PATIENT CARE CONCEPTSPATIENT CARE CONCEPTS

Outline Outline

Physical health and its relationship to the ST Physical health and its relationship to the ST and the surgical patientand the surgical patient

Post-operative complicationsPost-operative complications Equipment and immediate accessEquipment and immediate access PACU criteriaPACU criteria Post-operative discharge instructionsPost-operative discharge instructions KKübler-Ross Stages of Grief/Death and Dyingübler-Ross Stages of Grief/Death and Dying Alternative Healing MethodologiesAlternative Healing Methodologies Quality verses quantity of lifeQuality verses quantity of life Organ procurement and transplantationOrgan procurement and transplantation

Physical HealthPhysical Health(Student Presentations)(Student Presentations)

Relate the following health and Relate the following health and wellness concepts to the surgical wellness concepts to the surgical patient and the surgical technologist patient and the surgical technologist role:role:

Physical activityPhysical activity NutritionNutrition Tobacco useTobacco use Alcohol useAlcohol use Stress Stress

Post-Operative Post-Operative ComplicationsComplications

Complications are difficulties post-Complications are difficulties post-operatively that warrant immediate operatively that warrant immediate treatment and may result in returning treatment and may result in returning to surgery.to surgery.

Complications are accepted as risks of Complications are accepted as risks of having surgery, so are shared with having surgery, so are shared with the patient pre-operatively before the the patient pre-operatively before the surgical consent is signedsurgical consent is signed

Can result in prolonged Can result in prolonged hospitalization as well as prolonging a hospitalization as well as prolonging a patient’s recovery or return to normal patient’s recovery or return to normal functionfunction

Types of Post-Operative Types of Post-Operative ComplicationsComplications

ShockShock is inadequate blood flow, is inadequate blood flow, therefore poor oxygenation to vital therefore poor oxygenation to vital organs that can result in irreversible organs that can result in irreversible damage to the organs involveddamage to the organs involved

HemorrhageHemorrhage is heavy bleeding is heavy bleeding during, shortly after, or some time during, shortly after, or some time after surgeryafter surgery

Pulmonary Embolus Pulmonary Embolus or PE occurs or PE occurs when a blood clot forms, is dislodged, when a blood clot forms, is dislodged, and is carried to the heart’s pulmonary and is carried to the heart’s pulmonary arteryartery

Types of Post-Operative Types of Post-Operative Complications ContinuedComplications Continued

Respiratory secretion impairmentRespiratory secretion impairment can be from inadequate clearing of can be from inadequate clearing of secretions by the patient (coughing, secretions by the patient (coughing, turning, deep breathing) or the turning, deep breathing) or the accidental aspiration of secretions. This accidental aspiration of secretions. This can result in aspiration pneumonia.can result in aspiration pneumonia.

Gastro-intestinal/bowel Gastro-intestinal/bowel obstruction obstruction is most often seen after is most often seen after surgery involving the abdomen. It can surgery involving the abdomen. It can occur in 3 to 5 days post-op or years occur in 3 to 5 days post-op or years down the road. down the road.

Types of Post-operative Types of Post-operative Complications ContinuedComplications Continued

Post-op PsychosesPost-op Psychoses is caused is caused by temporary lack of oxygen to by temporary lack of oxygen to the brain. It can result in the brain. It can result in depression, anxiety, mental depression, anxiety, mental confusion, and hallucinations. confusion, and hallucinations. This can also be a result of the This can also be a result of the anesthetic or pain medications.anesthetic or pain medications.

Retained foreign bodyRetained foreign body

Equipment/Immediate Access Equipment/Immediate Access Preparing for Complications Preparing for Complications

Keep set-up sterile as well as Keep set-up sterile as well as yourself if able until the patient yourself if able until the patient is assuredly stable and ready for is assuredly stable and ready for transporttransport

Need to be prepared should you Need to be prepared should you have to go back in to a patienthave to go back in to a patient

OxygenOxygen DefibrillatorDefibrillator

Post-Anesthesia Care Post-Anesthesia Care UnitUnit

(PACU)(PACU) Given there are no Given there are no

complications, established complications, established criteria must be met by the criteria must be met by the patient before they can be patient before they can be discharged to the surgical floor discharged to the surgical floor of the hospital or home in the of the hospital or home in the case of out-patient surgerycase of out-patient surgery

PACU CriteriaPACU Criteria

Uncomplicated breathingUncomplicated breathing Stable or a return to 20% of baseline VSStable or a return to 20% of baseline VS Temperature at 36Temperature at 36°C or 96°F or better°C or 96°F or better Urine output not less than 30ml per hourUrine output not less than 30ml per hour Nausea and vomiting controlledNausea and vomiting controlled Minimal pain complaintsMinimal pain complaints Verbally responsive and oriented to Verbally responsive and oriented to

person, location , and eventsperson, location , and events Can move all four extremitiesCan move all four extremities

Outpatient PACU CriteriaOutpatient PACU Criteria

The same criteria must be met The same criteria must be met with the additional two criteriawith the additional two criteria

Can tolerate small amounts of Can tolerate small amounts of clear fluids without vomitingclear fluids without vomiting

Have a responsible adult to drive Have a responsible adult to drive the patient home and stay with the patient home and stay with them the remainder of the daythem the remainder of the day

Post-Operative/Discharge Post-Operative/Discharge Instructions Instructions

May vary with type of operationMay vary with type of operation Activity will be encouraged/Limits will Activity will be encouraged/Limits will

be on lifting, pulling, and strainingbe on lifting, pulling, and straining Rest will be encouragedRest will be encouraged Driving and operation of heavy Driving and operation of heavy

machinery may be discouraged for machinery may be discouraged for awhileawhile

Resumption of sexual intercourse may Resumption of sexual intercourse may have a time framehave a time frame

Resumption of showering and tub Resumption of showering and tub bathing may have a time framebathing may have a time frame

Discharge or Post-Discharge or Post-Operative Instructions Operative Instructions

ContinuedContinued Alcoholic beverage consumption may Alcoholic beverage consumption may

have a time framehave a time frame Smoking will be discouragedSmoking will be discouraged Diet may be progressiveDiet may be progressive Instructions on dressing changes will Instructions on dressing changes will

be givenbe given Prescriptions will be givenPrescriptions will be given Follow-up doctor appointment will be Follow-up doctor appointment will be

mademade

Discharge or Post-Discharge or Post-Operative Instructions Operative Instructions

ContinuedContinued The following will be reported to the The following will be reported to the

patient’s doctor by the patient patient’s doctor by the patient immediately:immediately:

FeverFever Prolonged nausea and vomitingProlonged nausea and vomiting Swelling or excessive bleedingSwelling or excessive bleeding Excessive painExcessive pain Inability to urinate or voidInability to urinate or void Inability to pass stool or defecate Inability to pass stool or defecate

Death and DyingDeath and Dying(The Grieving Process)(The Grieving Process)

KKübler-Ross Stages of Griefübler-Ross Stages of Grief as as experienced by the patient and the experienced by the patient and the family:family:

DenialDenial-does not accept death as a -does not accept death as a reality. Pretends it isn’t happening. This reality. Pretends it isn’t happening. This prolongs communication of concerns.prolongs communication of concerns.

AngerAnger-Important not to take personally if -Important not to take personally if the health care provider. The person is the health care provider. The person is expressing their sense of helplessness expressing their sense of helplessness and outrage over their situation.and outrage over their situation.

KKübler-Ross Stages of übler-Ross Stages of Grief ContinuedGrief Continued

BargainingBargaining-involves a deal made with -involves a deal made with God, the doctor, or nurse. For God, the doctor, or nurse. For example “If I can live until my example “If I can live until my grandson is born next month, I’ll be grandson is born next month, I’ll be ready to die.” When possible, ready to die.” When possible, requests will be granted.requests will be granted.

DepressionDepression-the previous methods are -the previous methods are no longer working. The person feels no longer working. The person feels sad and full of anguish. Death is a sad and full of anguish. Death is a reality. Support is important at this reality. Support is important at this time.time.

KKübler-Ross Stages of übler-Ross Stages of Grief ContinuedGrief Continued

AcceptanceAcceptance-The person has accepted -The person has accepted the fact they are going to die and is at the fact they are going to die and is at relative peace with it. They will want relative peace with it. They will want loved ones near. They may or may loved ones near. They may or may not want to reflect on the past and not want to reflect on the past and consider the future without them.consider the future without them.

These stages do not always occur in These stages do not always occur in order. Patients and families may go order. Patients and families may go back and forth between stages and back and forth between stages and will likely each be at different stages.will likely each be at different stages.

Alternative Healing Alternative Healing MethodologiesMethodologies

Besides surgical and medical Besides surgical and medical intervention, patients may also seek intervention, patients may also seek help from alternative healing methodshelp from alternative healing methods

Alternative healing needs to be Alternative healing needs to be recognized by the health care recognized by the health care provider and every attempt should be provider and every attempt should be made to accommodate these desires made to accommodate these desires of the patient provided they are of the patient provided they are harmlessharmless

The majority of alternative practices The majority of alternative practices are harmless whether they are are harmless whether they are effective or noteffective or not

Types of Alternative Types of Alternative Healing MethodologiesHealing Methodologies

Folk healersFolk healers VoodooVoodoo Spiritual leaders/counsel/prayerSpiritual leaders/counsel/prayer AcupunctureAcupuncture Medicine manMedicine man HerbalistHerbalist Home remediesHome remedies

Quality verses Quantity Quality verses Quantity of Lifeof Life

Terms Related to Quality Terms Related to Quality verse Quantity of Lifeverse Quantity of Life

Advance DirectivesAdvance Directives Tells your family/caregivers Tells your family/caregivers and physician what kind of care you would want if and physician what kind of care you would want if you couldn’t speak for yourselfyou couldn’t speak for yourself

A. A. Living WillLiving Will Written by you when you were well and Written by you when you were well and comes into effect when your are terminally/incurably comes into effect when your are terminally/incurably ill or in a persistent vegetative state. It details your ill or in a persistent vegetative state. It details your wishes given the previous circumstances. wishes given the previous circumstances.

B. B. HCPA (Health Care Power of Attorney)HCPA (Health Care Power of Attorney) A A document more flexible than a living will. Allows document more flexible than a living will. Allows designation of a family member or friend to be your designation of a family member or friend to be your medical decision maker should you become medical decision maker should you become temporarily or permanently unable to make your own temporarily or permanently unable to make your own decisions (only concerned with health care decisions decisions (only concerned with health care decisions not personal/financial). not personal/financial).

Without a will, we are at the mercy of our Without a will, we are at the mercy of our family’s decisions or physician, who may or family’s decisions or physician, who may or may not do what is “right” or what we would may not do what is “right” or what we would want.want.

Organ Procurement and Organ Procurement and Transplantation MythsTransplantation Myths

Wealthy and famous people get Wealthy and famous people get prioritypriority

The patient is too old and sick to be The patient is too old and sick to be a donora donor

If I’m a donor, doctors won’t If I’m a donor, doctors won’t attempt to save my life if I’m in an attempt to save my life if I’m in an accidentaccident

To be a donor, all I have to do is To be a donor, all I have to do is check that box on my drivers check that box on my drivers licenselicense

Organ Transplantation Organ Transplantation and Procurement Factsand Procurement Facts

Organ transplantation is one of the Organ transplantation is one of the twentieth century’s greatest twentieth century’s greatest breakthroughsbreakthroughs

Nineteen people die every day Nineteen people die every day waiting to receive an organ transplantwaiting to receive an organ transplant

Supply and demand gaps are growingSupply and demand gaps are growing Organ procurement is based on Organ procurement is based on

patients and families volunteering to patients and families volunteering to donate their organsdonate their organs

Cost is a factor (many insurances do Cost is a factor (many insurances do not cover expense/cost can range not cover expense/cost can range from $35,000 to $200,000 the first from $35,000 to $200,000 the first year of a transplantyear of a transplant

Summary Summary

Physical health and its relationship to the ST Physical health and its relationship to the ST and the surgical patientand the surgical patient

Post-operative complicationsPost-operative complications Equipment and immediate accessEquipment and immediate access PACU criteriaPACU criteria Post-operative discharge instructionsPost-operative discharge instructions KKübler-Ross Stages of Grief/Death and Dyingübler-Ross Stages of Grief/Death and Dying Alternative Healing MethodologiesAlternative Healing Methodologies Quality verses quantity of lifeQuality verses quantity of life Organ procurement and transplantationOrgan procurement and transplantation