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SURGICAL NURSING

DR. ELORIA SIMON-CAMPBELL, RN

Perioperative Phase
Assessment
Subjective data
Past health history
Medications/Allergies
Review of systems Objective data
Malnursished- over or under
Objective data- physical exam and labs
Documented history for each exam
Physical exam
Lab and diagnostic tests

Informed Consent

What is it?
Active shared decision
When is it needed? Who can sign?
Any time there is a procedure to be performed, the parent or guardian if
minor or unable
Who cannot sign?
Those unable to sign
When is a consent not required? Can a consent be withdrawn?
If a pt decides they dont want the surgery
Who is responsible for obtaining consent? What is the nurses role?
Whoever performs the procedure, make sure consent is valid make sure that
the pt understands, voluntarily consents
What make a consent valid?
Adequate disclosure , clear understanding

Psychological Preparation
Situational changes
Ask the pt if there has been any changes, some can be worried about a
scar
Concerns with unknown
Concerns with body image
Past experiences
Knowledge deficit
What is the nurses role?

Educational Preparation
What are some things that a nurse might need to teach prior to surgery?
Making sure they are wearing correct clothing, explaining the process of
going to sleep
Sensory
Process
Procedural
What are some things that a nurse may teach to prepare for post op?

Preoperative Medications
Analgesia

Nausea and vomiting


Sedation and amnesia
Anesthetic requirements
Apprehension and anxiety
Autonomic reflex response
Respiratory and gastric secretions
When are administered prior to surgery?
PO by mouth, with sip of water 60-90 min before
IM or SCIV

Ambulatory Surgery

Preadmission Prep
Arrival 1-2 prior to surgery NPO
Should the patient take his regular morning medications

Cultural Awareness
What cultural differences might a nurse encounter?
Blood administration surgical consent religious beliefs, surgical consent,
Hispanic women let the family decide,

Language barriers Pre op teaching


Evaluation & Documentation
Prior to transferring the patient to the OR, what does the nurse need to
do?
Documentation needs to be correct befor surgery, how they were
transported, alert and oriented, what was their mental and physical
state.

Intraoperative Phase
Members of the OR Team
Surgeon
Registered Nurse 1st Assist
CRNA
Circulating nurse
LVN/Scrub tech

Patient Safety
Infection
Physical injury
Fire
Airborne contaminant
Smoke

Positioning
Correct skeletal alignment
Make sure the pt is safe and taken care of, keep them dignified
Prevent pressure
Thoracic chest expansion
Prevent occlusion
Provide modesty
Recognize & respect individual needs

Anesthesia
General you are under, require skeletal muscle relaxation
Local a certain site that interrupts nerve signals
IV conscious sedation
Makes them not remember what happened, pain meds, muscle
blockers

Regional goes deep, like a spinal tap epidural


Adjuncts to anesthesia
Opioids
Benzodiazepines NBAs
Antiemetics

Asepsis
Sterile environment
Who is responsible for maintaining the sterile field? Everyone involved in the
procedure
What is the correct method for prepping a surgical site? depends on where it
is
Is shaving a surgical site recommended? No longer, but depends on doctor
or policy

Catastrophic events
Anaphylactic Shock- need to know what they are allergic to
Bronchospasm, tachycardia, hypotension. Closing airway
Malignant Hyperthermia
What are the S/S? rigidity of skeletal muscles, from anesthesia
When does it occur? After surgery
What is the treatment? Dantrolene slows metabolism, reduces muscle
contraction
Can it be prevented?

Evaluation & Documentation


Prior to transferring the patient to the OR, what does the nurse need to do?
Documentation, handoff

Postoperative Phase
Immediate Post-op Period
Assessment-ABCs, are they awake, any output- urine,
Recovery from anesthesia
Family
Post anesthesia recovery score
Angry Family
When should the family be updated? And hour after 4 hours

When should the family be allowed to see the patient?after the pt has been
cleaned up
What should the nurse tell the family prior to visitation? Tell them what to
expect
What should be explained to family once in recovery? Explain the same,

Post-op Care Unit


Discharge criteria are they stable, know the S/S, any education they will
need, how to take care of them selves
ABCs
Neurological status
Emergence delirium restlessness, agitation, disoriented, first sign of hypoxia
I&O- urinate,
Assess surgical site
Monitor for complications vitals

Post-op Complications
Airway obstruction
Hypoxemia- lack of ox to blood
Atelectasis lung collapse
Pulmonary edema, swelling in lungs
Bronchospasm
Hypoventilation to much O2 or CO2
Cardiac

Wake-up Regimen
Gas exchange
Positioning can they move
Pain relief are they in pain

Later Post Op
Wound healing
Evisceration & dehiscence removal of viscera or internal organs, the
suture comes undone
Circulation
Thrombus & embolism
Metabolic equilibrium
Nutritional status, fluid, & electrolytes
Urinary function
Retention, infection
Embolism

DVT
Gastrointestinal
n/v, hiccoughs, paralytic ileus, & constipation

Evaluation & Documentation


What will a nurse need to evaluate and document during the post op
period?
How did the pt leave document that mother