Preoperative patient care
Patients facing any surgical procedure tend to be fearful. They require emotional and physical support from the
time of admission through discharge. Surgery is often associated with anxiety, pain, and
discomfort. Before surgery, the patient is given medication to promote relaxation. During
surgery, anesthetics are given to prevent pain. After surgery, medications are given to reduce
discomfort.
ANESTHESIA
Anesthesia is given to prevent pain, to relax muscles, and to induce forgetfulness. General
anesthetics cause the patient to become unconscious and block reception of pain in the brain. Local
anesthetics induce loss of feeling n a specific area of the body. Spinal anesthesia is used for some surgeries. The
patient will be unable to feel or move the legs after surgery. Special monitoring is required.
http://www.youtube.com/watch?v=WuGiuGagkNk
SURGICAL CARE
Care of the surgical patient (perioperative) can be divided into three parts:
 Preoperative(before surgery)
 Operative(in the operating room)
 Postoperative(after surgery)
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http://www.youtube.com/watch?v=XZq1gExGh8k
Physical Preparation
The nursing assistant’s responsibilities begin when the person is admitted. If the patient is
in the facility the evening before surgery, part of the surgical preparation may be done then. The patient will
be placed on NPO(nothing by mouth) orders after midnight. Remove the water pitcher from the room and post
an NPO notice over the bed, on the door, on the patient’s chart, and on the Kardex. The surgical prep area- You
may be assigned to prepare the patient’s skin before surgery. Hair removal was routine for many years. The
current trend is to avoid shaving whenever possible. In many facilities, preoperatives having requires a
physician’s order. Hair may be removed with clippers if it is especially thick. Studies have shown
that shaved patients develop more infections than unshaved patients. You may be instructed to
wash and repair the operative area. This area will be larger than the surgical incision area Immediate
preoperative care- Approximately one hour before surgery, the nurse will give additional medication. You will be
instructed to elevate the side rails. Do not let the patient get up alone after the medication is given.
Make sure the call signal is within reach. You may be asked to:
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Take and record vital signs
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Remove dentures and any other prosthesis(artificial part), such as a hearing aid contact lenses, or
glasses.
Store these items appropriately.
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Remove nail polish, makeup, hairpins, and jewelry. You may be permitted to tape a plain wedding band
in
place. However, metal on the patient’s body interferes with an instrument used in some surgeries, and
could result in serious burns. Check with the nurse before taping a ring.
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Dress the patient in a gown and cover the hair with a surgical cap. Assist the patient to avoid and
measure the urine, if ordered. Drain the catheter, if present, and record.
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Keep the room quiet and comfortable.
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Move furnishings to one side to make room for a stretcher.
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Elevate the bed to stretcher height and assist in transferring the patient from the bed to the stretcher
and, after
surgery, from the stretcher to the bed.
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Complete the surgical checklist, if this is your responsibility.
http://www.youtube.com/watch?v=VHeTWttHECUhttp://www.youtube.com/watch?v=IDK8yji
X138&list=PL151F383DB97F7B2B
Caring for the Emotionally Stressed Patient
There are varying degrees and differing aspects of health. A person who is in poor physical health may be
mentally healthy. Because of good mental health, the person may be self-reliant, able to make decisions and to
live an effective, productive life. In contrast, a person with good physical health may not be able to cope
with and adapt to changes. This inability limits the person’s ability to participate successfully in
society.
The nursing assistant can help patients become better able to cope and adapt by:
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Being a good listener. Trying to identify the source of stress so it can be removed.
Being sensitive to body language that may give clues to the source of stress. Recognizing the patient as a
unique individual and treating him or her with respect.
Trying to understand the patient’s point of view without passing judgment.
Showing that you are dependable and respect the patient’s privacy and feelings.
Being supportive.
THE DEMANDING PATIENT In every nursing care situation, you will meet patients who are very
demanding. This can be a difficult experience for everyone if it is not handled correctly. Being demanding
is a coping behavior that some patients use when they are frustrated. Persons who are very demanding
are usually feeling as if they have lost control. To be successful in caring for these patients, the
nursing assistant can use several tactics:
Reassure the patient that you understand the complaint or problem and will report it to the appropriate person.
If the complaints are about care given by others, remain neutral and do not criticize other workers. If
complaints are about your care, listen, but do not argue or become defensive. Attempt to determine the cause
of unjustified complaints and correct it, if possible.
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Try to identify the triggers of the demanding behavior.
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Show that you care, but control your emotions.
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Support the patient; be a good listener and be sensitive to the patient’s body language.
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Provide opportunities for the patient to regain some control.
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Encourage and allow the patient to make decisions about things that affect him or her.
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Be consistent in the manner of care.
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Do not take the patient’s demands personally.
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Stop and check on the patient without being asked.
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Keep your promises.
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Report observations to the nurse with suggestions for changes in the care plan.
MALADAPTIVE BEHAVIORS
Mental illness or maladaptive behavior occurs when behaviors and responses disrupt the person’s ability to
unction smoothly within the family, environment, or community. Avoid labeling anyone as
mentally ill. Even when an official diagnosis of mental illness has been made, avoid stereotyping the person.
Note and report any unusual behavior or symptoms. Be objective and do not make judgments. Blaming and
judging a patient is not helpful.
Evaluating the Patient’s Behavior
An initial assessment of the patient’s mental and emotional state will be made by licensed personnel. You
contribute to the nursing process through careful and sensitive objective observations.
Report:
 Physical responses related to eating, personal hygiene, sleeping, participation in
activities, or any strange or unusual behaviors.
 Emotional responses related to interactions between the patient and yourself or between the patient
and other
 patients.
 Also report emotional outbursts and inappropriate responses.
 Patient behavior as it relates to judgment and affects memory, orientation, and comprehension.
 Disorientation – (Disordered Consciousness)
Disorientation is a condition in which a person shows a lack of reality awareness with regard to time, person, or
place. It may be mild or severe, temporary or prolonged. The person has impaired judgment, memory, and
understanding. Delirium is an acute confusional state caused by reversible medical problems. It is often hard to
tell whether a person is disoriented, has delirium, or both. Delirium is common in elderly persons as a result of
medical problems such as infection and dehydration. Anesthesia, some medications, and uncorrected vision or
hearing may cause the patient to misinterpret the environment. Delirium goes away when the physical and
mental triggers of the problem are identified and eliminated. This can be confusing, because delirium often has
multiple causes. All must be treated before the mental status returns to baseline. Nursing
Assistant Responsibilities People with disorientation and delirium are not responsible for their
actions, and cannot protect themselves. The patient’s sensory problems (delusions or hallucinations) may
put others at risk. Protecting the patients is the most important nursing responsibility. Assist
disoriented patients with reality orientation activities. Reality orientation involves making the
patient aware of person, place, and time by visual reminders, activities, and verbal cues. This
approach reduces agitation in some patients, but increases agitation in others. Follow the care plan and the
nurse’s instructions.