The person undergoing surgery

DK/CIII/surgical pt1

The person undergoing surgery


The person undergoing surgery

If you work in a hospital, you may have contact with a person before and after surgery. In nursing facilities, many residents are recovering from surgery. Many post operative patients need home care. Your role in caring for surgical patients depends on certain factors:

The employer’s policies Whether the surgery was major or minor The person’s condition before surgery The person’s condition after surgery


Preoperative Care

The preoperative phase begins when surgical intervention is first considered and ends when the patient is admitted to the operating theatre

Preparations for surgery depend on diagnosis & type of surgery


Pre operative preparation including client communication/teaching

An important part of modern surgery is day surgery, also know as ambulatory surgery. Advance surgical techniques and better client preparation have allowed for clients to be admitted, operated on and discharged in the same day. All types of anaesthesia can be used.

Surgery is treating diseases, injuries and deformities by operation. As part of the client’s preparation you may need to discuss various terms used to describe surgery.


Types of surgery

Elective surgery is done for the person’s well-being. It is not life saving and may not be necessary for the person’s health. The surgery is scheduled well ahead of time, allowing the person to be well prepared psychologically and emotionally and leaving time for any pre testing to be done.

Urgent surgery is necessary for the person’s health. It must be done soon to prevent damage or disease.

Emergency surgery is done immediately It is life saving and the need is sudden and unexpected.


Surgical intervention

May be directed towards: a tumour (excess of tissue) A defect (deficiency of tissue) A deformity (displacement of structures) Or the removal of foreign bodies (non-living

material)


Methods of performing surgical procedures:

open surgery e.g. mastectomy – external surgical wound

closed surgery e.g. T.U.R.P. – wound is internal

minimal access e.g. laparoscopic – minimal external wounds and faster recovery time


Preparation

Providing information Teaching activities Examining/assessing the individual Performing laboratory tests and diagnostic

studies Gaining the individual’s informed consent Preparing the individual psychologically and

physically


The person needs to be prepared for what happens before after and during surgery.

Physical and psychological preparation is necessary.

Often the person who needs to have surgery experiences many fears, - fear of loss of an organ, - who will care for the children, - how will they cope with the pain, - will they survive?

http://affiliates.art.com/get.art?T=15055608&A=725183&L=8&P=12566896&S=2&Y=0


Purpose of surgery

diagnostic surgical exploration to aid diagnosis e.g. biopsy to determine presence and/or extent of pathology

Constructive restores function lost or reduced (congenital anomalies) e.g. congenital defects

transplant due to organ damage reconstructive restores function or

appearance to traumatised or malfunctioning tissues e.g. fractures

palliative relieve or reduce intensity of disease symptoms e.g. colostomy to bypass inoperable bowel obstruction from cancer

Cosmetic to improve appearance e.g. rhinoplasty, repairing burns scars.


Common Fears and Concerns of Surgical Patients

•The fear of cancer •The fear of prolonged recovery

•The fear of body disfigurement and scarring •The fear of more surgery and treatments

•The fear of disability •The fear of being separated from family and friends

•The fear of pain •The fear of tubes, needles and other equipment

•The fear of dying •Concerns

•The fear of anaesthesia and it’s effects •Who will look after the partner

•The fear of going to sleep and not waking up •Who will take care of the pets

•The fear of exposure •Who will pay the bills

•The fear of complications •Who will take care of the unit


Nursing Assistant responsibilities in caring for the person who has fears and concerns:

Listen to the person who voices fears or concerns about surgery

Refer any questions about the surgery or it’s results to the nurse

Explain any procedures you do

Perform your tasks in a competent and confident manner


The Pre-operative Period

The doctor or registered nurse will do any pre-operative teaching. Once the doctor explains what is going to be done the person may sign a consent form should they wish to proceed. The registered nurse does the pre-operative teaching and tells the person what to expect after surgery.

It is not your role to educate the patient, but you should be aware of what is happening so you can give efficient basic care.


Pre operative preparation

elective: pre-admission clinics/tests early intervention programs patient education/assessment referralemergency day only/short stay/long stay: transit lounge/pre-op prep areas


Anaesthesia

Factors influencing the choice of anaesthetic include :

1. Nature of the surgery (length & complexity of

of operation).

2. Client’s status (pre-existing medical

conditions).

3. Anatomical & physiological conditions.

4. Client preference.


Anaesthesia

Anesthesia blocks the perception of pain. Anesthesia is classified according to the CNS effects: i) local – the loss of sensation without the loss of consciousness ii) regional – the loss of sensation to a region of the body without loss of

consciousness when a specific nerve or group of nerves is blocked with the administration of a local anaesthetic

iii) general – the loss of sensation with loss of consciousness,+/- skeletal muscle relaxation, analgesia and elimination of the somatic, autonomic and endocrine responses


awareness of patient teaching

deep breathing and coughing exercises pain management (including PCA) moving and changing position wounds, drains, intravenous infusions,

indwelling catheters, nasogastric tubes specialised surgical procedures



anti-embolic stockings

support blood vessels prevent stasis prevent thrombus formation


pre-op

base line data collection (including weight) skin preparation ( you may be involved with this),

according to policy clipping showering total body wash gastrointestinal preparation, e.g. bowel preparation fasting regimes ( NBM 6-8 hours before) there

should be a sign above the person’s bed and the water jug should be removed.


Pre-Operative Checklist

Item Time Rationale

1. Operative area shaved 1 day pre- op or in OT

Hairs – harbour micro-organisms - obscure op site

2. Special skin preparation

1-2 days pre-op morning of op

Decreases risk of infection.

3. Weight 1 day pre-op Calculation of drug dosage Baseline for comparison

4. Consent Pre-op Legal purposes – written consent necessary for operative procedures

5. Bowel preparation Night before Prevents incontinence during anaesthesia. Decreases risk of post-op discomfort and abdominal distension.



Item Time Rationale

6. Premedication given As ordered Promotes relaxation. Reduces apprehension. Dries up oral secretions. Decreases risk of inhalation.

7. Natural teethDentures – in situ Removed

Prior to transfer to OT May be dislodged during anaesthesia.

8. Make up; nail polish,jewellery,

hairpins, contact lenses removed

Day of surgery Nail polish – easier to observe the individual for cyanosis. Prosthesis – may cause injury. Jewellery – may come in contact with metal and burn individual if diathermy used.



Item Time Rationale

9. Temp:Chart

Pulse:Resp:B.P.:

On admission and on day of surgery

Abnormality may mean postponement of operation

10. NBM:- Morning op

-- afternoon op

-Usually 12mn night before - 6 hrs prior

Present of food/fluid causes vomiting and risk of inhalation.

11. Intragastric tube in situ

As ordered Aspiration of stomach contents and decompression of stomach.



Item Time Rationale

12. Stomach aspiratedTime:Amount:

If emergency op and patient has had food during the past 6 hours.

13. Voided/CatheterisedTime:Amount:Urinalysis:

1 hr pre-op

Morning of op

To prevent incontinence and prevent injury to bladder.Detect renal dysfunction.

14. X rays with patient(eg

Orthopaedic,Gallbladder)E.C.G.

To accompany

patient to OT For referral by surgeon.For referral by anaesthetist.



Item Time Rationale

15. Outpatient clinic notes To accompany patient to OT

For referral by anaesthetist and surgeon.

16. All current and previous history notes

To accompany patient to OT

For referral by anaesthetist and surgeon.

17. Blood cross matched and typed

Day before Possible need for transfusion.



Item Time Rationale

18. No. of blood bottles in O.T. fridge

Day of op Easy access if transfusion necessary

19. Night sedation Night before To relax, decrease anxiety.


Recovery room


Post-op

- preparing the patient’s room (surgical bed, placing equipment and supplies in the room, as directed by the nurse)

- observations: You may be assigned to measure vital signs and observe the patient’s condition.

- Other observations: time and amount of first voiding, FBC.

- care of drips/drains ( If the drip is not dripping, do not touch the drip(IV), inform the RN) Inform the registered nurse of the appearance of bright red blood from the drainage tubes or suction tubes.


Post-op assessment

Vital signs Colour Level of consciousness

(LOC) Wound dressing Drainage from urinary

catheter Presence of discomfort

or pain


Post op

An IV (intravenous catheter) in your hand or arm to provide fluids and medicines until you are able to drink fluids well.

A face mask or tube under your nose to supply oxygen.

A tube to drain urine from your bladder. You may feel the urge to urinate even though your bladder is empty.

An NG (nasogastric) tube through your nose into your stomach to help prevent nausea and vomiting.

Wound drains to help your incision heal.

Leg wraps that inflate and deflate and/or elastic stockings to help circulation in your legs while you are less active.


Post op

Remember: The post-op person is NBM until they have been given permission by the doctor to progress to a different diet. The registered nurse will tell you when to change the signs above the patient’s bed.


Subsequent post-op care

Assessing respiratory and circulatory needs Comfort needs Nutritional and fluid needs Elimination needs Movement and exercise needs Hygiene needs Psychological needs Protection and safety needs Wound care needs (including drainage tubes, sutures and

clips) Observe for complications Preparation for discharge


Complications

Pain Haemorrhage Shock (hypovolaemic) respiratory complications (pneumonia,

atelectasis) Thrombophlebitis Pulmonary embolism Nausea and vomiting (N&V) Abdominal distension Paralytic ileus Urinary retention Wound infection/dehiscence/evisceration


Operative procedures

Some examples include: Prostatectomy Hysterectomy Cholecystectomy Appendicectomy Tonsillectomy (Breast) lumpectomy Hip replacement Knee replacement


Operating room



Documents

The person undergoing surgery