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[TRANS] UNIT XX: PERIOPERATIVE NURSING - PREOPERATIVE PHASE
Module 1A
Perioperative Nursing - Preoperative Phase Outline
- Define the different phases of perioperative patient care.
- Recognize the meaning of surgical terminologies and their implications.
- List the principles of asepsis in the care of patient during preoperative, intraoperative and postoperative phase.
- Differentiate among the various types and purposes of surgery.
- Discuss the legal and ethical considerations and issues in obtaining informed consent for surgery.
- Describe appropriate nursing care for people having surgery in the preoperative, phase of surgery.
- Create a nursing process framework for providing individualized care for people about to undergo surgery.
Surgery
- Medical treatment that involves operations or manipulations on the patient’s body and, usually, cutting the body open. o Invasion – requires informed consent o Help cure or repair o Making the patient risk for infection, that is why the operating room is sterile Illustration of Surgery in an Operating Theater CTTO: https://cdn.xxl.thumbs.canstockphoto.com
Perioperative Nursing
- Period of time that constitutes the surgical experience which include the preoperative, intraoperative, and postoperative phases.
Three (3) Phases
1. Preoperative Phase
- Period of time when the decision for surgical intervention is made to when the patient is transferred to the operating room table.
- From the admission of the client to the hospital to the time that the surgery begins. o The patient agreed to have surgery to brought to the OR and placed on the operating table.
2. Intraoperative Phase
- Period of time when the patient is transferred from the operating room table to when he or she is admitted to the post anesthesia care unit (PACU). o Patient on the OR table then surgery will be performed then after surgery patient will be transferred to the PACU (also known as the recovery room or RR).
3. Postoperative Phase
- Period of time that begins with the admission of patient to the PACU and ends after a follow-up evaluation in the clinical setting or home. o Patient in the PACU/RR stay for about 2 hours. o Patient is stable (v/s, no complications) - PACU for 2 hours before going to their room (ward), and home (if OPD).
Goal of Perioperative Care
- Fewer surgical complications
- The outcome of the surgical experience is a positive outcome.
- Shorter hospital stays
- Because the patient is at risk for infection.
- Better patient satisfaction with care
- Better health outcomes Perioperative Period CTTO: https://twitter.com
Surgical Terminologies
Table 1 : Prefixes Prefixes Meaning a– without, absence Anuria , sometimes called anuresis, refers to the lack of urine production. ecto– external, outside Ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. infra– below Infratemporal fossa is an irregular space at the lateral aspect of the skull. inter– between Intercostal muscles are muscles that present within the rib cage. intra– within Intraperitoneal means within or administered through the peritoneum.
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pan– all Pancreas is an organ and a gland. peri– around, near Pericardium is a serous membrane that encloses the heart poly– many Polyphagia is an excessive or extreme hunger. It is also a symptom of DM (polyphagia polydipsia and polyuria) pseudo– false Pseudoglaucoma is defined as false or deceptive glaucoma with or without ocular damage. retro– behind Retroperitoneal means situated or occurring behind the peritoneum. supra– above Supraclavicular fossa is an anatomically complex region of the upper neck. Table 2 : Root Root Meaning adeno gland Adenoma is a benign tumor originating in glandular tissue. arthro joint Arthroscopy is a procedure for diagnosing and treating joint problems. auto self Autoimmune is a condition in which the body's immune system mistakes its own healthy tissues as foreign and attacks them blephar eyelid Blepharitis is a common eye condition that makes your eyelids red, swollen, irritated, and itchy. cardio heart Cardiomegaly is an enlarged heart. cephalo head Encephalopathy means damage or disease that affects the brain. cerebro brain Cerebrospinal fluid is a clear, colorless, watery fluid that flows in and around your brain and spinal cord. cheilo lip Cheiloplasty is a surgical lip restoration chole bile Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in the gallbladder. cholecyst gallbladder Cholecystitis is a redness and swelling (inflammation) of the gallbladder. choledocho common bile duct Choledocholithiasis is the presence of at least one gallstone in the common bile duct. chondro cartilage Chondrocytes are the cells responsible for cartilage formation. colpo vagina Colposcopy is a test to take a closer look at the cervix. costo rib Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone (sternum). lapar abdomen Laparotomy is a surgical incision (cut) into the abdominal cavity. nephro kidney Nephropathy is the deterioration of kidney function. oculo eye Oculomotor nerve is the third cranial nerve (CN III). oophoro ovary Oophoropexy is a procedure used to help keep a woman fertile by preventing damage to the ovaries during radiation therapy. orchi testis Orchitis is an inflammation of one or both testicles. osteo bone Osteoporosis is a disease that weakens bones to the point where they break easily. oto ear Otomycosis is a fungus infection in the outer ear. phlebo vein Phleboliths are small blood clots in a vein that harden over time due to calcification. pyel renal pelvis Pyelitis is an inflammation of the renal pelvis and calyces. salpingo fallopian tube Salpingostomy is a procedure in which the contents of the fallopian tubes are removed by making an opening.
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dissect to cut apart tissue enucleation removal of an organ from its supporting structure. *The organs are anchored in the body. When there is a broken one, it will be re- attached to supporting structures. evisceration protrusion of internal organ through a wound/surgical incision. *The internal organ has already come out. *Don’t push, get a normal saline and gauze cover and call a doctor for referral to the operating room to bring back the organ inside the body. excision removal/ cutting fissure narrow slit/cleft/cracklike fistula abnormal tubelike communication between body cavities or organs. *Hemodialysis is done to patients with renal failure because the toxins go to the blood. *Create a fistula (AV fistula). An arteriovenous (AV) fistula is an irregular connection between an artery and a vein. hemorrhoidectomy removal of hemorrhoids (almoranas) hernioplasty surgical (luslos)^ repair^ of^ a^ hernia incision and drainage cutting discharge^ and^ withdrawal^ of isthmectomy excision or removal of an isthmus (connects part of an organ – isthmus) intestinal resection excision of a portion of the bowel laceration wound produced by tearing of tissue. *There is tearing. laminectomy excision of the posterior arch of a vertebra. mammoplasty construction or alteration in size or contour of the female breast. marsupialization suturing of cyst walls to edges of the wound, following evacuation to remain the wound intact. mastoidectomy excision of mastoid cells. purulent containing pus Assessment data to collect:
- Assess ROI
- Fever
- Incision site *Presence of purulent drainage (because it contains puss). rectocele protrusion of the rectum into the vagina resection surgical removal of a considerable portion of an organ *Bariatric surgery is performed to prevent being fat. shunt to divert, as arterial blood to vein, or cerebrospinal fluid to peritoneal cavity
Aseptic / Sterile Technique
Surgical Asepsis
Definition of Terms
- Asepsis : absence of microorganisms that cause diseases. o The patient is free from infection.
- Aseptic technique : method by which contamination with microorganisms is prevented. o In wound care, the doctor will clean it first then afterwards they will assess it, this is done after the surgery. o If there are no orders on the chart, do not yet open the wound. o The nurse has a role in giving health education to patient as well as significant others about proper wound care because most of the time, nurses are in contact with patients.
- Sterile : free of microorganisms including spores (inactive but viable state of microorganisms in the environment). o Higher level o Observed in the operating room because the patient is as risk for infection. o Remember that the physical barrier is the skin. When there is break in the continuity in the skin, the nursing diagnosis will be “impaired skin integrity.”
- Contaminated : soiled with microorganisms. o Example: body fluid of the patient.
- Infection : Invasion of the body by pathogenic microorganisms.
- Microorganism : living organism, invisible to the naked eye including bacteria, fungi, viruses, and molds.
- Pathogenic : capable of causing disease. o Normal intestinal flora is already present in the body and they are beneficial to us that helps in digestion (Yakult).
- Sterile technique : method by which contamination with microorganisms is prevented to maintain sterility.
- Surgically clean : mechanically cleansed but unsterile.
- Surgical conscience : an individual’s personal sense of honesty and integrity with regard to adherence to the principles of aseptic technique. o Below the waist is considered unsterile.
Signs of infection
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Cardinal Signs of Inflammation
- Based on visual observation, the ancients characterized inflammation by five cardinal signs, namely o Redness (rubor) o Swelling (tumour) o Heat ( calor ; only applicable to the body' extremities) o Pain (dolor) o Loss of function (functio laesa)
Note:
- Surgically cleaned – mechanically cleaned but not sterile, it needs to undergo sterilization.
Five (5) Sources of Contamination
1. Skin
- Not only to patient but also skin who is performing the operation
- How to prevent skin contamination: o Handwashing ▪ Two types: - Surgical handwashing / hand scrub - more extensive to remove most bacteria or microorganism in the hand before wearing the gloves (there is no need to apply alcohol because it is considered sterile already). - Medical handwashing - caring for a wound of patient. o Proper gloving technique o Proper attire o Once the drapes are places, they cannot be removed because it is considered sterile o Skin preparation
Two (2) Types of Bacterial Flora
A. Transient Bacterial Flora
- Can be reduced by washing with soap and water or by using suitable antiseptics.
B. Resident Bacterial Flora
- Lives and multiplies on the skin. With conventional scrubbing, the population that the team carry out a proper scrub up technique with ample use of antiseptics.
Preventive Measures
- Proper attire
- Proper scrub up technique
- Proper gloving technique
- Keep a sharp look out for holes or tears in gloves or gowns
- Exclusion from the operating room personnel with skin lesion
- Proper preoperative skin preparation to patient
- Draping of the operative site
2. Respiratory Tract
Preventive Measures
- Wear mask properly (covers nose, mouth, cheek, and chin)
- Minimize forceful talking and laughing during operation
3. Articles Used in The Procedure
- Once it is wrapped and taped, it is properly labeled and the date of sterilization (sterilization also has validity).
Preventive Measures
- All supplies must be properly checked of its sterility
- Proper packaging of supplies and sterilizing procedures
- Fomites : contaminated articles. o Objects or materials that are contaminated
4. Circulating Air
Preventive Measures
- Keep OR doors closed o Buzzer o Receiving recovery room – OR complex o ‘Yung suot sa labas ilalagay lang sa isang lugar tulad ng sapatos. o Sa OR complex, may baon na shoeware, ‘di pwede suot although out ang uniform.
- Minimize traffic in and out of the OR o Selective
- Avoid scattering of powder in OR
- Keep sterile tables when not in use
- Regular cleaning of the OR o Kahit hindi ginagamit
- Proper ventilation
- Ultraviolet rays’ disinfection if possible o Even in ward in private hospitals
5. The Scrub Team’s Hair and Patient’s Hair
- Make sure that there would be no hair outside the cap.
Preventive Measures
- Hair must be properly tucked under head cap.
- Hair follicles or strands must be removed from the operative site.
Principles of Aseptic Technique
- Only sterile items are used within the sterile field. o Factors breaking the sterility: ▪ Once the paraphernalia drops below the waist or below the surface of the table. - “Mayo scissors down” ▪ The back of the scrub team.
- Sterile persons are gowned and gloved.
- Items of doubtful sterility must be considered unsterile. o Basis: surgical conscience. If feeling mo ‘yung item na ‘to di na sterile, unsterile… HINDI WALANG PWEDE PA.”
- Whenever a sterile barrier is permeated it must be considered contaminated. o Surface of the back table is sterile o Sterile pataas ng or table then unsterile na ‘yung sa baba.
- Sterile gowns are considered sterile in front from the shoulder to level of the sterile field and at the sleeves 2 inches above the elbow cuff.
- Tables are sterile only at table level. o Even the packages enclosed can be considered unsterile.
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- Kills all bacteria by coagulating or denaturing of the protein of the bacteria. o Sa proteins, sa bacteria protein siya galing pati membrane wala ng protein synthesis tas mamamatay sila nasisira ‘yung integrity ng bacteria
a. Boiling (Non-Pressure Sterilizer)
- Kills only vegetative bacteria.
- Sharp instruments are not included. When subject to boiling, they can become dull.
- Minimum of 20 minutes.
b. Saturated Steam Under Pressure
- Autoclaving is recommended for sterilization of linens and instruments.
B. Dry Heat
- Recommended for use only where direct contact of material with steam is impractical or not available.
c. Dry Heat Autoclave (Hot Air Oven)
- Used for oil, ointment, and powders.
- May be used for glassware and sharp instruments and needles to prevent rusting (60 minutes).
2. Chemical Sterilization
- Accomplished by the use of ethylene oxide gas.
- Sterilize items that are heat or moisture sensitive. o Using gas Chemical Methods of Sterilization CTTO: https://microbenotes.com *Mas gagamitin ang ang sterilization, paki-erase ang limitations.
Ethylene Oxide Gas
- Chemical agent that kills microorganisms, including spores, by interfering with the normal metabolism of protein and reproductive process, resulting in death of cells.
Limitations of Disinfection
- It doesn’t always kill spores.
- Absolute strength is not always known.
- Long timing period is necessary for effectiveness.
- It is difficult to submerge some articles.
- Disinfected materials may cause irritation of the tissues of not rained off.
- The ability of the disinfectant to damage materials limits the maximum concentration which may be used.
- It is not suitable for some materials.
Factors That Determine Shelf Life
- Condition of the storage.
- Material used for packaging.
- Seal of the package.
- Integrity of the package.
Note:
- Disinfection does not kill spores.
- Sterilizing kills spores.
- Chemical disinfectants can kill bacteria, but they do not destroy their spores. A process called sterilization destroys spores and bacteria.
Disinfection Versus Sterilization
- Disinfection differs from sterilization by its lack of “ sporicidal power .”
Medico-Legal Aspects
- Adherence to correct protocol para hindi mademanda.
Three (3) Potential Legal Involvement
1. Consent for Operation
- Hindi pwedeng operahan ang tao kapag ‘di pumayag.
- Merong critical decision of the patient to undergo surgical procedure.
- Only after appropriate explanation of the condition and surgical procedure: o Condition o Bakit need? o Anong gagawin sa operation? o Complication of operation o Cost of operation o Paano ‘yung magiging outcome pagkatapos ng operation? o Kung ‘di siya papaopera, ano ‘yung pwedeng mangyari at pwedeng gawin? o Give adequate information the decision is based on good judgement. o All information should be given and voluntary and in a form.
- Before the client signs the consent and information is given to the patient, hindi dapat binigyan ng sedative or medications, dapat clear ‘yung mind niya to make decision.
- Diagnostic procedure kahit anong pinasok mo sa patient (MRI, contrast media, or any invasive procedure) needs consent! o Catheterization o Radiation
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- Informed consent come from competent patients (sila ‘yung makakapag-sign and give consent physically.
- Incompetent patients like these conditions cannot sign. o Coma o Mentally ill patient o Cognitively impaired / difficulty understanding o Children
Informed Consent
- Patient’s autonomous decision about whether to undergo a surgical procedure.
- Voluntary and written consent from the patient at least 18 years old before non-emergent surgery to protect patient from unsanctioned surgery as well as the surgeon from claims of unauthorized surgery or battery.
- Patient signs the consent prior to administration of psychoactive premeds and nurse may sign as witness.
- The surgeon is responsible in providing a clear and simple explanation of what the surgery entails: benefits, alternatives, risks, complications, disfigurement, disabilities and what to expect postoperatively.
Indications for Informed Consent
- Invasive procedure
- Use of anesthesia
- Non-surgical procedures which might be slightly risky
- Radiation
Criteria for Valid Informed Consent
- Voluntary consent : freely given, without coercion.
- Competent patient : individuals who are autonomous and can give/withhold consent.
Incompetent Patient
- Individual who is not autonomous and cannot give or withhold consent.
- Those who are mentally ill, cognitively impaired, neurologically incapacitated.
Informed Patient
- Consent should be in writing and should include the following: o Explanation of procedure and risks o Benefits and alternatives o An offer to answer questions about procedure o Instructions that a patient may withdraw o A statement informing patient if protocol differs from customary procedure
2. Loss of Sponges
- When to do sponge count? o Before start of the operation o Before the closure of the peritoneum o Immediately after the closure of the peritoneum o Closure of fascia - The circulating nurse have the list. - The scrub nurse and the circulating nurse work hand in hand.
3. Injury to the Patient
- During the 3 phases, clients may suffer from injuries.
- Burns o Nasunog si px, sinara mo naman maayos kaya lang dinikit mo sa katawan niya (first degree burn… tsaka ‘di mo sinabihan so oh tingnan mo baka napapaso na siya.
- Falls o Sedative given katapos magawa lahat ng toiletries, activity para nakahiga nalang, then handrails ‘di mo nataas then nahulog then negligence ‘di mo hinarangan higaan. o Health education: binigyan na po namin ng sedative o pampatuog ang px baka mahulog.
- Infection o By not doing aseptic technique.
- Improper identification of the patient
- Giving of wrong drugs o Hydrochloride kalahating vial lang. ▪ Nubain – opioid analgesic – pampaalis ng sakit, pampa-high siya. - Binigay mo 2 vials – wrong drug, wrong dosage - Be cautious, we save lives, we never destroy lives
- Loss of specimen o Naoperahan nga, kinuha tissue inalis then dadalhin sa laboratory then poorly identified. Kung hindi nalagyan, naligaw.
Two (2) Categories of Surgery
1. Emergency Surgery
- Done immediately to save life or limb.
- E.g., ruptured aneurysm, gunshot wound, and acute appendicitis.
2. Elective Surgery (Scheduled Surgery)
- Done at the patient’s and surgeon’s convenience.
Four (4) Classification of Surgery
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o People can die from hemorrhage. o Internal hemorrhage ‘di mo makikita.
- Organ function/s are disrupted o Connected to physiological stress o E.g., liver and kidney ▪ When surgery, anesthesia and medication is given, these will make metabolites (waste product) that needs to be eliminated. ▪ Sometimes these are affected. Hindi lumalabas ‘yung waste product ng gamot. Napaka- importanteng i-check ang renal function prior surgery and function of renal function.
- Lifestyle maybe changed o Amputation due to DM, mag-c’cause ng pagbabago sa buhay niya. – psychological impact on patients’ life. o Cholecystectomy – kailangan diet less in fat kase kailangan mo ng (wala ka ng gallbladder na mag- s’store ng bile). Bile is used to digest fat.
- There may be change in body image o E.g., reconstructive surgery (na-aksidente ka) the fracture sa katawan then reconstruct pwede ‘di mangyari as like it before / hindi na ganon katulad ng dati) bababa self-esteem. o AV fistulae dialysis o Nursing intervention: vent out to relieve their feeling, support system. Be therapeutic, listen to them and validate their feelings. Give them comfort.
Surgical Risk Factors
- Age
- Nutritional status
- Fluid and electrolytes
- General health
- Medications
- Mental health and attitude
Preoperative Nursing - Nursing Process
- Time beginning with patient’s decision to have surgery and ending at the time of the induction of anesthesia.
1. Assessment
A. Nursing History
- Physical condition → general health/medical condition
- Medical history – meron bang previous surgical experience o First time ba
- Previous experience → surgical procedures/anesthesia
- Allergies (dye in diagnostic test if MRI or contrast ct scan) o To prevent further complications (hypersensitivity reactions)
- Family health history o Familial tendency
- Mental attitude (in going to surgery) o Important kase ‘di lang during the ongoing na surgical procedure, when going to surgery and after, ang px contributes to the healing and recovery of px. o Our mind is very strong. o Attitude happens a lot in recovery.
- Understanding of surgical procedures
- Expected outcomes
- Use of alcohol, tobacco and other substances (lifestyle) o Can interfere with the intraoperative and operative phase of client, it can affect the outcome of surgery.
- Use of medicines, remedies, therapies
- Blood donations o Nagkaroon na ba ng hypersensitivity reaction?
- Allergies
- Knowledge about the perioperative period
- Adequacy of the client’s support system o Who will take care of the patient after the surgery? o If we know more about, we are able to provide the care the clients need.
B. Physical Examination
- Must be brief but complete
- Head to toe approach (cephalocaudal)
Determine
- Nutritional status o Obese (mahihirapan si doctor because it will cut off on skin) maraming layers na dadaanan
- Height and weight
- Body mass index (BMI)
- Skin fold measurements (by caliper)
- Mid-upper arm circumference
- Serum protein level
- Nitrogen balance o Fluid and electrolyte status. o Important to cope up with the demands of the body
C. Nutritional and Fluid Status
D. Respiratory Status
- Advise patient to stop smoking 6 weeks prior to surgery.
- Teach breathing exercises (Usually DBE) → to be done after the operation for promotion of lung expansion and prevent pneumonia.
- All of these and any health teachings should be taught before the operation. o History: the client is smoking: 6 weeks prior surgery to relax o Complications of surgery is respiratory disorder (pneumonia and atelectasis) o Pneumonia is brough about the infection o DBCE: inhale and exhale (this will allow lung expansion) ▪ Purpose of coughing is i-mobilize ‘yung plema or secretion na nakadikit sa respiratory tract. ▪ Mahirap mag cough pag may tahi (dehiscence) they need to support or splinting the incision site
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(pillow) para pag nag cough, ‘di masyado malakas ‘yung pressure. o Incentive spirometry can also be done to promote lung expansion. ▪ Taught prior to surgery Note: If the client has respiratory infection, postpone the surgery.
E. Cardiovascular Status
- HPN → no surgery (postpone!)
- Avoid sudden changes in position, prolonged immobilization, hypotension, hypoxia and overloading the cardiovascular system.
- Any abnormality should be referred to the doctor to have better management or proper intervention.
- Diuretics – water pill - losing electrolyte imbalance.
- Blood thinners to prevent blood clot – clients have high risk of bleeding (aspirin or acetyl salicylic acid)
F. Hepatic and Renal Function
- Optimal liver function is essential so that medications, anesthesia, body wastes, toxins will be removed from the body.
- Surgery is contraindicated in patients with acute renal insufficiency because of the role of the kidneys in anesthesia excretion.
G. Endocrine Function
- DM patient are prone to hypoglycemia & hyperglycemia
- Hypoglycemia may develop during anesthesia/postoperatively due to inadequate carbohydrate consumption or excessive administration of insulin.
- Risk for infection because of poor wound healing in hyperglycemia.
- Acidosis and glucosuria should be watched out for.
- Perform CBG (Capillary Blood Glucose) but usually fasting blood sugar (FBS) is used before, during, and after surgery.
- Maintain the blood glucose at or below 200 mg/dl.
- Use of corticosteroids places the patient at risk for adrenal insufficiency.
- Patients with thyroid disorders are at risk for thyrotoxicosis and respiratory failure.
H. Immune Function
- Determine allergies and document any sensitivity to medications and past adverse reactions.
- Identify substances that triggered past allergic reactions such as medications, blood transfusions, contrast agents, latex, and food product.
- Antibiotics are given prior to surgery because it serves as prophylaxis (“loading dose”).
- Strict asepsis should be ensured.
I. Neurologic System
- Mental status, LOC, orientation, and ability to follow commands.
- Motor and sensory deficits.
J. Musculoskeletal System
- Presence of prosthesis, joint replacements, and other orthopedic history.
K. Medications
- Anaesthesia interaction with some medications can cause respiratory difficulties, hypotension and circulatory collapse.
- Anticoagulants (including aspirin) may cause intraoperative and postoperative hemorrhage → monitor for bleeding. Assess prothrombin time (PT) and partial thromboplastin time (PTT).
- Diuretics (particularly thiazides) may lead to fluid and electrolyte imbalances, producing altered cardiovascular response and respiratory depression → monitor fluid input and output and electrolytes. Assess cardiovascular and respiratory status.
- Antihypertensives (particularly phenothiazines) increase the hypotensive effects of anaesthesia → closely monitor blood pressure.
- Antidepressants (particularly monoamine oxidase inhibitors) increase the hypotensive effects of anaesthesia → closely monitor blood pressure.
- Antibiotics (particularly the ‘mycin’ group) may cause apnea and respiratory paralysis → monitor respirations.
- Herbal supplements some may prolong the effects of anaesthesia or may increase the risks of bleeding or raise blood pressure → these should be discontinued at least 2 weeks before surgery.
L. Physical Preparations
a. Diagnostic/Laboratory Tests
- Provide baseline data or reveal problems that may place the person at additional risk during and after surgery.
- Performed preadmission within a week prior to elective surgery as part of the assessment process. A. CBC (anemic) B. FBS (to see blood sugar level) C. Electrolyte studies (sodium, potassium – muscle contraction of the heart, chloride) D. Coagulation studies ▪ PTT ▪ APTT E. Urinalysis F. BUN (blood urea nitrogen) G. Creatinine ▪ Products of muscle metabolism and protein metabolism. ▪ Mataas – hindi nakakalabas and ‘yung functioning affected din. Tapos magbibigay ka pa ng medications. ▪ CPR clearance (internist gagawa) go signa if qualified na for surgery. H. Chest x-ray I. Electrocardiogram (ECG) J. Pregnancy test for females
2. Diagnosis
- When you make, you identify the nx diagnosis that is appropriate to the client based on the assessment done. o Actual or potential ▪ Actual - meron na signs and symptoms – actual (meron siyang ineffective tissue perfusion – blood supply to the certain parts of the body is not enough.
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- Pneumatic compression devices enhance venous blood flow by providing intermittent periods of compression on the legs.
- Leg and ankle exercises also promote venous return, urge client to practice these exercises before surgery.
- Turning in bed
- Lessens risk for circulatory, respiratory, or gastrointestinal dysfunction following surgery.
C. Range of Motion Exercises
- Passive or active range of motion exercises helps prevent joint rigidity and muscle contracture.
- Client should perform 3 to 5 times, 3 to 4 times per day while bedridden.
- Early ambulation
- Mobility soon after surgery stimulates intestinal motility, enhances lung expansion, mobilizes, mobilizes secretions, promotes venous return, prevents joint rigidity, and relieves pressure.
D. Pain Management
- Introduce the use of pain scale to rate patient’s postoperative pain intensity.
- Discuss with the patient the use of pain medications such as patient-controlled analgesia (PCA), epidural bolus/infusion, or patient-controlled epidural anesthesia (PCEA).
- Introduce use of guided imagery, distraction & optimistic self-recitation and touch therapy.
Preoperative Chart Review
- Review the client’s chart to ensure that all documentation, preoperative procedures, and orders are completed.
- Check the surgical informed consent form.
- Document allergies according to the hospital policy.
- Accurate documentation of height and weight is important for proper dosage calculation of the anesthetic agents.
- Ensure that the results of the radiographic, laboratory and diagnostic tests are on the chart.
- Document for any abnormal results and report them to the surgeon and the anesthesia provider.
- Report any special needs, concerns, and instructions to the surgical team.
Client Transfer to the Surgical Suite
- Review and update the client’s chart, reinforce teaching, ensure that the client is correctly dressed for the surgery, and give prescribed preop medications.
- Drug selections based on the client’s age, physical and psychological condition, medical history, height, and weight
- Given to lessen the client’s anxiety: o Opiates : morphine, meperidine, promethazine HCl (Phenergan, nalbuphine HCl (Nubain), midazolam (Dormicum). o Anticholinergics : atropine sulfate and scopolamine o Barbiturates/Tranquilizers : Phenobarbital midazolam (Dormicum) → sedative o Prophylactic antibiotic : 1 hour before the surgery
- Turn client to side if patient is unconscious and wants to vomit. Documentation
5. Evaluation
- It is the basis for modification to the overall care plan.
- It is the time for comparing the patient post-intervention status with expected outcome.
