The
nursing care of the patient to be operated on are realized three periods:
•
preoperative
•
Intraoperative
•
postoperative
For
greater legibility and locate the nursing care in these periods , you should
consider the following classification:
·
Preoperatorio:
Mediato
Inmediato
·
Intraoperatorio o transoperatorio
·
Posoperatorio:
Inmediato
Mediato
Period preoperative: It is the time that elapses
between the decision to perform surgery the patient until he is brought to the
operating room. The decision can be planned or urgent.
Mediate: In the decision until 12 or 2 hours before,
depending on the surgical procedure, either higher or lower.
Immediate: From 12 to 2 hours before surgery until the
arrival to the operating room.
Consequential Care
Mediate: from the decision up to twelve or two hours
earlier, depending on the surgical procedure, either higher or lower,
respectively.
Nursing interventions in the immediate period can be:
General: those that are provided for each type of patient according to hospital routine established.
General: those that are provided for each type of patient according to hospital routine established.
Specific: those that are provided according to the
type of surgery that will be subjected.
Nursing interventions in the preoperative period aimed
mental and physically prepare the patient will be surgically intervened.
Nursing interventions in the immediate preoperative
period.
1. Patient
reception and authorization for contaminantsormed consent
Rationale:
- The period between the approach of the need for surgery and hospitalization are causing anxiety to the patient.
- The psychological balance requires the development and ability to use the psychological mechanisms to avoid anxiety, and adequately adapt to different situations.
· 2. Participation in clinical examination
Rationale:
- They are surgery physiological responses corresponding to the stress stages:
- Alarm to the stimulus alertness (tachycardia, hypertension, tachypnea) appear,
- Resistance adaptation stimulus reactions are maintained with less intensity,
- Exhaustion or inability to adapt
- They are psychological responses to
surgery, loss of control in a situation of dependence in relation to the health
team; fear of surgical experience, anesthesia, pain, loss of limb and death;
concern over the separation from his family, possible alteration of patterns of
life
· All surgery requires legal authorization (consent download information)
· Consent under information is based on patient self-determination to assert their rights to decide will be done with your body and not be forced to accept unwanted treatment.
- Cardiovascular and respiratory devices,
along with the urinary tract have a homeostatic role in the human body.
· Tests of blood count, urinalysis, blood clotting times and ESG can supplement the assessment of the physical condition of the patient.
3. Participation in physical preparation of the
patient
Rationale:
- Each patient has an individual situation, therefore, the correction of abnormal physiological states depends on your medical condition and weight
- Un estado óptimo relacionado con la nutrición favorece la reparación tisular y aumenta la resistencia a la infección.
- A state of dehydration predisposes a state of shock, retention of metabolic waste products and electrolyte disturbances.
- Exercise helps reduce post-promote tissue repair in minimum time circulatory complications.
- Fear of surgery alters the rest and sleep of the patient.
4. monitoring frequency and characteristics of
elimination
Rationale:
- Electrolyte balance the body requires a certain amount of defined amounts of water and electrolytes.
- The body fluid (water, electrolytes) contained in 60% or 70% of body weight, acts as an intermediate body for chemical reactions are carried out, as curator of healthy cells, providing water and electrolytes to the secretions and excretions.
5. personal cleanliness
Rationale:
·
The sanitization process is the security
level decreases, the number of bacterial contaminants.
6. drug administration
Rationale:
·
The night sedation is aimed at reducing
the apprehension and ensure sleep
7. Emotional and spiritual support:
Rationale:
• Fear of the unknown, of death and disability and
even fatal prognosis, alter the balance psychophysiological .
8- Specific measures:
•The
orientation and implementation of procedures related to breathing exercises ,
expulsion of secretions, mobilization or use of equipment , influences
collaboration during the postoperative period without fear of pain, anxiety or
other aspects.
•The
use of an enema on the eve of surgery to prevent postoperative intestinal
disorders.
•The
injury and colonization of the dermis is a risk factor of surgical wound
infection .
• Surgical
procedures are classified
• Objective function :
- healing to repair , replace or remove diseased
tissues or organs
- to improve aesthetic appearance.
-Explorer to determine a diagnosis
- palliative to reduce or delay clinical disease
process
- Reparative to restore lost function or correct
deformities
• Depending emergency or life-threatening :
- Scheduled according to the convenience of the
patient or surgeon.
- Urgent or to avoid immediate danger or threat to the
physical integrity or life
Immediate care
1. Monitor and record vital signs
Rationale:
• Vital
signs determine the state of health and disease.
• Some
medications tend to disrupt vital signs.
2. Physical preparation of the patient.
Rationale:
• The
sanitation and antisepsis are processes that control the growth and development
of pathogens.
• The
cleaning , waxing or shaving off the area to intervene in the immediate
preoperative period facilitates the cleanliness and visibility , in addition to
reducing the frequency of infection .
• The injury
and colonization of the dermis is a risk factor of surgical wound infection
• The
wool , plastic, nylon, nacrón , rayon, and metal objects are electrostatic
materials.
• Bladder
distention infers adequate exposure of the abdominal contents
• The placement
of the surgical clothes to the patient (clinical gown , hat or turban , elastic
stockings or bandages chaps ) is applied in aseptic surgical field.
• The
pressure in superficial veins decreases the risk of deep vein thrombosis.
3. Administration preanesthetic medication 30 or 45
min before surgery
Rationale:
• The
maximum effect of premedication between his administration and the induction of
anesthesia is obtained between 45 and 60 min.
• premedication
reduces anxiety , basal metabolism , the secretions from the airways, reflex
irritability and counteracts the undesirable side effects of the anesthetic
• Barbiturates
produce minimal cardiorespiratory depression and have a ipnotico and sedative
effect.
• Opioids
produce necrosis, raise the pain threshold and decrease motor irritability, can
cause nausea , vomiting, constipation and postoperative contraction of smooth
muscle stimulation .
• belladonna
derivatives have depressant action inhibiting the formation of mucus.
• The
choice of anesthetic depends on the physical and mental condition , age and
weight of the patient and the surgical anesthetic procedure or features
4. Perform the specific measures according to the type
of surgery.
Rationale:
• Timely
development of actions for patient risk , ensures a high degree of attention to
their health
• The
preoperative preparation in emergency surgery is limited to basic essential
details , such as channeling vein clotting time , check hemoglobin and blood
type , evacuation of gastric contents if necessary , removal of the urine to
empty the bladder and get samples for laboratory study
5.Transfer stretcher trolley patient surgical unit or ward corresponding operations upon the specific identification method for each institution
Rationale:
• The presence of nursing staff provides physical and
psychological patient safety
6. Take the patient to the nursing staff working with
the full medical record .
Rationale:
• The communication process increases a helping
relationship
