Introduction to Operating Room Nursing
Operating Room Nursing is the application of the nursing process during the Operation or Surgery.
- Many surgical procedures that were once performed in an inpatient setting now take place in an Ambulatory or Outpatient setting.
nursinglectures.blogspot.com - Approximately 60% of elective surgeries are now performed in an ambulatory or outpatient setting.
nursinglectures.blogspot.com - Pre -operative Phase – begins when decision to proceed with surgical intervention is made and ends with the transfer into the operating table
- Intra -operative Phase – starts from the transfer of patient to the operating table and ends with the admission of the patient to the PACU (post-anesthesia care unit)
- Post -operative Phase – begins with admission to the PACU and ends with follow-up evaluation in the clinical setting or home
nursinglectures.blogspot.com - Diagnostic – Eg. Biopsy or explorative laparotomy
- Curative – Eg. Excision of a tumor or inflamed appendix
- Reparative – Eg. Multiple Wound Repair
- Reconstructive / Cosmetic – Eg. Mammoplasty or facelift
- Palliative – Eg. To relieve pain, a PEG tube is inserted to compensate for dysphagia
nursinglectures.blogspot.com - Voluntary and written INFORMED consent from the patient is necessary before nonemergent surgery can be performed.
- Consent must be signed before administration of ANY PSYCHOactive medications .
nursinglectures.blogspot.com - Voluntary Consent – given FREELY
- Incompetent Patient – (those who are mentally ill, and comatose CANNOT give consent)
- Informed Subject – should be in WRITING. Includes explanation of risks, procedure. Description of benefits & alternatives
- An EMANCIPATED Minor may sign his consent form
nursinglectures.blogspot.com - nursinglectures.blogspot.com Brunner & Suddarth’s Textbook
- The signed consent form is placed in a prominent place on the patient’s chart and accompanies the patient to the operating room.
nursinglectures.blogspot.com - The overall goal in the pre-operative period is for the patient to have as many positive health factors as possible…
nursinglectures.blogspot.com - o besity, u ndernutrition, w eight loss,
- m alnutrition, d eficiencies in specific nutrients, m etabolic a bnormalities,
- the e ffects of medications on nutrition, and s pecial p roblems of the hospitalized patient (Quinn, 1999)
- m easurement of b ody m ass i ndex and
- w aist c ircumference (National Institutes of Health, 2000)
nursinglectures.blogspot.com - Thiamin, Niacin, Riboflavin, Folic Acid, Vit. B12
nursinglectures.blogspot.com - People who abuse drugs attempt to HIDE and DENY it
- Acutely intoxicated persons are susceptible to injury
- Alcohol withdrawal delirium ( delirium tremens ) may be anticipated up to 72 hours after alcohol withdrawal.
nursinglectures.blogspot.com - Goal : Optimal Respiratory Function
- Use of I ncentive S pirometry
- Surgery is USUALLY postponed if patient have a R espiratory I NFECTION
- SMOKING urged to STOP 2 Months before surgery (Counseling has a positive effect 24 hours before operation)
nursinglectures.blogspot.com - i ncreased a irway r eactivity
- d ecreased m ucociliary c learance,
- p hysiologic c hanges in the c ardiovascular and i mmune systems
nursinglectures.blogspot.com - GOAL : to ensure a well functioning cardiovascular system to meet the oxygen, fluid, and nutritional needs of the perioperative period.
nursinglectures.blogspot.com - GOAL : optimal function of the liver and urinary systems so that medications, anesthetic agents, body wastes, and toxins are adequately processed and removed from the body.
nursinglectures.blogspot.com - Hypoglycemia and Hyperglycemia
- GOAL : Maintain the blood glucose level at less than 200 mg/dl
- Adrenal insufficiency – for those who have received corticosteroids
- Thyrotoxicosis (hyperthyroid disorders)
- Respiratory failure (hypothyroid disorders)
nursinglectures.blogspot.com - The mildest symptoms or slightest temperature elevation must be investigated.
- Great care is taken to ensure strict asepsis
nursinglectures.blogspot.com - OTC Meds – Aspirin, HPN meds, Insulin
- garlic ( Allium sativum),
- kava kava ( Piper methysticum),
- St. John’s wort ( Hypericum perforatum)
- licorice (Glycyhiza glabra)
- valerian ( Valeriana officinalis)
nursinglectures.blogspot.com - Anxiety – Anticipatory response
- Different responses of persons to FEAR:
- 1. Repeatedly asking questions
- 2. Withdrawal, avoiding communication
- *** NURSE Must be an EMPHATETIC listener
nursinglectures.blogspot.com - Cortico steroids – Prednisone(Delta sone )
- Diuretics – Hydrochlorothiazide(Hydro DIURIL )
- Pheno Thiazines – Chlorpromazine (Thor azine )
- Tranquil izers – Diazepam (Val ium )
- Anti biotics – Erythro mycin (Ery-tab)
- Anti coagulants – Warfa rin (Coumadin)
- Anti seizure – Pheny toin (Dilantin)
- MAO Inhibitors – Phenelzine sulfate (Nardil)
nursinglectures.blogspot.com - Sensory limitations – vision, hearing and reduced tactile sensitivity
- Arthritis – may affect mobility
- Dental assessment – impt to Anesthesiologist
- Ability to perspire – fragile skin (dry)
nursinglectures.blogspot.com - Fatty Tissues – susceptible to infection
- Technical & Mechanical Problems
- Wound dehiscence(separation) and wound infections are more common.
- For Every 30 lbs excess weight, additional 25 miles of blood vessels needed, thus increasing workload of the heart.
nursinglectures.blogspot.com - IDEAL timing – Pre-admission visit not ON the DAY of SURGERY
- GOAL – Promote OPTIMAL Lung Expansion after ANESTHESIA
- USE of Incentive SPIROMETER
- Splinting of Incision line if possible
- GOAL – Coughing, mobilizes secretions
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- Identification of ACUTE and CHRONIC Pain
- Patient Controlled Analgesia ( PCA )
- Epidural Catheter (Bolus/Infusion)
- P.Controlled Epidural Analgesia ( PCEA )
- Cognitive Coping Strategies – Imagery , Distraction , Optimistic Self-recitation
nursinglectures.blogspot.com - Watch out! UNNECESSARY LONG FASTINGS
- Warn Patients they might feel thirsty and teach strategies(as permitted): b rushing teeth, r insing the mouth, and c hewing gum
- 8 hours fasting after eating fatty foods
- 4 hours after ingesting milk products
- 2 hours for clear liquids in an elective procedure
nursinglectures.blogspot.com - G own left U ntied, O PEN in the B ACK
- M outh Inspected, D entures removed
- Jewelries not WORN , If patient refuse , some allow ring to be taped in finger
- All Patients should VOID immediately(except those with UROLOGIC D/O) to promote continence and make abdominal organs more accessible
nursinglectures.blogspot.com - nursinglectures.blogspot.com
- Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery
- Fear related to perceived threat of the surgical procedure and separation from support system
- Knowledge deficit of preoperative procedures and protocols and postoperative expectations
nursinglectures.blogspot.com - 1. During the preoperative assessment of a man scheduled for hand surgery in an ambulatory setting, you think that the patient’s responses indicate that he does not understand the procedure and that he has not made plans for postoperative care. What further assessment and teaching is indicated? What nursing interventions are warranted?
nursinglectures.blogspot.com - 2.A patient with a long history of the use of several herbal supplements is scheduled for major surgery. What effect would this information have on your preoperative care of this patient?
nursinglectures.blogspot.com - 3. Two patients are admitted to the same-day surgery unit for bilateral knee replacements. One patient is a 30-year-old who ambulates with crutches and the other is a 75-year-old who lives alone. How would your assessments, preoperative teaching , and preparation differ for these two patients?
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