CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, - Preoperative care runs from the time the

FLUID AND ELECTROLYTES, INFECTIOUS, patient is admitted to the hospital or

INFLAMMATORY AND IMMUNOLOGIC RESPONSE, urgicenter to the time that the surgery begins.
CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Preoperative Phase.

1.1 preoperative Phase

PERI-OPERATIVE - begins when the decision to proceed with
surgical intervention is made and ends with the
Concept in the Care of at Risk and Sick Adult Clients
transfer of the patient onto the operating
Health System room table.

- The maintenance or improvement of health via Intraoperative

the prevention, diagnosis, treatment, recovery
- admitted to the operating room to the line of
or cure of disease, illness, injury, and other
anesthesia administration to performance of
physical and mental impairments in people.
the surgical procedure and until the client is
1.1 The organized provision of medical care to
transported to the recovery room or post-
individuals or a community
anesthesia care unit (PACU).
1.2 Efforts made to maintain or restore physical,
mental, or emotional well-being especially by Postoperative Care
trained and licensed professional.
- the care you receive after a surgical procedure.
Global Health The type of postoperative care you need
depends on the type of surgery you have, as
- is the health of populations in the global
well as your health history. It often includes
context
pain management and wound care.
2.1 The area of study, research, and practice that
Principle of Safety, Comfort and Privacy during the
places a priority in improving health and achieving
Perioperative Period
equity in health for all people worldwide.
Theatre Preparation
2.2 Is about worldwide health improvement (including
mental health), reduction of disparities, and protection - to ensure efficient and safe running of the
against global threats that disregard national borders, theatre list, it should be managed by a
and designated person, usually the most senior.
- There should be sufficient staff on duty, and
2.3 Is not to be confused with International Health,
they should all have a clear understanding of
which is defined as the branch of public health focusing
their role in the team, based on their skills and
on developing nations and region aid efforts by
abilities (Taylor and Campbell, 1999b).
industrialized countries.
Infection Control
National Health
- A meticulous theatre-cleaning regime is
- the public system of medical care
fundamental to preventing infection. Theatres
3.1 Local Health. Is a government agency in a country should be clean and dust free, ventilation
on the front lines of public health. systems must be in working order and doors
must be kept closed.
Local health departments and often report to a - Cleaning, disinfection and sterilization
mayor, city council, country board of health or country - Reusable instruments should be processed
commission. according to local policy, along with theatre
Pre-operative / Nursing Care drapes and reusable scrub gowns.

- a care given before the surgery when physical Sterile Technique

and psychological preparations are made for - Is used for surgery or the preparation of sterile
the operation, according to the individual materials for multiple patients. It involves:
needs of the patient.
 • Surgical hand rub with long acting 17. Do not lean on the nurse’s mayo tray.
antiseptic 18. Non-sterile persons, when you are observing a
• Hands dried with sterile towels case, please stay in the room until the case is
• Sterile field completed. Do not wander from room to room
• Sterile gown and mask as traffic in the operating room should be kept
• Sterile gloves as minimum. Patient privacy needs to be
• Sterile supplies respected.
• Skin prep 19. Keep non-essential conversation to a
minimum.
Principles of Sterile Technique 20. The circulating nurse is in charge of the room-
if you have any questions, please refer them to
1. All article used in an operation have been
her, the supervisor or your instructor.
sterilized previously
2. Persons who are sterile touch only sterile Forceps
articles; persons who are not sterile touch only
nonsterile articles. 1. Allis
3. Sterile persons avoid leaning over an unsterile - Are toothed surgical instruments, used
area, non-sterile persons avoid reaching over a to grasp firm tissues (such as fascia)
sterile field. Unsterile persons do not get closer
than 12 inches from a sterile field.
4. If in doubt about the sterility of anything,
consider it not sterile. If a non-sterile person
brushes close, consider yourself contaminated.
5. Gowns are considered sterile only from the
waist to shoulder level in front and the sleeves
to 2 inches above the elbow.
2. Babcock
a. Keep hand in sight or above waist level
- are jawed instruments with a smooth
away from the face
end, allowing for more delicate
b. Arms should never be folded
structures (such as bowel) to be held
c. Article dropped below waist level are
in an atraumatic manner.
discarded
6. Sterile persons keep well within the sterile area
and follow those rules from passing: Face to
face or back to back
7. Turn back to a non-sterile person or when
passing
8. Face a sterile area when passing the area.
9. Ask a non-sterile person to step aside rather
than trying to crowd past him.
10. Step back away from the sterile field to sneeze
or cough.
11. Turn head away from sterile field to have 3. Dunhills
perspiration mopped from the brow. - are small forceps with curved serrated
12. Stand back at a safe distance from the ends, often used to grasp vessels
operating table when draping the patient. prior to ligation.
13. Members of the sterile team remain in the
operating room if waiting for the case.
14. do not wander around the room or go out in
the corridors.
15. Sterile persons keep contact with sterile areas
to a minimum.
16. Do not lean on the sterile tables or on the
draped patient.
 4. Lane tissue forceps 3. Suture scissors
- have interlocking teeth, allowing the - are widely used for suture removal.
grasping of tough tissues,such as These scissors feature a small hook on
fascia. one tip that slides under the sutures
to slightly lift the suture before
cutting and removal.

Retractors

1. Langenbeck
- is a hook shaped retractor with an L-
shaped end, used to keep back tissue
or separate the edges of wounds.
They come in small, medium, or large
5. Mosquito forcep sizes, depending on the depth of the
- For homeostasis to prevent blood loss cavity required.
during surgery
- They are machined with high-quality
materials, strong and durable.

2. Norfolk and Norwich

- The Norfolk and Norwich retractor is a
self-retaining retractor, used to keep
deep wounds and cavities open, with
blunt ends to reduce risk of iatrogenic
Scissors tissue injury

1. Mayo
- are heavy scissors, with semi-blunt
ends, often used to cut thick tissues
or sutures, either straight or curved

3. Travers
- The Travers retractor is a self-
retaining retractor, with short ends
2. McIndoe for use in keeping superficial wounds
- are used often for cutting or open
dissecting tissues, characteristically
have a curved blade
Others The following are the physiologic assessments
necessary during the perioperative phase:
1. Needle holder
- For holding needles, will come in a. Age: Age of patient
varying sizes and length depending on b. Obtain: obtain a health history and perform a
the needle and tissue in question physical examination to establish vital signs
and a database for future comparisons.
c. Assess: assess patient’s usual level of
functioning and typical daily activities to assist
in patients care and recovery or rehabilitation
plans.
d. Assess mouth for dental caries, dentures, and
partial plates. Decayed teeth or dental
prostheses may become dislodged during
intubation for anesthetic delivery and occlude
2. Rampley Sponge Holding the airway.
- used to handle gauze or sponges e. Nutritional status and needs – determined by
measuring the patient’s height and weight,
triceps skinfold, upper arm circumference,
serum protein levels and nitrogen balance.
Obesity greatly increases the risk and severity
of complications associated with surgery.
f. Fluid and Electrolyte Imbalance –
Dehydration, hypovolemia and electrolyte
imbalances should be carefully assessed and
documented.
g. Infection
h. Drug and alcohol use – the acutely intoxicated
3. Towel Clips person is susceptible to injury.
- most commonly used to secure towels i. Respiratory status – patients with pre-existing
or drapes in place, however they can pulmonary problems are evaluated by means
be used to grasp tissue if required pulmonary function studies and blood gas
analysis to note the extent of respiratory
insufficiency. The goal for potential surgical
patient us to have an optimum respiratory
function. Surgery is usually contraindicated for
a patient who has a respiratory infection.
j. Cardiovascular status – cardiovascular
diseases increases the risk of complications.
Depending on the severity of symptoms,
surgery may be deferred until medical
treatment can be instituted to improve the
patient’s condition.
F. Nursing Responsibilities during Perioperative Care k. Hepatic and renal function – surgery is
contraindicated in patients with acute
1.1 Physical Preparation
nephritis, acute renal insufficiency with
- Before any treatment is initiated, a health oliguria or anuria, or other acute renal
history is obtained, a physical examination is problems. Any disorder of the liver on the
performed during which vital signs are noted, other hand, can have an effect on how an
and a database is established for future anesthetic is metabolized.
comparisons. l. Presence of trauma
m. Endocrine function – diabetes, corticosteroid
intake, amount of insulin administered
 n. Immunologic function – existence of allergies, expressing feelings openly. Individuals from
previous allergic reactions, sensitivities to some cultural groups may not make direct eye
certain medications, past adverse reactions to contact with others; this lack of eye contact is
certain drugs, immunosuppression not avoidance or a lack of interest but a sign of
o. Previous medication therapy – It is essential respect.
that the patient’s medication history be • Listen carefully to patient, especially when
assessed by the nurse and anesthesiologist. obtaining the history. Correct use of
The following are the medications that cause communication and interviewing skills can
particular concern during the upcoming help the nurse acquire invaluable information
surgery: and insight. Remain unhurried, understanding,
• Adrenal corticosteroids – not to be and caring.
discontinued abruptly before the
surgery. Once discontinued suddenly,
cardiovascular collapse may result for
patients who are taking steroids for a
long time. A bolus of steroid is then
administered IV immediately before
and after surgery.
• Diuretics – thiazide diuretics may
cause excessive respiratory depression
during the anesthesia administration.
• Phenothiazines – these medications
may increase the hypotensive action
of anesthetics.
• Antidepressants – MAOIs increase the
hypotensive effects of anesthetics. Perioperative Nursing Types of Surgery:
• Tranquilizers – medications such as Purpose/Reasons
barbiturates, diazepam and
• Degree of urgency – necessity to preserve the
chlordiazepoxide may cause an
client’s life, body part, or body function
increase anxiety, tension and even
seizures if withdrawn suddenly. • Degree of risks – involved in surgical procedure
is affected by the client’s age, general health,
• Insulin – when a diabetic person is
nutritional status, use of medications, and
undergoing surgery, interaction
mental status.
between anesthetics and insulin must
be considered. • Extent of surgery – simple and radical
• Antibiotics – “Mycin” drugs such as Based on Urgency
neomycin, kanamycin, and less
frequently streptomycin may present a. Elective
problems when combined with • These surgeries are pre-planned and
curariform muscle relaxant. As a result can be delayed without negative
nerve transmission is interrupted and effects.
apnea due to respiratory paralysis • Examples include tonsillectomy,
develops. hernia repair, cataract extraction,
mammoplasty, face lift, and cesarean
Respecting Spiritual and Cultural Beliefs section.
• Help patient obtain spiritual help if he or she b. Urgent
requests it; respect and support the beliefs of • These surgeries are necessary for the
each patient. client’s health and are usually
• Ask if the patient’s spiritual adviser knows performed within 24 to 48 hours.
about the impending surgery. • Examples include gallbladder removal,
• When assessing pain, remember that some amputation, colon resection, coronary
cultural groups are unaccustomed to artery bypass, and tumor removal.
 c. Emergent Degree of Risk
• These surgeries must be done
▪ Major
immediately to preserve the client’s
➢ Involve high degree of risk, longer and
life, body part, or body function.
extension than a minor procedure
• Examples include control of
▪ Minor
hemorrhage, repair of trauma,
➢ Normally involves little risk, often
perforated ulcer, intestinal
done with local anesthesia
obstruction, and tracheostomy.
Age
Based on Purpose
- Very young and elder clients are greater
a. Diagnostic
surgical risks than children and adult
• These surgeries are done to determine
the cause of an illness and confirm a General Health
diagnosis. Examples include biopsy
- Surgery is least risky when the client’s general
and exploratory laparotomy.
health is good.
b. Ablative/Curative
• These surgeries remove diseased parts Nutritional Status
or organs. Examples include
- Required for normal tissue repair
gastrectomy, thyroidectomy, and
appendectomy. Medications
c. Palliative
• These surgeries relieve symptoms - Regular use of certain medications can
without curing the disease. Examples increase surgical risk
include colostomy and debridement of Mental Status
necrotic tissue.
d. Reconstructive - Disorder that affect cognitive function
• These surgeries restore function to Extent
traumatized or malfunctioning tissue
and improve self-concept. Examples Extent of Surgery, Simple:
include skin grafts, plastic surgery, and
- Description: only the most overly affected
scar revisions. areas involved in the surgery
e. Transplant
- Condition of : simple/partial mastectomy
• These surgeries replace diseased or
malfunctioning organs or structures. Extent of Surgery, Radical:
f. Constructive
- Description: Extensive surgery beyond the area
• These surgeries restore function in
obviously involved, is directed at finding a root
congenital anomalies. Examples
cause.
include cleft palate repair and closure
- Condition: Radical hysterectomy
of atrial-septal defect.
g. Exploratory Types of Anesthesia
• These surgeries estimate the extent of
1. General
disease or confirm a diagnosis.
- Reversible state of unconsciousness with loss
Examples include exploratory
of sensation of the entire body
laparotomy and pelvic laparotomy.
2. Regional
h. Cosmetic
- Blocks sensation in large region or portion of
• These surgeries improve physical
the body
features within the normal range. An
3. Sedation
example is breast augmentation.
- Decreased level of consciousness or relaxed
state, but not fully unconscious
4. Local
- Blocks sensation in a specific area of the body
Nursing Diagnosis of the patient by monitoring activities of
members of the surgical team and checking the
▪ Knowledge deficit
conditions in the operating room.
▪ Anxiety
a. Responsibilities of a circulation nurse:
▪ Risk for ineffective airway clearance
1. Assures cleanliness in the OR.
▪ Fear related to disturbed sleep pattern
2. Guarantees the proper room temperature,
▪ Anticipatory grieving related to
humidity and lighting in OR.
Teaching 3. Make certain that equipment are safely
functioning
- Begin with assessment, baseline knowledge of 4. Ensure that supplies and materials are
patient and family, readiness to learn available for use during surgical
- Barriers to learning, patient and family procedures.
concern, and learning styles and 5. Monitors aseptic technique while
- Patient familiarity with procedural events coordinating the movement of related
Anxiety personnel.
6. Monitors the patient throughout the
- Privacy, comfort, and confidence operative procedure to ensure the
- Patient family and friends person’s safety and well being
- Empowering their sense of control
- Deep breathing, relaxation exercise, music Scrub Nurse
therapy, massage and animal assisted - The scrub nurse assists the surgeon during the
- Medications for anxiety whole procedure by anticipating the required
- Encourage communication instruments and setting up the sterile table.
- Using distraction
The responsibilities of the scrub nurse are:
Surgical Safety Checklist
1. Scrubbing for surgery.
2. Setting up sterile table.
3. Preparing sutures and special equipment.
4. Assists the surgeon and assistant during the
surgical procedure by anticipating the required
instruments, sponges, drains and other
equipment.
5. Keeps track of the time the patient is under
anesthesia and the time the wound is open.
6. Checks equipment and materials such as
needles, sponges and instruments as the
surgical incision is closed.

Postoperative Phase Discharge Criteria

Intraoperative Phase - The recovery process and discharge criteria

vary from institution to institution. Some
- The intraoperative phase extends from the institutions require an assessment by a
time the client is admitted to the operating physician before discharge for all patients, but
room, to the time of anesthesia others require an evaluation only if routine
administration, performance of the surgical discharge criteria are not met. The modified
procedure and until the client is transported to Aldrete scale is the most common system used
the recovery room or postanesthesia care unit to assess discharge readiness, but specific
(PACU). criteria depend on the particular situation or
environment to which the client will be
Circulating Nurse Functions
discharged.
- The circulating nurse manages the operating - From the Post Anesthesia Care Unit, patients
room and protects the safety and health needs can be admitted to a short-stay recovery unit
 or to a hospital ward. Regardless of the II. Purpose, Indications, Nursing Responsibilities for
patient's disposition, the anesthesiologist is the following surgical, and special procedures
responsible for monitoring, ensuring that
1. Pulmonary
anesthetic complications do not arise, and
maintaining care for patients requiring specific A. Surgical Procedures
procedures for pain control.
1. Tracheostomy

a. Purpose

A tracheostomy is usually done for one of three

reasons: to bypass an obstructed upper airway; to
clean and remove secretions from the airway; to more
easily, and usually more safely, deliver oxygen to the
lungs.

b. Indications

Acute respiratory failure with the expected need for

prolonged mechanical ventilation, failure to wean from
mechanical ventilation, upper airway obstruction,
difficult airway, and copious secretions.

It is a medical procedure (temporary or permanent)

that involves creating an opening in the neck to place a
tube into a person’s windpipe.

The Aldrete scoring system is, as previously mentioned,

a measure of recovery after Anesthesia involving a
patient's perception, movement, breathing, blood
pressure, And the level of oxygen saturation. For each
of the five categories assessed a score of 0-2 is given. A
score of 8-10 is taken as adequate for discharging a
post-anesthesia recovery patient from Phase I.

c. Nursing Responsibilities
1. Secure Consent of the procedure
2. Check the current laboratory results
needed for the procedure like complete
blood count, hepatitis profile and blood
chemistry.
3. Ask the client about allergies, medications
taken example blood thinners and other
medications taken.
4. Gather and prepare all the equipment
needed and assist the surgeon during the
procedure.
5. Perform tracheostomy care once a day
preferably in the morning. Suction client’s
secretion as needed.
6. Assess respirations: note the quality, rate,
rhythm, nasal flaring, and any increased
use of accessory muscles of respiration.
 7. Auscultate the lungs, noting areas of - 1 bottle
decreased ventilation and for the presence The simplest form of underwater seal drainage
of adventitious breath sounds. systems. This system can drain both fluid and
8. Provide warm, humidified air air. The distal end of the drainage tube must
9. Prepare tracheal obturator at bedside for remain under the water surface level. There is
emergency use. always an outlet to the atmosphere to allow air
to escape. It is suitable for use with a simple
2. Thoracostomy
pneumothorax, when the vent is left open to
a. Purpose the atmosphere, or following a
pneumonectomy when the tubing is clamped
Chest tubes drain blood, fluid, or air from around your and released hourly
lungs. - 2 bottle
b. Indications This system is suitable for the drainage of air
and fluid. The first chamber is for collection of
Tube thoracostomy is indicated for pneumothorax, fluid and the second is for the collection of air.
hemothorax, pleural effusion, empyema, and As the two are separate, fluid drainage does
chylothorax. not adversely affect the pressure gradient for
evacuation of air from the pleural space. A
separate chamber for fluid collection enables
monitoring of volume and expelled matter.
- 3 bottle
Suction is required when air or fluid needs a
greater pressure gradient to move from the
pleural space to the collection system. Suction
may be applied via a third bottle or a suction
chamber.

Precautions that must be taken in the maintenance of

the drainage system are:
- Small incision of the chest wall, with
maintenance of the opening for drainage. It is 1. Bottles and collection apparatus of the system
most commonly used for the treatment of a must be kept below the level of the chest to
pneumothorax. prevent backflow.
- This is performed by physicians, paramedics, 2. The lumens of the tubes must be kept open to
and nurses usually via needle thoracostomy or allow for drainage.
an incision into the chest wall with the 3. The system must be a closed (airtight) system.
insertion of a thoracostomy tube (chest tube) There can be no leaks around connections, and
or with a hemostat and the provider's finger the lower end of the glass tube must remain
(finger thorocostomy) under water in the bottle.
- Drainage in pleural cavity - The amount, color, and consistency of the fluid
drainage should be checked at least once each
Chest tubes/one, two and three bottle methods for hour for the first 24 hours after surgery. The
providing a closed drainage system chest tubes should be milked and stripped
every one to two hours to assure patency and
adequate drainage. The amount of air being
removed is indicated by occasional bubbling in
the water-seal chamber. Excessive bubbling
may indicate air leaks in the tubing.

c. Nursing responsibilities
1. Secure Consent of the procedure
2. Check the current laboratory results
needed for the procedure like complete
 blood count, hepatitis profile and blood Empyema
chemistry.
- Is defined as a collection of pus in the pleural
3. Ask the client about allergies, medications
cavity, gram-positive, or culture from the
taken example blood thinners and other
pleural fluid.
medications taken.
4. Gather and prepare all the equipment
needed and assist the surgeon during the Chylothorax
procedure.
5. Check for oscillation and air leak in the - Is a rare condition in which lymphatic fluid
water seal drainage. leaks into the space between the lung and
6. Milking of chest drains is only to be done chest wall. When this fluid builds up in the
with written orders from medical staff. lungs, it can cause a severe cough, chest pain,
Milking drains creates a high negative and difficulty breathing. Chylothorax is a
pressure that can cause pain, tissue lymphatic flow disorder.
trauma and bleeding. Patient Care
7. Check consistency and volume of the
drainage. - Proper positioning to maintain adequate
8. Prepare two drain clamps per drain for use drainage
in emergency e.g. accidental disconnection - Frequent turning, coughing, and deep
and two suction outlets: One for chest breathing are instituted on a regular basis to
drain and one for airway management avoid serious pulmonary complications
9. If the patient needs to be transferred to - Observed for signs of respiratory distress and
another department or is ambulant, the buildup of air in the pleural cavity
suction should be disconnected and left LUNG RESECTION
open to air. Do not clamp the tube. Ensure
the chamber is below the patient’s chest - Pulmonary (lung) resection is used for the
level during transport. treatment of pulmonary malignancy, infection,
10. For Accidental disconnection of the and trauma.
system: Clamp the drain tubing at the - A surgical procedure in which a section of a
patient end and notify the physician. lung or the entire lung is removed. Lung
11. For Accidental drain removal: Apply resection is performed on patients with a
pressure to the exit site and seal with damaged or diseased lung.
steristrips. Place an occlusive dressing over - Reasons for needing lung resection include:
the top Lung cancer or tumor

Hemothorax Indication

- Derived from hemo (blood) + thorax (chest), - Lung cancer or tumor, Lung diseases such as
plural hemothoraces emphysema, infection, such as Tuberculosis,
- Is the accumulation of blood within the pleural dilated bronchi of bronchiectasis, Lung
cavity abscess, and atelectasis
- The symptoms of hemothorax include chest
LOBECTOMY
pain and difficulty breathing, while the clinical
signs include reduced breath sounds on the - A lobectomy is most commonly performed for
affected side and a rapid heart rate. non-small cell lung cancers (NSCLC) in which
the tumor is confined to a single lobe.
Pleural Effusion
- Treatment of lung cancer, fungal infections,
- Sometimes referred to as “water on the lungs,” benign tumors, emphysema, lung abscess, and
is the build-up of excess fluid between the tuberculosis.
layers of the pleura outside the lungs. The - Is a surgery to remove one of the lobes of the
pleura are thin membranes that line the lungs lungs. The lungs have sections called lobes. The
and the inside of the chest cavity and act to right lung has 3 lobes. The left lung has 2 lobes.
lubricate and facilitate breathing. A lobectomy may be done when a problem is
found in just part of a lung.
PNEUMONECTOMY changes, such as pulmonary congestion,
dyspnea, or SPO2 below 92%.
- Purpose
2. Monitor Vital Signs and record Intake and
It is performed for diffuse malignant pleural Output hourly. Note the urine color, clarity
mesothelioma and other diffuse pleural cancers. and specific gravity. Notify the surgeon of
any signs of decreased renal perfusion
- Indications 3. Assess the client’s hemodynamic and
Clients with a benign disease with progression, cardiac status.
carcinoma including a secondary carcinoma and 4. Perform peripheral and neurovascular
recurrent metastases. assessments hourly for the first eight
hours. Then if the client is stable, perform
- Benign indications for pneumonectomy checks every two hours for the next eight
include the following: hours and every four hours for the
1. Chronic lung infection (multiple abscesses, following eight hours.
bronchiectasis, fungal infection, 5. Monitor neurologic status
tuberculosis)
2. Traumatic lung injury Pacemaker Insertion Purpose
3. Bronchial obstruction with destroyed lung - A pacemaker insertion is the implantation of a
4. Congenital lung disease small electronic device that is usually placed in
SPIROMETER the chest (just below the collarbone) to help
regulate slow electrical problems with the
- Used to evaluate the functioning of the lungs. heart.
It measures the amount of air you inhale and - A pacemaker may be recommended to ensure
exhale. It also assesses how quickly you exhale. that the heartbeat does not slow to a
It has vacuum tube-like mouth piece dangerously low rate.
MECHANICAL VENTILATION - A pacemaker regulates your body’s electrical
system, which controls your heart rhythm.
- When patient cannot breathe on its own With each heartbeat, an electrical impulse
travels from the top of your heart to the
bottom, signaling your heart’s muscles to
CARDIAC SURGICAL PROCEDURE contract.
- Indication
Coronary Artery Bypass
Bradyarrhythmia is main indication of pacemaker
- Coronary artery bypass grafting (CABG), also
insertion.
called heart bypass surgery, is a medical
procedure to improve blood flow to the heart. - Nursing Responsibilities
It may be needed when the arteries supplying 1. Provide routine preoperative nursing car
blood to the heart, called coronary arteries, are 2. Note any history of smoking, respiratory
narrowed or blocked. and cardiac diseases, and other chronic
- Purpose conditions in the nursing history.
3. Provide emotional and psychologic
A type of surgery that improves blood flow to the
support for the client and family.
heart
4. Instruct about postoperative procedures
- Indication and should avoid keeping a cell phone or
MP3 player in the pocket over your
Coronary artery bypass grafting (CABG) is used to
pacemaker, standing for too long near
treat people who have severe coronary heart certain appliances, such as microwaves,
disease (CHD) that could lead to a heart attack. long exposures to metal detectors, high-
- Nursing Responsibilities voltage transformers.
1. Maintain airway patency. Monitor client’s Valve Replacement
pulmonary status closely and report any
 - To replace a heart valve, a surgeon removes the lungs go to other parts of the body
the heart valve and replaces it with a instead, or vice versa.
mechanical valve or a valve made from cow, - Nursing Responsibilities
pig or human heart tissue 1. Monitor vital signs.
- Valve repair or replacement surgery is done to 2. Auscultate heart and lungs for abnormal
correct the problems caused by one or more sounds.
diseased heart valves. 3. Assess skin for cyanosis or pale color.
- The most common indication for mitral valve 4. Obtain 12 lead ECG per facility protocol.
surgery is symptomatic chronic severe primary 5. Monitor for dysrhythmias.
mitral regurgitation, usually owing to 6. Assess peripheral pulses and capillary
degenerative valve disease, with a left refill.
ventricular ejection fraction (LVEF) of >30% 7. Note weak or absent pulses, slow capillary
(Class I recommendation). refill due to decreased cardiac output.
- Nursing Responsibilities: 8. Obtain daily weights.
1. Let the client sign the informed consent. 9. Position patient for comfort in upright or
2. Collect blood tests and Transesophageal semi-Fowler’s position.
echocardiogram result. 10. Administer supplemental oxygen via mask
3. Nothing per orem post-midnight. or hood as required.
4. Check the vital signs and SPO2 percentage. 11. Monitor oxygen saturation to maintain
5. Put an intravenous access and arterial line. above 92% or as ordered.
6. Assess the client’s hemodynamic and 12. Administer medications appropriately
cardiac status postoperatively. 13. Provide adequate rest period.
7. Perform peripheral and neurovascular 14. Prepare patient preoperatively and assist
assessments hourly for the first eight with catheterization or surgery.
hours. Then if the client is stable, perform 15. Provide client education regarding lifestyle
checks every two hours for the next eight restrictions and prevention of
hours and every four hours for the complications.
following eight hours.
Atrial Septal Defect
8. Monitor neurologic status
- is a congenital heart defect that involves a hole
Repair of Congenital Abnormality
in the atrial septum. This is the muscular wall
- Purpose that separates the two upper chambers (atria)
of the heart. Small ASDs usually don’t need
Congenital heart defect corrective surgery fixes or
treatment. Larger ones may require
treats a heart defect that a child is born with.
percutaneous (nonsurgical) repair or surgery
A baby born with one or more heart defects has to lower the risk of serious complications.
congenital heart disease. Surgery is needed if the
Patent Ductus Arteriosus
defect could harm the child's long-term health or
well-being. - is a persistent opening between the two major
blood vessels leading from the heart. The heart
- Indication
problem is present from birth. That means it is
1. Heart valve defects: One may be too
a congenital heart defect. An opening called
narrow or completely close.
the ductus arteriosus is part of a baby's blood
2. Problems with the heart’s walls: It could be
flow system in the womb.
the ones between the chambers (atria and
ventricles) of your heart Tetralogy of Fallot
3. Issues with the heart’s muscle: These can
- a hole between the lower chambers of the
lead to heart failure, which means the
heart
heart doesn’t pump as efficiently as it
- an obstruction from the heart to the lungs
should.
- The aorta (blood vessel) lies over the hole in
4. Bad connections among blood vessels: In
the lower chambers
babies, this may let blood that should go to
 - The muscle surrounding the lower right 2. Collect blood tests, 12 leads
chamber becomes overly thickened Electrocardiogram, 2D Echo and cardiac
catherization result.
Insertion of Ventricular Assist Device
3. Nothing per orem post midnight.
- Purpose 4. Check the vital signs and SPO2 percentage.
5. Put an intravenous access and arterial line.
A left ventricular assist device (LVAD) is implanted 6. Assess the client’s hemodynamic and
in your chest. It helps pump blood from the left cardiac status postoperatively.
ventricle of your heart and on to the rest of your 7. Perform peripheral and neurovascular
body. A control unit and battery pack are worn assessments hourly for the first eight
outside your body and are connected to the LVAD hours. Then if the client is stable, perform
through a port in your skin. checks every two hours for the next eight
- Indication hours and every four hours for the
following eight hours.
A ventricular assist device (VAD) is used in people 8. Monitor neurologic status.
who have weakened hearts or heart failure. 9. Monitor fluid balance, daily weight, four-
- Nursing Responsibilities: hourly hemodynamic observations,
1. Let the client sign the informed consent. assessment of wounds and maintenance of
2. Collect blood tests, 12 leads anticoagulation therapy
Electrocardiogram, 2D Echo and cardiac B. Special Procedure
catherization result.
3. Nothing per orem post midnight. Laser Therapy
4. Check the vital signs and SPO2 percentage. - Purpose
5. Put an intravenous access and arterial line.
6. Assess the client’s hemodynamic and Laser beam is so small and precise, it allows health
cardiac status postoperatively care providers to safely treat tissue without
7. Perform peripheral and neurovascular injuring the surrounding area.
assessments hourly for the first eight
- Indication
hours. Then if the client is stable, perform
checks every two hours for the next eight Lasers are often used to treat varicose veins,
hours and every four hours for the corneal repair, repair a detached retina of the eye,
following eight hours. prostate repair, removal of kidney stones, tumor
8. Monitor neurologic status. and often used in skin surgery.
9. Monitor of fluid balance, daily weight,
- Nursing Responsibilities:
four-hourly hemodynamic observations,
1. Provide routine preoperative care.
assessment of wounds and maintenance of
2. Advise client to take precautions such as
anticoagulation therapy
stopping any medications that can affect
Heart Transplant Purpose blood clotting, such as blood thinners for
at least five days.
- Heart transplant is surgery that removes a
3. Provide postoperative nursing care such as
diseased heart and replaces it with a healthy
monitoring the vital signs and
heart from a deceased donor to improve your
administering pain medications.
quality of life and increase your lifespan.
4. Assess airway, breathing and circulation
- Indication
before transferring the client to the
People who have advanced (end stage) heart assigned room
failure, but are otherwise healthy, may be
Transmyocardial Revascularization
considered for a heart transplant.
- Transmyocardial revascularization, also known
- Nursing Responsibilities:
as TMR or TMLR, is a surgical procedure that
1. Let the client sign the informed consent
uses a special carbon dioxide (CO2) laser to
shoot tiny pinholes or channels through the
heart muscle and into the heart's lower left
 chamber (left ventricle). These new channels 2. Collect blood tests, 12 leads
improve the flow of oxygen-rich blood to the Electrocardiogram, 2D Echo and cardiac
heart muscle, reducing the effects of angina catherization result.
(chest pain), a symptom of coronary artery 3. Nothing per orem post midnight.
disease. 4. Check the vital signs and SPO2 percentage.
- is performed to treat a blockage or narrowing 5. Put an intravenous access and arterial line.
of one or more of the coronary arteries when a 6. Assess the client’s hemodynamic and cardiac
bypass procedure is not possible. status postoperatively.
- Patients who have TMR often suffer from 7. Perform peripheral and neurovascular
angina, a symptom of coronary artery disease assessments hourly for the first eight hours.
characterized by: Then if the client is stable, perform checks
• Chest pain every two hours for the next eight hours and
• Chest pressure or discomfort every four hours for the following eight hours.
• Jaw pain 8. Monitor neurologic status. Monitor fluid
• Neck pain balance, daily weight, four-hourly
• Back pain hemodynamic observations, assessment of
• Arm pain wounds and maintenance of anticoagulation
therapy.
Vascular 9. Administer low dose medication of Aspirin and
A. Surgical Procedure remind the client to take medication for at
least three months.
1. Endarterectomy
2. Anueresmectomy
- Purpose
- Purpose
The aim of the procedure is to recanalize the occluded
vessel and restore vascular supply to the tissue and to The purpose of aneurysmectomy is to repair an aortic
prevent the development of an ipsilateral stroke. aneurysm that is likely to rupture if left in place

- Indication - Indication
1. Symptomatic/significant occlusive arterial Aneurysmectomy is indicated for an aortic aneurysm
diseases that grows to at least 2 in(5 cm) or for an aortic
2. The indications for each type of aneurysm of any size that is symptomatic, tender, or
endarterectomy are enlarging rapidly.
A. Carotid endarterectomy (CEA): treatment of choice - Nursing Responsibilities:
for patients with significant (> 80%) or symptomatic 1. Routine Preoperative nursing care.
carotid artery stenosis 2. Collect blood tests, Chest radiograph,
B. Pulmonary endarterectomy: treatment of choice for angiogram, transesophageal
chronic thromboembolic pulmonary hypertension echocardiography, and magnetic
resonance imaging (MRI) and Duplex
C. Aortic endarterectomy ultrasonography or computed
tomography (CT) and inform the
1. Aortoiliac endarterectomy: for aortoiliac
physician of the results.
peripheral arterial disease
3. Nothing per orem post midnight.
2. Transaortic mesenteric endarterectomy: for
4. Check the vital signs and SPO2
chronic mesenteric ischemia
percentage.
D. Femoral endarterectomy: for symptomatic lower 5. Put an intravenous access and arterial
limb claudication due to femoral artery disease that line.
does not respond to medical management 6. Assess the client’s hemodynamic and
cardiac status postoperatively.
Nursing Responsibilities:
7. Perform peripheral and neurovascular
1. Let the client sign the informed consent. assessments hourly for the first eight
hours. Then if the client is stable,
 perform checks every two hours for 7. Perform peripheral and neurovascular
the next eight hours and every four assessments hourly for the first eight
hours for the following eight hours. hours. Then if the client is stable,
8. Monitor neurologic status. perform checks every two hours for
9. Monitor fluid balance, daily weight, the next eight hours and every four
four-hourly hemodynamic hours for the following eight hours.
observations, assessment of wounds 8. Monitor neurologic status.
and maintenance of anticoagulation 9. Monitor fluid balance, daily weight,
therapy. four-hourly hemodynamic
observations, assessment of wounds
Discharge and Home Healthcare Guidelines
and maintenance of anticoagulation
1. Wound care. Explain the need to keep the therapy.
surgical wound clean and dry.
B. Special Procedure
2. Activity restriction. Instruct the patient to lift
nothing heavier than 5 pounds for about 6 to Application of Anti embolic stockings Purpose
12 weeks and to avoid driving until her or his
1. To improve blood circulation in the leg veins by
physician permits.
applying graduated compression
3. Smoking cessation. Encourage the patient to
2. Promote supplementing the action of muscle
stop smoking and to attend smoking cessation
contraction by venous return from the legs
classes.
3. Prevent deep vein thrombosis in the immobile
4. Compliance with treatment regimen.
client Indication
Insertion of Intravascular Stenting. 4. To reduce the risk of venous
thromboembolism
- Purpose
- Equipment
A stent is a small mesh tube made of either stainless • Stockings (available in knee-high and
steel or cobalt chromium alloys that is placed by a thigh-high lengths)
catheter into a narrowed (blocked) coronary artery. • Measuring tape to assess correct size
of stocking
The stent helps enlarge a segment of the artery to
• Baby powder or talcum powder
improve blood flow, which should reduce or eliminate
• Towel or waterproof pad if applying
symptoms of chest pain
powder
- Indication - Procedure
1. Position client in supine position for a
The primary indication was the potential salvage of an
half-hour before applying stockings
unacceptable angioplasty result and early
2. Provide for the client's privacy and
Percutaneous Transluminal Angioplasty re-stenosis.
explain the purpose of the antiembolic
- Nursing Responsibilities: stockings.
1. Routine Preoperative nursing care. 3. Measure for proper fit before first
2. Collect blood tests, Chest radiograph, application. Measure length (heel to
angiogram, transesophageal groin) and width (calf and thigh) and
echocardiography, and magnetic compare to manufacturer's printed
resonance imaging (MRI) and Duplex material to ensure proper fi
ultrasonography or computed 4. Make sure legs are dry or apply a light
tomography (CT) and inform the dusting of powder
physician of the results. 5. Turn the stocking inside out, tucking
3. Nothing per orem post midnight. the foot inside
4. Check the vital signs and SPO2 6. Ease foot section over the client's toe
percentage. and heel, adjusting as necessary for
5. Put an intravenous access and arterial proper smooth fit
line. 7. Gently pull the stocking over the leg,
6. Assess the client’s hemodynamic and removing all wrinkles
cardiac status postoperatively.
 8. Assess toes for circulation and and supine if sternum or anterior iliac
warmth. Check area at top of stocking crest will be used. After aspiration,
for binding apply direct pressure for five to 10
9. Antiembolic stockings should be minutes until bleeding stops and cover
removed at least twice daily site with sterile gauze.
5. Monitor vital signs and check for any
Blood Forming Organs
sign of bleeding.
A. Surgical Procedures 6. Label the specimen correctly with
clients name, age, sex and hospital
1. Bone Marrow Aspiration number and send to laboratory after
- Purpose the procedure.
7. Administer pain reliever as needed
The test helps identify the particular disease, and it
monitors the progression or treatment of a disease.
Conditions and diseases related to bone marrow
problems include:

• anemia, which is a low red blood cell count

• bone marrow diseases, such as myelofibrosis
or myelodysplastic syndrome
• blood cell conditions, such as leukopenia or
polycythemia vera
• cancers of the bone marrow or blood, such as
leukemia or lymphoma hemochromatosis,
which is a genetic disorder in which iron
increases in the blood and builds upin organs
and tissue
• infection, especially chronic diseases like
tuberculosis
• storage diseases, such as amyloidosis or
Gaucher’s disease

Bone marrow aspiration can be an important test if

you’re having cancer treatment. It can help determine
if the cancer has spread to the bones

- Indication

Bone marrow examination is a useful tool in the

diagnosis and staging of various hematologic diseases
and in the assessment of bone marrow cellularity,
cellular morphology, and maturation. Highly
specialized testing, such as cytogenetic,
immunophenotypic, and molecular analyses, can be
performed on these specimens, and have become
critically important in establishing certain diagnoses,
especially the leukemias and lymphomas

- Nursing Responsibilities
1. Procure informed consent.
2. Routine preoperative nursing care.
3. Assess bleeding risk.
4. Determine the ability of the client to
stay still lateral decubitus or prone if
posterior iliac crest is the insertion site