I

Perioperative Nursing Practice

Entry level salary : WHO CANNOT GIVE CONSENT ?

Neil Benigno S615 > Minors >

Mentally-ill
: refers to the performance on
nursing activities Asystole : cardiac > Unconscious

NURSING ↳ NO , Parents
,
Pre-op Intraop Post-op , stand still
ACTIVITIES
,
Siblings
R
Visit the pt PREOP PHASE starts when the pt decides to Cardioversion : wave CONDITIONS requiring Informed Consent

Interviw/informed consent undergo procedure : wen the procedure Lo prevent

E-wave
-

-
Minor major procedures

Preparation X esical logical is scheduled > Anesthesia administration

Safety INTROP PHASE Pt is admitted to the OR

Radiographic exam; the use of contrast medium

A septic-controlled environment
bed until pt is transferred to PALI >
Entry to body cavity (invasive
Positioning
Input output CLASSIFICATIONS OF SURGERY

Temp us POSTOP PHASE pt is admitted to PAC Acdng to magnitude

O2 status
until pt is transferred to regular ward : major & minor

rainage/pressing
↳ irway ~
Principle :
AONOMY CHARACTERISTICS OF MAJOR

Informed consent : agreement made by pt to ·

High risk for morbidity & mortality

Preop assessment undergo surgical procedure provided · Extensive or prolonged

and complete
↳ baseline data
is given necessary info abt amount of blood loss
-
that pt ·
Large

Most common fear procedure before giving consent · Presence of complications

rIt surgery INFO provided : ~

Along to purpose

↓ fear of the Nature and magnitude of the procedure :

Diagnostic -
to determine nature of disease

(anxiety)

I Exploratory exlap
unknown ,
Risks and benefits of the procedure : -

Alternative treatment Curative -

to cure disease

↓
> :

> Prognosis Ablative-removal of a body part

PHYSIYAN : secure informed consent Constructive repair of -

a
congenital defect

damaged/diseased
a
NURSE :
pt advocate Skin graft Reconstructive repair of a

↳ acting in behalt of the pt , defend

Palliative alleviate SPS
rights of pt rhitotomy : -

Assess by DIRECT QUESTIONING C Adding to urgency

cosmetic
to pt's discretion
WITNESS
surgeries
:
Optional-adng
nontoxic
> not coerced , pressured, forced
soiter
: Elective-auding to availability/convenience of pt
cataract should be done within
>
pt not under influence of mind-altering :
Required -
a few weeks

substance appendectory :
Urgent -
should be performed within 24-48 hours

ruptured should be performed immediately

pt's identity
:
Emergency
-

make sure
~
appendectomy
 > Sterilization : to render the instruments free
from all microorganisms including spores
Heat moisture
labile/unstable to radiation
Physical exposure of instruments
·
:
& ↑

instruments : result
of steam sterilization Steam : steam under pressure

(
·

chemical : good for

labile /unstable · chemical : use of ethylene oxide gas
instruments
N Steam Sterilization

autoclave : 120 to Steam alone does not sterilize

Physical preparation of the Pt 121 C for

°
15 mins

↓ Health Teaching-deep breathing , Cough Hash sterilization: Steam is exposed to a certain pressure

exercise encourage early ambulation ;

steam emergency
,

Sterilization of Temp of the steam rises

.
2 Pre-operative Checklist

.
3 What is to be removed & retained unwrapped items

Shaving causes the 1 Methods

.
of Hair Removal moist heat is produced

showing (veet)
↑ risk of infection
·
.
Depillation
method of
in barteria
hair remova l . Clipping kills protein
How to maintain sate Paseptic controlled Dr .

Spaulding-TYPES Of INSTRUMENTS

environment ?

1. Traffic control

~ movement of personnel
:
kept to a minimum
intact skin-
Dont open stan stanle

supplies to
.
2 Humidity temp
prevent
enters the but
2 50 -
55 % Ly 20 24
-
°
( body -

infections not the blood stream

intact mucous
membranes
Conscience
.
3 Surgical
Sterilization
TREATMENT/PROCESS for OR Items

> Decontamination : removal of debris from

samtandent
nursi
the instrument either through mechanical

or chemical means

> Disinfection : to render the instrument free

from disease causing or pathologic

Hallways :
microorganism access to Or -
or
· Low level :
hydrogenle proper
attire -

Alcohol
Glutaraldehyde · Intermediate level : 70 % Isopropyl
immersion time for
Sterilization : -
10 hrs ·
High level Glutaraldehyde immersion
: ,

time : 20 mins L capable of sterilization

 Stages of Anesthesia Hematologic function
~

~ Induction :
administration a
Infection
laughing
laughing crying
nitrous Excitement/Delirium rl
,

(blue) CONCEPT OF PAIN

, :
,

start of
Surgical : operation NATURE

Danger Multidimensional

Other Concepts in OR # universal experience

nurse : talk abt the

· Time out : lead by the
Subjective
surgery
so that all will be aware and 5 the And individual

same level of knowledge ; to prevent inadverted eoed by stimuli

events (sentinel events Indicates a problem

if discard
conscience # he
:
·
Surgical unsure ,

person
is the authority of pain

Sentinel events : inadverted events PHYSIOLOGY

General Risk Factors to Surgery #ransduction : release of biochemical mediators

↑ residual volume
=
lung capacity
·
Age : older adults have reduced physiologic (bradykinin ,
histamine ,
prostagland in ,
substance

reserves P) from the site of injury pain stimuli is

converted to action
·
Obesity : fats produced potential
· Poor nutrition to be carried out to the brain

·
Fluid Selectrolyte imbalances #ransmission : Action potential is conducted to the

complications .
can cause
Pre-existing conditions : DM
. respi condition cerebral cortex throug
: .
1
Primary neuron

· Alwholism : can cause alwhol withdrawal .

2 Secondary neuron 3 .
Tertiary neuron

(Delirium tremens) Perception : Action potential reaches the

physical psychological
crebral cortex client becomes conscious
preparation
·
Severity &urgency of surgery

PREOP ASSESSMENT of the pain

Modulation : mechanism
Age compensatory
Pain

Nutional status

Fluid & Electrolyte status

C function

function
mptomatic uremic 61 hepatobillary
jasyPostiadvanced)
Kremirfetur
-

azotemia/kremia:
,

Endocrine function
c

acumulation of BUN
Renal function :
voiding patterns appearance ,

but have diffmanifes of urine , BUNA crea

tations