SURGERY For Nurses PDF
SURGERY For Nurses PDF
SURGERY For Nurses PDF
SURGERY an invasive medical procedure performed to diagnose or treat illness, injury, or deformity.
OPERATION for correction of deformities and defects, repair of injuries, diagnosis and cure disease processes, relief of suffering and prolongation of life. PERIOPERATIVE NURSING used to describe the nursing functions in the total surgical experience of the patients.
1.
PRE OPERATIVE PHASE : from the time the decision is made for surgical intervention to the transference of the patient to the operating room. 2. INTRA OPERATIVE PHASE : from the time the patient is received in the operating room, to the time of administration of anesthesia, surgical procedure is done, until he is admitted in the recovery room/post anesthesia care unit. 3. POST OPERATIVE PHASE from the time of admission to the recovery room, to the time he is transported back to the surgical unit, discharged from the hospital, until the follow-up care.
obstruction
Perforation
Tumor
I. According to PURPOSE:
1. Diagnostic 2. Exploratory 3. Curative 3.1) Ablative 3.2) Constructive 3.3) Reconstructive 4. Palliative 5. Transplant
1. Major 2. Minor
1. Aging
Nsg. Implications: 1. Consider using lesser doses for desired effect. 2. Adjust nutritional intake to conform to higher protein and vitamin needs. 3. Anticipate problems from long standing chronic disorders such as diabetes, anemia, obesity, cardiovascular disorders, respiratory disorders.
2. Obesity
Nsg. Implications: 1. Promote weight reduction if time permits. 2. Monitor closely for wound, pulmonary, and cardiopulmonary complications postoperatively. 3. Encourage coughing, turning, and diaphragmatic breathing exercises and early ambulation.
3.Malnutrition
Nsg. Implications: 1. Promote weight gain by providing wellbalanced diet high in calories, protein and vitamin C. 2. Administer total parenteral nutrition intravenously, nutritional supplements and tube feedings as prescribed. 3. Daily weight and calorie counts also may be ordered.
4. Dehydration/Electrolyte Imbalance
Nsg. Implications: 1. Administer intravenous fluids as ordered. 2. Keep a detailed input and output record. 3. Monitor client for evidence of electrolyte imbalance (Na+, K+, Ca++, etc.).
5. Cardiovascular Disorders
Nsg. Implications: 1. Diligently monitor vital signs, especially pulse rate, regularity, and rhythm, and general condition of the client. 2. Closely monitor fluid intake (oral & parenteral) to prevent circulatory overload. 3. Assess skin color.
4. Assess for chest pain, lung congestion, and peripheral edema. 5. Observe for signs of hypoxia, and administer oxygen as ordered. 6. Early postoperative ambulation and leg exercises reduce the risk of vascular problems, such as thrombophlebitis and pulmonary embolism. 7. Encourage change of position but avoid sudden exertion.
6. Respiratory Disorders
Nsg. Implications: 1. Closely monitor respirations, pulse, and breath sounds. 2. Assess for hypoxia, dyspnea, lung congestion, and chest pain. 3. Encourage coughing, turning, and diaphragmatic breathing exercises and early postoperative ambulation.
4. Encourage client to quit smoking or at least to reduce the number of cigarettes smoked. 5. Patients with chronic pulmonary problems such as emphysema, bronchiectasis, etc. should be treated for several days postoperatively with bronchodilators, aerosol medications, and conscientious mouth care.
7. Diabetes Mellitus
Nsg. Implications: 1. Monitor the client closely for signs and symptoms of hypoglycemia and hyperglycemia. 2. Monitor blood glucose levels every 4 hrs. as ordered. 3. Administer insulin as prescribed. 4. Encourage intake of food at the designated meal and snack times.
9. Alcoholism
Nsg. Implications: 1. Monitor closely for signs of delirium tremens. 2. Encourage well balanced diet. 3. Monitor for wound complications. 4. Administer supplemental nutrients parenterally as ordered.
10. Medications
A. Anticoagulants and Salicylates Nsg. Implications:
1. Monitor for bleeding. 2. Assess PTT / PT values.
C. Antihypertensives (particularly Phenothiazines) Nsg. Implication: 1. Closely monitor blood pressure. D. Antidepressants (particularly MAO inhibitors) Nsg. Implication: 1. Closely monitor blood pressure. E. Antibiotics Nsg. Implication: 1. Monitor respirations.
OTHER FACTORS:
1. Nature of the condition 2. Location of the condition 3. Magnitude and urgency of the surgical procedure 4. Mental attitude of the person toward the surgery 5. Caliber of the professional staff health care facilities.
COMMON ABBREVIATIONS:
TAHBSO Total Abdominal Hysterectomy Bilateral Salphingo Oophorectomy TURP Transurethral Resection of the Prostate TURBT Transurethral Resection of the Bladder Tumor STSG Split Thicknes Skin Grafting BKA Below Knee Amputation
AKA Above Knee Amputation ECCE w/ IOL Extra Capsular Cataract Extraction w/ Intra-Ocular Lens Implantation CHOLE w/ IOC Cholecystectomy w/ Intraoperative Cholangiogram D & C Dilatationof the cervix & Curettage of the uterus SMR Submucous resection of the Nasal Septum MRM Modified Radical Mastectomy
LCCS Low Cervical Cesarean Section LSTCS Low Segment Transverse Cesarean Section ORIF Open Reduction Internal Fixation BTL Bilateral Tubal Ligation
Preparations
PSYCHOLOGICAL Fear Manifestations: - Anxious - Bewilderment - Anger - Tendency to exaggerate - Sad, evasive, tearful, clinging - Inability to concentrate - Short attention span - Failure to carry out simple directions
LEGAL Considerations
Informed Consent - (Operative Permit / Surgical Consent) - LEGAL document required for certain diagnostic procedures or therapeutic measures, including surgery.
Purposes:
1. To ensure that the client understands the nature of the treatment including the potential complications and disfigurement. 2. To indicate that the clients decision was made without pressure. 3. To protect the client against unauthorized procedure. 4. To protect the surgeon and the hospital against legal action by a client who claims that an unauthorized procedure was performed.
Nursing Responsibilities:
1. Witnessing the exchange between the client and the surgeon. 2. Witnessing the clients signature. 3. Establishing that the client really did understand.
PHYSIOLOGICAL a. Cardiovascular ECG for patient aged 40 yrs. and above and those undergoing gen. anesthesia, or have cardiovascular disease. b. Hematologic CBC, Hgb & Hct, WBC, PTT & PT, Platelet count. c. Respiratory Chest x-ray, pulmonary function test / PFT. d. Metabolic FBS, Electrolytes(K+,Na++, etc). e. Genitourinary routine urine analysis.
B. Night Prior to Surgery: Preparing the skin Preparing the GIT Preparing for anesthesia Promoting rest and sleep
INTRAOPERATIVE PHASE
Definition of Terms:
Surgical Conscience ones inner voice for the conscientious practice of asepsis & sterile technique at all times. Asepsis absence of microorganism; freedom from infection; exclusion of microorganism. Sterile free of microorganism, including all spores. Spores inactive but visible sate of microorganism in the environment. Sterilization process by which all pathogenic microorganisms, including spores are killed.
3 Methods of Sterilization
1. Saturated Steam under Pressure e.g. autoclave
Sterile Field area around the site of incision into tissue or introduction of any instrumentation into the body orifice that has been prepared for use of sterile supplies and equipments including all furniture covered w/ sterile drapes and personnel who are properly attired. Sterile Technique method by which contamination w/ microorganism is prevented to maintain sterility throughout the operative procedure.
Surgically Clean mechanically cleansed but unsterile. Disinfection process of destroying all pathogenic microorganism except spore bearing one. Antiseptic used on tissue and skin and the growth of endogenous bacteria. Incision the result of cutting into a body tissue using sharp instrument.
Medical Asepsis include all practices intended to confine a specific microorganism to a specific area limiting the new growth and spread of microorganism. Surgical Asepsis (or sterile technique) refers to those practices that keep an area or object free of all microorganisms including practices destroying all microorganisms and spores.
5. Unsterile persons avoid reaching over a sterile field; sterile persons avoid leaning over an unsterile area. 6. Edges of anything that encloses sterile contents are considered unsterile. 7. Sterile field is created as close as possible to time of use. 8. Sterile areas are continuously kept in view. 9. Sterile persons keep well within the sterile area.
10. Sterile persons keep contact with sterile areas to a minimum. 11. Unsterile persons avoid sterile areas. 12. Destruction of integrity of microbial barriers results in contamination. 13. Microorganisms must be kept to an irreducible minimum.
ANESTHESIA
Effects of Anesthesia:
1. 2. 3. 4. Analgesia Amnesia Hypnosis Muscle relaxation
TYPES OF ANESTHESIA
I. General Anesthesia Types: a. Inhalation anesthesia - mask inhalation - endotracheal administration
b. Intravenous anesthesia
II. Regional Anasthesia Types: 1. Topical anesthesia 2. Infiltration anesthesia 3. Regional application Examples: - Nerve block - Intravenous regional extremity block anesthesia (Bier Block) w/ tourniquet - Spinal anesthesia / Intrathecal anesthesia
Complications & discomforts of Spinal Anesthesia: a. Hypotension b. Nausea & vomiting c. Headache d. Respiratory paralysis e. Neurologic complications
4. Epidural Anesthesia Ex. Cocaine, Novocaine, Xylocaine,Carbocaine
Surgical Incisions:
Subcostal Paramedian Midline Transverse Mcburneys Butterfly Pfannenstiel Limbal Halstead / elliptical
SURGICAL SUTURES
Classification: 1. Absorbable 2. Non-absorbable
Types: 1. Atraumatic 2. Non-atraumatic
Surgical Needles
Types: 1. Cutting 2. Round
Classification of surgical needles: 1. eye needle / free needle / non-atraumatic 2. eyeless / swaged needle / atraumatic
1. Cutting ex. Metzenbaum (metz), mayo scissors, suture scissors, knife. 2. Grasping - divided in the following categories: hemostats occluding clamps graspers and holders forceps or pick ups 3. Retracting 4. Accessory and ancillary instruments
CLASSIFICATION OF INSTRUMENTS
POSTOPERATIVE PHASE
Immediate post-op nursing care: - avoid exposure - avoid rough handling - avoid hurried movement and rapid changes in position
Assessment
Appraise air exchange and note skin color Verify identify, operative procedure, surgeon Assess neurologic status (LOC) Determine VS and skin temp (CV status) Determine operative site and check dressing Perform safety checks Require briefing on problems encountered in OR
Interventions
1. Ensure maintenance of patent airway and adequate respiratory function. 2. Assess status of circulatory system.
Common cardiovascular complication immediate post-op: 1. Hypotension 2. Cardiac arrhythmias
Respiration 2 1 0
Circulation
2 1 0 Consciousness 2 1 0 Color 2 1 0
20% pre anesthesia 20-50% pre anesthesia above 50% pre anesthesia fully awake rousable on calling not responding pink pale, dusky, blotchy cyanotic
Nursing Care of the client during the intermediate post op period (RRunit)
Baseline assessment: Respiratory status Cardiovascular status LOC Tubes Position
Goals: 1. Restore homeostasis and prevent complications. 2. Maintain adequate cardiovascular and tissue perfusion. 3. Maintain adequate respiratory function 4. Maintain adequate nutrition and elimination. 5. Maintain adequate fluid and electrolyte balance.
6. Maintain adequate renal function. 7. Promote adequate rest, comfort and safety. 8. Promote adequate wound healing. 9. Promote and maintain activity and mobility. 10. Provide adequate psychological support. Post op discomforts: 1. Nausea and vomiting 2. Pain 3. Thirst 4. Constipation 5. restlessness
POST OP COMPLICATIONS
a. b. c. CIRCULATORY COMPLICATIONS: Shock Hemorrhage Thrombophlebitis / deep thrombophlebitis
WOUND COMPLICATIONS a. Wound infections * Rule of thumb - fever 1st 24 hours post op - fever 48 hrs. post op - fever 48-72 hrs. post op - fever 72 hrs. post op b. Hemorrhage / Hematoma c. Wound dehiscence and evisceration