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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