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Nursing Care of the Postoperative Spine Patient Care. Michael D Smith MD Twin Cities Orthopedics October 2012. Objectives. Discuss indications for surgery Present perioperative complications to watch for Review practical surgeon concerns regarding nursing assessment - PowerPoint PPT Presentation
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Nursing Care of the Postoperative Spine
Patient CareMichael D Smith MD
Twin Cities OrthopedicsOctober 2012
Objectivesbull Discuss indications for surgerybull Present perioperative
complications to watch forbull Review practical surgeon concerns
regarding nursing assessment biased toward cervical spine
procedures
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Objectivesbull Discuss indications for surgerybull Present perioperative
complications to watch forbull Review practical surgeon concerns
regarding nursing assessment biased toward cervical spine
procedures
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Indications for Spinal Surgery
The Big Threebull Neurologic compressionbull Instabilitybull Deformity
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Pain -Indication for Surgery
bull Pain- unmanageable and associated with compression deformity or instability
bull Degenerative findings- common and incidental
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Disc Herniation
Grade 1-4 based on
morphology and extension
beyond PLL
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Neurological Indicationsbull Pain
numbness weakness tingling from cord or root compression
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Instability
bull Spine unable to tolerate daily loads without excessive motion
bull Degenerative acquired post-traumatic neoplastic congenital
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Traumatic
Instability
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Degenerative
Instability
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Cervical Deformity
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Perioperative Complications
bull General medical- cardiac (MI) respiratory urologic pulmonary (UTI)
bull Specific- device related (posterior gt anterior)
bull Surgical- hematoma vascular or visceral injury infection
Clin Orthop Relat Res 2011 March 469(3) 649ndash657
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Risk Factors for Complications
bull Pulmonary circulation 952bull Renal disease 555bull Metastatic Cancer 421bull Electrolyte abnl 397bull CHF 346bull Etoh abuse 116
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Demographics for Mortality
bull Malebull Posterior vs anteriorbull Rural vs Urbanbull Older vs youngerbull A-American vs
Caucasian
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Risk Factors for MortalityUnproven
bull DM simplebull DM complicatedbull Obesitybull PVOD
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Common Cervical Spine Procedures
bull Anterior discectomyfusion -ACDFbull Anterior corpectomyfusion -ACCFbull Anterior discectomyreplacement -ACD
bull Posterior decompression ndashforaminotomylaminaplasty -
bull Posterior fusion -PSF
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Surgical Technique-Anterior DecompressionFusion
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Operative Approach
bull Transverse incision -cosmeticbull Left sided preferred (recurrent
laryngeal nerve at less risk)bull Careful anatomic exposure
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Incision Localization
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Exposure Superficial Dissection
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Exposure Deep Dissection
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Completed Exposure
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Fusion Bone Graft Insertion
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Typical ACDF Fixation
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Cervical Corpectomybull Anterior approachbull Extensive exposurebull Longer OR timesbull More complicated
stenosisbull Increased
complication rate airway dysphagia
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Cervical Corpectomy
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Cervical Disc Replacement
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Posterior Procedures
bull Positioningbull Padding of
neurovascular points
bull Peruse facial-cervical area
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Posterior Procedure Positioning
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Posterior Proceduresbull Adhere to
demonstrated ROM to avoid impingement cordroot
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Indications and Need for Nursing Care
bull Varied patient populationbull Varying neurologic presentationbull Broad age range and support
structuresbull Outpatient to lengthy
hospitalizations
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Phases of Nursing Carebull Preoperative
bull Education
counseling support
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Phases of Nursing Carebull Perioperati
ve bull Routines
time outs counts cross pollination
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Phase of Nursing Carebull Postoperative bull Dependent on
nursing input and remote assessment
bull Typical defines patient perception f care
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Complicationsbull Anything that is touched moved
looked at exposed intubated extubated cooled or heated can be injured
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Postoperative Edema
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Nursing Concernsbull Tracheal obstruction- expanding
hematoma lymphatic congestion vocal cord paralysis
bull Stridor- an impending arrest
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Nursing Concernsbull Esophageal ndash retraction local
change in motility lacerationbull Indigo carmine for leak
assessmentbull Difficulty ndashgt barium swallow
steroids feeding tube
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Esophageal Perforation
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Esophageal Perforation
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Displaced Bone Graft
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Nursing Concerns
bull Neurological assessment- compare pre to post op status
bull Pain management ndash separate topic
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Mental Health Issuesbull Anxietybull Depressionbull Somatizationbull Unrealistic expectations
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Anxiety Disordersbull 18 of general
population (40M)bull Pervasive and
variable in expression
Kessler RC Arch Gen Psychiatry 2005 Jun62(6)617-27
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Anxiety Disordersbull OCDbull PTSD bull Social phobiasbull Specific
phobiasbull GAD
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Depressionbull 10 of general populationbull Variable expressionbull Surgeons do poor job in pre-op
recognitionbull May coexist with anxiety
syndromes
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Depression The 3 Rs
bull Reduced threshold for need for surgery
bull Reduced threshold for reporting pain after surgery
bull Reduced support systems and preop physical prowess
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Substance Abuse240M in Risk Group
bull Chemical 5 12Mbull Alcohol 1024Mbull Tobacco 1946Mbull Associated mental health issue (ie
anxiety+Etoh) 54
wwwhhsgovodaboutfact_sheetssubstanceabusehtml
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Coping Skill Set PointReadjusted
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Postoperative Anxietybull Assurancebull Adequate analgesiabull Anxiolytics-Ativan Valium Xanax bull Allied health approach (aroma therapy
massage music pets spouse)bull Anticipation and preop teachingThe impact of preoperative information on state anxiety postoperative pain and
satisfaction with pain managementSjoumlling M Patient Educ Couns 2003 Oct51(2)169-76
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
Thank You
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
CONFLICT OF INTERESTCONFLICT OF INTEREST
I hereby certify that to the best of my knowledge no I hereby certify that to the best of my knowledge no aspect of my current personal or professional aspect of my current personal or professional situation might reasonably be expected to affect situation might reasonably be expected to affect significantly my views on the subject on which I am significantly my views on the subject on which I am presentingpresenting
