Chapter 12

Nursing Care of Patients Having Surgery

Surgery Urgency LevelsEmergencyUrgentElective Optional

Purposes of SurgeryPreventiveDiagnostic Exploratory Curative Palliative Reconstructive

Types of SurgeryOpen IncisionMinimally Invasive Surgery

“Keyhole,” “Endoscopic” Scope Robotic Laser

Robotic Surgery – da VINCI

Three Perioperative PhasesPreoperative

Decision for Surgery to Transfer to SurgeryIntraoperative Transfer to Surgery to PACU

Postoperative PACU to Recovery

Preoperative PhaseLPN/LVN Role

Assist in Data CollectionReinforce Explanations/Instructions Provide Emotional/Psychological Support

Factors Influencing Surgical Outcomes

Emotional ResponsesAgeHydration/NutritionSmoking and AlcoholDiseases

Preadmission Surgical Patient Assessment

Health HistoryRisk FactorsEducation Discharge Planning Referrals Diagnostic Testing

Preadmission Surgical Patient Assessment (cont’d)

Pregnancy Test Advance Directive

Preoperative Teaching

Preoperative RoutinesDate/Time of Admission/SurgeryAdmission ProceduresLength of Stay, Items to Bring and WearRecovery after SurgeryFamily InformationDischarge Criteria

Preoperative InstructionsNPO Medications Bowel PrepPain Control

Preoperative Instructions (cont’d)Postoperative Exercises

Deep Breathing and Coughing Incentive Spirometry Leg Exercises

Incentive Spirometry

Preoperative Patient: Assessment

Health HistoryMedicationsPhysical Assessment

Preoperative Nursing Diagnoses

AnxietyFearDeficient Knowledge

Preoperative ConsentGives Legal Permission for Surgery

Informed Consent Physician’s ResponsibilityNo Sedation When SigningVoluntaryCan Withdraw at Any TimeValid 30 Days

LPN/LVN Role: Witnessing Consents

Ensure Patient Has Been Informed

Direct Questions to Physician

Signature Indicates Observed Voluntary Signing of Consent

Preparation for SurgeryPreoperative Preparation ChecklistPreoperative Medications

Preoperative Checklist

Transfer to Surgery

Holding Area

Holding AreaVerifications

Patient DataSurgical SiteTime Out

IV InsertionIV Antibiotic

Intraoperative Phase Begins

Arrival in SurgeryExplain What to ExpectPositionSafety Tubes Placed After AnesthesiaSkin Prep

Intraoperative PhaseLPN/LVN Role

Scrub Nurse Sterile Instrument Field

Assists Physician

AnesthesiaGeneral Anesthesia

Loss of Sensation, Consciousness, Reflexes IV or Inhalation Route

Local AnesthesiaLoss of Sensation to Body RegionInjection of a Local Agent

Endotracheal Tube

Malignant HyperthermiaRare Hereditary Muscle Disease Triggered by Some Types of General Anesthesia Agents

Spinal Anesthesia

AnesthesiaAdjunct Agents Conscious Sedation

Surgery

PACU

Postoperative PhasePACU Nursing Diagnoses

Risk for AspirationIneffective Breathing Pattern

Ineffective Airway Clearance

Deficient Fluid Volume

Risk for Injury

Postoperative Phase (cont’d)PACU Nursing Diagnoses (cont’d)

Disturbed Sensory Perception

Acute Pain

Family Visitation Keep InformedMaintain Confidentiality (HIPAA)

PACU Discharge CriteriaStable Vital SignsSao2 Greater Than 90%Awake, Baseline Level of ConsciousnessRespirations Not DepressedBleeding Controlled

Nursing Diagnoses for Postoperative Patients

Ineffective Airway Clearance Ineffective Breathing Pattern Acute Pain Deficient Fluid Volume Ineffective Tissue Perfusion Impaired Urinary Elimination

Nursing Diagnoses for Postoperative Patients (cont’d)

Urinary RetentionRisk for InfectionImpaired Skin IntegrityImbalanced NutritionConstipationImpaired Physical Mobility

Complication Prevention

Complication Prevention (cont’d)

Stapled Incision

Healing Phases

Wound Dehiscence/Evisceration

Ambulatory Surgery Discharge Criteria

Stable Vital SignsNo BleedingNo Nausea/Vomiting Controlled Pain Voided as Indicated No Dizziness When Upright

Discharge InstructionsWritten Instructions/SignedTeaching

Wound Care Medications Complications Equipment

Discharge Instructions (cont’d)Follow-up Physician’s VisitPrescriptions

Discharge Teaching

Home Health CareRN

Assessment, Complex Nursing Care, Teaching

LPN/LVN Basic Nursing Care

Assistants ADLs, Chores