August 23, 2019 - remove/repair damages or diseased tissue

or organs
Medical Surgical Nursing

Surgery Subtypes:
- branch of medicine concerned with disease Ablative
conditions requiring surgery - remove diseased organ
- Appendectomy, Nephrectomy
Reasons for surgery
- obstruction/blockage Reconstructive
- partial/complete restoration of damaged
- Perforation
organ by improving function
- Erosion - plastic surgery after severe burns
- Tumor
Constructive
Phases of surgical experience - repair congenitally detective organ by
1. Pre-operative improving function/appearance
- consent to transfer to OR Ex: Palatoplasty (Palate),
2. Intra-operative Orchidopexy

- OR to RR
Palliative
3. Post-operative
- relieves distressing manifestations
- RR to follow up/clinic evaluation
- Improves function but does not cure
Types of surgery according to purpose underlying disease
A. Diagnostic Ex: Hysterectomy for cervical CA

- confirmation/verification of diagnosis
- Determines underlying cause of presenting
signs and symptoms
- Biopsy and scopy
Cosmetic
- improves appearance secondary to aging
and tissue trauma
Ex: Mammoplasty, Blepharoplasty

B. Exploratory Types according to extent of surgery

- estimates extent of disease and damage to Major
organs - serious risk and complications
- Significant blood loss
C. Curative
- In surgical unit
- Uses general/regional anesthesia
Minor - same-day surgery
- few complications with minimal blood loss - Outpatient
- Performed in clinic or OPD - In OPD, Clinic, ER
- Local anesthesia
Types according to urgency of surgery
Emergency
- maintain life Perioperative nurses
Psychological preparations
- organ and limb function
- fear of pain, unknown, mutilation, death,
- Remove damaged organ
disruption of lifestyle
- Stop hemorrhage - explain procedure
Ex: GSW

Pre-op assessment
Imperative/Urgent
Goals:
- surgical intervention within 24-48 hours - adequacy of health status to undergo surgery
- Evacuation of blood clots from brain - identify risk factors
- Determine setting for surgery and
Planned/Required
technique to be used
- Scheduled
- Establish baseline vs
Ex: Tonsillectomy, Cataract Extraction
- Plan and institute pre-op care
Elective - Assess condition of pre-op
- for one’s well-being - Identify and manage health conditions
Ex: Circumcision, Cholecystectomy
Psychological preparations
Optional - Age
- preference but not needed Young: organs not fully developed
Ex: Rhinoplasty, Scar Revision, Old: excretes less toxins
Mammoplasty - nutritional status
Obese: needs greater amt of
According to surgical setting anesthetics
Inpatient surgery
- cardiovascular function
- admitted a day before or on the day of the
- pulmonary function
surgery
Assess for SOB, wheezing, cough,
clubbing
Ambulation
Lab/Dx: ABG, CXR, PFT
- Renal - light evening meal
Dysuria, Anuria - NPO post midnight or 8-10 hours before
- GI surgery
Must undergo cleaning enema the - Cleansing enema to prevent passing of
night before the operation stool
- liver function
Cirrhosis, diseased liver (can’t Urinary
detoxify), BUN, Meds - empty bladder before meds and OR
- endocrine function - if increased BP, postpone surgery
DM, Hyper/Hypothyroidism
- hematologic function Nervous system
Present blood problem - administer pre-op meds 60-90 mins before
Know if pt is taking anticoagulant anesthesia to allay anxiety and pharyngeal
Normal female: 10-12 secretion
- drug therapy - Reduce side effects of anesthetic agents
Antibiotics: mild respiratory
- Create amnesia
depression
Anti arrhythmic: tolerance to
Common pre-op meds
anesthesia
Barbiturates and sedatives
Corticosteroids: delays wound
healing - induce sleepiness
Anticoagulants: increases - Reduce anxiety
hemorrhage - Promote sedation
Antihypertension: alter response ex: Phenobarbital Na, Promethazine,
to muscle relaxant Midazolam HCl
SE: Hypotension, respiratory depression,
Physical preparations disorient
Integumentary *Check VS
- shave/cleanse on operative site
- Assess for abrasions, lacerations Tranquilizers
- No nail polish: for pulse ox - reduce anxiety
- Back acne: infection for anesthesia - Anti-emetic effect
ex: Diazepam (Valium)
- Do not shave abdomen if site is chest or
SE: Hypotension, confusion
above

Narcotic analgesics
GI
- sedative-hypnotic effect - Should understand
- Reduce anxiety and needed anesthetic - Doctor must sign if emergency situation
ex: Morphine sulfate, Meperidine, Nubain but the patient does not have a relative
SE: Respiratory and circulatory depression,
Hypotension 4. Pre op checklist
- remove dentures to prevent aspiration
Anticholinergic/Vagolytic Agent
- cosmetics: remove to check Hgb
- control secretion
- I&O, Meds, Oral hygiene
- Block vagal stimulation
- No nylon
- Prevent bradycardia and hypotension
- Head covered by towel
Ex: Atropine Sulfate
SE: Tachycardia, excessive mouth dryness - VS
* VS when experiencing itchiness and - Final check by OR nurse
alterations.
Preparation for surgery
1. Pre op health teaching
- Deep breathing exercises 5-10 times per
hour for lung expansion to present PNA
and Atelectasis
- Cough exercise 10 times per hour
- Turning exercise (1-2 hours) to prevent
venous stasis and respiratory problems
- Pain control analgesics
- Extremity exercises to prevent circulatory
problems and promote venous return

2. Pre op visit: done by anesthesiologist

3. Informed consent
- protection for health professionals
- Recognize autonomy to make decisions
- Prevent unauthorized surgery
- Verbal consent through phone must be
recorded and nurse must have 2 witnesses
and sign