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 and takes into consideration the following:

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
Any 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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