Class notes
Adult Health 1 Exam 1
- Course
- Adult Health 1
- Institution
- Rockhurst University
Class notes for Exam 1
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Adult Health Exam 1Factors that Increase the Risk for Surgical Complications
Age – older than 65
Medications (ex: anticoagulants)
Medical history (ex: malignant hypothermia, diabetes)
Prior surgical experiences
Family history
Type of surgical procedure planned
Specific Considerations for Older Adults
The older adult may have a variety of health-related issues that can have an impact on the planning of care and
outcome of surgery, including:
- Greater incidence of chronic illness
- Greater incidence of malnutrition
- More allergies
- Increased incidence of impaired self-care abilities
- Inadequate support systems
- Decreased ability to withstand the stress of surgery and anesthesia
- Increased risk for cardiopulmonary complications after surgery
- Risk for a change in mental status when admitted (related to unfamiliar surroundings, change in routine,
drugs)
- Increased risk for a fall and resultant injury
Preoperative Assessments
Complete set of vital signs and report abnormal findings
Focus on problem areas identified from the patient’s history & on all body systems affected by surgical procedure
- Report abnormal assessment findings to surgeon/anesthesiology personnel
Assess for and report any signs/symptoms of infection
Assess for and report factors that could contraindicate surgery, including:
- Increased prothrombin time (PT), international normalized ration (INR), or activated partial thromboplastin
time (aPTT)
- Abnormal electrolytes
- Report of possible pregnancy or positive pregnancy test
Assess for and report clinical conditions that may need to be evaluated by a provider before proceeding with
surgical plans:
- Change in mental status, vomiting, rash
- Recent administration of an anticoagulant drug
- Family or personal history of malignant hyperthermia with anesthesia
,Psychosocial assessment:
- Level of anxiety, coping ability, support systems
Laboratory assessment:
- Can depend on the patient’s age, medical history, and type of anesthesia and surgery planned:
o UA, blood type and screen
o CBC or H/H
o Clotting studies (PT, INR, aPTT, platelet count)
o Electrolyte levels
o Serum creatinine and BUN
o Pregnancy test
o ABG’s may be assessed for patients with chronic pulmonary problems
Informed Consent
Consent implies that the patient has sufficient information to understand:
- The nature of and reason for surgery
- Who will be performing the surgery and whether others will be present during the procedure
- All available options and the risks associated with each option
- The risks associated with the surgical procedure and its potential outcomes
- The risks associated with the use of anesthesia
The surgeon is responsible for having the consent form signs before sedation is given and surgery is performed
Nurses’ responsibility is that the consent form in signed, and you serve as a witness to the signature, not to the fact
that patient is informed
Nursing Interventions
Determining the existence and nature of the patient’s advance directives
Implementing dietary restrictions (NPO)
- This will be determined by surgeon and anesthesiologist
Administering regularly schedules drugs
Ensuring intestinal preparation
Performing skin preparation
Preparing the patient for tubes, drains, and vascular access
Teaching about postoperative interventions to prevent respiratory complications
- Deep diaphragmatic and expansion breathing
- Incentive spirometry
- Coughing and splinting
- Turning and positioning
Teaching about identification and prevention of cardiovascular complications
- Antiembolism stockings
- Pneumatic compression devices
- Leg exercises and early ambulation to promote venous return
Minimize anxiety
, - Assess the patient’s knowledge
- Allow ample time for questions
- Encourage communication, incorporating family or supportive persons
- Promote rest
- Provide opportunity for distraction
Plans for pain management
Preoperative Chart Review
Ensure all documentation, preoperative procedures, orders are complete
Check consent forms and others for completeness
Inform patient that area will be marked before procedure begins
Record height and weight for proper dosage of anesthetic agents
Document allergies
Ensure all laboratory, radiographic, and diagnostics test are present
Document abnormal results and report them to the surgeon and anesthesia provider
Record vital signs within 1-2 hours of the scheduled surgery time
Document any significant physical or psychosocial observations
Overview of PACU and Hand-Off Report
Post anesthesia care unit (PACU)/Recovery Room purpose is:
- Ongoing evaluation and stabilization of patients
- Anticipate, prevent, and manage complications after surgery
Hand-Off Report (two-way verbal interaction)
- Report between 2 healthcare professionals is required to communicate the patient’s condition and needs
Review Best Practice for Patient Safety and Quality Care
- Postoperative hand-off report
Assessment in the PACU
History
Initial assessment data
- LOC and awareness
- Respiratory assessment is the most critical assessment to perform after surgery for any patient who has
undergone general anesthesia or moderate sedation or has received sedative or opioid drugs
o Assess for patent airway and adequate gas exchange
- Temperature, pulse, respiration, blood pressure, oxygen saturation
- Examine the surgical area for bleeding and drainage
Discharge from PACU
Health care team determines the patient’s readiness for discharge from the PACU
Recovery rating score may vary from facility to facility
Other criteria for discharge:
- Stable vital signs and normal body temperature
- No overt bleedings
- Return of gag, cough, and swallow reflexes
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