MEDICAL SURGERY
PERIOPERATIVE NURSING
VI.
3 Phases
1. PRE-OPERATIVE
Patient decided to undergo procedure –
obtained consent, explanation regarding
procedure and possible risks
Until brought to OR
Reediness: perception of the patient
Preparation:
a. Physical – diagnostic exam prior to
procedure
Optimize the patient
Basic preparation:
I.
CBC
 Hemoglobin – tissue perfusion
 Hematocrit - hemoconcentration
 WBC – bacterial infection
 Platelet – blood clotting
-
II.






III.
IV.
V.
VII.
b.
Mental –
I.
Consent – witness and securing
Assess legal age and mental
capability in signing consent
Health proxy (spouse, child,
parents, siblings, relatives) or
legal
authorized
representative
II.
Health teaching – if there is
questions or need of clarification
refer
to
the
assigned
surgeon/physician; nurse can
reinforce
a) Process information (prior)
– let the patient know what
to anticipate or expect
b) Procedural – what the
patient will do after the
procedure
was
done
(breathing
exercises,
spirometry, bed mobility,
return to self-ambulation)
c.
Emotional/Social – concern with logistics
or caregiver (Social worker)
Circulating nurse – assigned
for updating the relatives on
what is going during surgery
d.
Spiritual – contributes in patient’s safety
and security and help reduce anxiety
prior to procedure.
Allowable practices can be
done with the approval of
the physician
Urinalysis – assess renal function
pH
Appearance
Creatinine
BUN
PLT (SGPT)
AST
Geriatric:
Cardiopulmonary
clearance – will be given out by an
internist
ECG
NPO
 (6-8 hours GA; 4-6 hours RA)
 WOF dehydration (Action: insert
IV line)
 Assess for IV fluid necessary for
the patient
 Enema – for colon and OBGYN
procedures
Solano, Nica B.
Bowel Preparation
 Prophylactic antibiotic – control
intestinal flora (neomycin or
Metronidazole)
 60 minutes prior to the opening
of cavity (do not delay for
optimization)
Remove unnecessary things on the
patient as it can disrupt the
assessment, procedure, and results
MEDICAL SURGERY
PREOPERATIVE MEDICATION
1) Anticholinergic – atropine sulfate (SO4)
2) Analgesics - increase pain threshold lesser
anesthesia requirement (Nalbuphine and
Fentanyl)
3) Sedatives – reduce anxiety (Diazepam and
midazolam)
4) Antihistamine
–
Promethazine
and
Diphenhydramine
5) Antibiotics
AREAS IN IN THE OPERATING ROOM
1) Non restricted
o Lobby
o Where can the family members can stay
o Doctors can talk with relatives
thru small
incision
-
CURATIVE
-
PALLIATIVE
2) Semi-restricted
o Apparels:
Clean scrub suit
Mask (optional)
Head cap
-
-
3) Restricted
o Sterile area
o Apparels:
Sterile scrub suit
Mask (required)
Head cap
Shoes
Goggles
o Scrub – Only allowed in sterile area
o Un-scrub – does not require gown and
must be outside sterile area
REASONS FOR SURGERY
Removal
and study
DIAGNOSTIC
of tissue
to make a
diagnosis
More
extensive
meant to diagnose
Exploratio
EXPLORATORY
n of body
cavity or
use
of
scopes
inserted
Solano, Nica B.
Breast
biopsy
Exploratory
laparotomy
Exploration
of abdomen
for
unexplained
pain
COSMETIC
-
Removal
of replace
of
defective
tissue to
restore
function
Relief of
symptom
s
or
enhance
ment of
function
without
cure
Correctio
n
of
defects
Improve
ment of
appearan
ce
Change in
physical
feature
-
Cholecystect
omy
Hip
replacement
-
Resection of
tumor
to
relieve
pressure
and pain
-
Rhinoplasty
Cleft
lip
repair
CATEGORIES OF SURGERY BASED ON URGENCY
Immediate Severe
Condition
bleeding
lifeGunshot
EMERGENCY
threatening
wound
Surgery at
once
Withing 24- Kidney
30hrs
stones
Requires
Gallbladder
URGENT
prompt
infection
attention
Fracture
hip
Planned for Cataracts
a weeks or BPG
months
after
REQUIRED
decision
Requires
surgery at
some point
MEDICAL SURGERY
-
ELECTIVE
OPTIONAL
-
Client will
not harmed
if surgery
not done
but
will
benefit if
done
Personal
preference
-
Scar
removal
-
Cosmetic
surgery
16)
17)
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19)
20)
21)
22)
23)
24)
25)
26)
PREFIXES
‘A’ – without, absence
‘Centesis’ - puncture
‘Copy’ – to view
‘Ecto’ – External, outside
‘Ectomy’ - surgical removal
‘Infra’ – below
‘Inter’ – between
‘Intra’ – within
‘Itis ‘– inflammation
‘Lith’ – stone or calculus
‘Lithotomy’ – removal of stones
‘Lysis’ – destruction, dissolution, loose
‘Oma’ - tumor
‘Ostomy’ – opening into (input or output)
‘Otomy’ – opening without input or output;
cutting or making an incision
‘Pan’ – all
‘Paxy’ – crushing of stone
‘Peri’ – around
‘Pexy’ – fixation (suturing in place)
‘Plasty’ - surgical formation
‘Poly’ – many
‘Pseudo’ – False
‘Retro’ - Behind, Posterior
‘Rrhapy’ – suturing of, repair
‘Supra’ – Above
‘Tripsy’ – general term for crushing of stone
1)
2)
3)
4)
5)
6)
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9)
10)
11)
12)
ROOTWORDS
‘Adeno’ – gland
‘Angio’ – blood or lympathic vessel
‘Ano’ – anus
‘Arthro’ – joint
‘Blephar’ – eyelid
‘Broncho’ – bronchus
‘Cardio’ – heart
‘Cephalo’ – Head
‘Cerebro’ – brain
‘Cheilo’ – lip
‘Chole’ – gall, bile
‘Cholecyst’ - gallbladder
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2)
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Solano, Nica B.
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‘Choledocho’ - common bile duct
‘Chondro’ - cartilage
‘Colo’ - large intestine, colon
‘Colpo’ - vagina
‘Costo’ - rib
‘Cranio’ - skull
‘Cysto’ - bladder
‘Esophago’ - esophagus
‘Gastro’ - stomach
‘Glosso’ – tongue
‘Hepar’ – liver
‘Hyster’ – uterus
‘Lapar’ – abdomen
‘Lipo’ – fat
‘Mast/Mammo’ – breast
‘Nephro’ – kidney
‘Oculo’ – eye
‘Oophor’ – ovary
‘Orchi’ – testis
‘Osteo’ – bone
‘Oto’ – ear
‘Phlebo’ – vein
Pneumo – lungs
Procto – rectum
Pyelo – renal pelvis
Rhino – nose
Salphingo – fallopian tube
Thoraco – chest
Urano – palate
Uretro - ureter
OPERATING TEAM MEMBERS
SURGEON
-
ASSISTANT SURGEON
-
head of the team;
captain of the ship
Will decide what
procedure to do
Will obtain consent
Role
of
nurse:
anticipate the need
of the surgeon
Assist surgeon in
various capacity
Retract or tying or
cutting
Consultant > fellow
> Resident > PG
intern > Junior
intern
MEDICAL SURGERY
-
ANESTHESIOLOGIST
SCRUB NURSE
CIRCULATING NURSE
PATHOLOGIST
OTHERS
Solano, Nica B.
Coordinate
with
surgeon regarding
the
necessary
medications
and
sedatives
Control
overall
hemodynamics
Pain management
(POST-OP)
Mainting sterility
Anticipate needs of
the surgeons
Counting
(before
and after surgery;
closure; cavity; final
count - fascia)
Counting
Senior nurse
Overall picture of
the room
Anticipate needs
Skin preparation
Documentation
Coordinate
with
family
Order of doctors
Coordinating with
other
units
/interdepartment
(depends)
Clinical Histopathology
–
determine if the
specimen is correct;
identify benign or
malignant; FS (fresh
specimen with a bag
and
properly
labeled)
* Histopath result –
clinic of the physician
Blood bank Autopsy
1. MedTech
2. Supervisor
–
administrative roles
3. Nursing Aids
4. Orderly
5. Perfusionist 6. Radiologist 7. Rad Tech – reads
results (Ortho)
8.
9.
10.
11.
12.
13.
2.
-
Intra-operative
Procedure is done
3.
-
Post-operative
End of procedure
Ward
Recovery
Biomed Tech –
Repairs
specific
equipment in the
hospital
Chaplain Medico legal Internist Intern NBI -
10 ESSENTIAL OBJECTIVES FOR SURGERY
1)
2)
3)
4)
5)
6)
7)
The team will operate on the correct px at
the correct site
a. Surgical site marking – indicate or
site (arrow, circle, initials)
Laterality – 2 copies
Not required for pedia patient –
can be permanent
The team will use methods known to prevent
harm from administration of anesthetics,
while protecting the patient from pain
Risk for GA – short neck or
snoring at sleep (airway risk and
obstruction)
Medication allergies
The team will recognize and effectively
prepare for life threatening loss of air way or
respiratory function
The team will recognize and effectively
prepare for risk of high blood loss
a. A:500 ml
b. C: 7ml/ kg per weight
The team will avoid inducing an allergic or
adverse drug reaction for which the patient
is known to be at significant risk
The team will consistently use methods
known to minimize the risk for surgical site
infection
The team will prevent inadvertent retention
of instruments and sponges in surgical
wounds
Counting is necessary
FS – diluted formalin solution
MEDICAL SURGERY
Specimen collection:
o Name
o Age sex
o Specimen and location
o Surgeon
o pathologist
8) The team will secure and accurately identify
all surgical specimens
9) Will effectively communicate and exchange
critical information for the safe conduct of
the operation
10) Hospitals and public health systems will
establish routine surveillance of surgical
capacity volume and results
SURGICAL SAFETY CHECKLIST
inspection
and
moral
obligation
involving
intellectual honesty
SOURCES OF CONTAMINATION
1) Skin – will never be sterile
2) Raspatory tract – talking in OR should be kept
in the minimum
3) Articles used in the procedure
4) Circulating air
a. Positive
b. Negative
Clipper should be used rather than Razor as
it can small cuts
5) Scrub team/patient’s hair
PRINCIPLES ON ASEPSIS
1) Sterile items
o Sterile to sterile
o Clean to clean
2) Sterile field
o Sterile field at the level of the waist
(back table - fixed)
o Line of vision = sterile
ASEPSIS AND PRINCIPLES OF STERILE TECHNIQUE
Absence
of
ASEPSIS
microorganism
DISINFECTION
CONTAMINATED
-
INFECTION
SPORES
STERILE
SURGICAL CONSCIENCE
Solano, Nica B.
-
Reduction
of
pathogenic
miroogranisms
without destroying
the spores
Soiled
with
microorganisms
Invasion of the
body by pathogenic
microorganisms
Are active but
viable state of a
microorganism
Free
from
microorganisms
including spores
Involves
the
concept of self-
3) Traffic
o Know the sequence of procedure to
prevent traffic and possible disruption
of sterile field
4) Drapes
o If soiled, change (if necessary)
5) Gown
o Sterile waist up below the collar line
and sleeves 2 in above the elbows
6) Gloves
o If ripped, change (if situation is stable)
7) Room disinfection
o Every after procedure, the OR room
should be cleaned
Dirty surgery should be done last
o If blood spilled, cover the area to
prevent increased circulation of air
MEDICAL SURGERY
MEDICAL AND SURGICAL INSTRUMENTS AND
SUPPLIES CATEGORY
CATEGORY
I
II
III
DESCRIPTION
Critical items
Non intact mucous
Blood vessels
Must be sterile
Intact mucosa
Non intact skin
Sterilization if
preferred but
disinfection is
acceptable
Non-critical items
cleans
STERILIZATION PROCEDURES
1) Physical sterilization
a. Moist heat
o Autoclaving – steam under pressure
o Not used for sharps
o Parameters:
1. Time (15-30 mins)
2. Temperature (122-123 c °)
3. Pressure (15-17 pressure)
b. Dry heating – dry heat autoclaving
2) Chemical sterilization
a. Ethylene Oxide gas
o Best for sharps
o Limitation:
1. 16 hours of sterilization (not
appropriate for fast handling
items)
b. Plasma hydrogen peroxide gas (sterrad)
o Limitation:
1. Liquid
2. Item with lumix
DISINFECTION PROCEDURES
Rinse
instrument
with sterile water
HIGH LEVEL
Rinse with PNSS
DISINFECTANT
(soaker)
Activated
glutaraldehyde
Disinfect the skin
INTERMEDIATE LEVEL
70% alcohol
DISINFECTANT
Iodine compounds
Chlorhexidine
Solano, Nica B.
LOW LEVEL
DISINFECTANT
-
Phenolic
compounds
Chlorine
compounds
STERILIZATION AND DISINFECTION
1) Labels
o Date
o Expiration date
o Produced by
o Item packed
o Processed by (will certify)
2) Wrappers
o If the packaged is not soiled or destroyed, it
can still be used
3) Shelf life
o Autoclaving – 2 weeks to 1 months
(expiration after a month)
4) Indicators
a) Chemical - change in color
b) Biologic – placing bacteria in instrument
then disinfecting it when checking of there is
still presence
2. INTRA-OPERATIVE PHASE
ANESTHESIA
FACTORS THAT DETERMINE THE CHOICE OF
ANESTHESIA
o Physical and mental condition of patient
Ability to understand (age, mental
condition) = determines if general
or regional anesthesia will be used
o Age and weight of patient
o Operation to be performed
Location :
o Above nipple line: GA
o Below nipple line: RA
o Type and probable duration of operation
Specific time (long or short)
o Long – Endotracheal anesthesia
o Short – mask or IV
o Patients’ preference
o Laboratory finding
o Any known idiosyncrasies
MEDICAL SURGERY
STAGES OF ANESTHESIA
Induction/stage
analgesia
Starts
from
induction period
until patient loses
STAGE 1
consciousness
Patient
may
appear drowsy or
dizzy
Keep the room
quiet
Excitement/delirium
Lasts from the
time the patient
loses
consciousness
until he loses
certain
reflexes
such
as
STAGE 2
swallowing, gag,
and eyelid
May
appear
excited,
may
breathe irregularly
Sensitive
to
external stimuli
Maintain silence
Surgical anesthesia
From the period
the patient lost
certain
reflexes
and
respiratory
paralysis occurs
Stage 3
Patient
with
regular
respiration,
constricted pupils,
jaws relax and
auditory sensation
is lost
Stage of danger
Reaches when too
much anesthesia
has been given
and the patient
Stage 4
has not been
observed carefully
Death may result
from respiratory
and or cardiac
arrest
unless
Solano, Nica B.
-
resuscitated
properly
Patient is not
breathing
with
little to no heart
beat
TYPES OF ANESTHESIA
Association
pathways
are
broken
in
the
cerebral cortex to
produce more or
less lack of sensory
and
motor
perception
Pain is controlled by
general insensibility,
the
patient
is
unconscious,
he
cannot hear, feel or
move his whole
body
Used in operation
above the thoracic
level
1) Inhalation:
With the use of
volatile gases and
GENERAL
vapors
Either per mask or
endotracheal tube
a) GETA/GAOT
orotracheal
b) GAET/GETA
–
endotracheal
c) LMA – laryngeal
mask airway
d) Face masks
Common anesthetics:
Nitrous oxide
Sevouflurane
(sevorane)
Desflurane
(suprane)
Isoflurane (forane)
Halothane
(fluothane)
-
2) Intravenous:
MEDICAL SURGERY
-
REGIONAL
Drugs the may
produce hypnosis,
sedation, amnesia,
and or analgesia is
administered via IV
-
3) Nerve blocks:
Anesthetizing
surrounding tissues
or group of nerves at
a given point
Common anesthetics:
Thiopental
Na
(pentohal)
Propofol (diprivan)
Ketamine (ketalar)
Depresses
superficial nerves
and interferes with
the conduction of
pain impulses from
certain area or
region
Pain is controlled
without loss of
consciousness; one
region or an area of
the
body
is
anesthetized
1) Epidural
anesthesia:
Used
for
long
procedures below
the thoracic level
Used for post op
management of pain
Use an epidural
catheter (perifix)
Common Anesthetics:
Bupivacaine
(Sensorcaine
Isobaric, Marcaine)
Levobupivacaine
(Chirocaine)
Lidocaine
(for
testing)
WOF:
seizures, arrythmias,
metallic
taste,
altered LOC
-
4) Field
block/local
infiltration
Agent is injected
into the tissues
around incision site
Anesthetics: Lidocaine
5) Topical
Agent
applied
directly
into
a
mucosa or surface
Ex. Lidocaine spray
Common anesthetics:
2) Subarachnoid
aesthesia:
Commonly termed
as spinal anesthesia
For short cases
below the thoracic
level
Uses spinal needle
gauge 22, 25, 27
-
Solano, Nica B.
Common anesthetics:
Bupivacaine
hyperbaric
(Sensorcaine heavy)
PFE (tetracaine –
pontocaine
dextrose
ephedrine)
COMMON COMPLICATION ASSOCIATED WITH
GENERAL ANESTHESIA
1.
2.
Post-op nausea and vomiting – drug is highly
lipid soluble
Malignant hyperthermia
genetic problem
cells become hyperactive > contraction >
rigidity
assess for black or brown blood
elevated carbon dioxide (metabolic and
respiratory acidosis)
NI: ice packs (decrease temp)
Dantrolene Na (antidote)
-
MEDICAL SURGERY
3.
4.
-
Epidural
Urinary retention
Nursing intervention: insert catheter
TYPES OF INCISION
Spinal
Spinal headache
Nursing intervention: patient lie flat on bed
for 8-12 hours post op
OTHER MEDICATION USED FOR ANESTHESIA
A. Premedication used
o Midazolam (Dormicum)
o Diazepam (Valium)
B. Opioid narcotic:
o Fentanyl (sublimaze)
C.
Muscle Relaxants
o Succinyl Choline (Anectine)
o Rocoronium Bromide (Esmeron)
o Atracutium (tracium)
o Pancoronium Bromide (Norcuron)
D. Anticholinergics
E. Acetylcholinesterase inhibitor
F. Dantrolene
INCISION, POSITION, AND PREPPING
LAYERS OF ABDOMEN/QUADRANTS)
1) Right subcostal incision (kocher’s)
Subcostal incision at upper right quadrant
(3cm below and parallel to the costal
margin)
Cholecystectomy
2) Median upper and lower abdominal
Laparotomy
very common surgical incision to gain
access into the intra-abdominal cavity
Performed during emergency situation
a) Paramedian incision – cut 2-5 cm
left or right of midline
Access to lateral viscera
9kidney, spleen, and adrenal
glands)
a) Pararectus incision – cut at the
lateral border of the rectus muscle
3) Mc Burney’s incision
Right lower quadrant
Runs obliquely through McBurney’s
point, generally perpendicular to the line
connecting the umbilicus and the right
anterior superior iliac spine
Appendectomy
4) Battle incision
Lower right paramedian incision but
place more laterally than the standard
paramedian incision.
Acute appendicitis
5) Lanz
incisions that can be used to access the
appendix
Solano, Nica B.
MEDICAL SURGERY
-
-
transversely crosses the McBurney’s
point outer third of a line joining the right
anterior superior iliac spine and the
umbilicus
Appendicectomy
6) Inguinal incision
A transverse or oblique incision over the
inguinal canal
Inguinal hernia repairs
7) Transverse suprapubic (Pfannensteil)
Commonly used for pelvic surgery
10 – 15 cm that is 2 – 5 cm above the
pubic symphysis
MISCELLANEOUS INCISIONS
COLLARLINE
(CURVILINEAR
INCISION)
CORONAL, BUTTERFLY
INCISION
THORACOTOMY
INCISION
LUMBOTOMY
STERNAL SPLIT
LIMBAL
ELLIPTICAL HALTED
POST/PRE AURAL
INCISION
CALDWELL LUC
-
-
-
-
Thyroidectomy
-
Craniotomy
-
Anterolateral
or
lateral
posterothoracic
Kidney surgery
Sternotomy
Cataract extraction
Radical
Mastectomy
Ear surgery
Tympanoplasty
Mastoid surgery
Removal of tooth
roots
within
maxillary sinus
-
POSITIONING
Choice of position is made by the surgeon
and positioning is done by the members of
the surgical team
Factors to consider:
o Length of the procedure
o Site of the operation
o Pain upon moving
o Kind of anesthetic
QUALIFICATION OF A GOOD POSITION
Not interfere with respirations
Circulation
Not cause pressure on any nerve
Solano, Nica B.
-
Provide total accessibility for administration
of anesthesia and surgery
Reflect proper body alignment, resulting in
no undue post operative discomfort
Patient safety
EQUIPMENT FOR POSITIONING
1) OR table – where the patient is placed
2) Body strap – support and anchor patient in
the position
3) Pillows – provide support for head and neck
4) Shoulder roll - prevent stress and tension in
the shoulder
5) Doughnut – protects patient’s eyes from
trauma; may also secure endotracheal to
prevent disconnection during surgery
6) Trochanter rolls – to keep hips and legs
adequately aligned to prevent further injury
7) Stirrups – support and position the patient’s
foot, lower and upper leg.
COMMON POSITIONS
1)
2)
3)
4)
5)
6)
7)
Dorsal/supine
Fowlers
Lithotomy
Trendelenburg and reverse Trendelenburg
Prone
Sims, knee chest
Kidney position
MEDICAL SURGERY
COMMON INJURIES RELATED TO POSITIONING
1) Brachial plexus injury
2) Ulnar/radial nerve injury
3) Saphenous and peroneal nerve damage
4) Integumentary damage
5) Eye and facial injury
SKIN PREPARATION (SPECIAL CONSIDERATION)
o Determine the area and the extent to be
prepared including proposed incision
o Practice modesty and privacy
o Examine area to be prepared
o In abdominal operations focus on the
umbilicus
o In shaving follow the direction of the hair
growth while the other hand exerts an
opposite force
o If a wound is present stat from the clean area
first before the dirty area
3) Retracting instruments
4) Cutting dissecting
INSTRUMENT CLASSIFICATION
1) Clamping/hemostats
5) Suturing instruments
2) Grasping/holding
Solano, Nica B.
MEDICAL SURGERY
6) Suturing instruments
SUCTION MACHINE
PARTS OF AN INSTRUMENT
HEART LUNG MACHINE
GAS TANKS/GAS CYLINDERS
RADIOLOGIC DEVICE
ENDOSCOPIC DEVICES
CAUTERY MACHINE
Solano, Nica B.
MEDICAL SURGERY
o
o
o
o
o
Minimal tissue reaction and inability to
create a favorable environment for infection
and tissues
High tensile strength
Easy to thread, easy to sterilize and will not
shrink
Made of non electrolyte, non capillary, non
allergenic and non carcinogenic materials
Absorbed with minimal tissue reaction
USES OF SUTURE
1) Ligating
2) suturing
3) closing
LAPAROSCOPIC INSTRUMENTS
TYPES OF SUTURES
1) Natural or synthetic
2) Absorbable or non-absorbable
3) Monofilament or multifilament
SIZE PROGRESSION CHART
DEFINITION OF TERMS
1) Suture
Any material used to sew stitch, or hold
tissues or body parts together
2) Ligature
A tie, to ligate blood vessels
3) Primary suture line
Main layers of tissues which must be
sutured
4) Stay or tension suture
Sutures placed at the incision to act as
reinforcement
5) Tensile strength
Amount of tension of pull that a strand will
withstand
o
o
CRITERIA FOR A GOOD SUTURE
Versatility
Ease of handling
Solano, Nica B.
COMMON SUTURES (ABSORBABLE)
MEDICAL SURGERY
COMMON SUTURES (NON-ABSORBABLE)
a.
b.
c.
d.
e.
f.
ALTERNATIVE METHODS TO SUTURING
Surgical strips
Skin clips
Skin staples
Ligation slips
Surgical staples
Tissue adhesive
LEGAL AND ETHICAL DIMENSIONS IN THE PRACTICE
OF OR NURSING
COMMON ISSUES
o
o
o
o
SURGICAL NEEDLES
o
o
Consent
Wrong patient/Site surgery
Counting
Specimen handling
Labeling
RFS
Medico-legal
Medication errors
Negligence
3. POST-OPERATIVE
o
Three basic sections:
1) Point
a. Taper
b. Blunt
c. Cutting
o Tapercut
o Conventional cutting
o Reverse cutting
2) Body or shaft
3) Eye
a. Atraumatic or swaged
b. Eyed
c. French eyed or spring
d. Controlled release
a.
b.
c.
SUTURING RESPONSIBILITIES
Handling sutures
Suturing techniques
Needle counts
Solano, Nica B.
o
o
o
o
o
o
o
GENERAL POSTOPERATIVE RESPONSIBILITIES
Promotion of Adequate respiratory function
Promotion of Adequate circulatory function
Promotion of Normal reflex return
Promotion of safety and comfort
Pain management
Promotion of wound healing
Promotion of Fluid and electrolyte balance