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Perioperative
| Question | Answer |
|---|---|
| Perioperative | 3 phases of surgical procedures: -Preop phase begins when client scheduled for surgery, ends with transfer to surgical suite -Intraoperative is the actual surgery phase -Postop phase begins when the client leaves the surgical suite until DC |
| Scope | Emphasis is on safety, advocacy, client education and a culture of safety |
| Reasons for Surgery | -Diagnostic (breast biopsy) -Curative (appendectomy) -Transplant (kidney transplant) -Restorative (total knee replacement) -Palliative (colostomy) -Cosmetic (liposuction) |
| Urgency of Surgery | -Elective (cataract removal, cosmetic) -Urgent (bone fracture) -Emergent (gunshot wound) |
| Surgical Approach | -Simple (partial mastectomy) -Minimally invasive surgery (laparoscopy) -Radical (radical hysterectomy) |
| Surgical Settings | -Inpatient (client is admitted to the hospital) -Outpatient/ambulatory (client enters surgical area same day as surgery and discharges home) |
| Perioperative Interprofessional Team | -Surgeon -Anesthesia personnel -Preoperative nurse -Circulating nurse -Surgical technician -First assistant -Postoperative nurse |
| Lifespan Considerations: Infants | -Immature respiratory status with possible lack of surfactant -Glucose regulation related to lack of brown fat reserves and intake restrictions -Fluid/electrolyte balance related to large surface area and high fluid volume to weight ratio |
| Lifespan Considerations: Children | -To maintain the child's hospital room as non-threatening, procedures may be performed in a treatment room -Intraoperatively, maintaining normothermia can be difficult for clients under 18 -Children in the postop phase need comfort and safety |
| Lifespan Considerations: Pregnant Women | -Possible addition of GBS for newborn prophylaxis -Client should be placed in left lateral recumbent position to shift uterus off vena cava -Pregnancy causes state of hypercoagulability -Fetal monitoring should be maintain through entire process |
| Lifespan Considerations: Older Adult | -Preexisting conditions can result in periop complications -Hearing, confusion, dementia, fall risk and depression need to be monitored -Decreased ability to maintain normal body temp -Higher risk for clots -Prevent formation of pressure sores |
| Risk Factors: Medical History | -Decreased immunity -Diabetes -Pulmonary or cardiac disease -Multi-system disease -Coagulation disorder -Anemia -Dehydration -Infection -Hyer/hypotension |
| Risk Factors: Across the Lifespan | -Pediatric clients are at higher risk of complications -Older adults (secondary to physiologic changes) -Decreased cardiac output -Increased BP -Loss of lung eleasticity -Decreased blood flow to kidney -Dry skin |
| Risk Factors: Medications | Medications -Antihypertensives -Tricyclic antidepressants -Anticoagulants -Nonsteroidal anti-inflammatory drugs (NSAIDs) -Immunosuppressives |
| Risk Factors: Surgical/Health History | -Less-than-optimal emotional reaction -Anesthesia reactions or complications -Postop complications -Malnutrition or obesity -Drug/alcohol/tobacco use/abuse -Altered coping ability -Herbal use |
| Risk Factors: Family History | -Malignant hyperthermia -Cancer -Bleeding disorder -Anesthesia reactions or complications |
| Risk Factors: Type of Surgical Procedure Planned | -Neck, oral, or facial procedures (airway complications) -Chest or high abdominal procedures (pulmonary complications) -Abdominal surgery (paralytic ileus, venous thromboembolism) |
| Preoperative Assessment | -Physical assessment (baseline vitals) -Cardiovascular -Respiratory -Renal/urinary -Neurologic (determine baseline) -Musculoskeletal -Nutritional status (malnutrition or obesity) -Psychosocial -Labs (UA, CBC, clotting studies, electrolyte levels) |
| Health Promotions: Primary Prevention | Teaching prior and post surgery -Site preparation -Medications to stop taking prior to surgery -Deep breathing and coughing exercises -Surgical wound care -Pain control -Prevention of clot formation by ambulation or TED hose |
| Health Promotions: Secondary Prevention | -Regular assessment of vital signs and pain -Regular assessment of edema -Regular assessment of wound healing |
| Independent Nursing Interventions | -Soothing the infant -Consider developmental level and preferred learning style -Explain preop shower/bath with chlorhexidine to client -Clip hair around the surgery site before surgery -Ensure client has removed metal and nail polish |
| Independent Nursing Interventions | -Place IV preop -Use 2 patient identifier during prep and pass of meds -Assist infant with bonding activities with parents -Postop: airway management, monitoring cardiac rhythms, VS, LOC, pain) |
| Collaborative Nursing Interventions | -Lab results analyzed by team -Nurse ensures surgeon obtained informed consent -Time-out prior to surgery -Handoff before, during, and after surgery to each nursing staff |
| Interrelated Concepts | -Collaboration -Comfort -Ethics -Tissue integrity -Gas exchange -Safety -Clotting -Clinical Judgment -Cognition -F&E -Mobility -Perfusion -Stress/coping -Health Promotion -Leadership -Mood/affect -Communication -Sensory perception |
Created by:
NikkiLeigh83
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