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Perioperative Nursing Manual (Preoperative, Intraoperative and Postoperative Nursing Care)
SN Nanjunde Gowda, Jyothi Nanjunde Gowda
1:
Preoperative Nursing Care
LEARNING OBJECTIVES
SURGERY
Concept, Phases of Perioperative Patient Care
Preoperative Phases
Intraoperative Phase
Postoperative Phase
Conditions Requiring Surgery
Obstruction or Blockage
Perforation
Erosion
Tumors
Types of Surgery
Extent of Surgery
Categories of Surgery Based on Urgency
Emergency
Urgent/imperative
Required
Elective
Optional
Types of Surgery According to the Purpose
ROLE OF NURSE
PHYSIOLOGICAL PREPARATION (ASSESSMENT)
AGE
PRESENCE OF PAIN
NUTRITIONAL STATUS
FLUID AND ELECTROLYTE BALANCE
INFECTION
CARDIOVASCULAR FUNCTION
PULMONARY FUNCTION
RENAL FUNCTION
GASTROINTESTINAL FUNCTION
LIVER FUNCTION
ENDOCRINE FUNCTION
NEUROLOGICAL FUNCTION
HEMATOLOGICAL FUNCTION
USE OF MEDICATIONS
HABITS
SOCIAL HISTORY
PSYCHOLOGICAL PREPARATION
NURSING INTERVENTIONS
PHYSICAL PREPARATION
Preparation Involves
Skin Preparation for Surgery
LEGAL PREPARATION – INFORMED CONSENT
PREOPERATIVE ASSESSMENT
General Guidelines
History
Physical Examination
Risk Factors for any Surgical Procedures
Systemic Factors
Cardiovascular Diseases
Endocrine Dysfunction
Hepatic Disease
Physiological Preparations, Day before surgery
Day before Surgery
Preparation on the Day of Surgery
PREOPERATIVE TEACHING
Preoperative Teaching Includes
Demonstrating Postoperative Exercise
Demonstrate Exercise
Coughing Exercise
Turning Exercise
Purposes
Leg Exercise
Purposes
Procedure
Extremity Exercise
Ambulation
Preoperative Visit by Preoperative Nurse
Preoperative Visits
Immediate Preoperative Preparation
Prepares for Surgical Intervention
Check
Operative Consent
Complete special preparation as ordered, which may include the following
Verify that the client has not taken any food drink for at least 8 hours
Preoperative Visit by Perioperative Nurse
Preoperative Visits
Immediate Preoperative Preparation
The Preoperative Checklist
Transporting the Patient to the Operating Room (Fig. 1.9)
2:
Anesthesia
LEARNING OBJECTIVES
TERMINOLOGY
ANESTHESIA
Types of Anesthesia
CHOICE OF ANESTHESIA
GENERAL ANESTHESIA
Induction of General Anesthesia
Preoxygenation
Loss of consciousness
Intubation
A. Inhalation Method of General Anesthesia
B. Mode of Action
C. Technique of Administrating Inhalation Anesthesia
D. Stages of Inhalation Anesthesia
The Four Stages of Anesthesia
Most Commonly used General Anesthetic Aaents
Problems Encountered during General Anesthesia and Nursing Implications
Complication of General Anesthesia
Malignant Hyperthermia
Etiology
Signs and Symptoms
Medical and Nursing Management
Neuromuscular Blockers (Muscle Relaxants)
A. Topical Anesthesia
B. Local Infiltration
Presentation of Local Anesthetics
Advantages of Xylocaine with Adrenaline
Advantages of Local anesthesia
C. Regional anesthesia
D. Epidural or Peridural Anesthesia
Advantages
Disadvantages
E. Spinal Anesthesia
Advantages
Disadvantages
Nursing care after spinal anesthesia
SUMMARY OF ANESTHESIA
Volatile Liquid Anesthetics, Technique of Administration Advantages, Disadvantages and Nursing Implications
Gas Anesthetics, Technique of Administration, Advantages, Disadvantages and Nursing Implications
Stages of Inhalation Anesthesia
Drugs used to Treat Malignant Hyperthermia
Muscle Relaxants, Action, Advantages And Disadvantages
Intravenous Anesthetic Agents
Rectal Anesthetic Agent
Local Anesthetic Agents
Spinal Anesthetic Aqents
3:
Physical Facilities for the Operation Room and Management of the Operation Room Environment
LEARNING OBJECTIVES
INTRODUCTION
Principles in Construction or Renovation of the Operation Room
Space Allocation, Preoperative Designated Space
Induction Room
Waiting-area
Dressing Rooms
The Operation Room Support Personnel Areas
Laboratory
Radiology Services
Central Sterile Supply Department (CSSD)
Substerile Room
The Work Area
Sterile Supply Room
Separate Room for Instruments
Surgical Scrub Room
Operation Room
Size
Ventilation
Floors
Walls and Ceiling
Gases, Computer Lines and Electrical Systems
Clocks
Furniture and Other Equipments
Preoperative Holding Area
Scrub Area
Post-Anesthesia Care Unit (PACU/recovery Room)
Preoperative Documentation
Intraoperative Documentation
Postoperative Care Documents
Physical Hazards and Safeguards in the Operation Room
Environmental Factors
Fire and Explosion
Flammable agents
Fire Safety
Chemical Hazards
Precautions
Reproductive Hazards
Male reproductive health hazards
Female Reproductive Hazards
Infectious Waste
Needle Stick Injury
Reporting of Needle Stick Injury and Exposed to Body Fluid Secretions
Body Fluids and Substances that may Transmit Pathogen
Favorable Living Conditions for Microorganisms
Management of the operation room and minimizing risk
Wounds Management
Wound Healing
Regeneration
GRANULATION TISSUE FORMATION
Contraction of Wounds
Wound Healing
Healing by first intention (primary intention)
Healing by Second Intention (Secondary Union)
Complication of Wound Healing
Postoperative Wound Disruption
TREATMENT AT THE BED SIDE
Wound Infections
Postoperative Wound Infections
Prevention of Wound Infections
Wound Care Materials
Factors Influencing Healing
A. Local Factors
B. Systemic Factors
Factors That Delay Healing
POSITION USED IN SURGERY
A good position must provide
Point to be Kept in Mind in Positioning the Patient for Surgery
SAFETY MEASURES
POSITION USED IN SURGERY
EQUIPMENT FOR POSITIONING
Operating Bed
Special Equipments
4:
Intraoperative Nursing Care
INTRODUCTION
The Operating Room Team
The Sterile Team
The Supporting Team
PREPARATION OF THE OPERATION THEATER
Introduction
The Preparation of Theater
Cleaning procedure include
Daily Cleaning Schedule
Walls
Furniture
Lights
Operation Tables
Diathermy Apparatus
Suction Apparatus
Anesthetic Machine
Floors
Cleaning in between the Cases
Collection and Disposal of used and Left Over items from OT
Cleaning the OR
Cleaning other Equipment
Equipment
Ensure that all the articles are
Re-setting the Room
Contract Cleaning of Walls and Ceilings
Pre-Sterilized basic Packs, Sterile Instrument Trays and Supplementary Packs
Swab Chart
Anesthesia Room
Ensure that
Preparation of the Operating Room for Infected Cases
PRINCIPLES OF ASEPSIS IN OT
Introduction
Asepsis
Sterile Technique
Transmission of Microorganisms
ASEPTIC TECHNIQUE AND ENVIRONMENTAL CONTROL
Basic Rules of Surgical Asepsis
General
Applicable to Sterile Technique
Principles and their Rationales
DRAPING
Guidelines for Nursing Action in Surgical Draping
Delivery of Sterile Supply
SOLUTIONS
PUTTING A STERILE CAP
PUTTING ON A FACE MASK
DONNING CAP AND MASK
MASKS
SURGICAL HAND SCRUB
Definition
GUIDELINES: SCRUBBING FOR AN OPERATION
Procedure for Timed Scrub (10 minutes)
Procedure for Stroke Count Method
GOWNING AND GLOVING
Operating Room Attire
METHODS
GOWNING
RECEPTION OF THE PATIENT IN OT
Introduction
On Arrival of the Patient at the Theater
Ensure the check that
PREANESTHESIA PREPARATION
In the Anesthesia Room
Before Induction
During Anesthesia
After Anesthesia
GUIDELINES FOR NURSING ACTIONS IN POSITIONING PATIENTS
Commonly Used Operative Patient Position
SAFETY PRECAUTIONS IN OT
Introduction
Safety Precautions
Prevention of Accidents
Prevention of Fire (Anti-Static Precautions)
Precautions
Avoid
THE ROLE OF CIRCULATING NURSE
Definition
The Role of the Circulating Nurse before Surgery
Role of the Circulating Nurse during Surgery
The Role of Circulating Nurse before end of Surgery (i.e. Before Surgeon Sutures the Cavity)
The Role of Circulating Nurse on Completion of Surgery
THE ROLE OF SCRUB NURSE
Definition
The Role of Scrub Nurse Before Surgery
Role of Scrub Nurse at the Commencement of Surgery
Role of Scrub Nurse before Surgeon Sutures the Cavity
COUNTING SWABS, INSTRUMENTS AND NEEDLES IN OT
General Rules to be followed for Counting Swabs in OT
COUNTING INSTRUMENTS
Introduction
General Rule to be followed in Counting Instruments in OT
Counting of Needles
COLLECTION AND PRESERVATION OF THE SPECIMENS IN OT
Introduction
Equipment Required
For Culture
For A Small Specimen
For A Large Specimen
Fixative
Nursing Measures
5:
Immediate Postoperative Care in Recovery Room (RR) or Post Anesthesia Care Unit (PACU)
ASSESSMENT PARAMETERS
Post-Anesthesia Assessment
Possible Nursing Diagnoses for the Anesthesia Patient
NURSING INTERVENTION
Maintaining Airway Ventilation
Promoting Normal Temperature
Maintaining Fluid Balance
Preventing Injury
Relieving Pain
Promoting Psychological Comfort
OBSERVE
Discharge from Recovery Room
Criteria for discharging Patients from recovery room
6:
Postoperative Nursing
LEARNING OBJECTIVES
Transfer of the Patient to the Clinical Unit/Ward
Preparing Room For the Patient's Return From the Surgery
NURSING PROCESS
Patient Assessment on Return to Ward from Recovery Room
Possible Nursing Diagnoses For the Postoperative Patient
PLANNING AND IMPLEMENTATION
Goals
NURSING INTERVENTIONS GUIDELINES FOR POSTOPERATIVE NURSING CARE
Maintain Aeration
Maintain Circulation
Maintain Fluid and Electrolyte Balance
Maintain Nutrition
Maintain Elimination
Promote Activity
Promote Comfort
Teach the Patient
Advantages of Early Postoperative Ambulation
COMMON POSTOPERATIVE DISCOMFORTS
POSTOPERATIVE COMPLICATIONS
WOUND HEALING
Types of Wound Healing
Healing by First Intention
Healing be Second Intention
Healing by Third Intention
PATIENT EDUCATION: WOUND CARE
Until Sutures are Removed
After Sutures are Removed
Risk Factors Contributing to Wound Sepsis
Evaluation
Expected Outcomes
7:
The Person Experiencing Pain
LEARNING OBJECTIVES
INTRODUCTION
List the Three Components of Pain
DEFINITION
TYPES OF PAIN
Acute Pain
Chronic Pain
Referred Pain
Psychogenic Pain
Clinical Manifestation of Pain
OBJECTIVE SIGNS OF ACUTE PAIN
Factors that Influence Responses to Pain
Guidelines for Assessment of the Patient with Pain
NURSING DIAGNOSES FOR THE PATIENT WITH PAIN
PLANNING
IMPLEMENTATION
General Strategies for Pain Management
Evaluation
Evaluative Statements Indicating Goal Achievements
8:
Stress and Coping
LEARNING OBJECTIVES
INTRODUCTION
CONCEPTS OF STRESS
Stress as a Stimulus
Stress as a Response
Alarm Reaction (AR)
Stage of Resistance (SR)
Stage of Exhaustion (SE)
Manifestations of Stress
Physiologic Manifestations
Psychologic Manifestations
Cognitive Manifestations
Verbal and Motor Manifestations
NURSING PROCESS OF STRESS
Assessment
Determine
Nursing Diagnoses
Planning
Implementation
Minimizing Anxiety
General guidelines to minimize the client's anxiety and stress
Evaluation
The Client
9:
Surgical Instruments
COMMON EQUIPMENT USED IN ANESTHESIOLOGY
SHARP INSTRUMENTS
Scissors (Fig. 9.10A to D)
INDEX
TOC
Index
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