Perioperative Nursing Care - Pediatric Nursing - Lecture Slides, Slides of Pediatrics

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Definition of Surgery

Surgery is any procedure performed on the human body that uses instruments to alter tissue or organ integrity.

• Perioperative Nursing- connotes the delivery of patient care in the preoperative,intraoperative, and postoperative periods of the patients surgical experience through the framework of the nursing process. The nurse assesses the patient- collecting,organizing, and prioritizing patient data; establishing nursing diagnosis;identifies desired patient outcomes;develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient.

Types of Surgery

• Urgency: reason for procedure: Elective-Performed on the basis of client’s choice; not essential and may not necessary for health. Urgent- Necessary for client’ health,may prevent additional problem from developing (e.g. tissue destruction);not necessarily emergency. Emergent- Must be done immediately to save life or preserve function of body part. Required- Has to performed at some point;can be pre- scheduled.

Perioperative Nursing

Types of Surgery

• Diagnostic- Allows to confirm diagnosis.
• Corrective- Excision or removal of diseased body part.
• Reconstructive-Restore function or appearance to traumatized or malfunctioning tissues.

Perioperative Nursing

Types of Surgery

• Extent of surgery : Simple- Only the most overtly affected areas involved in the surgery. Radical- Extensive surgery beyond the area obviously involved; is directed at finding a root cause.
• Location: Based on the area of the body on which the surgery occurs (e.g abdominal, heart surgery).

Surgical settings

• Surgical suites
• Ambulatory care setting
• Clinics
• Physician offices
• Community setting
• Homes

Method of teaching

• Timing-most useful when started the week before admission and reinforced before surgery and the client is less anxious.
• Content: Surgical Procedure Preoperative routines Intraoperative routines Postoperative routines Sensory preparation Pain relief

Phases

• Preoperative- begins with the decision for surgical intervention and ends with transfer to the OR. Nursing Interventions
• Baseline assessment during interview at clinic,office or over the phone.
• Assessment in the pre-admission unit, client room, holding area or induction room

Preoperative Surgical Phase

• Assessment continue….. Previous surgeries- past experience with surgery can reveal potential physical and psychological responses to procedure and alert you to special needs and risk factors. Complications such as anaphylaxis or malignant hyperthermia. Medication History- any medications that might predispose to surgical complications.

Preoperative Surgical Phase

Allergies- to medications, topical agents used to prepare the skin for surgery, and latex can create significant risks. Smoking Habits – greater risks for complications. Alcohol and Controlled Substance Use and abuse- to be prepared for adverse reactions, such as withdrawal, that may occur during surgery. Client Expectations- to identify the client’s and family perceptions and expectations regarding surgery and health care providers.

Preoperative Surgical Phase

Coping Resources- assessment of a client’s feeling and self-concept helps to reveal whether the client has the ability to cope with the stress of surgery.

Body image-surgical removal of a diseased tissue often leaves permanent disfigurement or alteration in body function.

Selected factors that in increase surgical risk.

• Age- Very young and older clients.
• Nutrition- a malnourished client is prone to poor tolerance of anesthesia, infection, poor wound healing and the potential for multiple organ failure after surgery.
• Obesity- often have difficulty in resuming normal activity after surgery.

Physical assessment/clinical manifestations

• Renal system-abnormal renal function can altered fluid and electrolyte balance and decrease the excretion of preoperative medications and anesthetic agents.
• Neurologic system- a client’s LOC will change as a result of general anesthesia but should return to the preoperative LOC after surgery.

Physical assessment/clinical manifestations

• Musculoskeletal system- Deformities may interfere with intraoperative and postoperative positioning. Avoid positioning over an area where the the skin shows signs of pressure over bony prominences.
• Gastrointestinal system- alteration in function after surgery may result in decreased or absent bowel sound and distention.
• Head and Neck- the condition of oral mucous membranes reveals the level of hydration.