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Assessing patient outcomesConsider developmental stageIntimacy vs. IsolationEarly adulthoodAble to reach out and connect with others Outcome: Become intimate with someone and work toward careerGenerativity vs StagnationMiddle adulthoodLook beyond self to embrace society and future generationsOutcome: Begin family, develop concern for those outsideIntegrity vs. DespairLate adulthoodTake stock of one’s pastOutcome: Get sense of satisfaction from looking at pastDespair vs. hope and faithVery old age (late 80’s and beyond)Face new sense of self over failing bodies and need for careLike to talk about past and reminisce (talk to patient and listen if you have time)Outcome: Achieve a new sense of wisdom and transcendencePerioperative12.Purposes of surgery and examples for eachDiagnosis – know there is a problem and they’re doing a specific procedure Usually to obtain a sampleEx. Breast biopsyCure – removes malignant tissue; elimination or repair of pathologic conditionEx: Clear margins when undergoing cancer surgeryPalliation – treating symptoms rather than treating actual diseasePrevention – lowers risk for developing diseaseEx. Risk for breast cancer; undergo mastectomyDon’t advise patients what you would doTakes focus away from patientMay disagree and patient doesn’t need to know that and become angryExploration – know there is an issue in a generalized area; trying to find specific locationEx. Patients with trauma frequently undergoCosmetic Improvement – enhancing the appearanceEx. Plastics; repair a burn scar; breast reconstructionOther typesElectiveEmergencyAmbulatory (outpatient/same day)Inpatient13.Preoperative assessment--be able to identify findings to notify provider about
Goal = identify risk factors and plan care to ensure safety throughout the surgical experienceSubjective dataPsychosocial assessment – fear, anxietyPast health historyMedications – prescription and over the counterPatients should know what medications to take the morning before surgeryAllergiesReview of symptomsFunctional health patternsObjective dataPhysical exam of body systemsDetect signs of infection or anything that needs to be addressed prior to surgeryCould delay surgery if serious enoughLaboratory dataOther diagnostic test based on patient’s history and surgery undergoing Chest x-rayEKG14.Preoperative teaching includes:Sensory informationWhat patient might hear, see, feel as they go into operating roomProcess informationInformation about general flow of surgeryWhere families can wait during surgeryProcedural informationMore specific about the events that’ll occur15.Informed consentPatient is aware of why they need the procedure, the risks, alternatives, etc.