ms handout (pain and perioperative nursing)
TRANSCRIPT
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gooBulacan State UniversityCOLLEGE OF NURSING
City of Malolos, Bulacan
Medical-Surgical NursingPAIN AND PERIOPERATIVE NURSING
Pain: the 5th Vital Sign
- An unpleasant sensory and emotional experience associated withactual or potential tissue damage
- Personal and private sensation of hurt- Harmful stimulus that signals current impending tissue damage- Pattern of response that protects an organism from harm
I. Classification of Pain
A. Classification According to the Cause
1. Nociceptive Pain resulting from noxious (harmful/injurious) stimuliwhich transmits in an orderly manner (e.g. sprains, bone fractures,
burn, bumps, bruises, inflammation, etc.)
Types
a. Somatic Pain caused by mechanical, thermal, chemical,
electrical, etc. affecting voluntarily controlled body tissues (e.g.
skeletal muscles)
b. Visceral Pain caused by ischemia, compression or injury
of the involuntarily controlled body parts (e.g. internal organs)
2. Neuropathic Pain always chronic that occurs or results from injury
or malfunction of PNS/CNS (e.g. cancers, phantom limb pain,
diabetic neuropathy)
B. Classification According to Duration and Severity
Acute Pain Chronic Pain
Seconds - < 6
months Short in duration andsudden onset
Intensity: mild tosevere
Localized
Sympathetic nervoussystem
6 months years
Long in duration andremote onset
Intensity: mild to severe
Generalized
Parasympathetic nervoussystem
Dry & warm skin + normalVS
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Diaphoresis + VS
Dilated pupils
Normal or dilated pupils
C. Classification According to Location
1. Referred Pain pain that comes from detached body parts (e.g.
phantom limb pain)
2. Radiating Pain felt on the source of pain that extends to nearby
tissues (e.g. MI)
3. Intractable Pain pain unresponsive to medical treatment (e.g.
cancers)
II. Pain Transmission
1. Transduction
- The phase wherein noxious stimuli trigger the release of biochemical
mediators (e.g. prostaglandin, bradykinin, serotonin, histamine,
substance P) that sensitize nociceptors.
2. Transmission
- Transmission of pain from cause of pain to the perception of pain
- pain control takes place during transmission pain
3. Perception
- Client becomes conscious of the pain
- Brain interprets the signals and localizes the pain (Nociception)
- Brain relates impulses to past pain experiences
4. Modulation
- descending system
- Neurons of the brain sends signals or pain killers (e.g. endorphins,
GABA) to the area of affectation
- It inhibits painful ascending stimuli
III. Pathophysiology of Pain
Noxious
Stimulation of
C FibersA delta fiberSubstantia gelatinosa
Spinal cord brain stem thalamus limbic system NOCICEPTIONRelease ofInhibits Pain /
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IV. Gate Control Theory
- According to Melzack and Wall, peripheral nerve fibers carrying pain to
the spinal cord can have their input modified at the spinal cord level
before they reach the brain
- Small diameter nerve fibers: carry pain stimuli through a gate
- Large diameter nerve fibers: carry non-pain stimuli through a gate
- Both nerve fibers enters the same gate which explain its gate closingmechanism
- Gate mechanism is thought to be situated in the substantia gelatinosa
in the dorsal horn of the spinal cord
- All pain perception are only mind over matter (Melzack and Wall)
V. Neurotransmitter
- Chemical substances that aids in transmission of pain or any stimuli
1. Acetylcholine
- Found throughout the spinal cord and brain stem
- Excitatory and inhibitory effect
- Responsible for voluntary movement of the muscle fibers
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- Examples of diseases associated with acetylcholine:
i. Myasthenia gravis
ii. Alzheimers disease
2. Norepinephrine
- Found in the brain stem and nerve tracts
- Excitatory and inhibitory effect
- For wakefulness and arousal
- E.g. cocaine, amphetamine, methamphetamine HCl
3. Serotonin
- Found in CNS and brain stem, especially in spinal cord
- Inhibitory effect
- Responsible for memory, emotions, mood, wakefulness, temperature
regulations, sleep, anxiety
- Examples of disorders associated with serotonin:
i. Narcolepsy
ii. Schizophrenia
4. Dopamine
- Found in the hypothalamus and nerve tracts
- Excitatory effect
- For voluntary contraction of muscle fibers
- Example of associated disorder:
i. Parkinsonism
5. GABA
- Found in the hypothalamus and CNS
- Produces local anesthesia
- For modulation of pain
- Generally inhibitory
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- E.g. Ritalin
6. Endorphins
- Found in the CNS widely and PNS
- Calming effects
- Anesthetic/ inhibitory effect
- Natural pain killers
- E.g. Morphine SO4, Opiates
VI. Pain Assessment
A. Characteristics of Pain
1. JCAHO Components of Comprehensive Pain Assessment
a. Intensity
b. Location
c. Quality
d. Onset
e. Duration
f. Variations
g. Patterns
h. Alleviating factors
i. Aggravating factors
j. Present pain management
regimen
k. Pain management history
l. Effects of pain
m. Persons goal for pain
control
n. Physical examination of
pain
O nset (What time?)
P rovoking Factors (What causes and worsens the pain?)
Q uality (is it burning, stabbing, sharp pain?)
R adiation (where do you feel the pain? Did it radiate?)
S everity (pain scale: 0-10)
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T iming (duartion)
Wong Baker FACES Pain Rating Scale: for pediatrics, with language
difficulty and mute which utilizes facial expression or grimaces to assess
pain sensation
0 -1= no pain
2-3 = mild, annoying pain
4-5 = nagging, uncomfortable or troublesome pain
6-7 = distressing, miserable pain
8-9 = intense, dreadful, horrible pain
10 = worst, unbearable, excruciating pain
VII.Pain Management
- It refers to the techniques used to prevent, reduce or relieve pain
A. Methods of Drug Administration
1. Oral (including sublingual)
2. Rectal
3. Transdermal
4. Parenteral
a. Patient controlled analgesia
b. Intraspinal analgesia
B. WHO 3-STEP LADDER
Step 1: mild to moderate pain lasting 3-4hours start with low doses of
nonopioid drugs
e.g. Acetaminophen, NSAIDs, Adjuvants
Step 2: intermediate pain not controlled by nonopioid;
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Use combination of opioid and nonopioid drugs
e.g. Acet/ASA + Codeine or Hydrocodone or Oxycodone,
Tramadol, other related adjuvants
Step 3: For severe pain, add higher dose of opioid to nonopioid or use a
drug that potentiates its analgesic effect
e.g. Morphine, Oxycodone, Hydromorphone, Methadone,
Fentanyl, other adjuvants
A fourth step is being considered for patients with pain associated with
cancer (Nerve blocks, electrical stimulation of the spinal cord,
neurosurgical analgesic techniques)
C. Analgesic Drug Therapy
1. Opioids chemical substance that has morphine like action in the
body. The main use is for pain relief. These agents work by binding
to opioid receptors, which are found principally in the CNS and GIT.
- Examples: Morphine SO4, Meperidine HCl (Demerol)
- Nursing Responsibility:
i. Assess RR before and after administration to prevent atelectasis
ii. Teach DBE and cough exercise using incentive spirometer
iii. Management for side effects:
a. Sedation raise the side rails, have ambulatory devices,
place a call bell
b. Constipation - fiber, give laxatives as ordered
Step 1 (MILD PAIN)
Aspirin (ASA)
Acetaminophen
NSAIDs+ Adjuvants
Step 3 (SEVERE PAIN)
Morphine
Hydromorphone
Methadone
Levorphanol
Fentanyl
Oxycodone+ Nonopioid
Step 2 (MODERATEPAIN)
Acet or ASA +Codeine orHydrocodone orOxycodone orDihydrocodeine
Tramadol (notavailable with ASA
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c. Hypotension move patient slowly, monitor BP q15min
d. Urinary retention insert urinary catheter if indicated
iv. Laugh therapy
2. Nonopioids it inhibits prostaglandin synthesis
- Examples: NSAIDs, ASA, Ibuprofen
- Nursing Responsibility:
i. Give NSAIDs pc because it cause gastric ulcer
ii. NSAIDs side effect renal impairment, dyspnea, constipation,
headache, dizziness
iii. If on ASA, monitor for signs of bleeding occult blood, bleeding
gums, easy bruising, epistaxis
3. Antidepressants effects are believed to be related to their effects
on neurotransmitter.
a. TCA
b. MAOIs
c. SSRI
4. Corticosteroids reduces inflammation and they are therefore
useful in treating pain where inflammation or edema is causing
symptoms.
- E.g. Dexamethasone, Betamethasone
- Nursing Responsibility:
i. Monitor weight, VS and serum glucose levels
ii. Monitor WBC levels
5. Anticonvulsants they are believed to suppress rapid and excessive
firing of neurons that start a seizure following pain perception
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- E.g. diazepam (Valium) it increases GABA
- Nursing Responsibility:
i. Give diazepam with food because of possible ulceration
ii. Monitor blood count
iii. Safety precautions (use of side rails, tongue guard)
6. Psychostimulants used as adjuvant to analgesic therapy to
increase effect to pain
- E.g. Ritalin for ADHD and depressed patients
- Nursing responsibility:
i. Give before bedtime for ADHD patients; give on daytime for
depressed patients
ii. Avoid caffeinated beverages if on Ritalin treatment
D. Neurosurgical Management
1. Cordotomy division of certain tracts of the spinal cord to interrupt
transmission of pain.
2. Rhizotomy sensory nerve roots are destroyed where they enter
the spinal cord.
Nursing Responsibility:
1. Obtain a written consent
2. Assess for pain level and neurologic status
3. Skin care, position and turn the patient q2h
4. Bowel and bladder management
E. Nonpharmacologic Interventions
1. Heat and cold application
2. TENS and PENS
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3. Acupuncture and acupressure
4. Imagery
5. Biofeedback
6. Breathing exercise
7. Hypnosis
8. Massage
9. Yoga/ meditation
10.Music Therapy
F. General Nursing Responsibility for Pain Management
1. Maintain a therapeutic relationship
2. Assess and document systematically
3. Intervene using a multidisciplinary team approach for maximum
relief
4. Advocate for the patient
5. Educate patient and family
6. Clarify orders
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PERIOPERATIVE NURSING
Surgical TerminologiesPrefixes
Meaning Root words
Meaning Suffixes Meaning
aectointrointerintrapanperipolypseudoretrosupra
without,absenceexternal,outsidebelowbetweenwithinallaround, nearmanyfalsebehind,posteriorabove
adenoarthroautoblepharcardiocephalocerebrocheilocholecholecystcholedochochondrocolpocostolaparnephrooculooophoroorchiosteootophlebopyelsalpingo
glandjointselfeyelidheartheadbrainlipbilegall bladdercommon bileductcartilagevaginaribabdomenkidneyeyeovarytestisboneearveinrenal pelvisfallopian tube
algiacentesiscopyectomyitislithlogylysisomaostomypexyplastyrrhaphy
painpunctureviewingremoval ofinflammation ofstone, calculusscience or study ofloose, dissolutiontumorartificial openingfixation or suturingrepair ofrepair of
Preoperative Phase extends from the time the client is admitted in the surgicalunit, to the time he/she is prepared physically, psychosocially, spiritually and legallyfor the surgical procedure, until he/she is transported into the operating roomIntraoperative Phase extends from the time the client is admitted to theoperating room, to the time of administration of anesthesia, surgical procedure isdone, until he/she is transported to the recovery room/post-anesthesia care unitPostoperative Phase extends from the time the client is admitted to therecovery room, to the time he/she is transported back into the surgical unit,discharged from the hospital, until follow-up care.
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I. Four Major Types of Pathologic Processes Requiring Surgical Interventions1. Obstruction impairment to the flow of vital fluids. E.g. blood, urine,
CSF, bile2. Perforation rupture of an organ3. Erosion wearing off of a surface or membrane4. Tumors abnormal new growths
II. Classification of Surgical ProcedureA. Classification According to Degree of Risk (Magnitude/Extent)
1. Major Surgery
High risk
Extensive
Prolonged
With large amount of blood loss
Vital organs may be handled or removed
Great risk of complications2. Minor Surgery
Generally not prolonged Leads to few serious complications
Involves less risk
Some minor operations exceeding 2hours is considered majoroperation
B. Classification According to Purpose1. Diagnostic Surgery to establish the presence of a disease
condition. E.g. biopsy2. Exploratory Surgery to determine the extent of the disease
condition. E.g. exploratory laparotomy3. Curative Surgery to treat the disease condition
a. Ablative Surgery involves removal of an organ (suffix used isectomy). E.g. appendectomy
b. Constructive Surgery involves repair of congenitally defectiveorgan (suffixes used are plasty, orrhaphy, pexy). E.g.cheiloplasty, orchidopexy
c. Reconstructive Surgery also called restorative surgery;involves repair of damaged organ (suffixes used are plasty,orrhaphy, pexy). E.g. plastic surgery after severe burns
4. Palliative Surgery to relieve distressing signs and symptoms, notnecessarily to cure the disease
5. Cosmetic Surgery improves appearance. E.g. facelifting
C. Classification According to Urgency1. Emergency Surgery
Done without any delay and requires immediate attention
Usually life-threatening
E.g. ruptured appendicitis, VA, gunshot wound, stabbedwound, fractured skull, CS for labor arrest
2. Urgent / Imperative Surgery
Done within 24 30 hours requiring prompt attention
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E.g. CAD, kidney stones, appendicitis (if not ruptured)3. Required Surgery
Patient needs to have surgery for well-being
Weeks months plans
E.g. cataract, thyroid disorder, prostatic hyperplasia,
scheduled CS4. Elective Surgery
Not absolutely necessary for survival; even without surgery itwill not be life-threatening
E.g. circumcision, cyst (non-malignant)5. Optional Surgery
Decision rest on the patient; usually for aesthetic purposes
E.g. plastic / cosmetic surgery
D. The Effects of Surgery to the Client1. Stress response is elicited2. Defense against infection is lowered
3. Vascular system is disrupted4. Organs function are disturbed5. Body image may be disturbed6. Lifestyle may change
III. PREOPERATIVE PHASEA. Goals
1. Assessing and correcting physiologic and psychological problemsthat might increase surgical risk
2. Giving the person and significant others complete learning/teachingguidelines regarding surgery
3. Instructing and demonstrating exercises that will benefit the person
during postop period4. Planning for discharge and any projected changes in lifestyle due to
surgeryB. Assessment
1. Age
Too young and too old are at high risk for surgery2. Fluids and Nutrition
Nutritional deficiency should be corrected preop
Dehydration and electrolyte imbalances
Obesity
NPO post midnight
3. Drugs or alcohol use Alcoholic patients requires higher dose of anesthesia
Prone to malnutrition and hepatotoxicity4. Respiratory Function
Assess RR perioperatively
Respiratory function may be depressed during surgery
Teach DBCT
Instruct to stop smoking at least 24h preop
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5. Cardiovascular Function
Assess PR, perform ECG as ordered
If with uncontrolled hypertension, surgery may postponeduntil corrected
6. Immune system
Assess for allergies on drugs, blood products, contrastagents, latex, etc.
Interview if on corticosteroids7. Hepatic Function
Secure result of liver enzyme test, function test
History of hepatitis8. Endocrine function
Monitor blood glucose level
Assess thyroid function9. Previous Medications Used
Assess for history of aspirin use
To prevent possible antagonistic effect of drugs during
surgery10.Neurologic Function
Assess LOC
Assess for fear and anxiety about the procedure and addressit therapeutically
Nursing Responsibility to Minimize Anxiety:i. Explore clients feelingsii. Allow client to speak openly about fears and concernsiii. Give accurate information regarding surgery (no false
reassurance)iv. Give empathetic supportv. Consider the persons religious preferences and
arrange for visit by priest/minister as desired11.Spiritual Concerns
Jehovahs witnesses no blood transfusion
Protestants avoid seafoods and vertebral animals
C. Informed Consent
Purposes:i. To ensure that the client understands the nature ofthe treatment including the potential complicationsii. To indicate that the clients decision was madewithout pressure
iii. To protect the client against any unauthorizedprocedureiv. To protect the surgeon and hospital against legalaction by a client who claims that an unauthorizedprocedure was performed
Circumstances Requiring a Permiti. Any surgical procedure where scalpels, scissors,suture, hemostats of electrocoagulation may be used
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ii. Entrance into a body cavity e.g. paracentesis,bronchoscopyiii. General anesthesia, local infiltration, regional block
Requisites for Validity of Informed Consenti. Written permission is best and is legally acceptableii. Signature is obtained with clients complete
understanding of what to occuriii. Obtained before sedationiv. Secured without pressure or duressv. A witness is desirable nurse, physician, or otherauthorized personsvi. In an emergency, permission via telephone ortelefax is acceptablevii. For minor (below 18yrs), unconscious,psychologically incapacitated, permission is requiredfrom responsible family member (parent/legalguardian)
D. Physical Preparation1. Before the Surgery
Correct any dietary deficiencies
Reduce an obese persons weight
Correct fluid and electrolyte imbalance
Prepare blood products for possible blood transfusion
Treat chronic diseases DM, heart disease, renalinsufficiency
Halt or treat any infectious process
Treat an alcoholic person with vitamin supplements, IVFs ororal fluids, if dehydrated
2. Teaching Preop Exercises DBCT
Incentive spirometry
Turning exercises
Foot and leg exercise3. Preparing the Person the Evening Before the Surgery
Preparing the skin have full bath to reduce microbes on theskin
Preparing the GIT NPO; cleansing enema as required
Preparing for Anesthesia avoid alcohol and smoking at least24h preop
Promoting rest and sleep administer sedatives as ordered4. Preparing the Person on the Day of Surgery
Early AM carei. Awaken 1h before preop medicationsii. Morning bath and mouth washiii. Provide clean gowniv. Remove hairpins, braid long hairs, cover hair with capv. Remove dentures, foreign materials, colored nail
polish, hearing aid, contact lenses
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vi. Take baseline VS before preop medicationsvii. Check id band, skin prepviii. Check for special orders enema, GI tube insertion, IV
line (g.18)ix. Check NPOx. Have client void before preop medication
xi. Continue to support emotionallyxii. Accomplish preop care checklist
5. Preoperative Medications / Preanesthetic Drugs
Goals:i. To facilitate the administration of any anestheticii. To minimize respiratory tract secretions and change in
HRiii. To relax the client and reduce anxiety
Commonly Used Preop Meds:1. Sedatives
Given to anxiety
Lowers BP and pulse
Lowers the administration of anesthetics
E.g. barbiturates, Phenobarbital, nubain, Demerol
Overdose: respiratory depression2. Anticholinergics
To tracheobronchial secretions
To bowel motility and fluid retention
Interrupts vagal nerve impulses HR
E.g. Atropine Sulfate
Overdose: severe tachycardia, arrhythmias3. Tranquilizers
To anxiety and BP
E.g. Phenergan, Thorazine4. Narcotics / Analgesics
Relaxes patient and anxiety
E.g. morphine, meperidine HCl (Demerol)
Side Effects: RR, n & v, hypotension5. Prophylactic Antibiotic to flora in the bowel
Transporting the client to the OR
Patients Familyi. Direct proper visiting roomii. Doctor informs family immediately after surgeryiii. Explain reason for long interval of waiting: anesthesia
prep, skin prep, surgical procedure, RRiv. Explain what to expect postop
IV. INTRAOPERATIVE PHASEA. Members of the Surgical Team
1. Scrub Teama. Operating Surgeon
Leader of Operating Team
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Doer of the operationb. Assistant to the Surgeon
Clerk, intern, resident or another surgeon
Holds retractors
Exposes surgical area
Clamps all the bleeders or sutures bleeders
Tying clamped vessels
Assist surgeons in ligating bleedersc. Scrubbed Nurse (Instrument and Suture Nurse)
Prepares and arrange instruments and supply
Checks the completeness of instruments and preliminarycount
Passes sponges
Assist scrub team during gowning and gloving
Assist in draping the patient2. Unscrubbed Team
a. Anesthesiologist (either MD or RN)
Monitor VS during the surgical procedure
Keeps the surgeon aware of the patients condition
Determines if the patient is viable to be transferred to PACUb. Pathologists
Consulted by the surgeon on the diagnosis of the removedtissue or organ
Consulted for possible treatmentc. Circulating Nurse
Overseer of the OR
Maintains sterility of the OR
Assist all the scrubbed for their needs
Checks the completeness of the chart Ties the gowns of members stoop and swing method
Maintain lightings
Provide footstools for the team
Carries and opens lap packs
B. Parts of the Operating Unit1. Unrestricted Area
Provides an entrance to and exit from surgical suite
Contains the holding or admission area, hospital lobby andPACU
Street clothes are permitted here2. Semi restricted area
Provides an access to the procedure rooms and peripheralsupport areas within the surgical suite
PACU, Anesthesia room, packing area (autoclave area) withwindow
3. Restricted Area
Includes the procedure room in which surgery is performed
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Personnel in OR attire + surgical masks
C. OR Attires (Protective Barriers)1. Scrub suits2. Head coverings (cap/hood)3. Shoe coverings
4. Masks5. Lead aprons and thyroid shield
D. Principles of Surgical Asepsis1. Patient is the center of the sterile field2. Only sterile items are used within the sterile field3. Sterile persons are gowned, gloved, masked and with bonnet or cap
Hands above the waist
Keep your hands away from the face
Remove all jewelries
Gowns are considered sterile at the front area
Sit only if the operation requires or allows sitting position4. Tables are sterile at the topmost level only5. Sterile persons touches sterile items and unsterile persons touches
unsterile only
For sterile persons, avoid overreaching over the unsterilefields
For unsterile persons, avoid overreaching over the sterilefields
6. All edges of the mayo table are considered unsterile7. Sterile items are always kept in view8. Microbes are kept irreducibly minimum
E. Types of Anesthesia1. General Anesthesia
Total loss of consciousness and sensation
Produces amnesia
Methods of administration:i. Inhalationii. Intravenous
Anesthetic agent given through inhalation:i. Halothane (Fluothane)ii. Enflurane (Ethrane)iii. Isoflurane (Forane)iv. Sevoflurane (Sevorane)
Anesthetic agent given via IV (sometimes via IM):i. Thiopental Na (Pentothal Na)ii. Propofol (Diprivan)iii. Ketamine HCl (Ketalar)iv. Fentanyl (Sublimaze)v. Diazepam (Valium)vi. Midazolam (Dormicum)
Complications of General Anesthesia:
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i. Cardiopulmonary complications:
Cardiac arrhythmias
Cardiac arrest
Bronchospasm and laryngospasm
Respiratory obstruction and failure
Vomiting and aspiration
Shock and Hypotensionii. Cerebral Complications:
CVA
Convulsionsiii. Renal Complucations:
Renal ischemia2. Regional Anesthesia
Reduce all painful sensation without in one region of thebody without inducing unconsciousness
Methods of Administration:i. Topical application via spray or instillation; e.g.
xylocaine (Lidocaine)ii. Local Infiltration agent injected into the tissue around
the incisional area; e.g. Xylocaine 1-2%iii. Nerve Block anesthetizing a group of nerve of nerve at a
given pointExamples:
Digital block
Axillary block
Radial block
Intercostals nerve block
Cervical block
iv. Field block blocking off the operative site with wall ofanesthetic solution by series of injection into proximal andsurrounding tissues
v. Spinal and Epidural Block solution is injected either inspinal space or epidural space; for surgeries below thediaphragm
Components of Spinal Anesthesia:a. Pontocaine main anesthetic agentb. Dextrose 10% in water diluentsc. Ephedrine vasoconstrictor (to prolong anesthetic
effect)
Anesthetic agent given through spinal anesthesia:
i. Procaine (Novocaine)ii. Tetracaine (Pontocaine)iii. Lidocaine (Xylocaine)iv. Mepivacaine (Carbocaine)v. Bupivacaine (Marcaine)
Complications of Spinal Anesthesiai. Hypotensionii. N & V
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iii. Headacheiv. Respiratory paralysisv. Paraplegia or severe muscle weakness
vi. Cryoanesthesia produced by marked cooling
F. Stages of Anesthesia
Stage I (Induction Stage) Extends from the administration of anesthesia to the time of loss
of consciousness
Reaction: dizzy, drowsy
Nursing Responsibility: keep the room quiet and standby toassist
Stage II (Excitement/Delirium Stage)
Extends from the loss of consciousness to the loss of lid reflex
Reaction: shouting, struggling, uncontrolled muscle movement
Nursing Responsibility: secure the patient properly and assistanesthesiologist
Stage III (Surgical Anesthesia Stage) Extends from the loss of lid reflex to the loss of most reflexes
Reaction: reflexes disappear, all senses
Surgical procedure is started
Nursing Responsibility: skin prep, insert catheter, position theclient properly
Stage IV (Medullary/Danger Stage)
Characterized by respiratory/cardiac arrest due to anesthesiaoverdose
Nursing Responsibility: assist in resuscitation
G. Common OR Instruments/Equipment1. Lap Pack
Army Navy (2)
Thumb or TissueForceps (2)
Straight clamps (3)
Curved clamps (3)
Allis (1)
Sharps:
- Metzenbaumscissor (1)
- Mayo scissor (1)- Bandage scissor (1)
Scalpel (1)
Blade holder (1)
Needle holders (2)
Towel clips (4)2. Needles and Sutures
Types of Sutures:
a. Absorbable Sutures Types:
i. Plain Gut used to ligate small vessels andsubcutaneous tissue
ii. Chromic / Catgut used to ligate larger vesselsiii. Vicryl Plus used in reproductive tractiv. Vicryl Rapide used to close mucosa in the mouthv. Coated Vicryl used in reproductive tractvi. Monocryl used in urinary bladder; GIT
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b. Non-Absorbable Sutures
Types:i. Silk used in serosa of the GITii. Cottoniii. Nylon used by ophthalmologistiv. Polyester fiber
v. Polythylenevi. Stainless steel use of staple wires
Common Colors of Suture Packaging:
Plain gut (yellowish tan)
Chromic (tan)
Silk (medium blue)
Cotton (pink and white)
Polyester (medium green)
Nylon (light green)
Classification of Needles:
According to the Eye
a. Eyedb. Eyeless/Swayed/Atraumatic
Single arm 1 needle on suture end onlyDouble arm both ends of suture have needles
c. Spring/French
According to the Shapea. Non-cutting rounded body or shaft + pointed endb. Cutting sharp edge of the body or shaft + pointed end
According to Shaft or Bodya. Straightb. Curved
H. Samples of Surgical Incisions1. Butterfly for craniotomy2. Limbal for eye surgeries3. Halstead / elliptical for breast surgeries4. Abdominal for abdominal surgeries5. McBurneys for appendectomy6. Lumbotomy / Transverse for kidney surgeries
I. Positions during Surgery1. Dorsal Recumbent hernia repair, mastectomy, bowel resection2. Trendelenburg lower abdomen, pelvic surgeries3. Lithotomy vaginal repairs, D and C, rectal surgery, APR4. Prone spinal surgeries, laminectomy5. Lateral kidney, chest, hip surgeries
Nursing Responsibility:i. Explain purpose of the procedureii. Avoid undue exposureiii. Strap the person t prevent fallsiv. Maintain adequate respiratory and circulatory functionv. Maintain good body alignment
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V. POSTOPERATIVE PHASEA. Goals
To maintain adequate body system functions
Restore homeostasis
Alleviate pain and discomfort
Prevent postop complications
Ensure adequate discharge planning and teaching
B. Transport of the Client from the OR to RR
Avoid exposure
Avoid rough handling
Avoid hurried movement and rapid changes in positionB.1 Nursing Assessment1. Appraise air exchange status and note the skin color2. Verify identity, operative procedure, surgeon3. Assess neurologic status (LOC)
4. Determine VS and skin temperature if with fever, suspectinfection
5. Examine operative site and check dressing6. Perform safety checks:
Position for good body alignment
Side rails
Restraints for IVFs, BT7. Require briefings on problems encountered in ORB.2 Nursing Interventions1. Ensure patent airway and adequate respiratory function
Lateral position with neck extended
Keep airway in place until fully awake
Suction secretions
DBE
O2 therapy2. Assess status of circulatory system
Monitor VS and report abnormalities
Observe for signs of shock and hemorrhage
Continuous care until patient is completely out of anesthesia
C. Transfer of the Client from RR to the Surgical UnitC.1 Parameters for Discharge from RR
Activity able to obey commands, e.g. DBCT
Respiration Easy, noiseless Circulation BP is within the normal range
Consciousness responsive
Color pinkish skin and mucous membraneC.2 Nursing Intervention
Maintain adequate fluid and electrolytes
Maintain adequate renal function
Promote rest, comfort and safety
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Promote adequate wound healing
Promote and maintain activity and mobility
Provide adequate psychological support
D. Postoperative Complications1. Shock a circulatory collapse due to specific factors (e.g. blood
volume, bleeding, cardiac dysfunction, etc.)2. Femoral Phlebitis / Deep thrombophlebitis inflammation/injury of
the blood vessels due to prolonged immobility, obesity, hemorrhage3. Pulmonary complications:
a. Atelectasis lung collapseb. Bronchitisc. Bronchopneumonia and lobar pneumoniad. Pleurisy
4. Urinary difficultiesa. Retentionb. Incontinence
5. Intestinal obstruction6. Hiccups7. Wound Infection
Rule of Thumb:1. Fever 1st 24hours pulmonary infections2. Within 48hours UTI3. Within 72hours wound infection
8. Wound complications
Kinds:1. Hemorrhage / Hematoma2. Wound Dehiscence disruption in the coaptation of wound
edges (wound breakdown)
3. Wound Dehiscence dehiscence + outpouching of abdominalorgans9. Delirium (Mental Aberration)
Prepared by:JOHN PAUL E. MENDOZA
R.N.