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Perioperative Nursing

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 ACCORDING TO Type of Surgery

 ACCORDING TO Type of Surgery










INFOR$E# %ONSENT     Elements: o   o   •

• •

o •

The signed consent form is placed in a prominent place on the patient’s chart and accompanies the patient to the operating room.

PREOPERATIVE TEA%"ING Ideal Timing: What to expect post-op Notify nurse if the client experiences any pain post-op Requesting an opioid post-op will not cause addiction Non-invasive pain relief techniques o   o   o   top smo!ing at least """""""""" #efore surgery  T  Techniques echniques to prevent development development of pneumonia and atelectasis atelectasis • • •


   $EE% &RE'T(IN) 'N$ *+,)(IN) EER*IE o &reathe deeply .x/ inhale thru the nostrils and exhale thru pursed lips o Instruct the client that the third #reath should #e held for . sec0 then the client should cough deeply .x1 o %erform q2-3 h IN*ENTI4E %IR+5ETR6 %IR+5ETR6 o 'ssume sitting or upright position o %lace mouth tightly around the mouthpiece o Inhale slowly to raise and maintain the 7ow rate indicator (usually between 600 and 900 marks) o (old #reath for 8 seconds then exhale thru pursed lips o

o • •


Repeat process 29xhr

$ANAGING NUTRITION AN# F&UI#S Maor purpose of withholding food and !uid before surgery"   #atients who do not ha$e a compromised airway airway or coe%isting diseases or disorders that a&ect gastric emptying or !uid $olume (eg' pregnancy' obesity' diabetes' gastroesophageal re!u%' enteral tube feeding' ileus or bowel obstruction)' lengthy restriction of uid and food is unnecessary. unnecessary. The recommendations depend on the o   o    ;atty foods  5il! products:  *lear liquids: •


PREPARING PREP ARING 'O(E& FOR SURGERY  )oals: o   o    ENEMAS are not  commonly  commonly ordered preoperati$ely preoperati$ely unless the patient is undergoing undergoing ado!inal or "el#ic surgery . o leansing enema or la%ati$e may be prescribed the $$$$$$$$$$$$  $$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$ and may be repeated the $$$$$$$$$$$$$  $$$$$$$$$$$$$$$$$$. $$$$$. •

I$$E#IATE PREOPERATIVE NURSING INTERVENTIONS Remove """""""""""""""""""""""" """"""""""""""""""""""""""""""""""""" """""""""""""""""  """"  o f patient obects to remo$ing a ring"   'll patients <except those with urologic disorders= should immediately #efore going to the +R •

INTRAOPERATIVE PERIO# T"E SURGI%A& TEA$ %atient *irculating Nurse cru# Nurse • • • • •

urgeon 'nesthesiologist %IR%U&ATING NURSE



T"E SURGI%A& ENVIRON$ENT )* +* ,* EIG"T 'ASI% PRIN%IP&ES OF ASEPTI% TE%"NI-UE 21 'll material materials s in contact with with the surgical surgical wound wound and used within within the sterile sterile >eld must #e sterile1 terile surfaces or articles may touch other sterile surfaces or articles and remain

sterile0 contact with unsterile o#?ects at any point renders a sterile area contaminated1 31 )owns of the surgical surgical team are considered considered sterile in front from the chest to the level of the sterile >eld1 The sleeves are also considered sterile from """""""""""""""""""""""""""" """""""""""""""""""""""""""" to the stoc!inette [email protected]


.1 terile drapes are used to create a sterile sterile >eld1 +nly the top surface of a draped ta#le is considered sterile1 $uring draping of a ta#le or patient/ the sterile drape is held h eld well a#ove the surface to #e covered and is positioned from front to #ac!1 A1 Items should should #e dispensed dispensed to a sterile sterile >eld #y methods methods that preserve preserve the sterili sterility ty of the items and the integrity of the sterile >eld1 'fter a sterile pac!age is opened/ the edges are considered unsterile1 terile supplies/ including solutions/ are delivered to a sterile >eld or handed to a scru##ed person in such a way that the sterility of the o#?ect or 7uid remains intact1 81 The movements of the surgical surgical team team are from sterile sterile to sterile sterile areas and from unsterile to unsterile areas1 """""""""""""""""" and sterile items contact only sterile areas0  """""""""""" """und andaunsterile contact contact only areas1 B1  """"""""""""""" 5ovement 5ovement around aro sterile >eld >eitems ld must not cause cau se unsterile contaminati contamination on of the >eld1 >eld1 terile terile areas must #e !ept in view during movement around the area1 't least a """""""""" distance from the sterile >eld must #e maintained to prevent p revent inadvertent contamination1 C1 Whenever Whenever a sterile #arrier #arrier is #reached/ #reached/ the area must #e consider considered ed contaminate contaminated1 d1 '  """"""""""""""""""""""""  """""""""""" """""""""""" permitting access to an unsterile surface underneath rrenders enders the area unsterile1 uch a drape must #e replaced1 D1 Every sterile sterile >eld should should #e constantly constantly monitor monitored ed and maintained maintained11 Items of  """""""""""""""""  """""""""""" """"" are considered considered uns!erile 1 terile >elds should #e prepared as close as possi#le to the time of use1 SURGI%A& S.IN PREPARATION PREPARATION Purpose/  

o o •



TYPES OF ANEST"ESIA A* GENE GENERA RA& &         tages of )eneral 'nesthesia:   • • • • •

'* REGI REGION ONA& A&   client loses sensation in an area of the #ody #ut remains conscious  Types:  Types: o   o   o   o   o   POSITIONING •

INTRAOPERATIVE %O$P&I%ATIONS             • • • • • •

$alignan! "yper!0ermia igns and ymptoms: o   o 4entricular dysrhythmia o   o   o   o *ardiac arrest •

  5anagement: o   o   o



POSTOPERATIVE %O$P&I%ATIONS %omplia!ions Signs and Symp!oms  


*hest pain

$&*E Incentive spirometry Early am#ulation $&*T exercises Incentive spirometry Early am#ulation   +3

 T  Tachycardia achycardia (ypotension Wea! and rapid pulse *old and clammy s!in $ecreased urine output


Elevate extremities .9degrees   'E Early am#ulation 'nticoagulants   &ladder sounds li!e a drum +;I Early am#ulation (igh >#er food tool softeners and laxatives   '#dominal distention ;ever In7amed incision site Elevated W&*

Encourage am#ulation 5aintain asepsis *hange dressing 'nti#iotics

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