Perioperative Nursing Peg Trueman RN MSN Ed.D. CNE

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Perioperative NursingPeg Trueman RN MSN Ed.D. CNE
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Meet the Patient

• The experience of surgery is a routine event for
  everyone involved EXCEPT for the patient!

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Nursing Management after Surgery
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Postoperative PhasePlan of Care
System Assessments and related nursing diagnoses
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System Assessments

• Respiratory
• Cardiovascular
• Fluid Status
• Nutrition
• Elimination
• Activity
• Wound Healing

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Respiratory

• Pulmonary assessment data
• TCDB
• C/I CHI, eye sx
• O2 therapy
• IPPB
• I.S.

The real reason dinosaurs became extinct.
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Cardiovascular
Okay, Williams, well vote how many here say
the heart has four chambers?

• Cardiac assessment data
• Leg exercises
• Avoiding venous statsis
• ICD/hose

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Fluid Status

• Hydration status data
• Drainage amts
• vital signs
• daily weights!
• IV therapy
• Blood therapy

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Nutrition

• NPO status
• Progression of diet
• check bowel sounds
• Feedings
• TPN

The Nurse says a trip-o-loomin cow-filler is
feeding Grandma. It has three loops--one for
breakfast, one for lunch, and one for dinner!
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Elimination

• Urinary output
• retention?!!
• Dehydration
• Catheter is the last resort!
• Bowel activity
• bowel sounds
• flatus
• Ambulation!!!!

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Activity

• OOB ASAP!!
• Usually within 24 hrs
• Psychological impact
• Needs encouragement!

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Physiology of Wound Healing

• Inflammatory Stage
• insult
• Proliferative Stage
• reinforcemen/framework
• Maturation Stage
• settling in

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Wound HealingFirst Intention

• Scar formation is minimal
• Properly closed
• Heal with little tissue reaction

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Wound HealingSecond Intention

• Wound is left open to granulate
• Resultant in scar formation
• Healing by granulation

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Wound HealingThird Intention

• Two opposing granulation surfaces are brought
  together
• Scar is deeper and wider
• Delayed closure

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Factors Affecting Wound Healing

• Age
• Hemorrhage
• Hypovolemia
• Local Factors
• Nutritional Deficits

• Oxygen deficit
• Drainage
• Medications
• Systemic Disorders
• Wound Stressors

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Wound Care
Just a friendly suggestionnext time you do a
dressing change, dont say, OH MY GOD, WILL YOU
LOOK AT THAT!
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Post-op Pain Control

• What is pain?
• Factors affecting pain
• Administration
• Preventative Approach
• PRN vs ATC
• Routes of Administration
• Intramuscular
• Intravenous
• PCA pump/Epidural lines

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Post-op Pain Control

• Common Pain Medication
• Demerol
• Morphine
• Dilaudid
• Stadol
• NSAIDs
• Side Effects of Pain medication

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Managing Potential Complications

• Shock/Hemorrhage
• Deep Vein Thrombosis (DVT)
• Pulmonary Embolism
• Respiratory Complications
• Urinary Retention
• Intestinal Obstruction
• Wound Complications

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Surgery Specific Care

• Postoperative Uniquities and worries

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Remember Mr. P?

• Case Study Review

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Perioperative Nursing
"Dr. Trueman, can I be excused? My brain is
full."