Download - 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)