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BC VNRS B1 - Chapter 50 - The Surgical Client - Preoperative Care

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BAKERSFIELD COLLEGELICENSED VOCATIONAL NURSING PROGRAM1ST SEMESTER FUNDAMENTALSCLIENTS WITH SPECIAL NEEDSCHAPTER 50 - THE SURGICAL CLIENT: PREOPERATIVE CAREINTRODUCTIONThe goal of this module is to assist you in providing adequate emotional and physical support to clients and family members during a client’s surgical experience. The anticipation of surgery produces considerable fear in the client who faces many unknowns.OBJECTIVESUpon completion of this unit, the student will be able to:A. Theory1. Define Perioperative nursing.2. List four pathological processes responsible for most surgical conditions and give an example of a surgical condition for each process.3. List the three major classifications for all surgical procedures.4. List and describe the five purposes of surgery.5. Describe three conditions that increase a person’s surgical risk.6. Identify and state the purpose of lab work and tests that might be ordered preoperatively.7. List factors to include in the preoperative assessment of the surgical client.8. Identify who is responsible to provide information for the informed consent.9. State what the nurse’s signature on a consent form means.10. Identify who can sign a surgical consent.11. Describe how fear and anxiety is expressed by the surgical client.12. List each step of the preoperative check list.13. Identify medications and their purpose that are used as preops.B. Laboratory1. Demonstrate postoperative exercises: diaphragmatic breathing, coughing, turning, and leg exercises.ASSIGNMENTA. Read Chapter 50- Potter & Perry –pgs. 1365 – 1390, omit N/G’s, Critical Thinking Exercise # 2 and Review Questions B. Study Guide for Chapter 50- Chapter 50 The Surgical Client- Preoperative Careo The goal of this unit is to assist you in providing adequate emotional and physical support to clients and family members during a surgical experience- The anticipation of surgery produces considerable fear in the client who faces many unknowns- History of Surgical Nursing- Nursing played a major role in disease prevention.- Early surgical nurseso Cleaned rooms and equipment, obtained supplies, cared for clients postoperatively- Association of Operating Room Nurseso Established 1956- Ambulatory surgeryo Perioperative Nursing- Refers to the role of the operating nurse during the preoperative, intraoperative, and postoperative phases of surgery- In some institutions this is the way it is done and in others different nurses care for the client during each phase of the surgical experience- Four Pathological Processes Responsible for Surgical Conditions- Obstructiono blocks flow of body substances- Perforationo Rupture of body part- Erosiono Result of continuous irritation; infection- Tumorso Benign or malignant- Classification of Surgery- Seriousnesso Major Length of procedure Blood loss Risk of post-op complicationso Minor Brief procedure Minimal risk- Urgencyo Elective Performed for client’s well being Not absolutely necessaryo Urgent Necessary for client’s health Prevent additional problemso Emergency Immediate need to save a life  Preserve a body part- Purpose – Why it is doneo Diagnostic To confirm diagnosiso Ablative Excise or remove diseased body parto Palliative Relieve symptomso Reconstructive Restores function or appearanceo Transplant Replace organso Constructive Restores function lost from congenital anomalies- Cosmetic To improve appearance - Preoperative Surgical Phase- Surgical clients enter the health care setting in different stages of health- Some enter with a planned surgery and some through the emergency department- Assessment- History o client ageo Past illnesses and surgerieso Medical conditions- Review client and family members understanding and perception of surgery- Medication history- Smoking habitso Risk for respiratory complications- Alcohol ingestiono Reactions to anesthesiao Need more analgesia post-op- Family supporto Provide assistance during recovery- Occupationo May not be able to return to former job- Review of emotional healtho Verbalize fears and feelings- Physical examo Focus on body systems affected by surgeryo Monitor vital signs- Estimation of Surgical Risk- Physical and Mental Conditiono Clients at risk Age Obesity Fluid or electrolyte imbalance- Extent of Disease- Magnitude of Operation- Resources and Preparation of:o Surgeon, nurses, hospital- Nursing Diagnosis- Preoperative diagnoses:o Fearo Knowledge deficito Risk for ineffective airway clearance- Planning and Implementationo Informed consent Client must understand procedure and risks Physician responsibility to inform client Client must be alert and oriented Client signature implies he is informed Witnessed by member of health care team Nurse verifies consent with client Check for time limit on signed consent Nurse witness verifies only client signed consent- Who can sign the consent form?- Legal age- Underage but married- Emancipated minor- Without legal guardianship- Parent or guardian of minor- Spouse or next of kin for unconscious or mentally incompetent- Telephone consent obtained by 2 witnesses – or telegram- Court order- Emergency situations the surgeon can perform without a consent- Preoperative Teaching- Office or home settingo Printed literatureo Video tapes- Admission or pre-admission nurseso Educate clients and family members- Better prepared and less anxious- AORN Criteria - Client sites reasons for each of preop instructionso Diaphragmatic breathing Improves lung expansion o Incentive spirometryo Controlled coughing Removes secretionso Turning Improves blood flowo Leg exercises Prevents clots- The client states the time surgery is scheduled- The client states the unit to which he will return to after surgery- The client discusses anticipated monitoring and therapeutic devices- The client describes the scheduled procedure and treatment plan- The client describes anticipated recovery steps- The client verbalizes expectations of pain and pain relief measures- The client expresses feelings regarding the surgical intervention and the expected outcome- Physical preparation- Maintenance of normal fluid and electrolyte balanceo NPO at midnight o May brush teeth and rinse without swallowing watero Notify MD if client eats or drinks during NPO period- Minimize the risk of surgical wound infectiono Bath evening before surgery with antimicrobial soapo Skin prep

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