1. PERIOPERATIVE NURSING
JAYESH PATIDAR

2. SURGERY
 Is the use of instruments during an operation
to treat injuries, diseases, and deformities
 Is a stressful, complex event
 The branch of medicine concerned with
diseases and trauma requiring operative
procedures

3.  Surgical procedures are named according to
(1) the involved body organ, part, or location
and (2) the suffix that describes what is done
during the procedure
 Physicians who perform surgery include
surgeons or other physicians trained to do
certain surgical procedures

4. SURGICAL PROCEDURE SUFFIXES
 -ectomy - Removal by cutting
 -orrhaphy - Suture of or repair
 -oscopy - Looking into
 -ostomy - Formation of a permanent artificial
opening

5.  -otomy - Incision or cutting into
 -plasty - Formation or repair

6. CLASSIFICATION OF
SURGERY

7. ACCORDING TO URGENCY
 Emergent - Patient requires immediate
attention; disorder may be life threatening;
immediately without delay to maintain life or
organ, remove damage, stop bleeding
 Urgent/ Imperative - Patient requires prompt
attention; within 24 – 30/48 hours

8.  Required/ Planned - Patient needs to have
surgery; plan within a few weeks or months
 Elective - Patient should have surgery;
failure to have surgery not catastrophic;
planned/scheduled with no time
requirements
 Optional - Decision rests with patient; at the
preference of patient

9. ACCORDING TO PURPOSE
 Aesthetic - Requested by patient 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

10.  Preventive - Removal of tissue before it
causes a problem
 Curative (Ablative) - Removal of diseased or
abnormal tissue
 Reconstructive - Correction of defects of body
parts
 Palliative - Alleviation of symptoms without
curing disease

11. ACCORDING TO EXTENT
 Major - Extensive surgery that involves
serious risk and complications, as it involves
major organ
 High risk, extensive, prolonged, large amount
of blood loss, vital organs may be handled or
removed, great risk of complications

12.  Minor - Involves minimal complications &
blood loss
 Generally not prolonged, leads to few serious
complications, involves less risk

13. PRINCIPLES OF SURGICAL
ASEPSIS

14. MOISTURE CAUSES CONTAMINATION
 Prevent splashing of liquids in the sterile fields
 Place wet objects on sterile, water-
impermeable surfaces, such as sterile basin
 Rationale: microorganisms travel more easily
through moist environment. When sterile
surface becomes moist, microorganisms from
the unsterile surface may be transmitted into
the sterile surface

15. NEVER ASSUME THAT AN OBJECT IS STERILE
 Ensure that it is labeled as sterile
 Always check the integrity of the packaging
 Always verify the expiration date on the
package
 Whenever in doubt of the sterility of an
object, consider it unsterile

16.  Rationale: commercially prepared products
are labeled as sterile on their packaging;
special indicators are used to show that
objects have completed their sterilization
process; packages that are
torn, punctured, or moist are considered
unsterile

17. ALWAYS FACE THE STERILE FIELD
 Rationale: objects that are out of the line of
vision may be inadvertently contaminated

18. STERILE ARTICLES MAY TOUCH ONLY STERILE
ARTICLES OR SURFACES IF THEY ARE TO
MAINTAIN THEIR STERILITY
 Rationale: anything considered unsterile
may transfer microorganisms to the sterile
object it touches

19. STERILE EQUIPMENT OR AREAS MUST BE KEPT
ABOVE THE WAIST AND ON TOP OF THE STERILE
FIELD
 Waist level is the limit of good visual field.
Maximum visibility of all sterile objects
prevents inadvertent contamination

20. PREVENT UNNECESSARY TRAFFIC AND AIR
CURRENTS AROUND THE STERILE AREA
 Close doors
 Unfold drapes or wrappers properly
 Do not sneeze, cough, or talk excessively
over the sterile field

21.  Do not reach across sterile fields
 Move around a sterile field to reach for an
object, if necessary
 Rationale: microorganisms cannot be
completely excluded from the air;
overreaching across sterile fields will render
sterile objects unsterile

22. OPEN, UNUSED STERILE ARTICLES ARE NO
LONGER STERILE AFTER THE PROCEDURE
 Rationale: once protective wrapping have
been removed, the article is being
contaminated by air so, it must be discarded
or sterilized before it is used; liquids opened
during the procedure that remain in the
container are also considered contaminated

23. A PERSON WHO IS CONSIDERED STERILE WHO
BECOMES CONTAMINATED MUST REESTABLISH
STERILITY
 Rationale: if a “scrubbed” person punctures
the gloves or is contaminated by touching an
unsterile object, he or she must change the
contaminated articles; if a “scrubbed” person
leaves the area of the sterile field, he or she
must go through the procedure of
rescrubbing, gowning, and gloving

24. SURGICAL TECHNIQUE IS A TEAM EFFORT
 A collective and individual “sterile
conscience” is the best method of enhancing
sterile technique
 Rationale: staff members must rely on one
another to maintain sterile technique;
periodic review of procedures and infection
control surveillance reports enhance
everyone’s sterile technique

25. FOUR MAJOR TYPES OF
PATHOLOGIC PROCESSES
REQUIRING SURGICAL
INTERVENTION (POET)

26. P – PERFORATION
 rupture of an organ

27. O – OBSTRUCTION
 impairment to the
flow of vital fluids
e.g.
blood, urine, CSF,
bile

28. E – EROSION
 wearing off of a
surface or
membrane

29. T – TUMORS
 abnormal new
growths

30. EFFECTS OF SURGERY TO THE
CLIENT

31.  Stress response is elicited
 Defense against infection is lowered
 Vascular system is disrupted
 Organ functions are disturbed
 Body image may be disturbed
 Lifestyles may change

32. SURGICAL RISK FACTORS

33. NUTRITIONAL AND FLUID STATUS
 Optimal nutrition is an essential factor in
promoting healing an resisting infection and
other surgical complications
 obesity, undernutrition, weight
loss, malnutrition, deficiencies in specific
nutrients, metabolic abnormalities, and the
effects of medication on nutrition

34.  Nutritional needs may be measured
through BMI and waist circumference
 Nutritional deficiency should be corrected
before surgery
 Nutrients important for wound healing are:
protein, arginine, carbohydrates and
fats, water, vitamin C, vitamin B
complex, vitamin A, vitamin
K, magnesium, copper, zinc

35. DRUG OR ALCOHOL USE
 The person with a history of chronic
alcoholism often suffers from malnutrition
and other systemic problems that increase
surgical risk

36. AGE
 very young
 very old

37. PRESENCE OF DISEASE/S
 Respiratory
 Renal/urinary
 Cardiovascular
 Endocrine
 Hepatic

38. CONCURRENT OR PRIOR PHARMACOTHERAPY
 A medication history is obtained from each
patient because of the possible effects of
medications on the patient’s perioperative
course, including the possibility of drug
interactions
 Document all medications

39.  Stop aspirin 7-10 days before surgery
 Currently it is recommended that the use of
herbal products be discontinued 2 to 3 weeks
before surgery

40. OTHER SURGICAL RISK FACTORS
 Nature of condition
 Location of the condition
 Magnitude and urgency of the surgical
procedure
 Mental attitude of the person toward surgery
 Caliber of the professional staff and health
care facilities

41. THE SURGICAL TEAM

42. THE CIRCULATING NURSE
 Also known as the circulator
 manages the OR and protects the patient’s
safety and health by monitoring the
activities of the surgical team, checking the
OR conditions, and continually assessing
the patient for signs of injury and
implementing appropriate interventions

43.  verifying consent, coordinating the
team, and ensuring cleanliness, proper
temperature, humidity, lighting, safe function
of equipment, and the availability of
supplies and materials
 Monitors aseptic practices to avoid breaks
in technique
 “surgical or pre-procedure pause” or time-
out”

44. THE SCRUB ROLE
 Performs a surgical hand scrub
 Setting up the sterile tables
 Prepares sutures, ligatures, and special
equipment

45.  Assists the surgeon and the surgical
assistants during the procedure by
anticipating the instruments and supplies
that will be required
 As the surgical incision is closed, the scrub
person and the circulator count all
needles, sponges, and instruments

46.  Standards call for all sponges to be visible
on x-ray and for sponge counts to take
place at the beginning of surgery and twice
at the end
 Tissue specimens obtained during surgery
are labeled by the scrub person and sent to
the laboratory by the circulator

47. THE SURGEON
 Performs the surgical procedure and heads
the surgical team

48. THE ANESTHESIOLOGIST AND ANESTHETIST
 An anesthesiologist is a physician
specifically trained in the art and science of
anesthesiology
 An anesthetist is a qualified health care
professional who administers anesthetics

49.  They assess the patient before
surgery, selects the
anesthesia, administers it, intubates the
patient if necessary, manages any
technical problems related to the
administration of the anesthetic agent, and
supervises the patient’s condition
throughout the surgical procedure

50. THE SURGICAL
ENVIRONMENT

51.  Known for its stark appearance and cool
temperature
 Access is limited to authorized personnel
 The OR must be situated in a location that is
central to all supporting services
 The OR must have a specific air filtration
devices to screen out contaminating
particles, dust, and pollutants

52.  the unrestricted zone (street clothes are
allowed); the semi restricted zone (attire
consists of scrub clothes and caps); and the
restricted zone (scrub clothes, shoe
covers, caps, and masks are worn)
 Shirts and waist drawstrings should be
tucked inside the pants

53.  Wet or soiled garments should be changed
 Masks are worn at all times at the restricted
zone
 Upper respiratory tract infections and skin
infections in staff and patients are sources
of pathogens and must be reported

54. PREOPERATIVE PHASE

55.  Extends from the time the client is a admitted
in the surgical unit, to the time he/she is
prepared
physically, psychosocially, spiritually, and
legally for the surgical procedure, until he is
transported into the operating room
 Begins when the decision to proceed with
surgical intervention is made and ends with
the transfer of the patient onto the OR table

56.  involves establishing a baseline evaluation of
the patient before surgery by carrying out a
preoperative interview
 ensuring that necessary tests have been or
will be performed
 arranging appropriate consultations; and
providing education about recovery from
anesthesia and postoperative care

57.  On the day of surgery, patient teaching is
reviewed, the patient’s identity and surgical
site are verified, informed consent is
confirmed, and an IV infusion is started

58. GOALS
 Assessing and correcting physiologic and
psychologic problems that might increase
surgical risk
 Giving the person and significant others
complete learning/teaching guidelines
regarding surgery

59.  Instructing and demonstrating exercises that
will benefit the person during post operative
period
 Planning for discharge and any projected
changes in lifestyle due to surgery

60. PHYSIOLOGIC ASSESSMENT OF THE CLIENT
UNDERGOING SURGERY
 Age
 Presence of pain
 Nutritional status
 Fluid and electrolyte balance
 Infection
 Cardiovascular function

61.  Pulmonary function
 Renal function
 Gastrointestinal function
 Liver function
 Endocrine function
 Hematologic function
 Use of medication
 Presence of trauma

62. PSYCHOSOCIAL ASSESSMENT AND CARE
 Causes of fears of the preoperative clients
 Fear of the unknown
 Fear of anesthesia, vulnerability while
unconscious
 Fear of pain
 Fear of death
 Fear of disturbance of body image
 Worries – loss of finances, employment, social
and family roles

63.  Manifestations of fears
 Anxiousness
 Bewilderment
 Anger
 Tendency to exaggerate
 Sad, evasive, tearful, clinging
 Inability to concentrate
 Short attention span
 Failure to carry out simple directions
 Dazed

64. NURSING INTERVENTIONS TO MINIMIZE ANXIETY
 Explore client’s feelings
 Assist client to identify coping strategies that
he or she has previously used to decrease
fear
 Allow client to speak openly about
fears/concerns

65.  Give accurate information regarding surgery
 Give empathetic support
 Consider the person’s religious preferences
and arrange visit by priest/minister as
desired
 Music therapy

66. INFORMED CONSENT (OPERATIVE
PERMIT/SURGICAL CONSENT)
 necessary before non emergent surgery can
be performed
 permission obtained from a patient to
perform a specific test or procedure

67. PURPOSES:
 to ensure that the client understands the
nature of the treatment including the potential
complications and disfigurement (explained
by AMD)
 to indicate that the client’s decision was
made without pressure

68.  to protect the client against unauthorized
procedure
 to protect the surgeon and hospital against
legal actions by a client who claims that an
unauthorized procedure was performed

69. CIRCUMSTANCES REQUIRING A PERMIT:
 any surgical procedure where
scalpel, scissors, or sutures may be used
 any invasive procedure such as surgical
incision, a biopsy, a cystoscopy, or
paracentesis

70.  a nonsurgical procedure, such as an
arteriography, that carries more than slight
risk to the patient
 procedures involving radiation
 procedures requiring sedation and/or
anesthesia

71. REQUISITES FOR VALIDITY OF INFORMED
CONSENT
 written permission is best and is legally
acceptable
 signature is obtained with the client’s
complete understanding of what is to occur
 adultssign their own operative permit
 obtained before sedation

72.  secured without pressure or duress
 a witness is desirable – nurse physicians or
authorized persons
 in an emergency, permission via telephone or
telefax is acceptable

73.  for minor (below
18), unconscious, psychologically
incapacitated, permission is required from
responsible family member (parent/legal
guardian)

74. INFORMED CONSENT SHOULD CONTAIN THE
FOLLOWING:
 explanation of procedure and its risks
 description of benefits and its alternatives
 an offer to answer questions about procedure

75.  instructions that the patient may withdraw
consent
 a statement informing the patient if the
protocol differs from customary procedure

76. PHYSICAL PREPARATION
 Before Surgery
 Correct any dietary deficiencies
 Reduce an obese person’s weight
 Correct fluid and electrolyte imbalances
 Restore adequate blood volume with blood
transfusion

77.  Treat chronic diseases
 Halt or treat any infectious process
 Treat
an alcoholic person with vitamin
supplementation, IVF’s or oral fluids if
dehydrated

78. TEACHING PREOPERATIVE EXERCISES
 Deep breathing exercises
 Practice
in the same position client would
assume in bed after surgery
 Allow hands in a loose fist position to rest lightly
on the front of the lower ribs with your finger tips
against lower chest to feel the movement

79.  Breathe
out gently and fully as the ribs sink
down and inward toward midline
 Take a deep breath your nose and mouth,
letting the abdomen rise as the lungs fill with air
 Hold this breath for a count of five
 Exhale
and let out all the air through your nose
and mouth

80.  Repeat this exercise 15 times with a short rest
after each group of five
 Practice twice daily preoperatively

81.  Incentive spirometry
 Let client sit upright, at 45 degrees minimum
 Take two normal breaths. Place mouthpiece of
spirometer in mouth
 Inhale until target, designated by spirometer
light or rising ball, is reached, and hold breath
for 3 to 5 seconds

82.  Exhale completely
 Perform 10 sets of breaths each hour

83.  Coughing exercises
 Have client sit up and lean forward
 Show client how to splint incision with hands,
pillow, or blanket
 Have client inhale and exhale deeply three
times through mouth

84.  Have client take in deep breath and cough out
the breath forcefully with three short coughs
using diaphragmatic muscles. Take in quick
deep breath through mouth, cough deeply, and
deep breathe

85.  Turning exercises
 Turnon your side with the uppermost leg flexed
most and supported on a pillow
 Grasp the side rail as an aid to maneuver to the
side
 Practice diaphragmatic breathing and coughing
while on your side

86.  Foot and leg exercises
 Lie in a semi-Fowler’s position
 Bend your knee and raise your foot – hold it a
few seconds, then extend the leg and lower it to
the bed
 Do this five times with each leg
 Then trace circles with the feet by bending them
down, in toward each other, up, and then out

87. PREPARING THE PERSON BEFORE SURGERY
 Preparing the skin
 Have full bath to reduce microorganisms in the
skin
 Preparing the GI tract
 NPO; cleansing enema as required
 Preparing for anesthesia
 Avoidalcohol and cigarette smoking for at least
24 hours before surgery

88.  Promoting rest and sleep
 Administer sedatives as ordered

89. PREPARING THE PERSON ON THE DAY OF
SURGERY
 Early morning care
 Awaken one hour before preoperative
medications
 Morning bath, mouth wash
 Provide clean gown
 Remove hairpins, braid long hairs, cover hair
with cap

90.  Remove dentures, foreign materials (chewing
gum), colored nail polish, hearing aid, contact
lens
 Take
baseline vital signs before preoperative
medication
 Check ID band and skin preparation
 Check for special orders – enema, GI tube
insertion, IV line

91.  Check NPO
 Have client void before preoperative medication
 Continue to support emotionally
 Accomplish “preoperative care checklist”

92. PREOPERATIVE MEDICATIONS/ PREANESTHETIC
DRUGS
 Goals:
 To facilitate the administration of any anesthetic
 Tominimize respiratory tract secretions and
changes in heart rate
 To relax the client and reduce anxiety

93.  Narcotics
 Morphine sulfate
 Fentanyl (Sublimaze)
 Meperidine (Demerol)
 Analgesia; enhancement of postoperative pain
relief

94.  Antianxiety and sedative hypnotics
 Diazepam (Valium)
 Hydroxyzine hcl (Vistaril)
 Lorazepam (Ativan)
 Midazolam (Versed)
 Phenobarnital sodium
 Sedation; anxiety reduction

95.  Anticholinergic
 Atropine sulfate
 Scopolamine hydrobromide
 Secretion reduction

96.  Antiemetic
 Ondansetron (Zofran)
 Metoclopramide (Reglan)
 Promethazine hcl (Phenergan)
 Control nausea and vomiting; may be effective
into the postoperative period

97.  H2 antagonist
 Cimetidine (Tagamet)
 Ranitidine (Zantac)
 Famotidine (Pepcid)
 Reduction of acidic gastric secretions in case
aspiration occurs

98.  Antibiotic
 Cefazolin (Ancef)
 Ampicillin (Omnipen
 Prevention of postoperative infection

99. INTRAOPERATIVE PHASE

100.  Begins when the client is transferred onto
the OR table and ends with admission to the
PACU
 Extends from the time the client is admitted
to the operating room, to the time of
administration of anesthesia, surgical
procedure is done, until he/she is
transported to the recovery room/PACU

101.  Nursing activities include: providing safety,
maintaining an aseptic environment, ensure
proper functioning of equipment, providing
the surgeon with specific instruments and
supplies for the surgical field, and proper
documentation

102. GOALS OF CARE (HASH)
 H – homeostasis
 A – asepsis
 S – safe administration of anesthesia
 H – hemostasis

103. POSITIONS DURING SURGERY
 Dorsal Recumbent – hernia repair,
mastectomy, bowel resection
 Trendelenburg – lower abdomen, pelvic
surgeries

104.  Lithotomy – vaginal repairs, D and C, rectal
surgery
 Prone – spinal surgeries, laminectomy
 Lateral – kidney, chest, hip surgeries

105.  Explain purpose of position
 Avoid undue exposure
 Strap the person to prevent falls
 Maintain adequate respiratory and
circulatory function
 Maintain good body alignment

106. TYPES OF ANESTHESIA
 General
 Anesthesia is a state of narcosis, analgesia,
relaxation, and reflex loss
 Clients
under general anesthesia are not
arousable, not even to painful stimuli
 Produces amnesia
 Can be administered through IV or inhalation

107.  Gasanesthetics are administered by inhalation
and are always combined with oxygen
 Nitrous
oxide is the most commonly used gas
anesthetic agent
 When inhaled, the anesthetics enter the blood
through the pulmonary capillaries and act on
cerebral centers to produce loss of
consciousness and sensation
 General anesthesia consists of four stages

108.  Stage I (beginning anesthesia)
 extends from the administration of anesthesia to
the time of loss of consciousness
 The client may have a ringing, roaring or
buzzing in the ears, and although still conscious,
may sense an inability to move the extremities
easily
 During this stage, noises are exaggerated
 Duringthis stage, noises are exaggerated.
Unnecessary noises and motions are avoided

109.  Stage II (excitement/delirium)
 extends from the time of loss of consciousness
to the time of loss of lid reflex
 Itmay be characterized by shouting, struggling,
talking, singing, laughing, or crying of the client
but often avoided if anesthetic is administered
smoothly and quickly
 Assist anesthesiologist/ anesthetist if needed to
restrain client. Client should not be touched
except for purposes of restraint.

110.  Stage III (surgical anesthesia)
 extends from the loss of lid reflex to the loss of
most reflexes. Surgical procedure is started
 Stage IV (medullary depression)
 it
is characterized by respiratory/cardiac
depression or arrest. It is due to overdose of
anesthesia. Resuscitation must be done

111.  Regional
 Reduce all painful sensations in one region of
the body without inducing unconsciousness
 Topical, local infiltration, epidural, spinal
 Client receiving regional anesthesia is awake
and aware of his/her surroundings unless
medications are given to produce mild sedation
or to relieve anxiety

112.  Nurse
must avoid careless conversation,
unnecessary noise, and unpleasant odors
 Diagnosis must not be stated allowed if the
client is not to know it at this time
A postdural puncture headache may occur after
spinal and epidural blocks caused by leakage of
CSF. Small-gauge spinal needle (less than
gauge 25) helps prevent headaches. Position
the client flat and force fluids to relieve
headache. A blood patch treatment can be done
if headache continues

113. TRANSFER FROM SURGERY
 After surgery client is stabilized for transfer
 After local anesthesia, the client may return
directly to a nursing unit
 After general and spinal anesthesia, the
client goes to the PACU or in some cases,
the intensive care unit

114.  SAFETY is always a priority at this time!
 Never leave client alone
 Ensure patent airways and prevent falls an
injury
 Continuous monitoring of client

115. POSTOPERATIVE PHASE

116.  Extends from the time the client is admitted
to the recovery room, to the time he is
transported back into the surgical unit,
discharged from the hospital, until the follow-
up care
 Begins when the client is admitted to the
PACU or a nursing unit and ends with the
client’s postoperative evaluation in the
physician’s office

117. GOALS:
 Maintain adequate body system functions
 Restore homeostasis
 Alleviate pain and discomfort
 Prevent postoperative complications
 Ensure adequate discharge planning and
teaching

118. ADMISSION TO PACU
 Goal is to promote safe recovery from
anesthesia
 Administer oxygen by nasal cannula or mask
as ordered
 Continuous monitoring is done for ECG,
pulse oximetry, and BP measurements

119.  Assess surgical site and dressing
 Check for patency of catheter, drains and
tubes
 Measure body temperature
 Provide warming blanket

120.  Control shivering by administering
Meperidine (Demerol) when anesthesia is
the cause
 Provide supplemental oxygen during
shivering
 Perform hand washing between clients
 VS taking every 5 to 15 minutes

121. GENERAL INTERVENTIONS
 Avoid exposure
 Avoid rough handling
 Avoid hurried movement and rapid changes

122.  Assessment
 Appraise air exchange status and note skin color
 Verify identity, operative procedure, surgeon
 Assess neurologic status
 Determine VS
 Perform safety checks

123.  Ensure maintenance of patent airway and
adequate respiratory function
 Lateral position with neck extended
 Keep airway in place until fully awake
 Suction secretions
 Encourage deep breathing
 Administer humidified oxygen as ordered

124. TRANSFER FROM RECOVERY ROOM TO
SURGICAL UNIT
 Parameters for Discharge from Recovery
Room
 Activity: able to obey commands
 Respiration: easy, noiseless breathing
 Circulation: BP is within +/-20 mmHg of the
preop level

125.  Consciousness: responsive
 Color: pinkish skin and mucus membrane

126. NURSING CARE OF CLIENT DURING THE
EXTENDED POSTOPERATIVE PERIOD
 2-3 days after surgery (discharge
planning/teaching)
 Self-care activities
 Activity limitation
 Diet and medications
 Complications
 Referrals, follow-up check up

127.  Postoperative discomforts
 Nausea and vomiting
 Restlessness & sleeplessness
 Thirst
 Constipation
 Pain

128. POSTOPERATIVE
COMPLICATIONS

129. SHOCK
 Response of the body to a decrease in the
circulating blood volume, which results to
poor tissue perfusion and inadequate tissue
oxygenation

130. HEMORRHAGE
 Copious escape of blood from the blood
vessel
 Capillary – slow, generalized oozing
 Venous – dark in color and bubble out
 Arterial – spurts and is bright red in color

131.  Manifestations
 Apprehension, restlessness, thirst, cold, moist,
pale skin
 Deep rapid respiration, low body temperature
 Low blood pressure, low hemoglobin
 Circumoral pallor
 Progressive weakness

132.  Management
 Administer Vitamin K as ordered
 Pressure dressings
 Blood transfusion
 IV fluids

133. FEMORAL PHLEBITIS/ DEEP
THROMBOPHLEBITIS
 Often occurs after operations on the lower
abdomen or during the course of septic
conditions as rupture ulcer or peritonitis
 Causes
 Injury– damage to vein
 Hemorrhage
 Prolonged immobility
 Obesity/ debilitation

134.  Manifestations
 Pain
 Redness
 Swelling
 Heat/warmth
 Positive Homan’s sign

135.  Nursing Interventions (prevention)
 Hydrate
adequately to prevent
hemoconcentration
 Encourage leg exercises and ambulate early
 Avoid any restricting devices that can constrict
and impair circulation
 Prevent use of bed rolls or dangling over the side
of the bed with pressure on popliteal area

136.  Nursing Interventions (Active)
 Bed rest, elevate the affected leg with pillow
support
 Wear antiembolic support hose from the toes to
the groin
 Avoid massage on the calf of the leg
 Initiate anticoagulant therapy as ordered

137. PULMONARY COMPLICATIONS
 Atelectasis
 Bronchitis
 Bronchopneumonia
 Lobar pneumonia
 Pleurisy

138.  Nursing Interventions
 Reinforce deep breathing, coughing, and turning
exercises
 Encourage early ambulation
 Incentive spirometry

139. INTESTINAL OBSTRUCTION
 Loop of intestine may kink due to inflamatory
adhesions
 Manifestations
 Intermittent, sharp, colicky abdominal pains
 Nausea and vomiting

140.  Abdominal distention
 Diarrhea(incomplete
obstruction), no bowel
movement (complete)
 Return flow of enema is clear

141.  Nursing Interventions
 NGT insertion
 Administer electrolyte/ IV as ordered
 Prepare for possible surgical intervention

142. WOUND INFECTIONS
 Causes
 Staphylococcus aureus
 Escherichia coli
 Proteus vulgaris
 Pseudomonas aeruginosa
 Anaerobic bacteria

143.  Clinical manifestations
 Redness, swelling, pain, warmth
 Pus or other discharge on the wound
 Foul smell from the wound
 Elevated temperature; chills
 Tender lymph nodes

144.  Rule of thumb:
 Fever within first 24 hours – pulmonary infection
 Within 48 hours – urinary tract infection
 Within 72 hours – wound infection

145.  Preventive interventions
 Strict aseptic technique
 Wound care
 Keep unit clean
 Antibiotic therapy as ordered

146. WOUND COMPLICATIONS
 Hemorrhage
 Wound dehiscence – disruption in the
coaptation of wound edges (wound
breakdown)
 Wound evisceration – dehiscence +
outpouching of abdominal organs

147.  Nursing interventions
 Apply abdominal binders
 Encourage proper nutrition (high protein, vitamin
C)
 Stay with client, have someone call for the doctor
 Keep in bed rest
 Supine or Semi-Fowler’s position, bend knees to
relieve

148.  Cover exposed intestine with sterile, moist
saline dressing
 Reassure, keep him/her quiet and relaxed
 Prepare for surgery and repair of wound