Surgery Categories

 Emergent – to save life or limb

• Ruptured aortic aneurysm

• Limb amputation

 Urgent – needed within 24-30 hrs

• Fracture, broken or compound (broken and punctured skin)

• Gallbladder –can rupture and cause infection if not removed

 Elective – planned or scheduled with no time requirements

• Joint replacement

• Cosmetic

Indications for Surgery

 Aesthetic—Requested by pt. for improvement

 Diagnostic—to obtain tissue samples, make an incision, or use a scope to

make a diagnosis

 Exploratory—confirmation or measurement of extent of condition

 Preventative—removal of tissue before it causes a problem

 Curative—removal of diseased or abnormal tissue

 Reconstructive—correction of defects of body parts

 Palliative—alleviation of symptoms when disease cannot be cured

Surgical Procedure Suffixes

 Ectomy – removal

 Orrhaphy – suture of or repair

 Oscopy – looking into

 Otomy – formation of permanent artificial opening

 Plasty – formation or repair

Perioperative Phases –all three phases surrounding and during

surgery
 Everything that has to do with surgery, pre, intra, and post phases.
Everything that the patient has to have done or taught is completed in this
phase.

 Preoperative phase—begins with decision for surgery and ends with transfer
to the operating room

 Intraoperative phase—begins with transfer to operating room and ends with

admission to perianesthesia care unit (PACU)

 Postoperative phase—begins with admission to PACU and continues until

recovery is complete

Factors Influencing Surgical Outcomes

 Emotional response—never say you are going to be alright, say we have

prepared you, you know what to expect, hold hand, inform physician if pt
fears are extreme, such as fear of dying and not waking up after surgery.

 Age—older people have less elasticity, poor healing abilities, children have
more body fluids, because fluid to body ratio,

 Hydration & nutrition—pts should be well nourished to adequately heal and

recover from surgery

 Smoking & alcohol use—pt should be encouraged to avoid smoking for 24

hours before surgery or 3 to 4 weeks before surgery if they have a chronic
lung disorder. Not smoking improves wound healing. Long term alcohol use
may cause nutritional deficiencies and liver damage, which can create
bleeding problems, fluid volume imbalances, and drug metabolism
alterations, and should be avoided before surgery. (she said 2 wks before
surgery avoid both)

 Diseases—for pt with diabetes, the stress of surgery can alter blood glucose
levels.

Preoperative Patient Assessment

 Health history –disease, cancer, hrt. disease

 Identify risk factors—smoking, age,

 Begin teaching—before surgery so pt is alert when being taught and has time
to learn. Teach pt how to report their pain level using a pain rating scale so
that prompt pain relief can be provided. Postoperative exercises are taught to
decrease complications, deep breathing and coughing, use incentive
spirometry, leg exercises, turning, and how to get out of bed, deep breathing.
Pt is taught to sit up, exhale fully, take in deep breaths through the nose,
hold the breath and count to three, and then exhale completely through the
 mouth. The pt is told to repeat this, 10 sets of breath hourly while awake, in
sets of five, for 24 to 48 hours postoperatively.

 Make necessary referrals

 Lab results

 EKG

 CXR

 Urinalysis

 Pregnancy test—to prevent fetal exposure to anesthetics

 Advanced Directives--

Preoperative Patient Admission

 Subjective data

• Problems with anesthesia

• Medications (Rx and OTC)

 Herbs

 Anticoagulants

 Insulin

 Steroid therapy

• Drug use

• LMP

Preoperative Patient Admission

 Objective data

• Physical assessment

 Skin assessment

 Sensory assessment

 Nervous system assessment

 Respiratory assessment

 Cardiovascular assessment

 Musculoskeletal assessment
  Gastrointestinal assessment

Nursing Interventions

 Anxiety or fear

 Deficient knowledge

Preoperative Instructions

 NPO (tiny sip of water if needed for med administration)

 Incentive spirometry (10 sets of breaths each hour)

 Enema

 Postoperative instructions (pain rating, pain relief, equipment utilized,

anticipated dressings, tubes, casts, traction, etc.) Let your pt know what is to
expect. If pt can tell you what will happen after surgery then they are ready
to go to surgery.

Preoperative Consent

 Whose responsibility is this? The DOCTOR!!! The nurse can only witness
signature, not explain the surgery! We are the pt advocate. You can ask if
they have a question. If you don’t know the answer call the dr! All paper
signed prior to med, or by next of kin.

Preoperative Checklist

 ID band

 Vital signs

 Make-up, nail polish removed

 Hair pins, jewelry

 Dentures, contact lenses, prosthesis

 Glasses & hearing aids

 All previous medical records (allergies, which extremity???)

 Valuables

 Voiding prior to procedure

 Pre-op meds administered—give meds at time ordered, usually 1 hr before,

or on call to surgery, document. The bed rails are raised for safety and the
patient is instructed not to get up alone after meds are given.
  Transfer to surgical suite (prepare for return) Bed ready for return, pillow or
not, bed lowered, emesis basin, call light, BP machine,

Intraoperative Phase

 Settings

 Aseptic technique

 Surgical scrubs (no artificial nails, jewelry)

Surgical Team Members

 Surgeon

 Surgical Assistant

 Anesthesiologist –dr of anesthesia, who puts pt under

 CRNA—nurse, RN, trained and certified in admin anesthesia,

 RN (circulating) Advocate, monitors sterility, checks positioning, monitors

equipment, documents, sponge counts

 Surgery technician—aid in positioning, equipment, clamps

Anesthesia

 Prevent pain

 Ordered by anesthetist

 Two types

• General anesthesia—totally unconscious, IV or inhalation, relieves

anxiety, complete muscle relaxation, uncooperative pt, surgery last a
long time

• Local—a certain part

General Anesthesia

 Given by IV

 Inhalation for anxiety

 Surgeries lasting long time or when need exists for muscle relaxation or client
can’t cooperate

Local Anesthesia

 Marcaine –last hours longer

 Lidocaine-local 4 hours
IV Drugs for Anesthesia

 Usually short-acting-count backwards from 100

 Followed by inhalation drugs

 Client is intubated after induction to provide mechanical ventilation

Malignant Hyperthermia

 Rare, hereditary disease

 Produces increased metabolism

 Causes high fever & muscle rigidity, tachycardia, tachypnea, HTN, and
irregular heart rate

Conscious Sedation—for quick procedures

 Minimal sedation

 Dental procedures

 Endoscopy—colonoscopy

 Cardiac cath –supra ventricular tachycardia

 Cardioversion

 Closed fracture reduction—hip

 Client awakens easily—Narcan reverses

Postoperative Phase

 Begins with admission to PACU & ends with client’s evaluation in physician’s
office

 PACU

 Respiratory function

 Cardiovascular function

 Neurological function

 Pain

Discharge from PACU

 Notify floor of transfer

 Bed in lowest position

  Call light in reach

 Emesis basin

 Pillow??

 Assist with ambulation

Surgical Wound Care

 Wound healing occurs in phases

• Phase 1

• Phase 2

• Phase 3

• Phase 4

Sutures & Staples

 Usually removed in 7-10 days

 Followed with steri-strips

 Observe wound drainage, color amt, consistency, odor

Dressing Change

 Surgeon usually removes first dressing

 Reinforce if necessary

 Circle drainage and notify physician if profuse

G I Function

 Postoperative bowel sounds auscultated q 4 hrs

 Up to 5 minutes

 Firmness, distention

 Note passage of flatus or stools

 Usually NPO until flatus, bowel sounds are heard.

Mobility

 Ordered per physician

 Usually up ASAP

 Prevents complications & promotes healing

 Turn q 2 hrs

 Change positions slowly