COMP3_Peri-op

• can be done by multiple members (nurse, OR nurse, surgeon, physician)
• can be done days before non emergency selective surgery
• gives patient and family opportunity to ask questions

• Baseline for later in OR
• psychological status: coping strategies
• physiological status
• labs & tests
• identify & verify surgical site
• medications - OTC, RX, supplements and recreational drugs

• medical hx
• surgical hx & reactions
• hx of current illness
• family hx
• level of understanding
• answer questions

• use common language
• anxiety and fear are normal
• -pain & discomfort
• -multaliation/ body image
• -anesthesia
• -life disruption
• -death
• Hope!

• respiratory
• cardiovascular
• urinary
• immune
• hepatic
• nervous
• endocrine
• fluids & electrolyte
• nutrition

• talk just enough, don't over explain or vague words
• tell them what to expect (ex: setting of OR)
• what happens in PACU
• possible complications
• skin prep might discolor skin but will wash off
• possible drains & bandages
• possible monitoring devices
• PCA/ epidural use
• incentive spirometer

• must be obtained for all non life threatening emergency surgeries
• obtained by doctor or person performing surgery: explain procedure, risks, benefits, & alternatives
• If pt is unable to consent/minor, legal guardian signs
• not needed if: life threatening and pt is unable to consent, no relatives present, must be documented

• wear hospital gowns, nothing else
• accurate ID band
• no makeup, nail polish
• no jewlery
• take of prosthetic (even contacts)
• leave hearing aids in to hear instructions
• start IV
• complete check list
• Medications: amnesic effect, decrease N/V & secretions

• Unrestricted area:
• - street clothes
• - office, education, locker rooms
• Semirestricted:
• - scrubs, OR shoes, hair cover
• - hallways, utilities and supplies
• Restricted:
• - scrubs, OR shoes, hair cover & mask

• RN/ circulating nurse:
• - traffic cntrl
• -pt advocate
• - documentation
• -contacting family
• -environment
• Scrub nurse/Tech/LVN:
• - hand instruments to surgeon
• - sterile instrument area
• MD assisstant/ RN 1st assist:
• - assist with surgery
• -experienced surgical rn
• Anesthesia Care Provider:
• - CRNA/ anesthesiologist
• Surgeon:

• In OR
• Baseline assessment data: physiological & psychological
• position patient: avoid pressure on bony surfaces
• allergies: chart review

• patient advocate
• safety precautions
• transfer patient
• position patient
• make sure surgical site is dry

• minimal: local
• moderate: "conscious" able to respond but wont remeber
• deep: hard to arouse, still breath & swallow
• anesthesia: sedated, can't breath/ swallow

• Pad patient more
• decreased skin elasticity
• they react differently to medications
• hypothermia: use bear huggers on legs

• respiratory/ cardiac arrest
• massive blood loss
• anaphylaxis to drugs/ antibiotics/ anesthesia
• malignant hyperthermia, rare but serious, muscles become rigid before they die.
• fire

• decrease NPO time
• bloodless surgery
• robotics surgery
• telesurgery

• Obstructive airway:
• - tongue, laryngeal spasms, laryngeal edema, retention of secretions
• Bronchiolspasms: SOB/ Wheezing
• Hypoxia:
• - atelectasis
• - pulmonary edemia
• - aspiration of gastric contents
• hypoventilations
• Nursing Implications:
• - turn pt Q2H
• - position pt correctly
• - deep breathing
• - O2 supplement

• HTN, hypotention, hemorrhage
• cardiac; MI, dysrhythmias, cardiac tamponade
• Nursing Implications
• -PACU: give O2, assess & correct fluids
• -unit: monitor I&O, wear compression stockings, watch for syncope/ orthostatic hypotension

• Delirium b/c
• - alcoholic withdrawl
• - hypoxia
• delayed emergence
• - normally frequent upon older population
• - sluggish & confused
• cognition- decrease concentration & memory
• anxiety & depression

• Cause:
• - traumatized skin
• - muscle spasms
• - position during surgery
• - internal devices
• - movement
• - anxiety & fear
• Nursing implications:
• - assess & reassess frequently
• - analgesics
• - transition from opiod to non opioid
• - PCA/ epidural pump

• Hypothermia
• first 48hrs
• < 100.4: surgical stress
• >100.4: respiratory distress
• after 48hrs, possible infections
• Nursing implications:
• passive warming - blankets
• active warming
• assess Q4H first 48 hrs.

• hiccups
• Nausea/Vomitting
• Abdominal distension
• decrease peristalsis( thats why NPO first during post op)
• Nursing implications:
• antiemetic medication
• assess bowel sounds
• IV fluids for dehydrations
• prevent aspirations
• NG tube to decompress stomach
• flatulation- turn to the right

Acute urinary retention is more likely to happen after abd surgery

Nursing implications: encourage normal positioning for voiding