NURS 325 The Surgical Client Summary

THE SURGICAL CLIENT

Perioperative involves THREE PHASES:

 Preoperative
o begins when the client decides to have surgery and lasts until the client is transferred to the surgical
suite
o RN responsibilities:
 Preoperative assessment
 Client teaching
 Informed consent has been obtained - ensure that the client is aware of and educated on the
planned procedure
 RN needs to verify and witness that the client or representative has signed the consent
in their presence, is of a legal age, and is competent.
 The nurse is also responsible for confirming the client has adequate information to make
the decision.
o HIGH PRIORITY = Identifying risk factors and collecting client’s baseline data.
o Head-to-Toe assessment
o Review of pt’s medical history, lab, diagnostic test, CBC, CMP
o Do a general survey
 VS
 Pain
o For the gastrointestinal (GI) system, the proper order of assessment techniques is inspection,
auscultation, palpation, and percussion.
 Intraoperative
o begins once the client is in the surgical suite and ends when the client is admitted to the recovery room
 Postoperative
o begins when the client is admitted to the recovery room and ends at the follow-up appointment.
o N/V
 High risk for dehydration and electrolyte imbalances
 Given antiemetic medication
o Atelectasis
 Decreased function of surfactant in the lungs, condition caused by anesthesia
 Collapsed alveoli in the lung = partial or full collapse of the lung, pneumonia, or RF, COPF and
smoker
 RN Intervention:
 Coughing and deep breathing exercises
 Use of incentive spirometer
RISK FACTORS FOR COMPLICATIONS

 Age
o 65 y/o and older
 Postoperative delirium
 Postoperative cognitive dysfunction
 Nutrition
 Obesity
o High risk of complications
 DVT
 Pulmonary Embolism

,  Complication of DVT
 S/S: chest pain when breathing, SOB, tachycardia, hypoxia
 Use IV anticoagulant
o Increased time for the body to provide anesthesia medication
o Respiratory complications when given narcotic pain
o Decreased oxygenation
o
 Infection
o Venous Thromboembolism
 High risk - If it’s a long and complex surgeries
 To avoid DVT: mobilization soon after surgery
 Application of Sequential Compression Devices
 Substance Abuse
o Smoking
 Difficult to regulate the pt’s breathing while under anesthesia = heart works harder
 Slower wound healing
 High risk for infection
 Medical History

Surgical Wound Complications

 Infection
o S/S: redness, swelling, pain, and purulent or foul-smelling drainage
o Diagnosis: wound cultures – identify the bacteria, and serum levels – assess for infection
o RN Intervention:
 Antibiotic
 Wound debridement
 Dressing changes

Dehiscence and Evisceration

 Dehiscence
o Separation of the wound of incisional edges developing on the surface layer
o Abdominal surgery
o Cause: infection in the wound
 Corticosteroid use
 New injury in the area
o RN Intervention:
 Antibiotic medication
 Frequent dressing changes
 Keeping the wound open to promote new tissue growth
 Evisceration
o Complication of dehiscence in which the internal organs begin to slip out of the abdominal cavity.
 Ileus
o Complication due to temporary disturbance in the peristaltic movement of the intestines.
o RN may note absent or minimal bowel sounds & non-tender abdomen. Small stool with a watery
consistency.

Oliguria and Acute Kidney Injury
 Low urinary is common in postoperative clients