Chapter 50: Care of Surgical Patients

Objectives: Demonstrate postoperative exercises: diaphragmatic breathing, coughing, incentive spirometer use, turning and leg exercises. (3,4,6)
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 Association

of perioperative Registered Nurses (AORN) was established in 1956. The structure, process and outcome standards of surgical nursing, align with the American Nurses Association (ANA). AORN Focus: Clinical practice Professional practice Administrative practice Patient outcomes Quality improvement

The American Society of Anesthesiologists (ASA) Classes 1, 2, & 3 = Ambulatory surgery Classes 4 & 5 = Inpatient surgery.
Inpatient

Surgery (Hospital)

Ambulatory

Surgery (Outpatient, short stay, same day)

Seriousness Major Minor Urgency Elective Urgent Emergent Purpose Diagnostic Ablative Palliative Reconstructive/ Restorative Procurement for transplant Constructive Cosmetic
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 The

synthesis of knowledge and information, from personal experience, critical thinking, practice standards, and patient/family assessment.

 Assessment

Expectations Focused exam Potential risks

Previous history
Patients resources Diagnostic test results

and Pain

 Diagnosis

What were the assessment patterns?

What are the potential issues? How do the related factors create a direction of

the patients care?

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 Planning

Preoperative teaching plan Early involvement Goals and outcomes

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 Implementation

Informed consent Health promotion Acute care

Physical preparation Reduction in risk of infection Bowel/Bladder preparation Rest

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 Evaluation

Through the eyes of the patient Patient Outcomes

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Circulating Nurse

Scrub Nurse

Must be an RN Monitors sterile technique Monitors patient Assists the physician Operates non-sterile equipment Provides some medications/blood/fluid Documenting as the case progresses Verifies counts

Can be an RN/LPN/licensed technologist Maintains sterile field Assists with sterile drapes Provides equipment and instruments to the doctor Assists with counts

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 Preoperative

Area (Holding Area)

Verification and Validation

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Assessment:
Assess Analyze

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 Diagnosis Plan
Goals and outcomes Priorities Teamwork and collaboration

Implementation

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Anesthesia:

General anesthesia paralyzed with amnesia Regional anesthesia loss of sensation at the area
of surgery / nerve block

Local Anesthesia loss of sensation at the desired

site.

Conscious Sedation procedures that do not need

complete anesthesia. The patient must independently monitor their respiratory status.

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 Assessment

Through the patients

fluid and electrolyte

eyes Airway Respiration Circulation temperature control

balance Neurological Skin integrity

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Diagnosis Planning
Goals and outcomes Priorities Teamwork and Collaboration

Implementation

Respiratory Circulatory Complications Rest Temperature Neurological function fluid and electrolyte balance normal bowel/bladder Nutrition Wound healing Self-Concept protection
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 Evaluation

Through the patients eyes Patient outcomes

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Obesity places patients at and increased surgical risk because of which of the following factors? (Select all that apply.)
1.

2.
3. 4.

Risk for bleeding is increased Ventilation is reduced Fatty tissue has a poor blood supply Metabolic demands are increased.
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Obesity places patients at and increased surgical risk because of which of the following factors? (Select all that apply.)
1.

2.
3. 4.

Risk for bleeding is increased Ventilation is reduced Fatty tissue has a poor blood supply Metabolic demands are increased.
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Hand-off communications that occur between the post anesthesia care unit (PACU) nurse and the nurse on the postoperative nursing unit should be done when a patient returns to the nursing unit. Select appropriate components of a safe and effective hand-off. (Select all that apply.)
1. 2. 3. 4.

Vital signs, the type of anesthesia provided, blood loss, and level of consciousness. Uninterrupted time to review the recent pertinent events and ask questions. Verification of the patient using one identifier and the type of surgery performed. Review of pertinent events occurring in the operating room (OR) while at the nurses station.
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Hand-off communications that occur between the post anesthesia care unit (PACU) nurse and the nurse on the postoperative nursing unit should be done when a patient returns to the nursing unit. Select appropriate components of a safe and effective handoff. (Select all that apply.)
1.

2.
3. 4.

Vital signs, the type of anesthesia provided, blood loss, and level of consciousness. Uninterrupted time to review the recent pertinent events and ask questions. Verification of the patient using one identifier and the type of surgery performed. Review of pertinent events occurring in the operating room (OR) while at the nurses station.

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