PATIENT CARE CONCEPTS

1. PATIENT CARE CONCEPTS

2. Outline • Physical health and its relationship to the ST and the surgical patient • Post-operative complications • Equipment and immediate access • PACU criteria • Post-operative discharge instructions • Kübler-Ross Stages of Grief/Death and Dying • Alternative Healing Methodologies • Quality verses quantity of life • Organ procurement and transplantation

3. Physical Health(Student Presentations) • Relate the following health and wellness concepts to the surgical patient and the surgical technologist role: • Physical activity • Nutrition • Tobacco use • Alcohol use • Stress

4. Post-Operative Complications • Complications are difficulties post-operatively that warrant immediate treatment and may result in returning to surgery. • Complications are accepted as risks of having surgery, so are shared with the patient pre-operatively before the surgical consent is signed • Can result in prolonged hospitalization as well as prolonging a patient’s recovery or return to normal function

5. Types of Post-Operative Complications • Shock is inadequate blood flow, therefore poor oxygenation to vital organs that can result in irreversible damage to the organs involved • Hemorrhage is heavy bleeding during, shortly after, or some time after surgery • Pulmonary Embolus or PE occurs when a blood clot forms, is dislodged, and is carried to the heart’s pulmonary artery

6. Types of Post-Operative Complications Continued • Respiratory secretion impairment can be from inadequate clearing of secretions by the patient (coughing, turning, deep breathing) or the accidental aspiration of secretions. This can result in aspiration pneumonia. • Gastro-intestinal/bowel obstruction is most often seen after surgery involving the abdomen. It can occur in 3 to 5 days post-op or years down the road.

7. Types of Post-operative Complications Continued • Post-op Psychoses is caused by temporary lack of oxygen to the brain. It can result in depression, anxiety, mental confusion, and hallucinations. This can also be a result of the anesthetic or pain medications. • Retained foreign body

8. Equipment/Immediate Access Preparing for Complications • Keep set-up sterile as well as yourself if able until the patient is assuredly stable and ready for transport • Need to be prepared should you have to go back in to a patient • Oxygen • Defibrillator

9. Post-Anesthesia Care Unit(PACU) • Given there are no complications, established criteria must be met by the patient before they can be discharged to the surgical floor of the hospital or home in the case of out-patient surgery

10. PACU Criteria • Uncomplicated breathing • Stable or a return to 20% of baseline VS • Temperature at 36°C or 96°F or better • Urine output not less than 30ml per hour • Nausea and vomiting controlled • Minimal pain complaints • Verbally responsive and oriented to person, location , and events • Can move all four extremities

11. Outpatient PACU Criteria • The same criteria must be met with the additional two criteria • Can tolerate small amounts of clear fluids without vomiting • Have a responsible adult to drive the patient home and stay with them the remainder of the day

12. Post-Operative/Discharge Instructions • May vary with type of operation • Activity will be encouraged/Limits will be on lifting, pulling, and straining • Rest will be encouraged • Driving and operation of heavy machinery may be discouraged for awhile • Resumption of sexual intercourse may have a time frame • Resumption of showering and tub bathing may have a time frame

13. Discharge or Post-Operative Instructions Continued • Alcoholic beverage consumption may have a time frame • Smoking will be discouraged • Diet may be progressive • Instructions on dressing changes will be given • Prescriptions will be given • Follow-up doctor appointment will be made

14. Discharge or Post-Operative Instructions Continued • The following will be reported to the patient’s doctor by the patient immediately: • Fever • Prolonged nausea and vomiting • Swelling or excessive bleeding • Excessive pain • Inability to urinate or void • Inability to pass stool or defecate

15. Death and Dying(The Grieving Process) • Kübler-Ross Stages of Grief as experienced by the patient and the family: • Denial-does not accept death as a reality. Pretends it isn’t happening. This prolongs communication of concerns. • Anger-Important not to take personally if the health care provider. The person is expressing their sense of helplessness and outrage over their situation.

16. Kübler-Ross Stages of Grief Continued • Bargaining-involves a deal made with God, the doctor, or nurse. For example “If I can live until my grandson is born next month, I’ll be ready to die.” When possible, requests will be granted. • Depression-the previous methods are no longer working. The person feels sad and full of anguish. Death is a reality. Support is important at this time.

17. Kübler-Ross Stages of Grief Continued • Acceptance-The person has accepted the fact they are going to die and is at relative peace with it. They will want loved ones near. They may or may not want to reflect on the past and consider the future without them. • These stages do not always occur in order. Patients and families may go back and forth between stages and will likely each be at different stages.

18. Alternative Healing Methodologies • Besides surgical and medical intervention, patients may also seek help from alternative healing methods • Alternative healing needs to be recognized by the health care provider and every attempt should be made to accommodate these desires of the patient provided they are harmless • The majority of alternative practices are harmless whether they are effective or not

19. Types of Alternative Healing Methodologies • Folk healers • Voodoo • Spiritual leaders/counsel/prayer • Acupuncture • Medicine man • Herbalist • Home remedies

20. Quality verses Quantity of Life

21. Terms Related to Quality verse Quantity of Life • Advance Directives Tells your family/caregivers and physician what kind of care you would want if you couldn’t speak for yourself • A. Living Will Written by you when you were well and comes into effect when your are terminally/incurably ill or in a persistent vegetative state. It details your wishes given the previous circumstances. • B. HCPA (Health Care Power of Attorney) A document more flexible than a living will. Allows designation of a family member or friend to be your medical decision maker should you become temporarily or permanently unable to make your own decisions (only concerned with health care decisions not personal/financial). • Without a will, we are at the mercy of our family’s decisions or physician, who may or may not do what is “right” or what we would want.

22. Organ Procurement and Transplantation Myths • Wealthy and famous people get priority • The patient is too old and sick to be a donor • If I’m a donor, doctors won’t attempt to save my life if I’m in an accident • To be a donor, all I have to do is check that box on my drivers license

23. Organ Transplantation and Procurement Facts • Organ transplantation is one of the twentieth century’s greatest breakthroughs • Nineteen people die every day waiting to receive an organ transplant • Supply and demand gaps are growing • Organ procurement is based on patients and families volunteering to donate their organs • Cost is a factor (many insurances do not cover expense/cost can range from $35,000 to $200,000 the first year of a transplant

24. Summary • Physical health and its relationship to the ST and the surgical patient • Post-operative complications • Equipment and immediate access • PACU criteria • Post-operative discharge instructions • Kübler-Ross Stages of Grief/Death and Dying • Alternative Healing Methodologies • Quality verses quantity of life • Organ procurement and transplantation