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Unformatted text preview: Adult Health 2 o Peri- operative nursing nursing care for patients who require surgery o Pre-op nursing begins when the decision to perform surgery is made until the patient enters the OR suite o Intra- Operative nursing begins when the patient enters the OR until the patient is transferred to PACU or ICU o Post-op begins when patient leaves OR and ends after the last follow up visit with surgeon Extent of Surgery o Major hysterectomy, heart transplant o Minor scar removal Purposes of Surgery o Diagnostic biopsy, exploratory lap o Curative removal of inflamed appendix, extension of benign ovarian cyst o Reparative knee replacement o Reconstructive/Cosmetic breast augmentation, facelift, rhinoplasty o Palliative NG tube for patient with difficulty swallowing o Preventative patient with history of breast cancer removes breasts o Exploratory laparoscope Urgency of Surgery o Emergent done immediately to save patients life (laceration of large blood vessel, arterial bleed, severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot/ stab wound, extensive burns) o Urgent must be performed within 24-30 hours (removal of kidney or urethral stones, acute gallbladder infection) o Required must be done within weeks to months; some patients may opt not to (cataract, tonsillectomy, prostatic hyperplasia without bladder obstruction) o Elective recommended but not required; no adverse effects occur if surgery not performed (bladder lift, vaginal repair, repair of scars) o Optional patients choice (cosmetic surgery) Common surgical terms o Ectomy removal of (tonsillectomy) o Lysis destruction of (lysis of adhesions) o Plasty repair of or reconstruction (angioplasty) o Ostomy creating an opening (colostomy) o Oscopy look into (colonoscopy may perform lysis of polyps) o Otomy cutting into (tracheotomy for removal of foreign objects) o Orrhapy repair of (herniaoraphy) Physiological Stress Response to Surgery o fear of death or the unknown, body image concerns (colostomy), lifestyle and role changes, recovery, economic stress, insurance, spiritual beliefs (impacts patients perception of surgery) o Identify anxiety and decrease it Physiologic Stress Response to Surgery o Increased BP, increased respiratory distress Age Elderly o Slower healing, increased risk for infection, less physiological reserve (decreased ability of organs to return to normal after changes in equilibrium), decreased renal and liver function (need less anesthesia because they hold onto it longer), presence of chronic illness and current meds may increase risk associated with surgery Nutrition Obese patients o At risk for wound dehiscence (treatment= moist, sterile dressings, stay with patient, have another RN notify doctor, continue to monitor patient) o Fat cells hold onto anesthesia longer and therefore is eliminated slower o Risk for pneumonia post-op due to difficulty turning, coughing, and deep breathing...
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- Spring '08