orif

http://nursinglectures.blogspot.com

Many surgical procedures that were once performed in an inpatient setting now take place in an Ambulatory or Outpatient setting.

nursinglectures.blogspot.com

2

Approximately 60% of elective surgeries are now performed in an ambulatory or outpatient setting.


3

Pre-operative Phase – begins when decision to proceed with surgical intervention is made and ends with the transfer into the operating table

Intra-operative Phase – starts from the transfer of patient to the operating table and ends with the admission of the patient to the PACU (post-anesthesia care unit)

Post-operative Phase – begins with admission to the PACU and ends with follow-up evaluation in the clinical setting or home


4

Diagnostic – Eg. Biopsy or explorative laparotomy

Curative – Eg. Excision of a tumor or inflamed appendix

Reparative – Eg. Multiple Wound Repair Reconstructive / Cosmetic – Eg.

Mammoplasty or facelift Palliative – Eg. To relieve pain, a PEG

tube is inserted to compensate for dysphagia


5

Voluntary and written INFORMED consent from the patient is necessary before nonemergent surgery can be performed.

Consent must be signed before administration of ANY PSYCHOactive medications .


6

Voluntary Consent – given FREELY Incompetent Patient – (those who are

mentally ill, and comatose CANNOT give consent)

Informed Subject – should be in WRITING. Includes explanation of risks, procedure. Description of benefits & alternatives

An EMANCIPATED Minor may sign his consent form


7


Brunner & Suddarth’s Textbook8

The signed consent form is placed in a

prominent place on the patient’s chart and accompanies the

patient to the operating room.


9

The overall goal in the pre-operative period is for the patient to have as many positive health factors as possible…


10

obesity, undernutrition, weight loss, malnutrition, deficiencies in specific nutrients,

metabolic abnormalities, the effects of medications on nutrition, and

special problems of the hospitalized patient (Quinn, 1999)

measurement of body mass index and waist circumference (National Institutes of

Health, 2000)


11

Protein Calories Water Vitamin C Thiamin, Niacin, Riboflavin, Folic Acid, Vit.

B12 Vitamin A Vitamin K Iron Zinc


12

People who abuse drugs attempt to HIDE and DENY it

Acutely intoxicated persons are susceptible to injury

Alcohol withdrawal delirium (delirium tremens) may be anticipated up to 72 hours after alcohol withdrawal.


13

Goal : Optimal Respiratory Function Breathing Exercises Use of Incentive Spirometry Surgery is USUALLY postponed if

patient have a Respiratory INFECTION SMOKING urged to STOP 2 Months

before surgery (Counseling has a positive effect 24 hours before operation)


14

increased airway reactivity

decreased mucociliary clearance,

physiologic changes in the

cardiovascular and immune systems


15

GOAL : to ensure a well functioning cardiovascular system to meet the oxygen, fluid, and nutritional needs of the perioperative period.


16

GOAL :optimal function of the liver and urinary systems so that medications, anesthetic agents, body wastes, and toxins are adequately processed and removed from the body.


17

Hypoglycemia and Hyperglycemia Acidosis Glucosuria GOAL : Maintain the blood glucose level at

less than 200 mg/dl Adrenal insufficiency – for those who have

received corticosteroids Thyrotoxicosis (hyperthyroid disorders) Respiratory failure (hypothyroid disorders)


18

Existence of Allergies Latex Allergy Immunosuppression The mildest symptoms or slightest

temperature elevation must be investigated.

Great care is taken to ensure strict asepsis


19

OTC Meds – Aspirin, HPN meds, Insulin Herbal Meds – echinacea, ephedra, garlic (Allium sativum), ginkgo, ginseng kava kava (Piper methysticum), St. John’s wort (Hypericum perforatum) licorice (Glycyhiza glabra) valerian (Valeriana officinalis)


20

Emotional Reaction Psychological Distress Anxiety – Anticipatory response Different responses of persons to FEAR:

1. Repeatedly asking questions2. Withdrawal, avoiding communication3. Some talk about it

*** NURSE Must be an EMPHATETIC listener


21

Corticosteroids – Prednisone(Deltasone) Diuretics –

Hydrochlorothiazide(HydroDIURIL) PhenoThiazines – Chlorpromazine (Thorazine) Tranquilizers – Diazepam (Valium) Insulin Antibiotics – Erythromycin (Ery-tab) Anticoagulants – Warfarin (Coumadin) Antiseizure – Phenytoin (Dilantin) MAO Inhibitors – Phenelzine sulfate (Nardil)


22

Less physiologic Reserve Sensory limitations – vision, hearing

and reduced tactile sensitivity Arthritis – may affect mobility Dental assessment – impt to

Anesthesiologist Ability to perspire – fragile skin

(dry)


23

Fatty Tissues – susceptible to infection Technical & Mechanical Problems Wound dehiscence(separation) and

wound infections are more common. For Every 30 lbs excess weight,

additional 25 miles of blood vessels needed, thus increasing workload of the heart.


24

IDEAL timing – Pre-admission visit not ON the DAY of SURGERY

GOAL – Promote OPTIMAL Lung Expansion after ANESTHESIA

USE of Incentive SPIROMETER Splinting of Incision line if possible GOAL – Coughing, mobilizes secretions Deep Breathing Promote Mobility POST-OP


25


26


27


28


29

Identification of ACUTE and CHRONIC Pain

PAIN Scale Patient Controlled Analgesia (PCA) Epidural Catheter (Bolus/Infusion) P.Controlled Epidural Analgesia (PCEA) Oral Meds for Home Meds Cognitive Coping Strategies – Imagery,

Distraction, Optimistic Self-recitation


30

Watch out! UNNECESSARY LONG FASTINGS Warn Patients they might feel thirsty and

teach strategies(as permitted):brushing teeth, rinsing the mouth, and chewing gum

8 hours fasting after eating fatty foods 4 hours after ingesting milk products 2 hours for clear liquids in an elective

procedure


31

Gown left Untied,OPEN in the BACK Mouth Inspected, Dentures removed Jewelries not WORN, If patient refuse,

some allow ring to be taped in finger All Patients should VOID

immediately(except those with UROLOGIC D/O) to promote continence and make abdominal organs more accessible


32


33

Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery

Fear related to perceived threat of the surgical procedure and separation from support system

Knowledge deficit of preoperative procedures and protocols and postoperative expectations


34

1. During the preoperative assessment of a man scheduled for hand surgery in an ambulatory setting, you think that the patient’s responses indicate that he does not understand the procedure and that he has not made plans for postoperative care. What further assessment and teaching is indicated? What nursing interventions are warranted?


35

2.A patient with a long history of the use of several herbal supplements is scheduled for major surgery. What effect would this information have on your preoperative care of this patient?


36

3. Two patients are admitted to the same-day surgery unit for bilateral knee replacements. One patient is a 30-year-old who ambulates with crutches and the other is a 75-year-old who lives alone. How would your assessments, preoperative teaching, and preparation differ for these two patients?


37

Nursinglectures.blogspot.com

orif

Documents

transfer of patient

freelyincompetent patient

hospitalized patient

consent form

informed consent

comvolunt consent

preoperative periodis

effects of medications