Periop Notes 1 PDF

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PREOPERTIVE PHASE *begins as soon as it is decided that pt. needs surgery* PREADMISSION TESTING PHASE -Diagnostic testing performed before admission to the hospital    

Diagnostic testing Prep prior to admission Initiation of the nursing assessment Post op expectations

TEACHING IN PREADMISSION PHASE:  

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Type of surgery Consent make sure they are aware that this is something they will need to sign NPO Medications to hold Preps: GI and Skin

ADMISSION TO HOSPITAL OR SURGICAL CENTER (OUT-PT.) -Assessment and teaching continues -The goal is to identify risk factors that may contribute to post-op complications and delay recovery *must complete* -Comprehensive health history -Allergies and comorbid conditions -Prescription and OTC meds -Activity level -Any latex allergies??

IN HOLDING AREA -This is 30 to 60 minutes prior to surgery -Pt. comfort and anxiety is addressed here this is where you may need to give them some meds to help w there anxiety -Safety pt. identification, surgical site marked, review for correct surgical procedure -Select medications may be administered

PREOPERATIVE PHASE [continued] ADMISSION TO HOSPITAL OR SURGICAL CENTER (OUT PT.) *during the admission process(after preadmission testing phase) we must assess certain meds that could potentially affect the surgical experience*

MEDICATIONS OF CONCERN AND WHY: STEROIDS: -Cardiovascular collapse can occur if discontinued suddenly. -Therefore a bolus of steroid may be administered IV immediately before and after surgery

ANTI-SEIZURES -May cause anxiety, tension, and even seizures if withdrawn suddenly

DIURETICS: -During anesthesia, may cause excessive respiratory depression resulting from an associated electrolyte imbalance

THYROID HORMONES -IV administration may be needed during the post-op period to maintain thyroid levels

OPIOIDS -Long-term use of opioids for chronic pain in the pre-op period may alter the patient’s response to analgesic agents

INSULIN -Interaction between anesthetics and insulin must be considered when a pt. with diabetes is undergoing surgery. IV insulin may be needed to be given to keep the blood glucose within the normal range.

ANTICOAGULANTS -Can increase risk of bleeding during the intra-op periods -Should be discontinued in anticipation of elective surgery

PREOPERATIVE PHASE [continued] ADMISSION TO HOSPITAL OR SURGICAL CENTER (OUT PT.) *during the admission process(after preadmission testing phase) a pre-op assessment must be completed*

PREOP ASSESSMENT: NUTRITION/ FLUID STATUS

DENTITION

SUBSTANCE ABUSE

-We have to make sure they are getting proper nutrition -Make sure they are hydrated -Do they have a sufficient amount of proteins? -We need to check and make sure they aren’t lacking any of the nutrients that are vital to their healing process

-Do they have any dentures, crowns, or caps? -Must be removed to prevent aspiration -Anesthesia will be really big on assuring this happens!

-This is big because it can cause nutritional deficits

HEPATIC/RENAL FUNCTION CARDIOVASCULAR STATUS -We need good perfusion

-GFR, creatinine -Effects how drugs and meds are absorbed, etc.

RESPIRATORY STATUS -We want pt. to stop smoking at least 30 days before surgery -Any abnormalities in respiratory status could delay or even keep physician from performing the surgery -Pt.’s with respiratory problems have a hard time handling the anesthesia

ENDOCRINE FUNCTION -Diabetic always has a risk of going in to hypo or hyper glycemia -We must know how stable is the pt’s diabetes?

MEDICATION HISTORY -We need a complete med history and current medication list because there are several drugs that we worry about when going into surgery

PREOPERATIVE PHASE [CONTINUED] ADMISSION TO HOSPITAL OR SURGICAL CENTER (OUT PT.) SPECIAL CONSIDERATIONS OBESE PATIENTS BARIATRICS GERENTOLOGIC CONSIDERATIONS: DISABLED PATIENTS -Obesity increases the risk and severity of -Older adult pt.’s have less physiologic reserve Special considerations: complications with surgery. -Respiratory and cardiac complications are the leading  Appropriate assistive devices -Wound infections are more common cause of post-op morbidity and mortality in geriatrics. Modifications in pre-op -Obesity also increases technical and  Cardiac reserves are lower education  Additional mechanical problems r/t surgery.  Renal and hepatic functions are depressed assistance with and attention to -Fatty tissues are susceptible to infection  GI activity is likely to be reduced. positioning or transferring during surgery. -Cardiac demand is increased -These pts. tend to have shallow respirations when supine, increasing the risk of hypoventilation and post-op pulmonary Preoperative assessment and education for OLDER ADULTS: complications Assessment -Airway constriction due to short thick necks,  Assess for allergies and medical comorbidities. large tongues, recessed chins, and redundant  Assess the pts. cognitive and sensory function pharyngeal tissue.  Determine the need for a power of attorney -Assess for sleep apnea and if present then it is  Review medications to identify potential polypharmaceutical risks to include the treated with continuous positive airway following:  Multiple medications, multiple prescribers, several filling pharmacies, too many forms of meds., OTC meds, or multiple dosing schedules.  Document baseline physical assessment parameters, including pain, anxiety, cardiac rhythm, and oxygen saturation level  Document a detailed skin assessment with notation of areas of dryness, lesions, or bruising  Document preoperative fasting status and assess for dehydration, malnutrition, and hypoglycemia  Identify social support to determine whether the patient has home assistance to complete ADLs Education  Discuss advanced directives and code status to identify the patient’s wishes.  Educate the patient about the benefits of controlling pain.  Be prepared to spend additional time, increase the amount of therapeutic touch utilized, and encourage family members to be present to decrease anxiety....