"relieves or reduces intensity of disease, not a cure"
restores function or appearance
involves removal or organs or tissues for transplant
restores function lost or reduced as result of congenital anomalies
performed to improve personal appearance
Client�s physiological conditions
"PS-I (healthy), PS-II (mild systemic disease), PS-III (sever systemic disease), PS-IV (severe disease is threat to life), PS-V (moribund client not expected to survive 24 hrs with/without surgery), PS-VI (brain dead clie, nt � donor), E (emergency)"
Where is preoperative assessment done?
"By Phone, Labs, Pretests, Dr. Office, 2hrs before"
Why is preoperative assessment so important
"Surgery is invasive, unknown outcome, risk with procedure, anesthesia; Outcomes from surgery are sometimes poor, client�s suffer complications and even death; Screening client�s for risk factors can identify those at higher risk for poor outcomes"
Conditions that increase risks of surgery
"A - allergies, B - bleeding tendencies, C - cortisone or steroid use, D - Diabetes Mellitus, E - emboli, Also heart disease, URI, chronic respiratory disease, liver disease, fever, kidney disease, sleep apnea"
"some potentiate anesthesia, some may cause mild respiratory depression"
decreased cardiac contractility and impulse conduction during anesthesia
increased risk of hemorrhage
can alter metabolism of anesthetics
"interact with anesthetic �bradycardia, hypotension, imparied ciruclation"
reduce body�s ability to withstand stress (delay wound healing & immune system drcreases)
altered needs with surgery
potentiate electrolyte imbalances
inhibit platelet aggregation and can prolong bleeding
Herbal therapy Risks
"ginger, ginko, ginseng all increase the risk of bleeding"
Intervention to allay fears and help control anxiety
"Assess client�s degree of anxiety and/or fears; Listen carefully to concern, questions, past experiences; Clarify any misconceptions"
important foci of pre-op education
"Leg exercises, Coughing and deep breathing, Pain control, Importance of early ambulation, sitting in chair, how will they urinate,diet alterations, expected nursing care, equipment to expect, What kind of wound, dressing, care of it, Length of stay, typical course of recovery, anesthetic effects"
Pre-operative check list
"Informed consent signed and witnessed, If hospitalized � bath and clean hospital gown; No hairpins, clips, hairpieces, wigs; No makeup, nail polish, artificial nails, false eyelashes, contact lenses; remove prostheses; safeguard valuables, tape wedding ring; assess vital signs; Insert IV and hang appropriate solution, antibiotic; NG tube & meds as ordered; note latex sensitivity/allergy; Lab results available on chart; Double check everything"
Informed Consent - Patient signature indicates that they understand:
Need for procedure in relation to diagnosis; Description and purpose of the procedure to be done; Benefits and risk associated with procedure; Likelihood of successful outcome; Alternative treatments; Possible effects of not having surgery; Physician's advice; They have the right to refuse
When client leaves for surgery - Prepare client�s room for return from surgery:
"Make surgical bed; Arrange furniture to allow cart to enter room with client; Emesis basis, IV pumps, pneumatic cuffs, measuring containers, wire cutters, sphygmomanometer, washcloth, towel, tissues, oxygen equipment, extra pillows"
Caring for the family
"Allow well wishes and goodbyes; Direct to waiting room � register with receptionist to ensure surgeon locates them following surgery; Offer emotional support, answer questions"
"Surgeon, Assistant(s), Anesthesiologist or CRNA, Scrub nurse or ORT"
physician who performs the procedure
"physician, nurse, physician�s assistant, trained personnel � who assist by exposing operative site, retracting nearby tissues, sponging &/or suctioning the wound, ligating bleeding vessels, suturing"
Anesthesiologist or CRNA
"monitors client�s general well being, preop eval, administers anesthesia and other meds, transfuses blood, blood products, IVF, alters surgeon to developing problems, supervises recovery in PACU"
"highly experienced RN, coordinated and manages activity before, during and after procedure, physical environment, equip, transferring and positioning, documents, counts, formulated care plan, advocates safety"
Scrub nurse or ORT
"needs technical skill, manual dexterity, in-depth knowledge of anatomic and mechanical aspects of surgery, sutures, instruments, equipment"
"Provide emotional support; Ensure safe environment and prevent injury( equipment, time out - all staff, comfort, documentation); Maintain asepsis; promote wound healing; Prevent heat los;, Monitor for Malignant hyperthermia"
Method of patient monitoring during anesthesia
"Arterial blood pressure; Heart rate (palpation, auscultation, doppler, EKG); Respiratory status (observation & auscultation); Respiratory status (observation & auscultation); Urinary output; pulse oximetry; Capnography (detects changes in resp, Circ or metabolic status, non-invasive, measures end-tidal conc of carbon dioxide); BIS moniotor (uses electroencephalogram to monitor depth of anesthesia)"
"Reduces cross contamination between Operating Room and other hospital departments; Minimizes bacterial shedding - to decrease wound contamination; Levels (unrestricted, semi-restricted, & restricted)"
"stop, one last look to make sure doing right surgery to right patient"
"Anesthesia related, respiratory, Cardiovascular, F & E imbalances, Gastrointestinal, Musculoskeletal, Infection, Pain, Physiologic stress response to surgery & anesthesia, Wound complications (dehiscence and evisceration)"
Treatment for Malignant Hyperthermia
"Dantrolene � provides skeletal muscle relaxation, retards biochemical actions that cause muscle contractions, 2-3 mg/kg initially followed by additional doses up to 10 mg/kg; Immediately stop anesthetic; 100% oxygen; Cooling with ice packs or cooling blanket to 38 degrees C; Lavaging body cavities with iced saline; Restore acid/base and treat hyperkalemia "
Risk of General Anesthesia
"Risks associated with circulatory and respiratory depression or arrest; Risks for oral or dental injury; Residual muscle paralysis; Hypotension, hypertension, hypothermia, hyperthermia; Renal dysfunction; Neurological dysfunction"
Risks of Local anesthesia
"Local � allergic reaction, toxicity, cardiac or respiratory arrest, anxiety, infection; Nerve block � inadvertnet intravascular injection, nerve damage, infection ; Spinal � risk of hypotension, inadvertent high level of spinal anesthesia resulting in respiratory depression or arrest and complete paralysis, tinnitis, arachnoiditis, meningitis, paresthesias, bowel/bladder dysfunction, paralysis, headache, infection; Epidural � dural puncture, hypotension, inadvertent spinal, neurological complications, hematoma, infection, intravascular injection with possible convulsions, hypotension, cardiac arrest; Monitored anesthesia � same as above; Conscious sedation � over sedation, respiratory depression, apnea, airway obstruction, hypotension, aspiration "
"Pneumonia � inflammation of lung tissue caused by microbe or foreign substance leading to infection; Atelectasis � incomplete expansion or collapse of lung tissue resulting in inadequate ventilation and retention of pulmonary secretions; Obstruction � laryngospasm due to irritation from endotracheal tube insertion (Symptom � stridor � a high-pitched, harsh inspiratory sound or increased respirations); Hypoventilation � due to effects of anesthesia and pain medication"
"MI and CVA; Shock; Hemorrhage; Deep vein thrombosis; Pulmonary embolism � pulmonary embolism is dislodged blood clot or other substance and lodges in pulmonary artery, life threatening emergency (50% of deaths in first 2 hours)"
"life threatening, insufficient blood flow to vital organs, inability to use oxygen and nutrients and inability to rid body of waste"
excessive blood loss
Deep vein thrombosis
formation of a blood clot (thrombus) and inflammation in deep veins