PERIOPERATIVE NURSING Earl Francis R. Sumile, RN, MAN Coordinator and Clinical Facult, Colle!e o" Nursin! , Uni#ersit o" Santo Tomas
+
$earest %ord, true source o" li!&t and 'isdom, !i#e us a (een sense o" understandin!, a retenti#e memor, and t&e ca)acit to !ras) t&in!s correctl. Grant us t&e !race to *e accurate in our e+)ositions, and t&e s(ills to e+)ress oursel#es 'it& t&orou!&ness and clarit. e 'it& us at t&e start o" our stud, !uide its )ro!ress and *rin! it to com)letion, !rant t&is t&rou!& -esus C&rist, our %ord. Amen Mot&er Mar Immaculate Seat o" /isdom, Pra "or us. Perioperative Nursing • • •
Assessment and History Physical Needs Laboratory works CP Clearance Diagnostics Procedures Psychosocial Needs Health eachings eachings In!ormed Consent Procedural and Process In!ormation "piritual Preparation
Preoperative eachings eachings • • • • • • • •
Process In!ormation Procedural In!ormation Dietary #estrictions Preoperative "have $amily %rientation Postoperative e&pectations #ehabilitation $ollow up
%perating #oom "etting Areas In the %perating #oom • •
Non-restricted Area Area "emi-restricted Area
Pa!e 0 1
•
#estricted Area
Intra-operative Phase Categories o! surgery •
•
+mergency - Done immediately to save li!e or limb* akes precedence over any other surgery scheduled +lective - Done at the patient,s and surgeon,s convenience * 'ay be per!ormed within days and even months a!ter diagnosis
'usts !or an %# Nurse • • • • • • •
'ust work rapidly but e!!iciently even under tension 'ust think and react uickly 'ust anticipate always one step ahead o! the surgeon 'ust be %rgani)ed and must work smoothly 'ust !ollow rules rigidly 'ust be patient 'ust have presence o! mind all the time.
Asepsis 1 Absence o! microorganisms Disin!ection 1 #eduction o! pathologic microorganisms without destroying the spores Contaminated 1 "oiled with microorganisms In!ection 1 Invasion o! the body by pathogenic microorganisms "pores 1 Are inactive but viable state o! a microorganism
Asepsis 1 Absence o! microorganisms Disin!ection 1 #eduction o! pathologic microorganisms without destroying the spores Contaminated 1 "oiled with microorganisms In!ection 1 Invasion o! the body by pathogenic microorganisms "pores 1 Are inactive but viable state o! a microorganism "terile 1 $ree !rom microorganisms including spores "urgical Conscience 1 Involves the concept o! sel!-inspection and moral obligation involving scienti!ic and intellectual honesty8 h onesty8
"ources o! Contamination • • • • •
"kin #espiratory tract Articles used in the procedure Circulating Air "crub team5patient,s hair
Principles on Asepsis • • •
"terile Items "terile $ield ra!!ic
• • •
Drapes 4owns 4loves
'edical and "urgical Instruments and "upplies Category • • •
Category I 9 Critical Items - 'ust be sterili)ed Category II9 "emi critical Items - "terili)ation i! pre!erred but disin!ection is acceptable Category III9 Non critical Items - clean
"tarts !rom induction period until paient loses consciousness Patient may appear drowsy or di))y 6eep the room uiet
"tage @ :+&citement5delirium; •
• • •
Lasts !rom the time the patient loses consciousness until he loses certain re!le&es such as swallowing*gag and eyelid8 'ay appear e&cited * may breathe irregularly "ensitive to e&ternal stimuli 'aintain silence
"tage :"urgical anesthesia; • •
$rom the period the patient lost certain re!le&es and respiratory paralysis occurs Patient with regular respiration* constricted pupils* 2aws rela& and auditory sensation is lost
"tage ( :"tage o! Danger;
Pa!e 0 5
•
• •
#eached when too much anesthesia has been given and the patient has not been observed care!ully8 Death may result !rom respiratory and or cardiac arrest unless resuscitated properly Patient is not breathing with little to no heart beat8
ypes o! Anesthesia 4eneral Anesthesia
•
• •
#eached when too much anesthesia has been given and the patient has not been observed care!ully8 Death may result !rom respiratory and or cardiac arrest unless resuscitated properly Patient is not breathing with little to no heart beat8
ypes o! Anesthesia 4eneral Anesthesia •
•
•
Association pathways are broken in the cerebral c erebral corte& to produce more or less lack o! sensory and motor perception Pain is controlled by general insensibility * the patient is unconscious* he cannot hear* !eel* or move his whole body8 7sed in operations above the horacic level
#egional Anesthesia •
•
Depresses super!icial nerves and inter!eres with the conduction o! pain impulses !rom certain area or region Pain is controlled without loss o! consciousnessB one region or an area o! the body is anestheti)ed
4eneral Anesthesia Inhalation Inhalation
- with the use o! volatile gases and vapors* +ither per mask or +ndotracheal tube
Common Anesthetics • •
"evo!lurane :sevorane; Des!lurane :"uprane;
• •
Iso!lurane :!orane; Halothane:!luothane;
Drugs that may produce hypnosis* sedation* amnesia and or analgesia is administered via I3
Intravenous Intravenous -
Common Anesthetics •
hiopental Na :pentothal;
•
Propo!ol :diprivan;
•
6etamine :6etalar;
#egional Anesthesia +pidural Anesthesia •
7sed !or Long Procedures below the horacic Level
Pa!e 0 6
• •
7sed !or post op management o! pain8 7ses an epidural Catheter :peri!i&;
Positioning - Choice o! Position is made by the surgeon and positioning is done by the members o! the surgical team $actors to Consider9 • •
Length o! the procedure "ite o! the operation
• •
Pain upon moving 6ind o! anesthetic
uali!ications o! a 4ood Position • • • • • •
Not inter!ere with respirations respirations Not inter!ere with circulation Not cause pressure on any nerve Provide total accesibility !or !or administration o! anesthesia anesthesia and surgery #e!lect proper body alignment* alignment* resulting in in no undue post operative discom!ort discom!ort Patient sa!ety
Determine the area and the e&tent to be prepared including proposed incision8 Practice modesty and privacy +&amine area to be prepared In abdominal operations !ocus on the umbilicus In shaving !ollow the direction o! the hair growth while the other hand e&erts an opposite !orce I! a wound is present start !rom the clean area !irst be!ore the dirty area
"uture 1 any material used to sew* stitch stitch or hold tissues or body parts together Ligature 1 a tie* to ligate blood vessels Primary suture line 1 main layers o! tissues which must be sutured "tay or tension suture 1 sutures placed at the incision to act as rein!orcement ensile ensile strength 1 amount o! tension o! pull that a strand will withstand
7ses o! suture • • •
Ligating "uturing Closing
ypes o! "utures • •
Absorbable or Non absorbable 'ono!ilament or 'ulti!ilament
Criteria !or a good suture • • •
• • • •
3ersatility +ase o! handling 'inimal tissue reaction and inability to create a !avorable en vironment !or in!ection and tissue re2ection High tensile strength +asy to thread* easy to sterili)e and will not shrink 'ade o! non electrolyte* non capillary* non allergenic and non carcinogenic materials Absorbed with minimal tissue reaction
"urgical Needles hree 0asic "ections • • •
Point 0ody or "ha!t +ye
Points
Pa!e 0 1:
• • •
aper Point 0lunt Point Cutting Point o apercut o Conventional cutting o #everse cutting
he +ye o! the Needle •
Atraumatic or "waged
"uturing #esponsibilities
• • •
aper Point 0lunt Point Cutting Point o apercut o Conventional cutting o #everse cutting
he +ye o! the Needle • • • •
Atraumatic or "waged +yed $rench +yed or "pring Controlled release
Alternative 'ethods to "uturing "urgical "trips "kin Clips • "kin "taples • Ligation Clips • "urgical "taples • issue adhesives "urgical•"crubbing* 4owning and 4loving Hemostatic Agents • Preparations immediately be!ore scrub 0one wa& • ?8 'ake•sure you have checked room and table including gowns and gloves to be used8 Absorbable gelatine your sponge sponge • @8 Attend toCollagen your personal needs i8e8 Hunger* voiding* de!ecating etc8 %&idi)ed cellulose • 8 Inspect hands !or cuts and abrasions8 "kin integrity o! hands and arms •
(8 #emove all !inger 2ewelry8 Fewelry harbors microorganisms8 microorganisms8 8 0e sure all hair is covered by cap or bonnet8 G8 Ad2ust mask snugly and com!ortably over nose and mouth8 <8 $old sleeves o! the scrub suit i! too long8 8 Clean eyeglasses i! worn8 Ad2ust eyewear or !ace shield com!ortably in relation to mask8 " ecure i! necessary8 Principles o! Asepsis #elated to "urgical 4owning and 4loving •
• • • • •
"terile persons keep well within sterile area8 "terile persons pass each other back to back or !ront to !ront8 o "terile person !aces a sterile area to pass it o "terile persons stay within the sterile !ield o 4owns are considered sterile only !rom the waist to shoulder level* in !ront and in the sleeves8 Pa!e 0 11 "terile persons keep hands in sight and at or above waist level only Arms are never !olded because there may be perspirations in the a&illary region8 Items dropped below the waist level are considered unsterile and must be discarded Hands are kept away !rom the !ace with elbows close to side
Legal and +thical Dimensions in the Practice o! %# Nursing Common Issues • • • •
Consent /rong /r ong Patient5"ite surgery Counting "pecimen Handling Labeling o #$" o
Legal and +thical Dimensions in the Practice o! %# Nursing Common Issues • • • •
• •
Consent /rong /r ong Patient5"ite surgery Counting "pecimen Handling Labeling o #$" o 'edico-legal o 'edication errors Negligence
T;E STOR< STOR< OF T;E %OST %OST ;AN$S One mornin! as I (nelt and )raed I !a=ed at t&e statue o" C&rist in cla. And lo> To m disma ;e?s !ot no arms and &ands t&at s'a. I searc&ed around "rom roo" to !round and e#en *eond. ;is 'ounded &ands could not *e "ound. So I turned to ;im and as(ed t&e %ord i" it?s a dream '& in ;is !lorious seat ;e seemed incom)lete@ ;e re)lied YOU ARE MY HANDS HANDS &eal t&e 'ounds o" t&e aBicted care "or t&e )oor !i#e &o)e to t&e &el)less reac& out to t&e 'ear clot&e t&e na(ed doin! t&is, m c&ild ou 'ill
