Preoperative Post Operative Care_lecture

Preoperative Post Operative Care_lecture - Nursing312...

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Nursing 312 Fall 2010 1
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Surgery can be for cosmetic, palliative, curative and/or functional reasons Preoperative Care- takes place from the time the surgery is scheduled until client care is transferred to operating room personnel 2
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Informed Consent - all risks, benefits, alternatives, prognosis explained to client by PROVIDER !!! The RN’s job is to ensure the client understands risks, benefits, alternative and prognosis and to witness the consent. The RN is a witness that the surgeon has spoken with the client and the client understands! RN witnesses that informed consent was obtained AT NO TIME IS THE RN TO OBTAIN CONSENT by explaining the procedured, risks, ect 3
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If the client is unable to sign full name an “X” is acceptable with two RN witnesses A client who has had sedatives/pain meds may NOT sign consent (8-24 hrs- depends on hospital policy). Must be signed by power of attorney or if no POA, next of kin (also extends to organic impairment- dementia) If no family is present and true emergency a surgeon can document in the progress notes and surgery can proceed with no consent---may need a 2 nd surgeon’s sign-off 4
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Phone consent can be obtained if client unable and no family present. Must also have two RN witnesses and family must speak to provider first. DNR (Do Not Resuscitate)Orders---all patients must have an order before the surgical procedure Revocation during surgery is decided by client, surgeon and anesthesia. Clear documentation must be present on chart If DNR is revoked for the operation a new order must be written in the post operative period. 5
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Pre-existing condition Effect on client Bleeding disorders risk of bleeding (PT, platelets); Affect oxygenation, wound healing Diabetes Delayed healing, neuropathies, renal function Heart disease Can be depressed from anesthesia but if well controlled poses minimal risk Respiratory (COPD, URI, asthma etc) General oxygen exchange, may require more suctioning, maybe more prone to pneumonia Liver disease Drug metabolism; clotting Chronic pain May require more meds due to tolerance Renal Excretion of drugs Obesity Workload on heart, hypertension, delayed healing, ? Impaired circulation, sleep apnea 6
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Assessment Rationale Detailed H & P, Patient or Family History of Anesthetic Problems (ex/ Malignant Hyperthermia), Allergies Provide critical information on health of patient for surgical team Labs (electrolytes, H&H) K+ 3.5-5.0 Glucose < 120 Hgb-12-18 g/dl Indicators of cardiac and hemodynamic stability Clotting Studies (PT, INR,INR, Plt) Platelets 150,000-400,000 mcr/l Indicator of liver function and possible bleeding difficulties Vital signs Baseline data: watch trends before going to surgery and in post-op 7
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Lab & diagnostics Importance of CXR-clear lungs EKG- normal sinus CBC (H&H; WBC) creatinine liver function tests  clotting studies  electrolytes Fluid, atelectasis,  Abnormal rhythm Poss infection; anemia (O2  carrying capacity affects  healing)
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This note was uploaded on 02/16/2011 for the course NURS 312 taught by Professor Glenn during the Fall '10 term at South Carolina.

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Preoperative Post Operative Care_lecture - Nursing312...

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