Palliative surgery is performed to relieve symptoms of a disease process,
* Call admissions.
* Cancel the surgery.
*Contact the surgeon.
* Talk to the operating team.
The operating team should be called to see if any clients with similar names are having surgery done.
The client should confirm the spelling of his or her last name. Also, confirm the procedure that is expected to be done and compare it with the informed consent form.
*Contact the anesthesiologist.
*Contact the surgeon.
*Explain the procedure.
*Have the client sign the form.
The nurse is not responsible for providing detailed information about the surgical procedure. Rather, the nurse’s role is to clarify facts that have been presented by the health care provider and dispel myths that the client or family may have heard about the surgical experience.
* “I will wake up with a tube in my throat.”
* “I will have a bandage on my chest.”
* “My family will not be able to see me right away.”
* “Pain medication will take away my pain.”
Pain medication will minimize pain, but will not take it away completely.
* Instruct the client to quit smoking.
* Teach about the dangers of tobacco.
* Teach the importance of incentive spirometry.
* Tell the client where the smoking lounge is.
Incentive spirometry is good for lung hygiene; it encourages deep breathing. The nurse can suggest quitting or advise about the dangers of tobacco, but it is not therapeutic to instruct it at this time.
* “I am taking vitamins.”
* “I drink a glass of wine a night.”
* “I had a heart attack 4 months ago.”
* “I don’t like latex balloons.”
Cardiac problems increase surgical risks, and the risk for a myocardial infarction during surgery is higher in clients who have heart problems.
* Age 59 years
* General anesthesia complications experienced by the client’s brother
* Diet-controlled diabetes mellitus
* Ten pounds over the client’s ideal body weight
Diabetes contributes an increased risk for surgery or postsurgical complications.
* Creatinine, 1.9 mg/dL
* Fasting glucose, 80 mg/dL
* Potassium, 3.9 mEq/L
* Sodium, 140 mEq/L?
A creatinine of 1.9 mg/dL is outside the normal range and may indicate renal problems. A fasting glucose of 80 mg/dL, a potassium level of 3.9 mEq/L, and sodium level of 140 mEq/L are normal laboratory values.
* Decrease expected blood loss during surgery
* Eliminate any risk of infection
* Ensure that the bowel is sterile
* Reduce the number of intestinal bacteria
Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria.
* “I will take off my stockings one to three times a day for 30 minutes.”
* “My stockings are too loose.”
* “These stockings will prevent blood clots.”
* “These stockings help promote blood flow.”
Antiembolism stockings alone will not prevent deep vein thrombosis (DVT). However, along with exercise, they will help promote venous return, which aids in preventing DVT.
* Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter.
* Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer.
* Obtain the medical history from a client who is scheduled for a total hip replacement.
* Assess the client who is being admitted for an elective laparoscopic cholecystectomy.
Insertion of a catheter is within the scope of skills approved for the LPN/LVN
* An allergy to iodine and shellfish
* Being nauseated after a previous surgery
* Having a small glass of juice at 7:00 a.m.
* Expressing anxiety about the surgery
Clients need to be NPO for a sufficient length of time before surgery. Intake of food or fluids may delay the start time of the surgery, so the nurse must notify the surgeon and anesthesiologist for possible rescheduling. The nurse should confirm that all allergies are charted, and that the client has the correct allergy band identification
* Use electric clippers to cut hair at the surgical site.
* Start an infusion of lactated Ringer’s solution at 75 mL/hr.
* Administer one-half of the client’s usual lispro insulin dose.
* Draw blood for glucose, electrolyte, and complete blood count values.
If blood work is abnormal, the surgery may be rescheduled. The blood sample needs to be drawn and sent to the laboratory first to confirm that results are within normal limits.
* Ensure written consultation of two noninvolved physicians.
* Read the surgeon’s consult to determine whether the client’s condition is life-threatening.
*Sign the operative permit.
* Withhold surgery until the next of kin is notified.
In a life-threatening situation in which every effort has been made to contact the person with medical power of attorney, consent is desired but not essential. In place of written or oral consent, written consultation by at least two physicians who are not associated with the case may be requested by the health care provider