M1 Activity 1 Plenary GROUP2 BSN3B
M1 Activity 1 Plenary GROUP2 BSN3B
M1 Activity 1 Plenary GROUP2 BSN3B
M1 Activity 1 Plenary
Activity 1: Perioperative Concepts and Nursing management
2. Identify legal and ethical considerations related to obtaining informed consent for surgery.
- Information provided in informed consent. The nurse gives the client enough information
relevant to the intervention. Information examples include:
● The client's condition's characteristics.
● The nature, benefits, possible threats, and outcomes of the intervention or operation.
● Suitable alternatives for the planned intervention or procedure.
● What is likely to happen if the intervention or procedure is neglected.
- Communication. As a part of the healthcare team, the nurse attends to the client's
information needs and preferences. The nurse uses clear language to communicate with the
patient. He or she encourages the client or family to talk about worries, concerns, frustrations,
and anxieties as well as to vent their sentiments. The nurse, acting as the client's advocate,
ensures that the client has enough time to think on the course of treatment.
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- Documentation. The nurse verifies accurate documentation, which is essential to the consent
process overall. The crucial components are as follows:
● Intervention indications
● The intervention's justification.
● A description of what will happen if action is not taken.
● Post-intervention strategy
● Possible dangers.
● The client's reaction to the justification.
- Right of refusal or withdrawal of consent. The nurse respects the client's right to decline or
revoke consent given at any time, any place, at any time. In these circumstances, the nurse
records the client's decision.
- Preoperative assessment is done before moving the patient inside the OR/DR to assess health.
Preoperative assessment is an opportunity to identify and examine a patient’s health
physically and mentally that may lead to complications during surgery. Knowledge and
information are very crucial to older adults during pre assessment in order for them to be
aware of what nurses and physicians will do to them. One of their rights is to know
everything. So during preoperative procedures, nurses must explain the procedures, rights,
medication, and other surgical-related information.
of resident and transitory bacteria, and decreasing the growth of microbes prior to surgical
operation.
- On the prep table, a sterile skin prep tray is opened. The prep tray is typically disposable,
although it always includes two or more towels and a tiny basin. for solutions, applicators,
and sponges (not to be confused with the counting sponges on the instrument tray).
- Remove hair with a specific clipping tool in the preoperative area and to offer a preparatory
cleaning of the entire surgical field on the day of the procedure, wipe with an antiseptic
solution (e.g chlorhexidine gluconate) also allows enough time to dry in order to maximize
adhesion and ensure good sterile draping.
During the interdisciplinary approach of care, different healthcare experts offer distinctive
perspectives on a patient’s condition. When treating a patient together, for example during a surgical
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The combination of interdisciplinary approaches makes faster treatments and reduces errors during the
care of patients in surgery. Operations are made more efficient. Faster treatment speeds up the
recovery of a patient and subsequent hospital discharges, and accurate therapy reduces the need for
additional testing and examinations. As a result of the increased efficiency, hospitals are able to accept
more new patients, and patients also benefit from lower expenses associated with shorter stays.
2. Sterile persons are gowned and - The portion of your body covered by a
gloved; gowns are sterile from table gown that allows you to look forward
to chest level in front including and down to the level of the sterile field
sleeves to 2 inches above the elbow. is considered to be sterile. As a result,
only the front of a gown and the sleeves
that extend from the elbow down to the
level of the sterile area are considered
sterile.
3. Tables are sterile only at table level. - Keep at least one meter away from the
table when opening your gown because
if you accidentally contact the table
below the surface level, your gown
becomes unsterile.
4. Sterile persons touch only sterile - For instance, sterile team members must
items or areas. Unsterile persons maintain contact with sterile fields by
touch only unsterile items or areas means of gowns and gowns. On the
other hand, non sterile team members
(circulating nurses) do not directly
come into contact with the sterile field.
The circulating nurse opens the wrapper
on the sterile package to deliver
supplies to the sterile team members.
5. Unsterile persons avoid reaching over - Unsterile team members should never
the sterile field. Sterile persons avoid reach over the sterile field to transfer
leaning over unsterile areas any sterile items.
- In pouring solution into the sterile
basin, the circulating nurse holds only
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6. Edges of anything that encloses sterile - The margins of wrappers are one
content are considered unsterile instance where sterile and non-sterile
area boundaries are not always clearly
delineated. Peel-open package flaps
should not be torn while opening sterile
products; instead, they should be pulled.
Flip the sterilized contents over and lift
it upward. The circulator should stop
sterile components from slipping over
non-sterile edges.
8. The sterile field is created as close as - The time that sterile items are
possible to the time of use uncovered and exposed to the
environment, is proportionate to the
degree of contamination. Sterile tables
are assembled prior to the operation
only and uncovering a sterile table for
later use is not recommended.
9. Sterile areas are continuously kept in - Sterile persons must face sterile areas.
view - When sterile packages are opened in an
operating room, or any sterile field is set
up, someone must remain in the room to
maintain vigilance, for example, the
circulating nurse.
10. Sterile persons keep well within the - To maintain sterility, sterile personnel
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3. Describe the roles of the surgical team members during the intraoperative phase of care.
The Registered Nurse First Assistant The duties of an RNFA may involve handling
tissue, supplying exposure at the surgical site,
suturing, and maintaining hemostasis. The role
requires a thorough understanding of anatomy
and physiology, tissue handling, and the
principles of surgical asepsis. The RNFA must
be knowledgeable of the surgical objectives,
possess the skills necessary to anticipate
demands and function as an effective team
member, and be capable of managing any
emergency that may arise in the operating room.
Anesthesia and surgery disrupt all major body systems. Although most patients can compensate for
surgical trauma and the effects of anesthesia, all patients are at risk during the operative procedure.
These risks include the following:
● Allergic reactions
● Cardiac dysrhythmia from electrolyte imbalance or adverse effect of anesthetic agents .
● Myocardial depression, bradycardia, and circulatory collapse.
● Central nervous system agitation, seizures, and respiratory arrest
● Oversedation or under sedation
● Agitation or disorientation, especially in older adult patients
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5. Identify the surgical risk factors related to age-specific populations and nursing interventions
to reduce those risks.
Surgical risk factors in Geriatric Population:
● Sleep disturbance due to medications, pain, and change in environment.
● Postoperative delirium which causes confusion and disorientation to geriatric patients. This
may come and go and usually disappears within a week.
● Increased risk of pulmonary edema due to decreased cardiac and pulmonary output and poor
circulation.
● Postoperative cognitive dysfunction (POCD). A serious condition that leads to long-term
memory loss.
● Geriatric patients have a precipitous postoperative decline in physiologic reserve, which can
lead to organ failure.
Nursing interventions:
● Monitor also elderly patients for dehydration, hypovolemia, and electrolyte imbalances.
● Manage environment to minimize sleep-disturbing factors. (e.g. minimize noise, adjust room
temperature as needed, etc.)
● Instruct the patient in the use of pain rating scale to promote postoperative pain management.
● Maintain a safe environment for patients with cognitive impairment such as delirium.
● Allow the patient to express fears and anxiety.
● Careful transfer and repositioning of the patient. Protect bony prominences from prolonged
pressure. Provide gentle massage to promote circulation.
6. Compare types of anesthesia with regard to uses, advantages, disadvantages, and nursing
responsibilities.
Type of Anesthesia Uses Advantages Disadvantages Nursing
responsibilities
1. General anesthesia General - The onset of the - The patient is at a. Close operating room
- the loss of all anesthesia is IV-infused risk of respiratory doors; keep the room
sensation and used for major anesthesia is depression, quiet; stand by to assist;
consciousness. It is operations and pleasant, with no sneezing, initiate cricoid pressure
usually administered long surgical buzzing, or coughing, or if requested.
by IV infusion or by procedures. (e.g. dizziness. The laryngospasm. b. Remain at the
inhalation through a Major abdominal duration of action is patient’s side quietly
mask. surgery, brief, the patient - Postoperative and ready to assist the
Head or neck awakens with Nausea and anesthesiologist as
surgeries, minimal nausea and vomiting, needed.
Eye surgeries, vomiting. The c. Position the patient
Thoracic surgery, anesthetic agents - Depresses the and prep skin only when
and are nonexplosive, respiratory and the anesthesiologist
Neurosurgery.) require little circulatory indicates the loss of
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2.2 Spinal anesthesia - - Uses of Spinal - Reduce nausea and - Nausea and
it requires lumbar anesthesia vomiting, Lower vomiting; severe
puncture through one depend on respiratory headache;
of the interspaces whether it is a complications, and hypotension due
between lumbar disk 2 low, mid, or high early postoperative to vasodilation.
(L2) and the sacrum spinal. Low recovery.
(S1). spinals (saddle or
caudal blocks)
are primarily
used for
surgeries
involving the
perineal or rectal
areas. Mid
spinals (below
the level of
umbilicus or
T10) can be used
for hernia repairs
or
appendectomy.
High spinals
(reaching the
nipple line or T4)
can be used for
surgeries such as
cesarean section.
3. Moderate sedation - Can be used in - The patient is able - Patient may a. Continuously monitor
- involves the IV procedures such to maintain a patent experience side the patient's vital signs.
administration of as endoscopies, airway, retain effects such as b. Assess the patient’s
sedatives or analgesic incision and protective airway headaches, level of consciousness
medications to reduce drainage of reflexes, and dizziness, and and cardiac and
patient anxiety and abscesses, and respond to nausea. respiratory functions.
control pain during balloon verbal and physical c. Secure resuscitative
diagnostic or angioplasty. stimuli. equipment, such as
therapeutic medications, artificial
procedures. airways, suction
supplies, and a
defibrillator, should be
readily available.
d. Provide safety
measures (e.g. adequate
lighting, raised side
rails, etc.) to prevent
injuries.
e. Communicate with
the anesthetist and other
members of the team
effectively.
f. Assist in
interventions, delegate
tasks when appropriate,
and keep records.
2014).
2. Compare postoperative care of the ambulatory surgery patient with that of the hospitalized
surgery patient.
Outpatient treatment, often known as ambulatory care, does not need hospitalization.
However, inpatient care does require a patient to stay in a hospital overnight throughout
treatment and recuperation. In terms of postoperative care, outpatient surgery is frequently
referred to as same-day surgery (ambulatory). Unless the patient exhibits evidence of
postoperative complications, he/she will be discharged the same day as their treatment. They
will not be required to remain overnight. But before that they must show that they can breathe
regularly, drink, and pee before being released. They will not be permitted to drive soon
following anesthesia-induced surgery. Make arrangements for transportation home, ideally
ahead of time. And it is natural for them to feel lethargic the next day.
While if the patient undergoes in-patient surgery, they will need to spend the night in the
hospital to continue getting postoperative care. They may be required to stay for many days or
more. In certain situations, other patients who were planned for outpatient surgery develop
difficulties and must be hospitalized for further treatment. After they’ve been transported out
of the initial recovery room, the patient’s postoperative care will continue. They will almost
certainly still have an IV catheter in their arm, a finger device that detects oxygen levels in
their blood, and a dressing on their surgery site. They may also have breathing equipment, a
cardiac monitor, and a tube in their mouth, nose, or bladder depending on the sort of surgery
they’ve had.
The medical personnel will continue to check the patient’s vital signs. They may also
administer pain relievers or other drugs through the IV, by injection, or orally. Depending on
the patient’s health, they may ask the patient to get up and move about. Or they may require
assistance with this. Moving will help reduce the patient’s risk of forming blood clots. It can
also help them retain muscle strength. To avoid respiratory issues, patients may be instructed
to practice deep breathing exercises or forced coughing.
The doctor will determine when the patient is ready to be released. Remember to request
discharge instructions from the physician assigned to the patient before leaving. Make plans
ahead of time if the patient requires continuing care at home.
Interventions
1. Assess lung and breath sounds.
2. Reposition the client every 1 to 2 hours.
3. Encourage the client to deep breathe, cough,
and use the incentive spirometer.
4. Provide chest physiotherapy and postural
drainage as prescribed.
5. Use suction to clear secretions if the client is
unable to cough.
6. Encourage fluid intake and early ambulation.
Hypoxia Assessment:
restlessness, dyspnea, hypertension, tachycardia,
diaphoresis, cyanosis
Interventions:
1. Monitor for signs of hypoxia.
2. Eliminate the cause of hypoxia.
3. Monitor lung sounds and pulse oximetry.
4. Administer oxygen as prescribed.
5. Encourage deep breathing and coughing and
use of the incentive spirometer.
6. Turn and reposition the client.
Interventions:
1. Notify the physician immediately.
2. Monitor vital signs.
3. Administer oxygen and medications as
prescribed
Hermorrhage Assessment:
restlessness, weak and rapid pulse, hypotension,
tachypnea, cool, clammy skin, reduce urine
output
Interventions:
1. Provide pressure to the site of bleeding.
2. Notify the physician immediately.
3. Administer oxygen as prescribed.
4. Administer IV fluids and blood as prescribed.
5. Prepare client for surgical procedure if
necessary
Shock Assessment:
Similar to assessment findings in hemorrhage
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Interventions:
1. If shock develops, elevate the legs.
2. If the client had spinal anesthesia, do not
elevate the legs any higher than placing them on
the pillow; otherwise the diaphragm muscles
could be impaired.
3. Determine and treat the cause of shock.
4. Administer oxygen as prescribed.
5. Monitor level of consciousness.
6. Monitor vital signs for increased pulse or
decreased blood pressure.
7. Monitor intake and output.
8. Assess color, temperature, turgor, and
moisture of skin and mucous membranes.
9. Administer IV fluids, blood, and colloid
solutions as prescribed.
Thrombophlebitis Assessment
1. Vein inflammation
2. Aching or cramping pain
3. Vein feels hard and cordlike and is tender to
touch
4. Elevated temperature
5. Positive Homan’s sign
Interventions
1. Monitor legs for swelling, inflammation,
pain, tenderness, venous distention, and
cyanosis.
2. Elevate the extremity 30 degrees without
allowing any pressure on the popliteal area.
3. Encourage the use of antiembolism stockings
as prescribed; remove stockings twice a day to
wash and inspect the legs.
4. Use intermittent pulsatile compression device
as prescribed.
5. Perform passive range of motion exercises
every 2 hours if the client is confined to bed
rest.
6. Encourage early ambulation as prescribed.
7. Do not allow the client to dangle the legs.
8. Instruct the client not to sit in one position for
an extended period of time.
9. Administer heparin sodium or warfarin
(Coumadin) as prescribed.
Interventions
1. Monitor for voiding.
2. Assess for distended bladder.
3. Encourage ambulation when prescribed.
4. Encourage fluid intake unless
contraindicated.
5. Assist the client to void by helping to stand.
6. Provide privacy.
7. Pour warm water over the perineum or allow
the client to hear running water to promote
voiding.
8. Catheterize the client as prescribed after all
non-invasive techniques have been attempted.
Constipation Assessment:
abdominal distention, absence of bowel
movements, anorexia, headache, and nausea
Interventions:
1. Assess bowel sounds.
2. Encourage fluid intake up to 3000 mL per day
unless contraindicated.
3. Encourage early ambulation.
4. Encourage consumption of fiber foods unless
contraindicated.
5. Administer stool softeners and laxatives as
prescribed.
6. Provide privacy and adequate time for bowel
elimination
Interventions
1. Monitor intake and output.
2. Maintain NPO status until bowel sounds
return.
3. Maintain patency of a nasogastric tube if in
place.
4. Encourage ambulation.
5. Administer IV fluids or total parenteral
nutrition as prescribed.
6. Administer medications as prescribed to
increase gastrointestinal motility and secretions.
7. If ileus occurs, it is treated first nonsurgically
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Interventions
1. Monitor temperature.
2. Monitor incision site for approximation of
suture line, edema, or bleeding, and signs of
infection (REEDA: redness, erythema,
ecchymosis, drainage, approximation of the
wound edges).
3. Maintain patency of drains, and assess
drainage amount, color, and consistency.
4. Keep drain and tubes away from incision line,
and maintain asepsis.
5. Change dressing as prescribed.
6. Administer antibiotics as prescribed.
Interventions
1. Place the client in low Fowler’s position with
knees bent to prevent abdominal tension on an
abdominal suture line.
2. Cover the wound with a sterile normal saline
dressing.
3. Notify the physician.
4. Prevent wound infection.
5. Administer antiemetics as prescribed to
prevent vomiting and further strain on the
abdominal incision.
6. Instruct the client to splint the abdominal
incision when coughing
Interventions
1. Place client in low Fowler’s position with
knees bent to prevent abdominal tension.
2. Cover the wound with a sterile normal saline
dressing.
3. Notify the physician.
4. Prevent wound infection through strict
asepsis.
5. Administer antiemetics as prescribed to
prevent vomiting and further strain on the
incision.
6. Instruct the client to splint the incision when
coughing
During the postoperative period, reestablishing the patient’s physiologic balance, pain
management. To do these it is crucial that the nurse perform careful assessment and
immediate intervention in assisting the patient to optimal function quickly, safely and
comfortably as possible.
Special consideration to the patient’s incision site, vascular status and exposure should be
implemented by the nurse when transferring the patient from the operating room to the
postanesthesia care unir (PACU) or postanesthesia recovery room (PARR). Every time the
patient is moved, the nurse should first consider the location of the surgical incision to prevent
further strain on the sutures. If the patient comes out of the operating room with drainage
tubes, position should be adjusted in order to prevent obstruction on the drains.
directly influence the characteristics of the wound itself, while systematic factors are the
overall health or disease state of the individual that affect his or her ability to heal. Many of
these factors are related, and the systematic factors act through the local effects affecting
wound healing.
Wound healing can be delayed by systematic factors that bear little or no direct relation to the
location of the wound itself. These factors include age, body type, chronic disease ,
immunosuppression, nutritional status, radiation therapy, and vascular insufficiencies.
● Introduce yourself to the patient and explain what you're doing and why you're doing it.
Provide privacy if at all possible.
● Before you begin, make sure the patient is comfortable and the surrounding area is clean and
tidy.
● Examine the patient's care notes to stay up to date on any changes in the patient's condition
and to ensure that the dressing is due to be changed.
● Put on an apron and wash your hands. Using soap and water or a disinfectant and a cloth,
clean the trolley. Begin at the top of the trolley and work your way down, using single strokes
with your damp cloth.
● Place the sterile dressing/procedure pack on the trolley's top. On top of the trolley, open the
sterile dressing pack. Using the corners of the paper, open the sterile field. Open any
additional sterile items required and place them on the sterile field without touching them.
● Put on sterile gloves and wash your hands. Remove the gloves, re-wash your hands, and put
on new sterile gloves if they become desterilised. This is best practice, but if resources are
limited, safe modifications to this process can be made, such as using non-sterile gloves to
protect the nurse while removing the dressing and then washing the hands with gloves on and
using alcohol gel on the gloves to clean the wound and redo the dressing. This safeguards
both the nurse and the patient.
● Begin in the dirty area and work your way out to the clean area. When doing this, exercise
extreme caution because the tissue or skin may be tender and there may be sutures in place.
Clean the area without causing any additional harm or distress to the patient.
● Make sure you don't reintroduce dirt or ooze by not overusing cleaning materials (such as
gauze or cotton balls). Change them on a regular basis (if possible, only once) and never
reintroduce them to a clean area after they have been contaminated. Check that you have
chosen the appropriate dressing type and materials for the type, size, and location of the
wound, according to the care plan or the physician's or senior charge nurse's
recommendations. Dress the wound as per instruction.
7. Identify assessment parameters appropriate for the early detection of post operative
complications.
● Vital signs - Vital signs should be taken in accordance with local policies or guidelines and
compared to baseline observations taken before, during, and after surgery. Nurses should also
be aware of the parameters for these observations as well as what is normal for the patient
being observed. These observations should not be considered in isolation when assessing
patients' recovery from anesthesia and surgery; the nurse should look at and feel the patient.
This also applies to children, and other signs and symptoms, such as abdominal tenderness or
decreased urine output, may indicate deterioration.
● Level of consciousness - Before being transferred to the ward and throughout the
postoperative period, postoperative patients should respond to verbal stimulation, be able to
answer questions, and be aware of their surroundings. A shift in consciousness can indicate
that the patient is in shock.
● Airway and respirations - If there is a change in cardiac or neurological state, the first vital
sign to be affected is often respiratory rate and function.
● Fluids and Electrolytes - The standard principles of fluid balance in the post-operative patient
are to correct any pre-existing deficits, replace unusual losses (e.g., from surgical drains,
pyrexia), and use the oral route whenever possible because there is frequently a delay in
starting oral intake after surgery.
● Sepsis - Sepsis is the systemic inflammatory response to infection. It is a progressive response
to infection that results in a generalized inflammatory response and, eventually, end-organ
dysfunction and/or failure. A post-operative patient's condition deteriorates dramatically when
they develop systemic sepsis. As a result, early identification and management of patients at
risk of developing sepsis is critical.
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COLLEGE OF NURSING, NUTRITION AND DIETETICS
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References:
Antoniadou, A. (2018). Preparing the Patient for Surgery. International Society for Infectious
Diseases. Retrieved from: https://isid.org/guide/infectionprevention/preparing-the-patient-for-surgery/
Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier and Erb's fundamentals of nursing:
Concepts, process and Practice (10th ed.). Pearson Australia.
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14th Edition by Hinkle and Cheever
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of Medical-Surgical Nursing
(14th ed.). Wolters Kluwer Health.
Markey, D., Brown R., (2002) An interdisciplinary approach to addressing patient activity and
mobility in the medical-surgical patient. Retrieved from https://europepmc.org/article/med/12125898
Nerve Blocks. (2021). Johns Hopkins Medicine. Retrieved September 15, 2022, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks#:%7E:text=Benefits%
Postoperative Care: Definition and Patient Education. (2016, August 8). Healthline.
https://www.healthline.com/health/postoperative-care#at-home
Why Teamwork and Communication are Critical in Nursing (2022) Retrieved from
https://learnonline.eiu.edu/programs/rn-to-bsn/teamwork-communication-critical-in-healthcare/
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What is an Interdisciplinary Team? Definition, Importance and Advantages (2021) Retrieved from
https://www.indeed.com/career-advice/finding-a-job/interdisciplinary-team
GROUP 2 BSN 3B
DIEL, WAYMEL
DINGCONG, VINCENT
DOLAR, MARY JESSLYN
DOMINES, XIOMARA
FAROCHILEN, ROSSANNE
FAUSTO, MARJORIE
GALLEGO, COLEEN
GERMO, KOBE BRYAN
GONZALES, MA. JOVYLYN