The person undergoing surgery

The person undergoing surgery

1 DK/CIII/surgical pt

The person undergoing surgery

 If you work in a hospital, you may have contact with
a person before and after surgery. In nursing
facilities, many residents are recovering from
surgery. Many post operative patients need home
care. Your role in caring for surgical patients
depends on certain factors:
 The employer’s policies
 Whether the surgery was major or minor
 The person’s condition before surgery
 The person’s condition after surgery


Preoperative Care

 The preoperative phase
begins when surgical
intervention is first
considered and ends
when the patient is
admitted to the
operating theatre
 Preparations for
surgery depend on
diagnosis & type of
surgery

Pre operative preparation including client
communication/teaching

 An important part of modern surgery is day surgery, also know
as ambulatory surgery. Advance surgical techniques and
better client preparation have allowed for clients to be admitted,
operated on and discharged in the same day. All types of
anaesthesia can be used.
 Surgery is treating diseases, injuries and deformities by
operation. As part of the client’s preparation you may need to
discuss various terms used to describe surgery.


Types of surgery

 Elective surgery is done for the person’s well-being.
It is not life saving and may not be necessary for the
person’s health. The surgery is scheduled well
ahead of time, allowing the person to be well
prepared psychologically and emotionally and
leaving time for any pre testing to be done.
 Urgent surgery is necessary for the person’s health.
It must be done soon to prevent damage or disease.
 Emergency surgery is done immediately It is life
saving and the need is sudden and unexpected.


Surgical intervention

May be directed towards:
 a tumour (excess of tissue)
 A defect (deficiency of tissue)
 A deformity (displacement of structures)
 Or the removal of foreign bodies (non-living
material)


Methods of performing surgical
procedures:

 open surgery e.g. mastectomy – external
surgical wound
 closed surgery e.g. T.U.R.P. – wound is
internal
 minimal access e.g. laparoscopic –
minimal external wounds and faster
recovery time


Preparation

 Providing information
 Teaching activities
 Examining/assessing the individual
 Performing laboratory tests and diagnostic
studies
 Gaining the individual’s informed consent
 Preparing the individual psychologically and
physically


The person needs to be prepared for
what happens before after and during
surgery.

 Physical and psychological
preparation is necessary.
 Often the person who needs
to have surgery experiences
many fears,
- fear of loss of an organ,
- who will care for the
children,
- how will they cope with the
pain,
- will they survive?


Purpose of surgery

 diagnostic surgical exploration to aid
diagnosis e.g. biopsy to determine
presence and/or extent of pathology
 Constructive restores function lost or
reduced (congenital anomalies) e.g.
congenital defects
 transplant due to organ damage
 reconstructive restores function or
appearance to traumatised or
malfunctioning tissues e.g. fractures
 palliative relieve or reduce intensity of
disease symptoms e.g. colostomy to
bypass inoperable bowel obstruction
from cancer
 Cosmetic to improve appearance e.g.
rhinoplasty, repairing burns scars.


Common Fears and Concerns of
Surgical Patients

•The fear of cancer •The fear of prolonged recovery

•The fear of body disfigurement and scarring •The fear of more surgery and treatments

•The fear of disability •The fear of being separated from family and
friends
•The fear of pain •The fear of tubes, needles and other
equipment
•The fear of dying •Concerns

•The fear of anaesthesia and it’s effects •Who will look after the partner

•The fear of going to sleep and not waking up •Who will take care of the pets

•The fear of exposure •Who will pay the bills

•The fear of complications •Who will take care of the unit


Nursing Assistant responsibilities in
caring for the person who has fears
and concerns:

 Listen to the person who
voices fears or concerns
about surgery
 Refer any questions about
the surgery or it’s results to
the nurse
 Explain any procedures you
do
 Perform your tasks in a
competent and confident
manner


The Pre-operative Period

 The doctor or registered nurse will do any pre-
operative teaching. Once the doctor explains what is
going to be done the person may sign a consent
form should they wish to proceed. The registered
nurse does the pre-operative teaching and tells the
person what to expect after surgery.
 It is not your role to educate the patient, but you
should be aware of what is happening so you
can give efficient basic care.


Pre operative preparation

elective:
 pre-admission clinics/tests
 early intervention programs
 patient education/assessment
 referral
emergency
 day only/short stay/long stay:
 transit lounge/pre-op prep areas


Anaesthesia

Factors influencing the choice of anaesthetic include :
1. Nature of the surgery (length & complexity of
of operation).
2. Client’s status (pre-existing medical
conditions).
3. Anatomical & physiological conditions.
4. Client preference.


Anaesthesia
 Anesthesia blocks the perception of pain.
 Anesthesia is classified according to the CNS effects:
i) local – the loss of sensation without the loss of consciousness
ii) regional – the loss of sensation to a region of the body without loss of
consciousness when a specific nerve or group of nerves is blocked
with the administration of a local anaesthetic
iii) general – the loss of sensation with loss of consciousness,+/- skeletal
muscle relaxation, analgesia and elimination of the somatic, autonomic
and endocrine responses


awareness of patient teaching

 deep breathing and coughing exercises
 pain management (including PCA)
 moving and changing position
 wounds, drains, intravenous infusions,
indwelling catheters, nasogastric tubes
 specialised surgical procedures


anti-embolic stockings

 support blood vessels
 prevent stasis
 prevent thrombus formation


pre-op
 base line data collection (including weight)
 skin preparation ( you may be involved with this),
according to policy
 clipping
 showering
 total body wash
 gastrointestinal preparation, e.g. bowel preparation
 fasting regimes ( NBM 6-8 hours before) there
should be a sign above the person’s bed and the
water jug should be removed.


Pre-Operative Checklist

Item Time Rationale
1. Operative area shaved 1 day pre- op or Hairs – harbour micro-organisms -
in OT obscure op site

2. Special skin 1-2 days pre-op Decreases risk of infection.
preparation morning of op

3. Weight 1 day pre-op Calculation of drug dosage
Baseline for comparison

4. Consent Pre-op Legal purposes – written consent
necessary for operative procedures

5. Bowel preparation Night before Prevents incontinence during
anaesthesia. Decreases risk of post-op
discomfort and abdominal distension.


Item Time Rationale
6. Premedication given As ordered Promotes relaxation.
Reduces apprehension.
Dries up oral secretions.
Decreases risk of
inhalation.

7. Natural teeth Prior to transfer to OT May be dislodged during
Dentures – in situ anaesthesia.
Removed
8. Make up; nail polish, Day of surgery Nail polish – easier to
observe the individual for
jewellery, cyanosis. Prosthesis – may
hairpins, contact lenses cause injury. Jewellery – may
removed come in contact with metal
and burn individual if
diathermy used.

Item Time Rationale
9. Temp: On admission and Abnormality may mean postponement of
Chart on day of surgery operation
Pulse:
Resp:
B.P.:
10. NBM:
- Morning op -Usually 12mn Present of food/fluid causes vomiting
night before and risk of inhalation.
-- afternoon op - 6 hrs prior

11. Intragastric As ordered Aspiration of stomach contents and
tube in situ decompression of stomach.



Item Time Rationale
12. Stomach aspirated If emergency op and patient has
Time: had food during the past 6 hours.
Amount:
13. Voided/Catheterised 1 hr pre-op To prevent incontinence and
Time: prevent injury to bladder.
Amount: Morning of op Detect renal dysfunction.
Urinalysis:
14. X rays with patient To accompany For referral by surgeon.
(eg patient to OT For referral by anaesthetist.
Orthopaedic,
Gallbladder)
E.C.G.



Item Time Rationale
15. Outpatient clinic notes To accompany patient to For referral by
OT anaesthetist and surgeon.

16. All current and To accompany patient to For referral by
previous history notes OT anaesthetist and surgeon.

17. Blood cross matched Day before Possible need for
and typed transfusion.



Item Time Rationale
18. No. of blood bottles in Day of op Easy access if transfusion necessary
O.T. fridge

19. Night sedation Night before To relax, decrease anxiety.


Recovery room


Post-op

- preparing the patient’s room (surgical bed, placing
equipment and supplies in the room, as directed by
the nurse)
- observations: You may be assigned to measure vital
signs and observe the patient’s condition.
- Other observations: time and amount of first
voiding, FBC.
- care of drips/drains ( If the drip is not dripping, do
not touch the drip(IV), inform the RN) Inform the
registered nurse of the appearance of bright red
blood from the drainage tubes or suction tubes.


Post-op assessment

 Vital signs
 Colour
 Level of consciousness
(LOC)
 Wound dressing
 Drainage from urinary
catheter
 Presence of discomfort
or pain


Post op
 An IV (intravenous catheter) in your
hand or arm to provide fluids and
medicines until you are able to drink
fluids well.
 A face mask or tube under your nose to
supply oxygen.
 A tube to drain urine from your bladder.
You may feel the urge to urinate even
though your bladder is empty.
 An NG (nasogastric) tube through your
nose into your stomach to help prevent
nausea and vomiting.
 Wound drains to help your incision
heal.
 Leg wraps that inflate and deflate
and/or elastic stockings to help
circulation in your legs while you are less
active.



Post op

 Remember: The post-op person is NBM
until they have been given permission by
the doctor to progress to a different diet.
The registered nurse will tell you when to
change the signs above the patient’s bed.


Subsequent post-op care
 Assessing respiratory and circulatory needs
 Comfort needs
 Nutritional and fluid needs
 Elimination needs
 Movement and exercise needs
 Hygiene needs
 Psychological needs
 Protection and safety needs
 Wound care needs (including drainage tubes, sutures and
clips)
 Observe for complications
 Preparation for discharge


Complications
 Pain
 Haemorrhage
 Shock (hypovolaemic) respiratory complications (pneumonia,
atelectasis)
 Thrombophlebitis
 Pulmonary embolism
 Nausea and vomiting (N&V)
 Abdominal distension
 Paralytic ileus
 Urinary retention
 Wound infection/dehiscence/evisceration


Operative procedures

Some examples include:
 Prostatectomy
 Hysterectomy
 Cholecystectomy
 Appendicectomy
 Tonsillectomy
 (Breast) lumpectomy
 Hip replacement
 Knee replacement


Operating room


The person undergoing surgery

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Editor's Notes