| Assessment of Fears: Toddler: Specific fear: | Separation |
| Assessment of Fears: Toddler: Nursing consideration (specific fear): | Teach parents to expect regression (in toilet training and difficult separations) |
| Assessment of Fears: Preschooler: Specific fear: | mutilation |
| Assessment of Fears: Preschooler: Nursing consideration (specific fear): | allow child to play with models of equipment |
| Assessment of Fears: School-age: Specific fear: | Loss of control |
| Assessment of Fears: School-age: Nursing consideration (specific fear): | Explain procedures in simple terms |
| Assessment of Fears: Adolescence: Specific fears: | loss of independence, being different from peers, alteration in body image |
| Assessment of Fears: Adolescence: Nursing consideration (specific fears): | Involve in therapies
Expect resistance
Express understanding of concerns |
| Obtain Informed Consent: Requirements: | Capacity- age (adult), competence (can make choices and can understand consequences)
Voluntary- Freedom of choice without force, fraud or deceit
Comprehensive- Information must be given in understandable form
Influenced- Cannot sign consent if client has been drinking alcohol or has been premedicated |
| Obtain Informed Consent: Requirements: Age (adult), competence (can make choices and can understand consequences) | Capacity |
| Obtain Informed Consent: Requirements: Freedom of choice without force, fraud or deceit | Voluntary |
| Obtain Informed Consent: Requirements: 3: Information must be given in understandable form | Information must be given in understandable form - (Comprehensive) |
| Obtain Informed Consent: Requirements: 4: | Cannot sign consent if client has been drinking alcohol or has been premedicated |
| Classification of Surgical Procedures: | Urgency- Elective or emergency
Risk- minor or major
Purpose- diagnostic, ablative, palliative, reconstructive, transplantation, constructive |
| Classification of Surgical Procedures: 1 | Urgency- Elective or emergency |
| Classification of Surgical Procedures: 2: | Risk- Minor or major |
| Classification of Surgical Procedures: 3: | Purpose: Diagnostic, ablative, palliative, reconstructive, transplantation, constructive |
| Purposes of Surgical Procedures: Confirms or establishes a diagnosis; for example, biopsy of a mass in a breast. | Diagnostic |
| Purposes of Surgical Procedures: Relieves or reduces pain or symptoms of a disease; it does not cure; for example, resection of nerve roots | Palliative |
| Purposes of Surgical Procedures: Removes a diseased body part; for example, removal of a gallbladder (cholecystectomy). | Ablative |
| Purposes of Surgical Procedures: Restores function or appearance that has been lost or reduced; for example, cleft palate repair. | Constructive |
| Purposes of Surgical Procedures: Replaces malfunctioning structures; for example, kidney transplant | Transplant |
| Three Phases of Perioperative Period: | Perioperative
Intraoperative
Postoperative |
| Three Phases of Perioperative Period: Begins with decision to have surgery, lasts until patient is transferred to operative room | Perioperative |
| Three Phases of Perioperative Period: Extends from admission to surgical department to transfer to recovery room | Intraoperative |
| Three Phases of Perioperative Period: Lasts from admission to recovery room to complete recovery from surgery | Postoperative |
| Types of Anesthesia: | General
Regional
Conscious sedation/ analgesia |
| Types of Anesthesia: Administration of drugs by inhalation, intravenous, rectal, or oral route | General |
| Types of Anesthesia: Anesthetic agent injected near a nerve or nerve pathway or around operative site | Regional |
| Types of Anesthesia: Used for short-term procedures | Conscious sedation/ analgesia |
| Types of Anesthesia: Regional: | 1. Topical (surface) anesthesia
2. Local anesthesia
3. Nerve block
4. Spinal anesthesia
5. Epidural (peridural) anesthesia |
| Types of Anesthesia: Regional: Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. | Topical (surface) anesthesia |
| Types of Anesthesia: Regional: (infiltration is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performing a biopsy | Local anesthesia |
| Types of Anesthesia: Regional: Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. | A nerve block |
| Types of Anesthesia: Regional: Is also referred to as a subarachnoid block (SAB). It requires a lumbar puncture through one of the interspaces between lumbar disk 2 (L2) and the sacrum (S1). | Spinal anesthesia |
| Types of Anesthesia: Regional: Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater. | Epidural (peridural) anesthesia |
| Three Phases of General Anesthesia: | Induction
Maintenance
Emergence |
| Three Phases of General Anesthesia: From administration of anesthesia to ready for incision | Induction |
| Three Phases of General Anesthesia: From incision to near completion of procedure | Maintenance |
| Three Phases of General Anesthesia: Starts when patient emerges from anesthesia and is ready to leave operating room | Emergence |
| States of Anesthesia: | Loss of consciousness
Analgesia
Relaxation
Loss of reflexes |
| Preoperative Surgical Phase: Assessment: | Risk factors
Medications
Allergies
Smoking habits
Alcohol ingestion and substance abuse and use
Pregnancy
Perceptions and knowledge regarding surgery |
| Preoperative Surgical Phase: Assessment:
Screen patients carefully
Take necessary precautions
Collaborate with health care provider
Obstructive sleep apnea, malnourishment, and smoking are all risk factors | Risk factors |
| Preoperative Surgical Phase: Assessment: Inpatient v.s. outpatient | Medications |
| Preoperative Surgical Phase: Assessment: Medications, topical agents, latex, food | Allergies |
| Preoperative Surgical Phase: Planning: | Goals and outcomes
Setting priorities
Teamwork and collaboration |
| Preoperative Surgical Phase: Planning: Review and modify the plan during the intraoperative and postoperative periods | Goals and outcomes |
| Preoperative Surgical Phase: Planning: Patients requiring emergent surgery often experience changes in their physiological status that require urgent reprioriticaions. | Setting priorities |
| Preoperative Surgical Phase: Planning: Preoperative instruction gives patients time to make necessary preparations | Teamwork and Collaboration |
| Preoperative Surgical Phase: Implementation: | Informed consent
Privacy and social media
Health promotion |
| Preoperative Surgical Phase: Implementation:
Preoperative teaching
Postoperative activity resumption
Pain relief measures
Rest
Feelings regarding surgery | Health Promotion |
| Preoperative Surgical Phase: Implementation: health promotion:
Reasons for preoperative instructions and exercises
preoperative routines
Surgical procedure
Time of surgery
Postoperative unit and location of family during surgery and recovery
Anticipated postoperative monitoring and therapies
Sensory preparation | Preoperative teaching |
| Preoperative Surgical Phase: Implementation: Surgical procedures require documentation of consent
Report any concerns about the patient's understanding of the surgery to the operating surgeon or anesthesia provider | Informed consent |
| Preoperative Surgical Phase: Implementation: Do not discuss confidential patient information in public areas or use social media to convey patient information; posting patient information and photos on websites is prohibited | privacy and social media |
| Nurse's Role ins Presurgical Testing: | Ensure tests are explained to the patient
Ensure results are recorded in patient records before surgery.
Ensure that abnormal results are reported. |
| Preoperative Surgical Phase: Implementation: Acute care:
Hygiene
Preparation of hair and removal of cosmetics
Removal of prostheses
Safeguarding valuables
Preparing the bowel and bladder
Vital signs
Prevention of DVT - Antiembolism devices
Administering preoperative medications
Documentation and hand-off
Eliminating wrong site and wrong procedure surgery | Acute care |
| Preoperative Surgical Phase: Evaluation: | Through the patient's eyes
Patient outcomes |
| Preoperative Surgical Phase: Evaluation: Evaluate whether the patient's expectations were met with respect to surgical preparation | Through the patient's eyes |
| Preoperative Surgical Phase: Evaluation: Deficient knowledge
Anxiety | Patient outcomes |
| Preparing the Patient through teaching: | Surgical events and sensations
Pain management
Physical activities
Deep breathing
Coughing
Incentive spirometry
Leg exercises
Turning in bed |
| Transporting to the Operating Room: | Notification
Transportation
Verify patient's identity- two identifiers
Family- allowed to visit before patient is transported to OR
- Directed to waiting area
Prepare room for patient's return |
| Preanesthesia care unit (PCU): | or presurgical care unit (PSCU) (holding area)
PCU nurse
Anesthesia provider |
| Preanesthesia care unit (PCU): Inserts IV catheter (if not already present)
Administers preoperative medications
Monitors vital signs | PCU nurse |
| Preanesthesia care unit (PCU): Performs patient assessment | Anesthesia provider |
| Intraoperative Surgical Phase: Nursing roles during surgery: | Circulating nurse
Scrub nurse
Registered nurse first assistant |
| Intraoperative Surgical Phase: Implementation:
Physical preparation
Intraoperative warming
Latex sensitivity/allergy | Acute care |
| Intraoperative Surgical Phase: Implementation: | Introduction of anesthesia
Positioning the patient for surgery
Documentation of intraoperative care |
| Intraoperative Surgical Phase: Implementation: General anesthesia
Regional anesthesia
Moderate (conscious) sedation | Introduction of anesthesia |
| Substances that can affect the client in surgery: | Antibiotics
Antibiotics in mycin group
Anticholinergics
Anticoagulants
Anticonvulsants
Antidysrhythmics
Antidepressants
Antihypertensives
Corticosteroids
Diuretics
Herbal substances
Insulin |
| Substances that can affect the client in surgery: Potentiate action of anesthetic agents | Antibiotics |
| Substances that can affect the client in surgery: Respiratory paralysis when combined with certain muscle relaxants | antibiotics in mycin group |
| Substances that can affect the client in surgery: Increases the potential for confusion | Anticholinergics |
| Substances that can affect the client in surgery: Alter normal clotting factor and increase risk of hemorrhage; should be discontinued 48 hrs before surgery or as specified by the surgeon
Precipitate hemorrhage | Anticoagulants |
| Substances that can affect the client in surgery: Alter the metabolism of anesthetic agents | Anticonvulsants |
| Substances that can affect the client in surgery: Reduce cardiac contractility and impair cardiac conduction during anesthesia | Antidysrhythmics |
| Substances that can affect the client in surgery: Lower BP during anesthesia
Tranquilizers- increase hypotensive effects of anesthetic agents | Antidepressants |
| Substances that can affect the client in surgery: Cause bradycardia, hypotension and impaired circulation | Antihypertensives |
| Substances that can affect the client in surgery: Cause adrenal atrophy and reduce the body's ability to withstand stress
Adrenal steroids- abrupt withdrawal may cause cardiovascular collapse | Corticosteroids |
| Substances that can affect the client in surgery: Potentiate electrolyte imbalance
- electrolyte imbalances, respiratory depression from anesthesia | Diuretics |
| Substances that can affect the client in surgery: Interact with anesthesia and can cause variety of adverse effects. May need to be stopped before surgery | Herbal substances |
| Substances that can affect the client in surgery: Need for it may be decreased because the client's nutritional status is reduced; or the insulin may be increases because of stress response and IV administration of glucose solutions after surgery. | Insulin |
| Postoperative assessments and interventions | Vital signs
Color and temperature of skin
Level of consciousness
Intravenous fluids
Surgical site
Other tubes
Comfort
Position and safety |
| 1 to 4 hours after surgery
Full system assessment (anesthesia can affect any system) | Postoperative Care |
| Postoperative care:
Stimulate patient postanesthesia
Monitor level of consciousness | Neuropsychosocial |
| Postoperative care: Monitor vital signs q 15 minutes 4 times, q 30 two times, q hour one time, then as needed | cardiovascular |
| Postoperative care:
Check breath sounds
Splint wound
Offer pain medication
Teach incentive spirometer
Get out of bed as soon as possible
Turn, cough, and deep breath (unless contraindicated; brain, spinal, eye surgery) if cannot move out of bed | Respiratory |
| Postoperative care:
Check bowel sounds in 4 quadrants (5 min each
Keep NPO until bowel sounds are present
provide good oral care while NPO
Check abdomen for distention
Check for passage of flatus and stool | Gastrointestinal |
| Postoperative care:
Monitor I & O (intake and output)
Encourage to void
Notify MD if unable to void within 8 h
Catheterize is needed | Genitourinary |
| Postoperative care:
Check pulses
Inform patient not to cross legs
Prohibit pillow behind knee
Monitor for Homan's sign- dorsiflexion of foot | Extremities |
| Return of consciousness | Unconscious
Response to touch and sounds
Drowsiness
Awake but not oriented
Awake and oriented |
| Potential Complications of Surgery: Hemmorhage:
Assessment:
Nursing considerations: | Assessment: decreased BP, increased pulse, cold clammy skin
Nursing considerations: monitor vital signs |
| Potential Complications of Surgery: Paralytic ileus:
Assessment:
Nursing considerations: | Assessment: absent bowel sound, no flatus or stool
Nursing considerations: gastric lavage, IV fluids |
| Potential Complications of Surgery: Atelectasis:
Assessment:
Nursing considerations: | Assessment: Pain on the affected side, dyspnea, cough, fever, tachycardia
Nursing considerations: Experienced 2nd day post op
suctioning
postural drainage
cough and turn |
| Potential Complications of Surgery: Dehiscence:
Assessment:
Nursing considerations: | Assessment: separation of wound edges
Nursing considerations: Experienced 5-6 days post op
Low-fowler's position
No coughing
Notify physician |
| Potential Complications of Surgery: Eviscration:
Assessment:
Nursing considerations: | Assessment: bowel erupts through surgical site
Nursing considerations: Experienced 5-6 d postop
Low fowler's position
No coughing
NPO
Cover viscera with sterile saline dressing or wax paper (if at home)
Notify physician |
| Cardiovascular Complications: | Hemorrhage
Shock
Thrombophlebitis
Pulmonary embolus |
| Interventions to Prevent Respiratory Complications | Monitor vital signs
Implementing deep breathing
Coughing
Incentive spirometry
Turning in bed
Ambulating
Maintaining hydration
Avoiding positioning that decreases ventilation
Monitoring responses to narcotic analgesics |
| Surgical drains: | Penrose
tube
Jackson-Pratt |
| Surgical drains: Simple latex drain
Nursing considerations:
Note location
Usually not sutured in place, but layered in gauze dressing | Penrose |
| Surgical drains: Used after gallbladder surgery
Placed in common bile duct to allow passage of bile
Nursing considerations:
Fasten tubing to dressings
Keep below waist
May clamp for 1 hour before and after each meal
May be discharged with T tube in place
Remove 7-14 days | Tube |
| Surgical drains: Portable wound self-suction device with reservoir
Nursing considerations: Monitor amount and character of drainage
Notify physician if it suddenly increases or becomes bright red | Jackson-Pratt |
| Safety Guidelines for Nursing Skills: | Coughing and deep breathing may be contraindicated after brain, spinal, head, neck, or eye surgery
Bariatric patients may have more improved lung function and vital capacity in the reverse Trendelenburg or side-lying position.
Report any signs of venous thromboembolism such as pain, tenderness, redness, warmth, or swelling in the upper or lower extremities to the medical team immediately. |
