partial thromboplastin Time;Partial thromboplastin time)time)

4.4. UrinalysisUrinalysis

5.5. ECGECG

6.6. Blood typing & crossmatchBlood typing & crossmatch

NPO-NPO-

Bowel prep Bowel prep

skin prepskin prep

Immediate preoperative Immediate preoperative preparation preparation

Complete checklist and chartComplete checklist and chart Hospital gown, voiding, removal of Hospital gown, voiding, removal of

dentures, jewelry, dentures, jewelry, Preoperative medicationPreoperative medication

TransportingTransporting

Adult client Adult client (over 18 y/o) signs own (over 18 y/o) signs own permit unless unconcious or permit unless unconcious or mentally incompetent.mentally incompetent.

1.1. If unable to sign, If unable to sign, relativerelative (spouse or (spouse or next of kin) or next of kin) or guardianguardian will sign. will sign.

2.2. In an emergency, permission via In an emergency, permission via telephone or telegram is acceptable; telephone or telegram is acceptable; have a 2have a 2ndnd listener on phone when listener on phone when telephone permission is giventelephone permission is given

3.3. Consents Consents are not needed are not needed for for emergency emergency care if all 4 of the ff. care if all 4 of the ff. criteria are met:criteria are met:

a.a. There is an immediate threat to life.There is an immediate threat to life.

b.b. Experts agree that it is an Experts agree that it is an emergency.emergency.

c.c. Client is unable to consent.Client is unable to consent.

d.d. A legally authorized person cannot A legally authorized person cannot be reached.be reached.

PREOPERATIVE PREOPERATIVE MEDICATIONSMEDICATIONS

PURPOSES:PURPOSES:

1.1. sedative.sedative.

2.2. narcotics.narcotics.

3.3. anticholinergics.anticholinergics.

4.4. antiemetics and H2-blockers.antiemetics and H2-blockers.

REVIEW MEDICAL RECORD AND PHYSICIAN’S ORDER: INITIALS

1. History and Physical completed and in chart

2. Laboratory studies/Reports in chart 3. EKG report in chart

4. Chest X-ray report in chart 5. Operative Permit completed, signed,

& witnessed in chart 6. Anesthesia Permit completed,

signed, & witnessed in chart 7. Consent for blood transfusion

completed, signed, & witnessed in chart 8. Medication Reconciliation Form

Completed & Signed

PREOPERATIVE PREPARATION: INITIALS 1. Identification bracelet accurate and affixed to wrist

or ankle prior to transport 2. Allergies checked, allergies bracelet on and allergy

sticker on chart 3. Isolation label on chart 4. Jewelry, hairpieces, hairpins, contact lenses, glasses,

prosthesis, underwear, money removed .. 5. Vital signs taken and

recorded ................................................................................................ 5. ____

Time taken_________ BP_________ Temp_______ HR_______ Resp_______

6. Dentures: Full: Upper Lower Partial: Upper Lower Removed: Sent Home Left at bedside Left in place as requested by: Anesthesiologist Patient 7. Patient NPO yes since ________ If no: O.R. notified (Time) _______ 8. Medication sheets on chart.. 9. Most recent nursing assessment attached 10. Report called to____________ at________________(time)