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According to URGENCY
Preoperative Phase, extends from the time the client is According to DEGREE OF RISK
admitted in the surgical unit, to the time he/she is Major Surgery
prepared for the surgical procedure, until he is - High risk / Greater Risk for Infection
transported into the operating room. - Extensive
- Prolonged
Intraoperative Phase, extends from the time the client is - Large amount of blood loss
admitted to the OR, to the time of administration of - Vital organ may be handled or removed
anesthesia, surgical procedure is done, until he/she is Minor Surgery
transported to the RR/PACU. - Generally not prolonged
- Leads to few serious complication
Postoperative Phase, extends from the time the client is - Involves less risk
admitted to the recovery room, to the time he is
transported back into the surgical unit, discharged from Ambulatory Surgery/ Same-day Surgery / Outpatient
the hospital, until the follow-up care. Surgery
- adult sign their own operative permit Interlace his fingers and place hands over the
- obtained before sedation proposed incision site, this will act as a splint and
For minors, parents or someone standing in their will not harm the incision.
behalf, gives the consent. Lean forward slightly while sitting in bed.
Breath, using diaphragm
Note: for a married emancipated minor parental Inhale fully with the mouth slightly open.
consent is not needed anymore, spouse is accepted Let out 3-4 sharp hacks.
With mouth open, take in a deep breath and quickly
For mentally ill and unconscious patient, consent give 1-2 strong coughs.
must be taken from the parents or legal guardian
If the patient is unable to write, an “X” ia accepted Turning
if there is a witness to his mark Changing positions from back to side-lying (vice
Secured without pressure and threat versa ) stimulates circulation, encourages deeper
A witness is desirable – nurse, physician or breathing and relieve pressure areas
authorized persons. Help the patient to move onto his side if assistance is
When an emergency situation exists, no consent is needed.
necessary because inaction at such time may cause Place the uppermost leg in a more flexed position
greater injury. (permission via telephone/cellphone than that of the lower leg and place a pillow
is accepted but must be signed within 24hrs.) comfortably between the legs.
Make sure that the patient is turned from one side to
the back and onto the other side every 2 hours.
Diaphragmatic Breathing
Refers to a flattening of the dome of the diaphragm
during inspiration, with resultant enlargement of
upper abdomen as air rushes in. During expiration,
abdominal muscles contract.
In a semi-Fowlers position, with your hands loose-
fist, allow to rest lightly on the front of lower ribs.
Breathe out gently and fully as the ribs sink down and
inward toward midline.
Then take a deep breath through the nose and mouth,
letting the abdomen rise as the lungs fill with air.
Hold breath for a count of 5.
Exhale and let out all the air through your nose and
mouth.
Repeat this exercise 15 times with a short rest after
each group of 5.
Coughing
Promotes removal of chest secretions.
Preparing the Patient the Evening Before Surgery Check ID band, skin prep
Preparing the Skin Check for special orders – enema, IV line
- have a full bath to reduce microorganisms in the Check NPO
skin. Have client void before preop medication
- hair should be removed within 1-2 mm of the skin Continue to support emotionally
to avoid skin breakdown, use of electric clipper is Accomplished “preop care checklist
preferable.
Preparing the G.I tract
- NPO, cleansing enema as required
PREOPERATIVE MEDICATIONS
ASA (American Society of Anesthesiologists)
Guidelines for Preoperative Fasting Goals:
To aid in the administration of an anesthetics.
Liquid and Food Intake Minimum To minimize respiratory tract secretion and changes
Fasting Period in heart rate.
Clear Liquids 2
To relax the patient and reduce anxiety.
Breast Milk 4
Nonhuman Milk 6 Commonly used Preop Meds.
Light Meal 6 Tranquilizers & Sedatives
Regular / Heavy Meals 8 * Midazolam
* Diazepam ( Valium )
Preparing for Anesthesia * Lorazepam ( Ativan )
- Avoid alcohol and cigarette smoking for at least 24 * Diphenhydramine
hours before surgery. Analgesics
Promoting rest and sleep * Nalbuphine ( Nubain )
- Administer sedatives as ordered Anticholinergics
* Atropine Sulfate
Preparing the Person on the Day Of Surgery Proton Pump Inhibitors
* Omeprazole ( Losec )
Early A.M Care * Famotidine
Awaken 1 hour before preop medications
Morning bath, mouth wash Transporting the Patient to the OR
Provide clean gown Adhere to the principle of maintaining the comfort
Remove hairpins, braid long hair, cover hair with cap and safety of the patient.
if available. Accompany OR attendants to the patient’s bedside
Remove dentures, colored nail polish, hearing aid, for introduction and proper identification.
contact lenses, jewelries. Assist in transferring the patient from bed to
Take baseline vital sign before preop medication. stretcher.
Complete the chart and preoperative checklist.
Make sure that the patient arrive in the OR at the
proper time.
ANESTHESIA
• State of “Narcosis”
• Anesthetics can produce muscle relaxation,
block transmission of pain nerve impulses and
suppress reflexes.
• It can also temporary decrease memory
retrieval and recall.
The effects of anesthesia are monitored by considering
the following parameters:
- Respiration
- O2 saturation / CO2 level
- HR and BP
- Urine output
Types of Anesthesia
1. General Anesthesia
reversible state consisting of complete loss of
consciousness and sensation.
protective reflexes such as cough and gag are lost
provides analgesia, muscle relaxation and sedation.
produces amnesia and hypnosis.
B. Inhalation Anesthesia
2. Regional Anesthesia
temporary interruption of the transmission of nerve
impulses to and from specific area or region of the
body.
achieved by injecting local anesthetics in close
proximity to appropriate nerves.
reduce all painful sensation in one region of the body Indicating a site for insertion of the lumber puncture
without inducing unconsciousness. needle into the subarachnoid space of the spinal
agents used are lidocaine and bupivacaine. canal.
A. Topical Anesthesia
applied directly to the skin and mucous membrane,
open skin surfaces, wounds and burns.
readily absorbed and act rapidly
used topical agents are lidocaine and benzocaine.
D. Peripheral Nerve Block Surgical. Extends from the loss of lid reflex to
achieved by injecting a local anesthetic to anesthetize the loss of most reflexes. surgical procedure is
the surgical site. started.
agents use are chloroprocaine, lidocaine and
bupivacaine. Medullary / Stage of Danger. It is
characterized by respiratory and cardiac
depression or arrest. It is due to overdose of
anesthesia. Resuscitation must be done.
WOUND CARE
INCISION SUPPORTING
RESPIRATORY
Hypostatic Immobility
Pneumonia Impaired
ventilation
Aspiration Aspiration of
Pneumonia gastric contents,
food
Atelectasis A condition in Mucous plugs - Fever ( 1st 24 Deep breathing exercises
which alveoli blocking bronchial hours) Coughing exercise
collapsed and are passageways - Dyspnea Early ambulation
not ventilated Inadequate lung - Tachycardia
expansion - Diaphoresis
Immobility - Pleural pain
- Dull or absent
lung sounds
- Dec. SaO2
Overt Bleeding
- Dressing
saturated with
bright blood
- Bright, free-
flowing blood in
drains or tubes.
Note:
Careful maintenance of
Embolus in the
IV catheters
Foreign body or clot Broken IV catheter venous system
that has moved from Fat usually becomes a
Embolus its site of formation Amniotic fluid pulmonary
to another area of embolus
the body
URINARY
Urinary Inability to empty Depressed bladder - Larger fluid Monitor I & O
Retention the bladder, with muscle tone from intake than output Interventions to facilitate
excessive narcotics and - Inability to void voiding
accumulation of anesthetics - Bladder Urinary Catheterization
urine in the bladder Handling of tissue distention as needed
during surgery on - Suprapubic
adjacent organs discomfort
Spasm of the - Restlessness
bladder sphincter
Urinary Inability of the Loss of tone of the - 30 – 60 ml of Monitor I & O
Incontinence bladder to hold bladder sphincter urine q 15-30 mins
accumulated urine
Urinary Tract Inflammation of the Immobilization - Fever ( 48 hours Adequate fluid intake
Infection bladder, ureters or Limited fluid postop) Early ambulation
urethra intake - Burning sensation Aseptic catheterization as
when voiding needed
- Urgency Good perineal hygiene
- Cloudy urine
- Lower abdominal
pain
GASTRO-
INTESTINAL
WOUND
Wound Infection Inflammation and Poor aseptic - Fever ( 72 hours Keep wound clean and
infection of incision techniques postop) dry
or drain site - Redness, swelling Surgical aseptic technique
, pain and warmth when changing dressing
- Pus or discharge Antibiotic therapy
on the wound site
- Foul smelling
discharge
PSYCHOLOGIC
STUDY HARD
GOD BLESS YOU
THANKS