Adult Health 2
o Peri- operative nursing à nursing care for patients who require surgery
o Pre-op nursing à begins when the decision to perform surgery is made until the patient
enters the OR suite
o Intra- Operative nursing à begins when the patient enters the OR until the patient is
transferred to PACU or ICU
o Post-opà begins when patient leaves OR and ends after the last follow up visit with
surgeon
Extent of Surgery
o Major à hysterectomy, heart transplant
o Minor à scar removal
Purposes of Surgery
o Diagnosticà biopsy, exploratory lap
o Curative à removal of inflamed appendix, extension of benign ovarian cyst
o Reparative à knee replacement
o Reconstructive/Cosmeticà breast augmentation, facelift, rhinoplasty
o Palliative à NG tube for patient with difficulty swallowing
o Preventative à patient with history of breast cancer removes breasts
o Exploratory à laparoscope
Urgency of Surgery
o Emergent à done immediately to save patient’s life (laceration of large blood vessel,
arterial bleed, severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot/
stab wound, extensive burns)
o Urgent à must be performed within 24-30 hours (removal of kidney or urethral stones,
acute gallbladder infection)
o Required à must be done within weeks to months; some patients may opt not to (cataract,
tonsillectomy, prostatic hyperplasia without bladder obstruction)
o Electiveà recommended but not required; no adverse effects occur if surgery not
performed (bladder lift, vaginal repair, repair of scars)
o Optional à patient’s choice (cosmetic surgery)
Common surgical terms
o Ectomyà removal of (tonsillectomy)
o Lysisà destruction of (lysis of adhesions)
o Plastyà repair of or reconstruction (angioplasty)
o Ostomyà creating an opening (colostomy)
o Oscopyà look into (colonoscopyà may perform lysis of polyps)
o Otomyà cutting into (tracheotomyà for removal of foreign objects)
,o Orrhapy à repair of (herniaoraphy)
Physiological Stress Response to Surgery
o fear of death or the unknown, body image concerns (colostomy), lifestyle and role changes,
recovery, economic stress, insurance, spiritual beliefs (impacts patients perception of
surgery)
o Identify anxiety and decrease it
Physiologic Stress Response to Surgery
o Increased BP, increased respiratory distress
Age
Elderly
o Slower healing, increased risk for infection, less physiological reserve (decreased ability of
organs to return to normal after changes in equilibrium), decreased renal and liver
function (need less anesthesia because they hold onto it longer), presence of chronic illness
and current meds may increase risk associated with surgery
Nutrition
Obese patients
o At risk for wound dehiscence (treatment= moist, sterile dressings, stay with patient,
have another RN notify doctor, continue to monitor patient)
o Fat cells hold onto anesthesia longer and therefore is eliminated slower
o Risk for pneumonia post-op due to difficulty turning, coughing, and deep breathing
Malnourished
o Slower wound healing (decreased protein)
o Any nutritional deficit must be corrected before surgery (need adequate protein)
Infection
o with chronic diseases, immunity is decreased; there is poor tissue perfusion and surgery is
an added stress on the body
o Post-pone surgery if respiratory infection present
o Prevent vomiting and aspiration by inserting NG tube with general anesthesia
o With chronic diseases, there is increased risk for respiratory impairment
o NPO status with Diabetics causes concerns about giving or withholding insulin pre-op
o Be patient advocate. If surgery is not until later in the day, post-pone NPO status until
after breakfast
, Alcohol Use
o Often malnourished, liver dysfunction, cirrhosis (decreased metabolism of drugs)
o Susceptible to injury; possibility of withdrawals
o Try to post-pone surgery if patient is intoxicated
o Excrete anesthesia slower
Drug use
o Risk for drug interactions and over sedation. Pain is harder to control. Require larger
doses of pain meds
Medications
o Anti- coagulants à risk for bleeding; notify surgeon immediately if patient is on anti-
coagulants
o Herbal medsà assess patient’s use of these; increased risk of interaction with anesthesia
o Diureticsà risk for fluid and electrolyte balance, leading to respiratory depression;
patient is already losing fluid during surgery. Monitor I and O
o Corticosteroidsà suppresses immune function; cardiovascular collapse can occur if d/c
suddenly. Therefore, a bolus of corticosteroid may be administered IV immed. before and
after surgery
o Assess patient’s use of OTC drugs
o Phenothizaines (Thorazine à may increase hypotensive action of anesthesia
o Tranquilizers (Valium) à anxiety, tension, and seizures if withdrawn suddenly.
o Insulin à to hold or not to hold? That is the question!
o Antibiotics (erythromycin) à if combined with a muscle relaxant, apnea from resp
paralysis may result
o Anti- seizure meds (Dilantin) à IV route of med may need to be admin to keep seizure
free
o MAOI (Nardil) à may increase hypotensive action of anesthetics
Disability
o Mental handicap à have trouble understanding. Ensure that family member or
caregiver is present during teaching
o Physical handicap à fluid build up from decreased mobility, pooling and stasis of blood
increase risk for clots (apply TED hose or SCD’s, dangle feet, ambulate, don’t massage),
risk for pressure ulcers from decreased mobility (turn frequently, assess skin, provide
padding between pressure areas
Smoking
o Causes poor wound healing; decreased tidal capacity; decreased effect of pain meds;
, restlessness and agitation; impaired coughing from paralyzed cilia, risk for infection;
increased airway reactivity
o Instruct patient to stop smoking 2 months before surgery. If not, at least 24 hours before
Pregnancy
o Risks to fetus, especially during first trimester.
o Only emergency or urgent surgery should be performed
Surgical Risk Factors
Fluid and Electrolyte Imbalance
o CHF from edema; kidney problems (K+ lossà risk for arrhythmias; usually replace
K+ pre-op)
o Risk for hypovolemia from decreased blood volume
o Risk for hypotension, esp. if on diuretics
o Risk for blood clots, hemorrhage and shock
o May post-pone surgery with uncontrolled hypertension
Immune Status
o Altered immunity causes decreased ability to fight infection
o Assess for increased temp. Maintain strict asepsis.
Cardiovascular Status
o Risk for hemorrhage, shock, hypotension, stroke and thrombophlebitis
o Example: patient with obstructed descended colon and coronary artery disease
may only receive a single temporary colostomy, instead of a colon resection due to
the increased risk of complication from CAD (need less time under anesthesia)
Respiratory Status
o Risk for atelectasis, bronchitis and pneumonia. With bronchitis and pneumonia,
only emergent or urgent surgery should be performed
o Anesthesia and post-op narcotics further decreases respiratory status
Renal Status
o Proper renal function necessary for excretion of drugs
o Do not perform surgery with acute nephritis, or renal insufficiency with oliguria or
anuria
Hepatic Status
o Proper liver function needed to metabolize drugs
o Peri- operative nursing à nursing care for patients who require surgery
o Pre-op nursing à begins when the decision to perform surgery is made until the patient
enters the OR suite
o Intra- Operative nursing à begins when the patient enters the OR until the patient is
transferred to PACU or ICU
o Post-opà begins when patient leaves OR and ends after the last follow up visit with
surgeon
Extent of Surgery
o Major à hysterectomy, heart transplant
o Minor à scar removal
Purposes of Surgery
o Diagnosticà biopsy, exploratory lap
o Curative à removal of inflamed appendix, extension of benign ovarian cyst
o Reparative à knee replacement
o Reconstructive/Cosmeticà breast augmentation, facelift, rhinoplasty
o Palliative à NG tube for patient with difficulty swallowing
o Preventative à patient with history of breast cancer removes breasts
o Exploratory à laparoscope
Urgency of Surgery
o Emergent à done immediately to save patient’s life (laceration of large blood vessel,
arterial bleed, severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot/
stab wound, extensive burns)
o Urgent à must be performed within 24-30 hours (removal of kidney or urethral stones,
acute gallbladder infection)
o Required à must be done within weeks to months; some patients may opt not to (cataract,
tonsillectomy, prostatic hyperplasia without bladder obstruction)
o Electiveà recommended but not required; no adverse effects occur if surgery not
performed (bladder lift, vaginal repair, repair of scars)
o Optional à patient’s choice (cosmetic surgery)
Common surgical terms
o Ectomyà removal of (tonsillectomy)
o Lysisà destruction of (lysis of adhesions)
o Plastyà repair of or reconstruction (angioplasty)
o Ostomyà creating an opening (colostomy)
o Oscopyà look into (colonoscopyà may perform lysis of polyps)
o Otomyà cutting into (tracheotomyà for removal of foreign objects)
,o Orrhapy à repair of (herniaoraphy)
Physiological Stress Response to Surgery
o fear of death or the unknown, body image concerns (colostomy), lifestyle and role changes,
recovery, economic stress, insurance, spiritual beliefs (impacts patients perception of
surgery)
o Identify anxiety and decrease it
Physiologic Stress Response to Surgery
o Increased BP, increased respiratory distress
Age
Elderly
o Slower healing, increased risk for infection, less physiological reserve (decreased ability of
organs to return to normal after changes in equilibrium), decreased renal and liver
function (need less anesthesia because they hold onto it longer), presence of chronic illness
and current meds may increase risk associated with surgery
Nutrition
Obese patients
o At risk for wound dehiscence (treatment= moist, sterile dressings, stay with patient,
have another RN notify doctor, continue to monitor patient)
o Fat cells hold onto anesthesia longer and therefore is eliminated slower
o Risk for pneumonia post-op due to difficulty turning, coughing, and deep breathing
Malnourished
o Slower wound healing (decreased protein)
o Any nutritional deficit must be corrected before surgery (need adequate protein)
Infection
o with chronic diseases, immunity is decreased; there is poor tissue perfusion and surgery is
an added stress on the body
o Post-pone surgery if respiratory infection present
o Prevent vomiting and aspiration by inserting NG tube with general anesthesia
o With chronic diseases, there is increased risk for respiratory impairment
o NPO status with Diabetics causes concerns about giving or withholding insulin pre-op
o Be patient advocate. If surgery is not until later in the day, post-pone NPO status until
after breakfast
, Alcohol Use
o Often malnourished, liver dysfunction, cirrhosis (decreased metabolism of drugs)
o Susceptible to injury; possibility of withdrawals
o Try to post-pone surgery if patient is intoxicated
o Excrete anesthesia slower
Drug use
o Risk for drug interactions and over sedation. Pain is harder to control. Require larger
doses of pain meds
Medications
o Anti- coagulants à risk for bleeding; notify surgeon immediately if patient is on anti-
coagulants
o Herbal medsà assess patient’s use of these; increased risk of interaction with anesthesia
o Diureticsà risk for fluid and electrolyte balance, leading to respiratory depression;
patient is already losing fluid during surgery. Monitor I and O
o Corticosteroidsà suppresses immune function; cardiovascular collapse can occur if d/c
suddenly. Therefore, a bolus of corticosteroid may be administered IV immed. before and
after surgery
o Assess patient’s use of OTC drugs
o Phenothizaines (Thorazine à may increase hypotensive action of anesthesia
o Tranquilizers (Valium) à anxiety, tension, and seizures if withdrawn suddenly.
o Insulin à to hold or not to hold? That is the question!
o Antibiotics (erythromycin) à if combined with a muscle relaxant, apnea from resp
paralysis may result
o Anti- seizure meds (Dilantin) à IV route of med may need to be admin to keep seizure
free
o MAOI (Nardil) à may increase hypotensive action of anesthetics
Disability
o Mental handicap à have trouble understanding. Ensure that family member or
caregiver is present during teaching
o Physical handicap à fluid build up from decreased mobility, pooling and stasis of blood
increase risk for clots (apply TED hose or SCD’s, dangle feet, ambulate, don’t massage),
risk for pressure ulcers from decreased mobility (turn frequently, assess skin, provide
padding between pressure areas
Smoking
o Causes poor wound healing; decreased tidal capacity; decreased effect of pain meds;
, restlessness and agitation; impaired coughing from paralyzed cilia, risk for infection;
increased airway reactivity
o Instruct patient to stop smoking 2 months before surgery. If not, at least 24 hours before
Pregnancy
o Risks to fetus, especially during first trimester.
o Only emergency or urgent surgery should be performed
Surgical Risk Factors
Fluid and Electrolyte Imbalance
o CHF from edema; kidney problems (K+ lossà risk for arrhythmias; usually replace
K+ pre-op)
o Risk for hypovolemia from decreased blood volume
o Risk for hypotension, esp. if on diuretics
o Risk for blood clots, hemorrhage and shock
o May post-pone surgery with uncontrolled hypertension
Immune Status
o Altered immunity causes decreased ability to fight infection
o Assess for increased temp. Maintain strict asepsis.
Cardiovascular Status
o Risk for hemorrhage, shock, hypotension, stroke and thrombophlebitis
o Example: patient with obstructed descended colon and coronary artery disease
may only receive a single temporary colostomy, instead of a colon resection due to
the increased risk of complication from CAD (need less time under anesthesia)
Respiratory Status
o Risk for atelectasis, bronchitis and pneumonia. With bronchitis and pneumonia,
only emergent or urgent surgery should be performed
o Anesthesia and post-op narcotics further decreases respiratory status
Renal Status
o Proper renal function necessary for excretion of drugs
o Do not perform surgery with acute nephritis, or renal insufficiency with oliguria or
anuria
Hepatic Status
o Proper liver function needed to metabolize drugs
