PERI - OPERATIVE PHASES
PREOPERATIVE - INTRAOPERATIVE - POSTOPERATIVE
WHAT ARE THE THREE PHASES OF SURGERY & PERIOPERATIVE NURSING
APPENDECTOMY
ABLATIVE
REMOVAL OF DISEASED BODY PART - AP - GB - SPLEEN
SURGERY IS RECOMMENDED COURSE OF ACTION BUT NOT TIME SENSITIVE
ELECTIVE
ROTATOR CUFF - REMOVAL OF POLYPS
AGE - DEMOGRAPHICS - MEDICAL & SURGICAL HISTORY - ALLERGIES - MEDICATIONS - MENTAL STATUS - PHYSICAL ASSESSMENT
WHAT IS COLLECTED DURING HEALTH HISTORY
Who determines if the patient is competent to to make an informed decision about the surgery.
SURGEON
WHY IS UNIVERSAL PROTOCOLS PERFORMED BEFORE SURGERIES AND PROCEDURES?
TO PREVENT:
Wrong Patient, Wrong Site, Wrong Procedure
The Joint Commission 2023 National Patient Safety Goals. ”Prevent Mistakes in Surgery”
Airway, Breathing, Circulation, Pain & Nausea
PACU Responsibilities & Priority Assessment
MY PHASE OF SURGERY BEGINS WHEN THE DECISION IS AGREED UPON TO HAVE SURGERY
PREOPERATIVE PHASE
PROCEDURE USED TO CONFIRM OR TO RULE OUT A DIAGNOSIS.
Diagnostic
BIOPSY - CARDIAC CATHETERIZATION
SURGERY MUST BE MUST BE DONE WITHIN 24-48 HOURS
URGENT
NAME EXAMPLES OF PRE-EXISTING CONDITIONS THAT CAN INCREASE SURGICAL RISK FOR COMPLICATIONS
ACTIVE INFECTIONS - RESPIRATORY DISEASES - DIABETES - LIVER DISEASE - KIDNEY DISEASE - NEUROLOGICAL DISEASES - CARDIAC DISEASES
Who explains the risks & benefits of surgery to th patient?
Surgeon
WHAT ARE THE UNIVERSAL PROTOCOL STEPS
PRE-VERIFICATION PROCESS
MARKING THE SURGICAL SITE
PERFORMING A TIME OUT INTRAOPERATIVELY
How do you assess airway
The patient is able to maintain a patent airway independently and to deep-breathe, cough, and expectorate secretions.
Can the patient breath in and out without restriction or obstruction.
POSTOPERATIVE PHASE ONE RECOVERY OCCURS WHERE
PACU
POST ANESTHESIA CARE UNIT
MY SURGERY IS NOT NOT CURATIVE
RELIEVES SYMPTOMS/PAIN - TUMOR DEBULKING
PALLIATIVE
ETHEL FELL OUT OF BED AND FRACTURED HER RIGHT HIP.
URGENT
CLOSED FRACTURES - RELIEVES SYMPTOMS AND RESTORES FUNCTION
ANTICOAGULANTS - ANTIHYPERTENSIVES - ASPIRIN - CORTICOSTEROIDS - OPIOIDS - NSAIDS - DIURETICS - ANTIBIOTICS -
MEDICATIONS THAT CAN INCREASE SURGICAL RISK AND COMPLICATIONS FOR THE PATIENT POSTOPERATIVELY
Who verifies that the consent has been signed, witnessed and in the medical record?
NURSE
what peri-operative location does the Time Out occur in?
Intra-operative.
In the actual operating room where the surgery will take place.
How do you assess breathing
THE CHEST IS RISING WITH INSPIRATION AND FALLING WITH EXPIRATION
RESPIRATORY RATE = HOW FAST OR SLOW IS THE BREATHING
PULSE OXIMETRY = WHAT IS THEIR OXYGEN LEVEL > 90%
MY PHASE ENDS WHEN I AM ADMITTED INTO THE PACU
INTRAOPERATIVE
PERFORMED TO RESTORE FUNCTION
TORN ACL - ROTATOR CUFF REPAIR
WHAT IS RECONSTRUCTIVE
CHILD REPEATEDLY SUFFERS FROM STREP THROAT AND BEST TREATMENT IS TO REMOVE TONSILS AND ADENOIDS.
ELECTIVE
WHAT ARE COMMON DIAGNOSTIC TESTS ARE PERFORMED PREOPERATIVELY
CBC - URINALYSIS - CMP -FASTING BLOOD SUGAR - BLOOD TYPE CROSS MATCH - EKG - CHEST XRAY
THE PATIENT RESPONDS WITH THE INCORRECT SURGICAL PROCEDURE WHEN THE RN ASKS WHAT HE IS HAVING DONE DURING THE CONSENT PROCESS. WHAT SHOULD THE RN DO?
STOP - DO NOT HAVE THE PATIENT SIGN THE CONSENT, THEY DO NOT UNDERSTAND, SO THEY ARE NOT INFORMED OR THEY ARE CONFUSED.
THEN NOTIFY THE SURGEON. THE SURGEON WILL NEED TO COME BACK & EVALUATE THE PT & EXPLAIN THE PROCEDURE
This intraoperative nurse sets up the sterile field, is part of the sterile team, and maintains the integrity of the sterile field.
Scrub Nurse
How do you assess circulation?
PULSE - HEART RATE -
BLOOD PRESSURE
PERIPHERAL PULSES
DRAINAGE - BLEEDING
SWELLING - HEMATOMA
THE CARE OF PATIENTS BEFORE, DURING, AND AFTER SURGERY OR INVASIVE PROCEDURES
PERIOPERATIVE NURSING
TOTAL HIP REPLACEMENT SURGERY
TRANSPLANT
REPLACE A FAILING BODY PART OR ORGAN - KIDNEY - TOTAL JOINT
A PATIENT IS DX IN THE ER WITH BOWEL PERFORATION FROM DIVERTICULITIS
WHAT DEGREE OF URGENCY?
EMERGENT
ANY ORGAN RUPTURE
WHAT ARE THE NURSES PREOPERATIVE TEACHING RESPONSIBILITIES.
PAIN MANAGEMENT - CAUGH & DEEP BREATHING - SPLINTING - INCENTIVE SPIROMETER - LEG EXERCISES - ANTI EMBOLI STOCKINGS - SEQUENTIAL COMPRESSION DEVICES - DRESSING CARE - EQUIPMENT & MONITORING DEVICES.
WHY DOES THE RN HAVE TO SIGN THE CONSENT AFTER THE PATIENT SIGNS?
THE RN's SIGNATURE VERIFIES THAT THE PATIENT CAN VERBALIZE THE CORRECT PROCEDURE & THAT THE CORRECT PATIENT HAS SIGNED THE CONSENT.
Which anesthesia indices rapid unconsciousness, loss of sensation, and requires intubation to assist the patient to breath?
General Anesthesia
Inhaled and given via IV
PACU RN Assessment occurs how often
Every 5 - 15 minutes