Caring For the Surgical Patient

A review of Definitions, Cases, Perioperative Phases of Nursing

InterventionJeanne M. Colia, RN, MSN

Reference

• Potter, P.A., & Perry A.G. (2005). Fundamentals of nursing (6th ed.). St. Louis:Mosby.

• Note: Refer to Assigned Chapter 49 “Care of the Surgical Patient” for reading and review.

Objectives

• Discuss case studies for the surgical patient.

• List two major types of anesthesia.

• List types of regional anesthesia.

Objectives (cont.)

• Identify three perioperative phases.

• Describe when interventions would be started during the perioperative phases.

• Define pertinent terminology related to the surgical patient.

Objectives (cont.)

• Identify medical orders and rationale for implementing orders.

• Prioritize nursing interventions the nurse would independently perform and provide rationale for nursing interventions.

• Apply critical thinking skills to test questions.

Definitions

• General Anesthesia• Regional Anesthesia• Thrombophlebitis• Atelectasis• Paralytic ileus• PCA (Patient controlled analgesia pump)• Pneumatic compression device (SCD’s

Sequential compression device)

Types of anesthesia

• List two major types of anesthesia.

1.

2.

Types of Anesthesia• General anesthesia:

Administration of inhalant or IV medication that affects the entire body and produces loss of consciousness.

• Regional anesthesia: Administration of an anesthetic agent or topical agent near a nerve or nerve pathway that inhibits the transmission of the impulse to the CNS.

General Anesthesia

• List two ways to administer.

• 1.

• 2.

• Define affect to Neuro system (LOC)

• Does this effect entire body or parts of body?

Regional Anesthesia

• Describe method of administered.

• How does regional anesthesia affect the Central Nervous System (CNS)

• List 5 types of regional anesthesia

1.______________

2.______________

3.______________

4.______________

5.______________

Types of Regional Anesthesia

• Results in loss of sensation in an area of the body.

1. Epidural anesthesia

2. Spinal anesthesia

3. Nerve block

4. Local anesthesia

5. Topical anesthesia

Definitions• Define General Anesthesia

• Define Regional Anesthesia

Perioperative Phase Nursing Interventions Brief Descriptions

• Pre-operative Phase ____________________________________________________________________

• Intraoperative Phase ____________________________________________________________________

• Post Operative Phase

____________________________________________________________________

Identify Perioperative PhasesPre-op Intra-op Post-op

• Use of incentive Spirometer.

• Coughing and deep breathing.

• Splinting of surgical site.

• Prepping surgical site.

Identify Perioperative PhasesPre-op Intra-op Post-op

• Changing the surgical dressing.

• Leg exercises.

• Pain Management.

• Discharge Planning Instructions.

Case Study

A female patient is admitted for a total abdominal hysterectomy (TAH) this morning. She is 52 years old and is obese.Her past medical history indicates that she stopped smoking 5 years ago. Both parents are deceased. Mother died at the age of 88 and father died from a heart attack at the age of 62.

The Clients vital signs are: T. 97.8- P.76-R.18-B/P 164/92. The following laboratory studies were done: CBC, PT, serum electrolytes of Na+,K+,serum FBG, BUN, and creatinine. The UA, chest xray report, and ECG report are in the chart.

Post Operative Complications

• List the factors from the Case Study that increase the patient’s risk of Postoperative complications:

• __________________________________• __________________________________• __________________________________• __________________________________

Interactive Activity:

• With a partner, use the follow-up case study to:

• (1) Identify which medical order the nurse would do first.

• (2) List the priority nursing interventions the nurse would independently perform and provide a rationale for each intervention:

Follow-up Case Study

• NPO- May have sips of water in AM

• IV-Dextrose 5/0.9% Normal Saline infuse at 100mL/hr.

• Ambulate this evening.

• VS q30 min. for the first hour, then q1h x 2hr, then q4h.

• Incentive spirometer q1h while awake.

• PCA- Morphine sulphate set at 1mg/6min (per patient demand not to exceed 20mg/4hr).

• Antiembolic stockings and pneumatic compression device to legs continuously.

• Indwelling urinary catheter to gravity- remove in AM

First Medical Order to ImplementPriority Rationale

1. Take the Vital Signs1.Establish a baseline and compare to the previous recording.

Priority Independent Nursing Interventions Rationale

1.Assess LOC, skin color, lungs, etc.

2.Check surgical dressing/surrounding site.

3.Assess IV, IV site, PCA

1. Establish baseline.

2. Establish baseline.

3. Assess for infiltration/rate/amt. left.

Priority Independent NursingInterventions Rationale

4.Assess Comfort level/pain

5. Assess urinary catheter/output

6. Assess peri-pad

7. Cough and deep breath.

4. Pain Management

5. Patency of cath./color of urine.

6. Assess for vaginal drainage/baseline.

7. Prevent Pulmonary complications.

Critical Thinking Test Question #1

1.The client is transferred to the surgical unit from the post anesthesia room after having abdominal surgery. There is a J-P drainage device in place. Which of the following reported findings on transfer requires immediate follow-up?

Answer Choices Question #1

A. Abdominal dressing reinforced in the recovery room.

B. R.14, P.86, B/P 126/90, lethargic, but responds to touch.

C. Bowel sounds absent in all quadrants.

D. J-P compressed with 10mL reddish drainage.

Rationale to Question #1• A. is the answer. Reinforcement of the

surgical dressing indicates excessive drainage. This should be carefully monitored.

• B. indicates vital signs WNL.

• C &D are expected findings for a client who had abdominal surgery.

Critical Thinking Test Question #2

• Which of the following client statements is correct in describing the appropriate use of incentive spirometer?

Question #2 ChoicesA. “I will first inhale then blow into the mouthpiece.”

B. “I will put the mouthpiece in my mouth and blow into the mouthpiece.”

C. “I will put the mouthpiece in my mouth then inhale slowly”.

D. “I will put the mouthpiece in my mouth, inhale and hold for 5 seconds.”

Rationale to Question #2

• C is the answer- This describes the procedure appropriately.

• A & B do not describe the procedure correctly.

• D is partially correct but the client does not need to hold for 5 seconds.

Critical Thinking Skills Question/Answers #3

• The nurse is preparing a client for emergency surgery. Before Surgery, it is most important for the nurse to ensure that the:

A. pre-op checklist is completed.

B. pre-op medications are documented.

C. lab results are in the chart.

D. surgical consent is signed.

Rationale Question #3

D- is the answer. Although the physician is responsible for obtaining the client’s signature, it is most important for the nurse to ensure that it has been signed.

A, B, and C are important but are not the most important.