lect 3 perioperative management
TRANSCRIPT
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Perioperative Phases
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Miss Iman Shaweesh 3
Surgical classifications
1. Diagnostic ( biopsy)2. Curative ( excision of tumor)3. Reparative (multiple wound repair)4. Reconstructive or cosmetic ( mamoplasty)5. Palliative (relief pain or correct a problem)
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Miss Iman Shaweesh 4
According to degree of urgency
Emergent: require immediate attention without delay.
Urgent: require prompt attention within 24-30 hours.
Required: requires operation, plan hospital admission within a few wks or months.
Elective: should be operated on, failure to have surgery isn’t catastrophic.
Optional: the decision rests with the pt, depend on personal preference
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preoperative phase
reduce patient’s anxiety, aid
recovery and allow the patient
express concerns and fears
nurses establish a rapport, and
develop a plan of care
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Invasive procedures, such as a surgical incision, a biopsy
Procedures requiring sedation and/or anesthesia
A nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient
Procedures involving radiation
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Miss Iman Shaweesh 7
Criteria for valid Informed consent: Voluntary consent Incompetent pt ( mentally retarded, mentally ill, or
comatose) Informed subject Explanation Description of risks and benefits Answer questions about procedure Instructions Information written in understandable language.
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Preoperative Assessment
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1.Providing Patient Teaching 2. Providing Psychosocial
Intervention 3. Maintaining Patient Safety 4. Managing Nutrition and Fluids 5. Preparing the Bowel 6. Preparing the Skin
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1. Providing Patient Teaching Deep
Breathing, Coughing, and Incentive Spirometry
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Mobility and Active Body Movement
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Pain Management
• A pain assessment
• Postoperatively, medications are administered to relieve pain and maintain comfort without suppressing respiratory function
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Cognitive Coping Strategies
Imagery: The patient concentrates on a
pleasant experience or restful scene.
Distraction: The patient thinks of an enjoyable
story or recites a favorite poem or song
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1.Providing Patient Teaching 2. Providing Psychosocial
Intervention 3. Maintaining Patient Safety 4. Managing Nutrition and Fluids 5. Preparing the Bowel 6. Preparing the Skin
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2. Providing Psychosocial Interventions
Reducing Anxiety and Decreasing
Fear
Respecting Cultural, Spiritual, and
Religious Beliefs
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2. Maintaining Patient Safety
3. Managing Nutrition and Fluids (fluid and food were restricted preoperatively overnight and often longer)
4. Preparing the Bowel
5. Preparing the Skin
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hospital gown remove hairpins, and cover the head
completely dentures or plates are removed Jewelry is not worn
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•Administering Preanesthetic Medication
•Maintaining the Preoperative Record
•Transporting the Patient to the Presurgical Area
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Intraoperative Nursing Management
The surgical team
the anesthesiologist or anesthetist,
the surgeon, nurses, and the surgical
technologists (or assistants).
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The Circulating Nurse
verifying consent; coordinating the team; and ensuring cleanliness, proper temperature, humidity, lighting, safe function of equipment, and the
availability of supplies and materials. The circulating nurse monitors aseptic
practices to avoid breaks in technique
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The Scrub Role performing a surgical hand scrub setting up the sterile tables preparing sutures, ligatures, and special
equipment (eg, laparoscope) assisting the surgeon and the surgical
assistants during the procedure. count all needles, sponges, and instruments Tissue specimens obtained during surgery are
labeled by the person.
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General :Sterility of surface or articles Personnel: Scrubbed personnel remain in
the area of the operation . Only a small part of the scrubbed person’s body is considered sterile: from front waist to the shoulder area, forearm and gloves.
Drapping Delivery of sterile supplies Fluids
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Types of Anesthesia and Sedation
General Anesthesia Regional Anesthesia (Epidural Anesthesia,
Spinal Anesthesia Moderate Sedation Local Anesthesia
Anesthesia is a state of narcosis (severe central nervous system depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss.
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General Anesthesia
Inhaled anesthetic agents include volatile liquid agents(e.g Halothane) and gases(e.g Nitrous oxide , o2).
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Regional Anesthesia
In regional anesthesia, an anesthetic agent is
injected around nerves so that the region
supplied by these nerves is anesthetized.
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Epidural anesthesia
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Spinal anesthesia
is an extensive conduction nerve
block that is produced when a local
anesthetic agent is introduced into
the subarachnoid space at the
lumbar level, usually between L4 and
L5
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Moderate sedation
is a form of anesthesia that involves the IV
administration of sedatives or analgesic
medications to reduce patient anxiety and
control pain during diagnostic or therapeutic
procedures.
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Local anesthesia
into the tissues at the planned incision site.
• It is simple, and nonexplosive.• Equipment needed is minimal. • Postoperative recovery is brief. •Undesirable effects of general
anesthesia are avoided. • It is ideal for short and minor surgical
procedures
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postoperative period
The postanesthesia care unit (PACU), also
called the recovery room or postanesthesia
recovery room, is located adjacent to the
operating rooms suite.
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Nursing Management in the PACU Assessing the Patient Maintaining a Patent Airway Maintaining Cardiovascular Stability
(Hypotension and Shock , Hemorrhage , Hypertension and Dysrhythmias)
Relieving Pain and Anxiety Controlling Nausea and Vomiting DeterminingReadinessforDischargeFr
omthePACU
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Nursing Management After Surgery Preventing Respiratory Complications Relieving Pain Promoting Cardiac Output Encouraging Activity Caring for Wounds Maintaining Normal Body Temperature Managing Gastrointestinal Function and
Resuming Nutrition
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Promoting Bowel Function Managing Voiding Maintaining a Safe Environment Providing Emotional Support to the
Patient and Family Managing Potential Complications Promoting Home and Community-
Based Care
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