interventions for preoperative clients care
DESCRIPTION
Interventions for Preoperative Clients Care. Perioperative Care. Three Phases Preoperative Intraoperative Postoperative. Preoperative. 3. Miss Iman Shaweesh. PREOPERATIVE NURSING CARE. CONDUCT A NURSING ASSESSMENT PROVIDE PREOPERATIVE TEACHING PERFORM METHODS OF PHYSICAL - PowerPoint PPT PresentationTRANSCRIPT
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Interventions for Preoperative Clients Care
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Perioperative Care
Three Phases
Preoperative IntraoperativePostoperative
Preoperative
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Miss Iman ShaweeshMiss Iman Shaweesh 33
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PREOPERATIVE NURSING CARE
CONDUCT A NURSING ASSESSMENT PROVIDE PREOPERATIVE TEACHING PERFORM METHODS OF PHYSICAL
PREPARATION ADMINISTER MEDICATIONS ASSIST WITH PSYCHOSOCIAL
PREPARATION COMPLETE THE SURGICAL CHECKLIST
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SURGERY CHECKLIST
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Purposes of Surgery
DiagnosticCurativeRestorativePalliative surgery, which makes the
client more comfortableCosmetic surgery, which reconstructs
the skin and underlying structures
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Collaborative Management Assessment
History and data collectionAgeDrugs and substance useMedical history, including cardiac and
pulmonary historiesPrevious surgery and anesthesiaBlood donationsDischarge planning
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Physical Assessment/Clinical Manifestations
Obtain baseline vital signs.Focus on problem areas identified by
the client’s history on all body systems affected by the surgical procedure.
Report any abnormal assessment findings to the surgeon and to anesthesiology personnel.
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System Assessment
Cardiovascular system Respiratory system Renal/urinary system Neurologic system Musculoskeletal system Nutritional status Psychosocial assessment
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Laboratory Assessment
Urinalysis Blood type and crossmatch Complete blood count or hemoglobin level and
hematocrit Clotting studies Electrolyte levels Serum creatinine level Pregnancy test Chest x-ray examination Electrocardiogram
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Preparing the Client (Continued)
Leg procedures and exercises, antiembolism stockings and elastic wraps, early ambulation, and range-of-motion exercises
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DEEP BREATHING, COUGHING, LEG EXERCISES
Deep breathing is a form of controlled ventilation that opens and fills small air passages in the lungs to prevent atelectasis and pneumonia.
Coughing is a natural method of clearing secretions from the airways.
Leg exercises help promote circulation and reduce the risk of forming a thrombus in the veins.
Antiembolism stockings help prevent thrombi and emboli by compressing superficial veins and capillaries redirecting blood to larger and deeper veins, where it flows more effectively toward the heart.
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DEEP BREATHING & COUGHING
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Pre-Operative EducationDiaphragmatic Breathing Exercises
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Pre-Operative EducationSplinting Abdomen while Coughing
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Spirometry
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Adapt from Smetana GW,et al. New Engl J Med 1999;340:937-944.
Stein 1970
Collin 1968
Appleberg 1974
Fogh 1987
Kispert 1992
10 2 4 6 8 10 12 14 16
Swensson 1991
Use of preoperative spirometry to predicted PPCs
Kroenke 1993
Kocabas 1996
Bando 1997
Jacob 1997
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Preoperative Care of Pulmonary Patients: Example
Male 60 yrs. Dx: NSCLC stage Ib , RULUnderlying COPDAssessment
Not urgent surgery, high benefitRisk ; elderly, COPDHistory / Physical examinationLaboratory
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Pre-RX(%)
Post –RX(%)
%CHG
FEV1/FVC (%)
55 60
FEV1 (L) 1.31(48)
1.39(53) 5
FVC (L) 2.40(66)
2.50(69) 4
FEF25- 75%
(L/min)
0.43(15)
0.6(22) 22
Spirometry of the patient
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Further evaluation PPO-FEV1
RUL : RLL= 0.55: 0.45
RUL = 24.7%
RLL= 20.3%
LL = 55%
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Preoperative Care of Pulmonary Patients
Many factors related to PPCsWorking as a team plays major rolesAssessment of the risks ,do appropriated
testing and modifying are the keys of preoperative caring
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Recommendation for preoperative CXR
Age > 50 yearsKnown pre-existing cardiopulmonary
diseasesS/S like hoods of cardiopulmonary disease
Smetana GW, et al Med Clin N Am 2003
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PFTs and PPCs
Case-control study, elective abdominal surgery:CXR highly associated with PPCs (OR 5.8)Abnormal PE associated with PPCsWhereas PFTs were not predictive
Lawrence VA, et al. Chest 1996;110:744-50.
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PFT Diagram in Preoperative Evaluation
PFT(FEV1,MVV,DLCO)
Cleared for any resection
High risk consider exercise
testPerfusion
Scanning PPO-FEV1
Consider “Lesser” resection
Non surgical therapy
Cleared for any resection
High risk consider exercise
test
FEV1 >2 L
MVV >50%DLCO >60%
FEV1 > 2 L
MVV<50%
DLCO <60%
FEV1 <2 L
PPO-FEV1 >1.3
PPO-FEV1 >0.8, <1.3PPO-
FEV1 <0.8
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Preoperative PFTs : Summary
Thoracic surgeryUpper abdominal surgery with
respiratory symptoms remain unexplained after careful evaluation
Routine PFTs should not ordered solely without clinical assessment
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Risk indices for preoperative assessment
Risk class
Pneumonia Risk
(total point)
Predicted
Prob. pneumonia
(%)
Respiratory
Failure
(total point)
Predicted
Prob.
Res. failure
(%)
1 0-15 0.2 0-10 0.5
2 16-25 1.2 11-19 2.2
3 26-40 4.0 20-27 5.0
4 41-55 9.4 28-40 11.6
5 >55 15.4 >40 30.5
Arozullah AM,et al. Med Clin N Am 2003
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Preoperative smoking cessation and PPCs
0
10
20
30
40
50
60
Stop >2 mth Stop<2 mth Stop>6 mth Never smoke
Warner MA,et al. Mayo Clin Proc 1989
Prospective study 200 patients, CABG
% Complication
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Preoperative smoking cessation and PPCs
0
10
20
30
40
50
60
Current <2wks Recent2-4wks Exsmoke Never smoke
Nakagawa M, et al Chest 2001;120:705-10
Retrospective study 288 patients, pulmonary surgery
% Complication
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Examples of external pneumatic
compression devices used to promote
venous return and prevent deep vein
thrombosis (DVT)
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Kendall SCD machine, sleeves, andTED stockings.
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Venodyne pneumatic compression system
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Flowtron DVT calf garments
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Anxiety Interventions
Preoperative teaching
Encouraging communication
Promoting rest
Using distraction
Teaching family and significant others
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Preoperative Chart Review
Ensure all documentation, preoperative procedures, and orders are complete.
Check the surgical consent form and others for completeness.
Document allergies
Document height and weight.
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