1. PSYCHOSOCIAL REACTIONS TO SURGERY

Mild to marked anxiety: may be expressed as fear.
 Pt needs help to decrease anxiety:
Establish rapport with the patient to decrease feelings of depersonalization.

Explain the preoperative and postoperative nursing care to decrease fear of the unknown.

Explain that anxiety is a normal reaction.
Enlist patient’s active participation in learning and practicing postoperative activities to give control over the environment.

When teaching include family and significant other to promote support.

Fear Of The Unknown:
Patient enters an environment in which they have very little control. Need to promote an atmosphere where they are free to ask questions.

"Discharge teaching" starts the moment they are admitted to decrease this problem. Also give them as much control as possible - "Would you like the IV on your right or your left?"
Nursing interventions are aimed at decreasing fear of the unknown and alleviating anxiety.

Coordinate information since patient is frequently not comfortable asking the surgeon questions.

If nurse is unable to answer the question, they must secure the information for the patient.

Avoid additional anxiety and not give too much information.

Sometimes avoidance is the best defense mechanism.

Purposes: Obtain patient information, Give information, and Get consent. Also allows assessment of emotional state and expectations. Careful assessment is necessary in order to prevent operative complications and alert nurse to postoperative care needs.

History and physical exam: (may find written in progress notes, or H&P faxed or brought in by surgeon from his office) must be completed by the physician, reviewed by the nurse, and a separate nursing assessment must be completed. Nursing assessment is holistic - baseline data - identify potential problems. Use lay terms in your questioning. Finally, an anesthesia preop assessment is usually written in the chart as well.

1. NURSING MANAGEMENT PREOP

General Principles of Preop teaching

1. Some things everyone having surgery has to know—see TABLE 16-7
2. Reinforce what the patient has been told about surgery. Find out patient’s understanding of procedure first. Know enough basic information about common procedures to anticipate and answer the common questions.
3. Balance telling too little vs too much
4. Avoid anxiety producing words -- "pain" (discomfort)
5. Include family members, if possible
6. Have the patient explain, give return demonstrations
7. Prepare for situations (cold, bright light, never left alone)

1. Patient Teaching About Postoperative Care

1. Therapeutic devices: indwelling catheter, n/g tube, chest tube
2. Medications for Pain: assured that medication will be available, PCA devices
3. Postoperative self-care procedures: C & DB, splinting, leg exercises, turning
4. Ambulation- don’t bound OOB, don’t do a sit up, sit at BS for a moment to check dizzyness

Immediate postoperative complications "ABC"

Airway obstruction

Causes:

effects of anesthetics, effects of narcotics given intraop or postop, secretions, swelling from a surgical site in the neck

S/S: snoring respirations, "rocking boat", apnea

Treatment: stimulation, chin lift, jaw thrust, nasal or oral airways, reintubation, mechanical ventilation

Breathing: Respiratory insufficiency
Causes- see above

S/S: shallow respirations, restlessness or other signs of hypoxemia, ABGs, pulse oximetry < 90%
Treatment: as above
Circulation

Causes: Internal hemorrhage: may occur from insecure sutures, erosion of a vessel.

S/S: rapid, deep respirations, rapid thready pulse, hypotension with narrow pulse pressure, cool, moist, pale skin, restlessness, faintness, dizziness, thirst.

Treatment: flat, pressure, IV, blood

Cause: decreased perfusion of tissues. Hemorrhage, trauma, anesthesia, pooling, or anaphylactic shock.

Treatment: Change position slowly, avoid Fowler’s, raise legs

Other problems

Pain

Nausea and vomiting

Neurological problems (delayed emergence, delirium, problems related to the surgery type i.e. carotid endarterectomy vs lumbar laminectomy)

Hypothermia