PERIOPERATIVE PATIENT CARE



Purposes of Surgery



1. Diagnostic – establish the presence of disease condition


2. Exploratory – determine the extent of disease condition


3. Curative – treats the disease condition


ABLATIVE – removal (EG: Appendectomy)


CONSTRUCTIVE – repair of Congenital defects (EG: Cheiloplasty)


RECONSTRUCTIVE – repair of damaged organ


4. Palliative – placement of PEG tubes for Stomach Cancer




Magnitude of Surgery


MAJOR – High risk for Cx; (EG: Craniotomy, Explore Lap)


MEDIUM – (EG: appendectomy, hemorrhoidectomy)


MINOR – decreased Cx is involved (EG: Excision, Removal of ingrown)




Urgency


Emergency – done immediately. Hemorrhage, VA


Imperative – done within 24-48° Gangrene, Amputation


Planned – in weeks or months Thyroidectomy, MRM


Elective – delay will not cause adverse effects Cauterization of warts, Lumps


Optional - requested by the client; for Aesthetic purposes Rhinoplasty, Blepharoplasty





PRE OP






ASSESSMENT


* Prep pts at least a day before


Age


Pain (Presence vs Tolerance)


Nutritional status


Hydration (IVF 1° prior to Surgery)


Infection (prophylaxis @ least 1° before Sx thru IV push; Skin Testing is done b4 giving)


Operation time:


ATBC or other drugs given?


Skin testing





Medications


STOP ASA at least 1 week before the Sx


Current drug therapy


Allergy





Others



Prepare 3 units of blood prior to Sx


Religion (not allowed if pt is Jehovah’s witness)


Occupation (post insertion of Harrington rod, he can no longer bear heavy objects)


SO (close relationships)





Review of Systems (for clearance)



Hematologic = CBC, Hct, Hgb


Pulmonary = Far advanced PTB, Asthma


Cardiovascular = pacemakers


Neurological = hemiphlegia


Renal = status post kidney transplant; BPH



GI = Ulcers because NPO is instructed


Endocrinological = ­BSL defers Sx; CBG q1°


Reproductive




CONSENT


* valid only for 24° only


* pt understands the nature of the Tx, potential Cx, alternatives


* w/o pressure; voluntary


* protection against legal action




PREPARATIONS




PRE-OP Rounds



* skin test


* personal hygiene – the night before


* diet = Liquid, NPO


* bowel – abdominal Sx = bowel prep; Cleansing enema


* skin Ortho prep (sa OR); Skin prep (shaving only)


* IV Line





INTRA OP



* Verification


* Quick assessment





POST OP





exercise (DBE)




Contraptions – Abdominal: NGT, IVF, O2


Explore lap: NGT





Miscellaneous


40 y/o & above – needs Cardiovascular clearance


Clearance from APs


Monitoring VS of pts


Check op site


Blood request (SOP: 2 units of blood)


Bill settlement





Expectations


Possible Cx


Health teachings: Abd Sx (Teach DBE & Side lying position = Adhesionlysis)


Limitations: Hip prosthesis (do logroll)





IMMEDIATE POST OP (post anesthesia recovery stage)






EXTENDED POST OP



Sphygmo


Stethoscope


IV equipment


Suction


Tongue depressor


Oral A/W


Emesis basin


Cardiac monitor

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