PATIENT CARE CONCEPTS

WEEK 7

Physical Health

• Relate the following health and wellness concepts to the surgical patient and the surgical technologist role:

• Physical activity• Nutrition• Tobacco use• Alcohol use• Stress

Post-Operative Complications

• Complications are difficulties post-operatively that warrant immediate treatment and may result in returning to surgery.

• Complications are accepted as risks of having surgery, so are shared with the patient pre-operatively before the surgical consent is signed

• Can result in prolonged hospitalization as well as prolonging a patient’s recovery or return to normal function

Types of Post-Operative Complications

• Shock is inadequate blood flow, therefore poor oxygenation to vital organs that can result in irreversible damage to the organs involved

• Hemorrhage is heavy bleeding during, shortly after, or some time after surgery

• Pulmonary Embolus or PE occurs when a blood clot forms, is dislodged, and is carried to the heart’s pulmonary artery

Types of Post-Operative Complications Continued

• Respiratory secretion impairment can be from inadequate clearing of secretions by the patient (coughing, turning, deep breathing) or the accidental aspiration of secretions. This can result in aspiration pneumonia.

• Gastro-intestinal/bowel obstruction is most often seen after surgery involving the abdomen. It can occur in 3 to 5 days post-op or years down the road.

Types of Post-operative Complications Continued

• Post-op Psychoses is caused by temporary lack of oxygen to the brain. It can result in depression, anxiety, mental confusion, and hallucinations. This can also be a result of the anesthetic or pain medications.

• Retained foreign body

Equipment/Immediate Access Preparing for Complications

• Keep set-up sterile as well as yourself if able until the patient is assuredly stable and ready for transport

• Need to be prepared should you have to go back in to a patient

• Oxygen

• Defibrillator

Post-Anesthesia Care Unit(PACU)

• Given there are no complications, established criteria must be met by the patient before they can be discharged to the surgical floor of the hospital or home in the case of out-patient surgery

Post-Operative/Discharge

Instructions

• May vary with type of operation• Activity will be encouraged/Limits will be on

lifting, pulling, and straining• Rest will be encouraged• Driving and operation of heavy machinery may

be discouraged for awhile• Resumption of sexual intercourse may have a

time frame• Resumption of showering and tub bathing may

have a time frame

Discharge or Post-Operative Instructions Continued

• Alcoholic beverage consumption may have a time frame

• Smoking will be discouraged• Diet may be progressive• Instructions on dressing changes will be given• Prescriptions will be given• Follow-up doctor appointment will be made

Discharge or Post-Operative Instructions Continued

• The following will be reported to the patient’s doctor by the patient immediately:

• Fever• Prolonged nausea and vomiting• Swelling or excessive bleeding• Excessive pain• Inability to urinate or void• Inability to pass stool or defecate

Death and Dying(The Grieving Process)

• Kübler-Ross Stages of Grief as experienced by the patient and the family:

• Denial-does not accept death as a reality. Pretends it isn’t happening. This prolongs communication of concerns.

• Anger-Important not to take personally if the health care provider. The person is expressing their sense of helplessness and outrage over their situation.

Kübler-Ross Stages of Grief Continued

• Bargaining-involves a deal made with God, the doctor, or nurse. For example “If I can live until my grandson is born next month, I’ll be ready to die.” When possible, requests will be granted.

• Depression-the previous methods are no longer working. The person feels sad and full of anguish. Death is a reality. Support is important at this time.

Kübler-Ross Stages of Grief Continued

• Acceptance-The person has accepted the fact they are going to die and is at relative peace with it. They will want loved ones near. They may or may not want to reflect on the past and consider the future without them.

• These stages do not always occur in order. Patients and families may go back and forth between stages and will likely each be at different stages.

Organ Transplantation and Procurement Facts

• Organ transplantation is one of the twentieth century’s greatest breakthroughs

• Fifteen people die every day waiting to receive an organ transplant

• Supply and demand gaps are growing• Organ procurement is based on patients and

families volunteering to donate their organs• Cost is a factor (many insurances do not cover

expense/cost can range from $35,000 to $200,000 the first year of a transplant