Care of Surgical Client
>
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3 preoperative phases >
-Postoperative complications - cognitive impairment
• preoperative - care before surgery, both physical and • delirium: confusion occurring in older adult
physiological preparations - temporary & may come/go
• intraoperative - when clients are moved onto bed • postoperative cognitive dysfunction (POCD):
into OR to transfer to recovery/PACU serious for older adults/clients with preexisting
• postoperative - immediately after surgery, can be neurocog disorders
brief or include rehabilitation/recuperation - permanent long term memory loss &
> preoperative assessment
-
behavioral changes
• confirm client identifiers, complete history and >
- postop complications - venous thromboembolism
consent obtained, teaching done, promotion of
safety for high risk • deep vein thrombosis (DVT): often extremities
• health history - risks: prolonged inactivity
- medical: comorbitites - manifestations: pain, redness, swelling,
warmth
- allergies: allergen, band
- interventions: early mobility, compassion
- meds: current prescribed & OTC devices, antithrombotics
- surgical: previous procedures, response to • pulmonary embolism (PE): DVT broken off and
anesthesia traveled to lungs
- tobacco & ETOH: frequency/amount - manifestations: chest pain, difficulty
- spiritual/cultural: culturally competent care breathing, tachycardia, hypoxia
• diagnostics - establish preoperative baseline, - interventions: antithrombotic, antiplatelet,
potential complications anticoagulant
- CBC, BMP/CMP, coagulation studies, pregnancy test, >postop complication - fluid imbalance
EKG, CXray, pulmonary function • hypovolemia
• education - prepare and inform of what to expect - causes: lack of intake, bowel prep, loss of
- preoperative: day of surgery (arrival, check in, blood, prolonged surgical time, anesthesia
visitor), preparation, NPO status, skin prep, meds - manifestations: tachycardia, hypotension,
- postoperative: pain expectation/interventions, confusion, oliguria, decreased central venous
splinting & incentive spirometer, activity, when to seek pressure & capillary refill
help - interventions: hemodynamic monitoring, fluid
>
- circulating nurse - coordinates care of client before, replacement
during, after surgery • hypervolemia
• responsible for: verifying consent forms, client - causes: underlying conditions (CHF, renal
safety, positioning, monitoring, enforcing policies failure), rapid transfusions
during surgery (time out), provides supplies to sterile
team - lead to: impaired gas exchange, wound
healing, bowel motility
- scrub nurse - instrument nurse
- manifestations: tachycardia, increased CVP,
• ensuring utensils are sterile, handing to surgeon HTN, crackles, peripheral edema, decreased
>
- anesthsia hemoglobin/hematocrit
• local - prevents conduction of pain, affects motor - interventions: hemodynamic, intake/output,
and sensory nerves at surgical site electrolyte monitoring, diuretics/fluid restriction
• regional - temporary loss of feeling in area of body - postop complication - atelectasis
• general - depress the CNS • decreased surfactant in lungs - collapse of
• moderate/conscious - client remain relaxed so can airways and small sections of lungs
follow commands without pain - considerations: smoking/chronic lung
> surgical complications conditions, can lead to partial/full collapse, maintain
• NV & aspiration, delirium, thrombus/pulmonary O2 sat, ambulate early, teach deep breaching/
embolism, hypotension/hypovolemia, atelectasis, inceptive spirometer
infection, dehiscence, ileus, AKI
>
-
3 preoperative phases >
-Postoperative complications - cognitive impairment
• preoperative - care before surgery, both physical and • delirium: confusion occurring in older adult
physiological preparations - temporary & may come/go
• intraoperative - when clients are moved onto bed • postoperative cognitive dysfunction (POCD):
into OR to transfer to recovery/PACU serious for older adults/clients with preexisting
• postoperative - immediately after surgery, can be neurocog disorders
brief or include rehabilitation/recuperation - permanent long term memory loss &
> preoperative assessment
-
behavioral changes
• confirm client identifiers, complete history and >
- postop complications - venous thromboembolism
consent obtained, teaching done, promotion of
safety for high risk • deep vein thrombosis (DVT): often extremities
• health history - risks: prolonged inactivity
- medical: comorbitites - manifestations: pain, redness, swelling,
warmth
- allergies: allergen, band
- interventions: early mobility, compassion
- meds: current prescribed & OTC devices, antithrombotics
- surgical: previous procedures, response to • pulmonary embolism (PE): DVT broken off and
anesthesia traveled to lungs
- tobacco & ETOH: frequency/amount - manifestations: chest pain, difficulty
- spiritual/cultural: culturally competent care breathing, tachycardia, hypoxia
• diagnostics - establish preoperative baseline, - interventions: antithrombotic, antiplatelet,
potential complications anticoagulant
- CBC, BMP/CMP, coagulation studies, pregnancy test, >postop complication - fluid imbalance
EKG, CXray, pulmonary function • hypovolemia
• education - prepare and inform of what to expect - causes: lack of intake, bowel prep, loss of
- preoperative: day of surgery (arrival, check in, blood, prolonged surgical time, anesthesia
visitor), preparation, NPO status, skin prep, meds - manifestations: tachycardia, hypotension,
- postoperative: pain expectation/interventions, confusion, oliguria, decreased central venous
splinting & incentive spirometer, activity, when to seek pressure & capillary refill
help - interventions: hemodynamic monitoring, fluid
>
- circulating nurse - coordinates care of client before, replacement
during, after surgery • hypervolemia
• responsible for: verifying consent forms, client - causes: underlying conditions (CHF, renal
safety, positioning, monitoring, enforcing policies failure), rapid transfusions
during surgery (time out), provides supplies to sterile
team - lead to: impaired gas exchange, wound
healing, bowel motility
- scrub nurse - instrument nurse
- manifestations: tachycardia, increased CVP,
• ensuring utensils are sterile, handing to surgeon HTN, crackles, peripheral edema, decreased
>
- anesthsia hemoglobin/hematocrit
• local - prevents conduction of pain, affects motor - interventions: hemodynamic, intake/output,
and sensory nerves at surgical site electrolyte monitoring, diuretics/fluid restriction
• regional - temporary loss of feeling in area of body - postop complication - atelectasis
• general - depress the CNS • decreased surfactant in lungs - collapse of
• moderate/conscious - client remain relaxed so can airways and small sections of lungs
follow commands without pain - considerations: smoking/chronic lung
> surgical complications conditions, can lead to partial/full collapse, maintain
• NV & aspiration, delirium, thrombus/pulmonary O2 sat, ambulate early, teach deep breaching/
embolism, hypotension/hypovolemia, atelectasis, inceptive spirometer
infection, dehiscence, ileus, AKI
