Nursing Care of the Client Having Surgery

CHAPTER 3


Nursing Care of the Client Having Surgery



CONSCIOUS SEDATION


In the acute care setting, many clients undergo invasive procedures using conscious sedation. Conscious sedation does not require the presence of an anesthesiologist. The physician is most often credentialed in conscious sedation based on the policies and procedures of the health care facility. The role of the nurse in conscious sedation focuses on the administration of the ordered sedative/narcotic agents and the physiological monitoring of the client’s response to both the medications and the procedure. Common opioids used in conscious sedation include morphine, meperidine (Demerol), and fentanyl (Sublimaze). Opioids are administered in combination with sedatives to reduce the incidence of pain and improve the client’s tolerance of the procedure. Common sedatives used for conscious sedation include diazepam (Valium) and midazolam (Versed).


The American Society of Anesthesiologists (2004, p. 1) defines conscious sedation as “a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.” When used safely, conscious sedation provides moderate sedation/analgesia while maintaining adequate cardiopulmonary function, protective reflexes, and the ability to respond appropriately to stimulation.


This care plan focuses on the care of the adult client who is receiving or has received conscious sedation for an invasive procedure. Because of the nature of ongoing assessment, intervention, and evaluation of the client’s tolerance to medications and procedure, delegation rarely occurs. Much of the information is applicable to clients having conscious sedation in an outpatient setting (e.g., physician’s office, surgical care center).




imageNursing Diagnosis ACTUAL/RISK FOR IMPAIRED RESPIRATORY FUNCTION*


Definition: Actual or risk for an ineffective breathing pattern NDx or inspiration/expiration that does not provide adequate ventilation. Actual or risk for impaired gas exchange NDx or a deficiency in oxygenation and/or excess in carbon dioxide elimination at the alveolar-capillary membrane level.
















PREOPERATIVE CARE


The preoperative phase begins when the client decides to have surgery, and ends when the client enters the operating room area. Although surgical procedures are performed in a variety of settings (e.g., hospitals, day surgery centers, physicians’ offices), the basic preoperative client care is similar. The goals of preoperative care are to prepare the client physically and psychologically for the surgery and the postoperative period. Thorough preoperative preparation reduces the client’s postoperative fear and anxiety and the risk of postoperative complications. In order to individualize this care plan, the client’s psychological and physiological status, the surgical setting, the length of time before the surgical procedure, the type of anesthesia to be used, and the planned surgical procedure must be considered.


This care plan focuses on the adult client who is scheduled for a surgical procedure. It should be used in conjunction with each surgical care plan.




Nursing Diagnosis FEAR NDx/ANXIETY NDx


Definition: Fear/anxiety related to a change in health status, situational crisis, and fear of the unknown












Nursing Diagnosis DISTURBED SLEEP PATTERN NDx


Definition: Time limited disruption of sleep (natural, periodic suspension of consciousness) amount and quantity






Nursing Diagnosis GRIEVING NDx


Definition: Intellectual and emotional responses through which an individual attempts to adjust self-concept based upon a perceived personal loss













Nursing Diagnosis DEFICIENT KNOWLEDGE NDx


Definition: Absence of cognitive information related to a specific topic






POSTOPERATIVE CARE


The postoperative phase begins when the client is transferred from surgery to a postanesthesia care unit (PACU) and ends when the client has recovered from the surgical intervention. The length of the postoperative phase varies depending on factors such as the client’s age and preoperative health status, the type of anesthesia used, the length and type of surgery, and the client’s physiological and psychological responses postoperatively.


This care plan focuses on postoperative care of an adult client who has received general anesthesia and has been transferred from the recovery area to the clinical care unit. Much of the information is applicable to clients having surgery in an outpatient setting (e.g., physician’s office, surgical care center) and to those receiving follow-up care in an extended care facility or home setting. This care plan should be used in conjunction with all surgical care plans.



OUTCOME/DISCHARGE CRITERIA


The client will




Nursing Diagnosis INEFFECTIVE TISSUE PERFUSION NDx (RENAL, CEREBRAL, CARDIOPULMONARY, GASTROINTESTINAL, PERIPHERAL)


Definition: Decrease in blood circulation to the periphery that may compromise health









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Feb 11, 2017 | Posted by in NURSING | Comments Off on Nursing Care of the Client Having Surgery

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