NUR2755 Section BTP3 Multidimensional Care IV
Module 04 Overview and Activities
Readings
Activity Time: 5 hours
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapters 14-16
. Recommended Reading -
. ATI: RN Adult Medical Surgical Nursing – Chapters 17-19, 24-26
Module 04 Perioperative
Overview
- The words “you need surgery” may cause anxiety in clients. The surgical client has
known risks that occur which the surgical team works to prevent. Complications and
errors that have occurred in the surgical suite have influenced how we practice today.
Progression through this module will center around three areas; perioperative,
intraoperative, and postoperative. Let’s begin with perioperative.
Perioperative
- The perioperative period begins when the client is placed on the surgical schedule and
ends when the client is transferred to the surgical suite. There are specific reasons for
surgery, such as: diagnostic, curative, transplant, restorative, palliative, or even
cosmetic. There are also different levels of urgency. For example, a total joint
replacement is an elective surgery and is a planned procedure. A displaced bone
fracture is urgent and intervention should not be delayed more than 24-48 hours. As
compared to a gunshot wound, which is emergent due to the life-threatening nature of
the injury, the client would immediately go to the surgical suite. The next consideration in
surgery is the surgical approach.
Simple, Minimally-Invasive, and Radical Surgical Approaches
- The simple surgical approach only applies to the areas involved in the surgery. An
example of this surgery would be simple/partial mastectomy. Another surgical approach
is minimally-invasive surgery. Most of the surgeries fall within this category. Examples
include: lung lobectomy, arthroscopy, and cholecystectomy. The last surgical approach is
termed radical which involves removing surrounding structures as well as lymph nodes.
Examples of the procedures are radical prostatectomy and hysterectomy.
Surgical Checklist
- No matter where surgery takes place, either as an inclient or outpatient, client safety is a
priority. It is standard practice for facilities to have a comprehensive surgical checklist to
complete. Lists of this nature are only as good as the person completing them. The RN
completes the pre-operative checklist, the anesthesiologist also completes a checklist,
interviews the patient, and assesses the airway preparing for safe administration of
anesthetics. One of the most important steps that is now standard practice is the Time-
Out. This occurs right before the skin incision is made. The designated team member
calls for a Time-Out to review and confirm that the correct procedure is going to be
performed on the correct client at the correct site. Other verifications include that a
signed informed consent by the client or designated health care surrogate is within the
records. Is the site marked clear and is it the correct site verified with consent? In other
words, is the team operating on the correct limb? Any other concerns are raised by the
team at that time. Remember, this step prevents errors.
Module 04 The Older Adult and Surgery
1
, NUR2755 Section BTP3 Multidimensional Care IV
The Older Adult and Surgery
At-Risk for Complications
The older adult is at risk for complications related to surgery as well as anesthesia. As the
health history is taken, questions will revolve around lifestyle and life choices. Encourage the
client to answer truthfully. Concerns would focus on the following:
. Comorbidities
. Age-related changes in the kidneys and liver
. Drugs and substance use
. Tobacco use
. Alcohol use
. Prescription medications
. Over-the-counter medications
. Herbal supplement use
Completeness
It is essential that the client has a complete history and physical. Have the client or family bring
in every medication that the client takes. Prepping a client for surgery can increase both stress
levels and induce anxiety. Many healthcare workers are asking lots of questions, and some are
repetitive. Reassure the client that every question is asked to ensure a safe journey through the
surgical experience. The client may be asked many times:
. State your name and date of birth?
. What are your allergies?
. Have you had any previous anesthesia?
. If the answer is yes, how did you react to the anesthesia?
. Do you have any loose teeth, dentures, partial plates, etc.?
. What surgeries have you had in the past?
When able, and if you sense frustration, give the client a mental break for a moment. The
perioperative period can feel overwhelming to the older adult.
Module 04 Allergies
Allergies
A part of the medical history is client allergies. Here are some relational allergies that may
impact decisions for the OR team.
. Allergy to povidone-iodine (Betadine) is the same allergens found in shellfish.
. Allergy to avocados, bananas, strawberries--alerts the team to a possible latex allergy.
. Allergy to egg, peanut, or soy should be an alert for the anesthesiologist. The client may
adversely react to propofol (Diprivan).
. Allergy to metal. Joint replacements are made from metal. Clients with a known nickel
allergy will receive an implant that is made from titanium to prevent a systemic allergic
response to the implanted item.
2
Module 04 Overview and Activities
Readings
Activity Time: 5 hours
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapters 14-16
. Recommended Reading -
. ATI: RN Adult Medical Surgical Nursing – Chapters 17-19, 24-26
Module 04 Perioperative
Overview
- The words “you need surgery” may cause anxiety in clients. The surgical client has
known risks that occur which the surgical team works to prevent. Complications and
errors that have occurred in the surgical suite have influenced how we practice today.
Progression through this module will center around three areas; perioperative,
intraoperative, and postoperative. Let’s begin with perioperative.
Perioperative
- The perioperative period begins when the client is placed on the surgical schedule and
ends when the client is transferred to the surgical suite. There are specific reasons for
surgery, such as: diagnostic, curative, transplant, restorative, palliative, or even
cosmetic. There are also different levels of urgency. For example, a total joint
replacement is an elective surgery and is a planned procedure. A displaced bone
fracture is urgent and intervention should not be delayed more than 24-48 hours. As
compared to a gunshot wound, which is emergent due to the life-threatening nature of
the injury, the client would immediately go to the surgical suite. The next consideration in
surgery is the surgical approach.
Simple, Minimally-Invasive, and Radical Surgical Approaches
- The simple surgical approach only applies to the areas involved in the surgery. An
example of this surgery would be simple/partial mastectomy. Another surgical approach
is minimally-invasive surgery. Most of the surgeries fall within this category. Examples
include: lung lobectomy, arthroscopy, and cholecystectomy. The last surgical approach is
termed radical which involves removing surrounding structures as well as lymph nodes.
Examples of the procedures are radical prostatectomy and hysterectomy.
Surgical Checklist
- No matter where surgery takes place, either as an inclient or outpatient, client safety is a
priority. It is standard practice for facilities to have a comprehensive surgical checklist to
complete. Lists of this nature are only as good as the person completing them. The RN
completes the pre-operative checklist, the anesthesiologist also completes a checklist,
interviews the patient, and assesses the airway preparing for safe administration of
anesthetics. One of the most important steps that is now standard practice is the Time-
Out. This occurs right before the skin incision is made. The designated team member
calls for a Time-Out to review and confirm that the correct procedure is going to be
performed on the correct client at the correct site. Other verifications include that a
signed informed consent by the client or designated health care surrogate is within the
records. Is the site marked clear and is it the correct site verified with consent? In other
words, is the team operating on the correct limb? Any other concerns are raised by the
team at that time. Remember, this step prevents errors.
Module 04 The Older Adult and Surgery
1
, NUR2755 Section BTP3 Multidimensional Care IV
The Older Adult and Surgery
At-Risk for Complications
The older adult is at risk for complications related to surgery as well as anesthesia. As the
health history is taken, questions will revolve around lifestyle and life choices. Encourage the
client to answer truthfully. Concerns would focus on the following:
. Comorbidities
. Age-related changes in the kidneys and liver
. Drugs and substance use
. Tobacco use
. Alcohol use
. Prescription medications
. Over-the-counter medications
. Herbal supplement use
Completeness
It is essential that the client has a complete history and physical. Have the client or family bring
in every medication that the client takes. Prepping a client for surgery can increase both stress
levels and induce anxiety. Many healthcare workers are asking lots of questions, and some are
repetitive. Reassure the client that every question is asked to ensure a safe journey through the
surgical experience. The client may be asked many times:
. State your name and date of birth?
. What are your allergies?
. Have you had any previous anesthesia?
. If the answer is yes, how did you react to the anesthesia?
. Do you have any loose teeth, dentures, partial plates, etc.?
. What surgeries have you had in the past?
When able, and if you sense frustration, give the client a mental break for a moment. The
perioperative period can feel overwhelming to the older adult.
Module 04 Allergies
Allergies
A part of the medical history is client allergies. Here are some relational allergies that may
impact decisions for the OR team.
. Allergy to povidone-iodine (Betadine) is the same allergens found in shellfish.
. Allergy to avocados, bananas, strawberries--alerts the team to a possible latex allergy.
. Allergy to egg, peanut, or soy should be an alert for the anesthesiologist. The client may
adversely react to propofol (Diprivan).
. Allergy to metal. Joint replacements are made from metal. Clients with a known nickel
allergy will receive an implant that is made from titanium to prevent a systemic allergic
response to the implanted item.
2
