Consent
Inform Consent
- Clientʻs understanding and choice to have a treatment/procedure (risks, benefits, alternatives, outcomes)
- Client is aware of procedure, treatment, health-care team, purpose, and expected outcome
- Right to withdraw treatment, medication, operation, etc.
Interventions for Surgical Patients
- hygiene
- skin prep
- elimination
- nutrition & fluids
- rest & sleep
- safety
Wound Dehiscence
- the opening of a surgical wound either internally or externally
Safety Considerations
- fall risk
- aspiration
- DVT/respiratory precautions (VTE preventing blood clots that can move to the lungs)
- impaired cognition
Outpatient/Same-Day Surgery
- reduces length of hospital stay cuts costs
- reduces stress for patient
- may require additional teaching & home care services for certain patients (older patients, chronically ill patients, no support system)
Inform Consent Information (part 1)
- description of procedure & alternative therapies
- underlying disease process and natural coarse
Preparing the Patient Through Teaching
- surgical events & sensations
- pain management
- physical activities
Respiratory Complications
- atelectasis
- pneumonia
- pulmonary embolism (blood clotting)
Pain Management & Patient Control Analgesia Pump (PCA)
- computerized pump with a syringe of pain medication connected to an IV line
- administer pain medications in small constant flow or self-administered by pressing a button
- educate patient to press button during early onset of pain (acute pain is more manageable than chronic pain)
Outcomes for Surgical Patient (part 1)
- receive respectful, culturally, and age-appropriate care
- free from injury & adverse effects
- free from infection and DVT
Inform Consent Information (part 2)
- name and qualifications of person performing procedure
- explanation of risks and frequency
- explanation of patient's rights to refuse or withdraw consent
- explanation of expected outcomes, recovery, rehabilitation plan, & course of treatment
Postoperative Physical Activities
- deep breathing (reduce respiratory complications)
- coughing (reduce respiratory complications)
- incentive spirometry (reduce respiratory complications)
- leg exercises (reduce DVT)
- repositioning ( reduce pressure injuries, DVT, respiratory complications)
- early ambulations (increase lung expansion, blood flow, pressure relief)
Ileus
- nausea/vomiting
- small bowel movement or none
- peristalsis (build up of gas, liquid, or solid contents)
Indications of Complications
- nausea/vomiting
- postoperative cognitive dysfunction (POCD)
- venous thromboembolism/pulmonary embolism
- hypotension/hypovolemia
- atelectasis
- wound infections
- ileus
- oliguria or astute kidney injury
Outcomes for Surgical Patient (part 2)
- fluid & electrolyte balance, skin integrity, and normal temperature
- pain managed
- demonstrate understanding of physiologic and psychological responses to surgery
- participate in rehab process
Preoperative Education (part 1)
- can be extensive
- goal to prepare and inform patient of what to expect before and after surgery
Three Phases of General Anesthesia
- Induction: from administration --> incision
- maintenance: from incision --> near completion of procedure
- emergence: when patient emerges from anesthesia & leaving OR
Deep vein thrombosis (DVT)
- Leg exercises to reduce DVT
- repositioning in bed to reduce pressure injuries, DVT, and respiratory complications
Postoperative Assessment & Priorities: Q10-15mins (part 1)
- patient related complications
- respiratory status
- cardiovascular status
- pain management
Surgical Risks of Medications (part 1)
- anticoagulants: predicate hemorrhage
- diuretics: electrolyte imbalances, respiratory depression from anesthesia
Preoperative Education (part 2)
- develop better understanding of the surgery, feel empowered, experience less pain, & be less anxious
- client teaching to decrease hospital stay and recovery period
- pay attention to skin prep and medication orders before surgery
Typical Preoperative Medications
- sedatives (benzodiazepine-reduce anxiety; reversal agent:flumazenil)
- anticholingerics (atropine-dies out oral secretions & reduce laryngeal spasms)
- narcotic analgesics (morphine/fentanyl-helps with pain; reversal agent:naloxone)
- hestamine-2 receptor antihistamines (decrees gastric acidity and volume)
Interventions to Prevent Respiratory Complications
- monitoring vital signs
- implementing deep breathing
- coughing
-splinting (using pillow/blanket for chest/abdomen during internal pressure to prevent dishiscence)
- incentive spirometry
- reposition Q2hr
- ambulating
- hydration
- avoid positions that decrease ventilation
- monitor responses to narcotic analgesics
Postoperative Assessment & Priorities: Q10-15mins (part 2)
- temperature & vital signs
- central nervous system status
- fluid status (I&Os)
- wound/skin status
- gastrointestinal status (nausea or vomiting)
- general condition
Surgical Risks of Medications (part 2)
- tranquilizers: increase hypotensive effects of anesthetic agents
- adrenal steroids: abrupt withdrawal may cause cardiovascular collapse
- antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants