Surgery may be needed to diagnose or cure a specific disease process, correct a structural deformity, restore a functional process, or reduce the level of dysfunction/pain. Although surgery is generally elective or preplanned, potentially life-threatening conditions can arise, requiring emergency intervention. Absence or limitation of preoperative preparation and teaching increases the need for postoperative support in addition to managing underlying
medical conditions.
CARE SETTING
May be inpatient on a surgical unit or outpatient/short-stay in an ambulatory surgical setting.
RELATED CONCERNS
Alcohol: acute withdrawal
Cancer
Diabetes mellitus/diabetic ketoacidosis
Fluid and electrolyte imbalances
Hemothorax/pneumothorax
Metabolic acidosis (primary base bicarbonate deficit)
Metabolic alkalosis (primary base bicarbonate excess)
Peritonitis
Pneumonia, microbial
Psychosocial aspects of care
Respiratory acidosis (primary carbonic acid excess)
Respiratory alkalosis (primary carbonic acid deficit)
Sepsis/septicemia
Thrombophlebitis: deep vein thrombosis
Total nutritional support: parenteral/enteral feeding
Also refer to plan of care for specific surgical procedure performed.
Patient Assessment Database
Data depend on the duration/severity of underlying problem and involvement of other body systems. Refer to specific plans of care for data and diagnostic studies relevant to the procedure and additional nursing diagnoses.
CIRCULATION
May report:History of cardiac problems, heart failure (HF), pulmonary edema, peripheral vascular disease, or vascular stasis (increases risk of thrombus formation)
May exhibit:Changes in heart rate (sympathetic stimulation)
EGO INTEGRITY
May report: Feelings of anxiety, fear, anger, apathy
Multiple stress factors, e.g., financial, relationship, lifestyle
May exhibit: Restlessness, increased tension/irritability
Sympathetic stimulation, e.g., changes in heart rate (HR), respiratory rate
ELIMINATION
May report: History of kidney/bladder conditions; use of diuretics/laxatives
Change in bowel habits
May exhibit: Abdominal tenderness, distension
Absence of bowel elimination
Decreased or absence of urinary elimination
FOOD/FLUID
May report: Pancreatic insufficiency/diabetes mellitus (DM) (predisposing to hypoglycemia/ketoacidosis)
Use of diuretics
May exhibit: Malnutrition (including obesity)
Dry mucous membranes (limited intake/nothing-by-mouth [NPO] period preoperatively)
RESPIRATION
May report: Infections, chronic conditions/cough, smoking
May exhibit: Changes in respiratory rate (respiratory pathology or sympathetic stimulation)
SAFETY
May report: Allergies or sensitivities to medications, iodine, food, tape, latex, and solution(s)
Immune deficiencies (increase risk of systemic infections and delayed healing)
Presence of cancer/recent cancer therapy
Family history of malignant hyperthermia/reaction to anesthesia, autoimmune diseases
History of hepatic disease (affects drug detoxification and may alter coagulation)
History of blood transfusion(s)/transfusion reaction
May exhibit: Presence of existing infectious process; fever
TEACHING/LEARNING
May report: Use of medications such as anticoagulants, steroids, nonsteroidal anti-inflammatories, antibiotics, antihypertensives, cardiotonic glycosides, antidysrhythmics,
bronchodilators, diuretics, decongestants, analgesics, anti-inflammatories, anticonvulsants, or antipsychotics/antianxiety agents, as well as over-thecounter (OTC) medications, herbal supplements, or alcohol or other drugs of abuse (risk of liver damage affecting coagulation and choice of anesthesia, as well as potential for postoperative withdrawal)
Discharge plan
DRG projected mean length of stay: 2.6 days for inpatient procedures, 2–36 hr for
outpatient
May require temporary assistance with transportation, dressing(s)/supplies, self-care, and
homemaker/maintenance tasks
Possible placement in rehabilitation/extended care facility
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
General preoperative requirements may include: Complete blood count (CBC), prothrombin time (PT)/activated partial thromboplastin time (aPTT), chest x-ray. Other studies depend on type of operative procedure, underlying medical conditions, current medications, age, and weight. These tests may include blood urea nitrogen (BUN), creatinine (Cr), glucose, arterial blood gases (ABGs), electrolytes; liver function, thyroid, nutritional studies, electrocardiogram (ECG). Deviations from normal should be corrected if possible, for safe administration of anesthetic agents.
CBC: An elevated white blood cell (WBC) count is indicative of inflammatory process (may be diagnostic, e.g., appendicitis); decreased WBC count suggests viral processes (requiring evaluation because immune system may be dysfunctional). Low hemoglobin (Hb) suggests anemia/blood loss (impairs tissue oxygenation and reduces the Hb available to bind with inhalation anesthetics); may suggest need for cross-match/blood transfusion. An elevated hematocrit (Hct) may indicate dehydration; decreased Hct suggests fluid overload.
Electrolytes: Imbalances impair organ function, e.g., decreased potassium affects cardiac muscle contractility, leading to decreased cardiac output.
ABGs: Evaluates current respiratory status, which may be especially important in smokers, patients with chronic lung diseases.
Coagulation times: May be prolonged, interfering with intraoperative/postoperative hemostasis; hypercoagulation increases risk of thrombosis formation, especially in conjunction with dehydration and decreased mobility associated with surgery.
Urinalysis: Presence of WBCs or bacteria indicates infection. Elevated specific gravity may reflect dehydration.
Pregnancy test: Positive results affect timing of procedure and choice of pharmacological agents.
Chest x-ray: Should be free of infiltrates, pneumonia; used for identification of masses and chronic obstructive pulmonary disease (COPD).
ECG: Abnormal findings require attention before administering anesthetics.
NURSING PRIORITIES
1. Reduce anxiety and emotional trauma.
2. Provide for physical safety.
3. Prevent complications.
4. Alleviate pain.
5. Facilitate recovery process.
6. Provide information about disease process/surgical procedure, prognosis, and treatment needs.
DISCHARGE GOALS
1. Patient dealing realistically with current situation.
2. Injury prevented.
3. Complications prevented/minimized.
4. Pain relieved/controlled.
5. Wound healing/organ function progressing toward normal.
6. Disease process/surgical procedure, prognosis, and therapeutic regimen understood.
7. Plan in place to meet needs after discharge.
medical conditions.
CARE SETTING
May be inpatient on a surgical unit or outpatient/short-stay in an ambulatory surgical setting.
RELATED CONCERNS
Alcohol: acute withdrawal
Cancer
Diabetes mellitus/diabetic ketoacidosis
Fluid and electrolyte imbalances
Hemothorax/pneumothorax
Metabolic acidosis (primary base bicarbonate deficit)
Metabolic alkalosis (primary base bicarbonate excess)
Peritonitis
Pneumonia, microbial
Psychosocial aspects of care
Respiratory acidosis (primary carbonic acid excess)
Respiratory alkalosis (primary carbonic acid deficit)
Sepsis/septicemia
Thrombophlebitis: deep vein thrombosis
Total nutritional support: parenteral/enteral feeding
Also refer to plan of care for specific surgical procedure performed.
Patient Assessment Database
Data depend on the duration/severity of underlying problem and involvement of other body systems. Refer to specific plans of care for data and diagnostic studies relevant to the procedure and additional nursing diagnoses.
CIRCULATION
May report:History of cardiac problems, heart failure (HF), pulmonary edema, peripheral vascular disease, or vascular stasis (increases risk of thrombus formation)
May exhibit:Changes in heart rate (sympathetic stimulation)
EGO INTEGRITY
May report: Feelings of anxiety, fear, anger, apathy
Multiple stress factors, e.g., financial, relationship, lifestyle
May exhibit: Restlessness, increased tension/irritability
Sympathetic stimulation, e.g., changes in heart rate (HR), respiratory rate
ELIMINATION
May report: History of kidney/bladder conditions; use of diuretics/laxatives
Change in bowel habits
May exhibit: Abdominal tenderness, distension
Absence of bowel elimination
Decreased or absence of urinary elimination
FOOD/FLUID
May report: Pancreatic insufficiency/diabetes mellitus (DM) (predisposing to hypoglycemia/ketoacidosis)
Use of diuretics
May exhibit: Malnutrition (including obesity)
Dry mucous membranes (limited intake/nothing-by-mouth [NPO] period preoperatively)
RESPIRATION
May report: Infections, chronic conditions/cough, smoking
May exhibit: Changes in respiratory rate (respiratory pathology or sympathetic stimulation)
SAFETY
May report: Allergies or sensitivities to medications, iodine, food, tape, latex, and solution(s)
Immune deficiencies (increase risk of systemic infections and delayed healing)
Presence of cancer/recent cancer therapy
Family history of malignant hyperthermia/reaction to anesthesia, autoimmune diseases
History of hepatic disease (affects drug detoxification and may alter coagulation)
History of blood transfusion(s)/transfusion reaction
May exhibit: Presence of existing infectious process; fever
TEACHING/LEARNING
May report: Use of medications such as anticoagulants, steroids, nonsteroidal anti-inflammatories, antibiotics, antihypertensives, cardiotonic glycosides, antidysrhythmics,
bronchodilators, diuretics, decongestants, analgesics, anti-inflammatories, anticonvulsants, or antipsychotics/antianxiety agents, as well as over-thecounter (OTC) medications, herbal supplements, or alcohol or other drugs of abuse (risk of liver damage affecting coagulation and choice of anesthesia, as well as potential for postoperative withdrawal)
Discharge plan
DRG projected mean length of stay: 2.6 days for inpatient procedures, 2–36 hr for
outpatient
May require temporary assistance with transportation, dressing(s)/supplies, self-care, and
homemaker/maintenance tasks
Possible placement in rehabilitation/extended care facility
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
General preoperative requirements may include: Complete blood count (CBC), prothrombin time (PT)/activated partial thromboplastin time (aPTT), chest x-ray. Other studies depend on type of operative procedure, underlying medical conditions, current medications, age, and weight. These tests may include blood urea nitrogen (BUN), creatinine (Cr), glucose, arterial blood gases (ABGs), electrolytes; liver function, thyroid, nutritional studies, electrocardiogram (ECG). Deviations from normal should be corrected if possible, for safe administration of anesthetic agents.
CBC: An elevated white blood cell (WBC) count is indicative of inflammatory process (may be diagnostic, e.g., appendicitis); decreased WBC count suggests viral processes (requiring evaluation because immune system may be dysfunctional). Low hemoglobin (Hb) suggests anemia/blood loss (impairs tissue oxygenation and reduces the Hb available to bind with inhalation anesthetics); may suggest need for cross-match/blood transfusion. An elevated hematocrit (Hct) may indicate dehydration; decreased Hct suggests fluid overload.
Electrolytes: Imbalances impair organ function, e.g., decreased potassium affects cardiac muscle contractility, leading to decreased cardiac output.
ABGs: Evaluates current respiratory status, which may be especially important in smokers, patients with chronic lung diseases.
Coagulation times: May be prolonged, interfering with intraoperative/postoperative hemostasis; hypercoagulation increases risk of thrombosis formation, especially in conjunction with dehydration and decreased mobility associated with surgery.
Urinalysis: Presence of WBCs or bacteria indicates infection. Elevated specific gravity may reflect dehydration.
Pregnancy test: Positive results affect timing of procedure and choice of pharmacological agents.
Chest x-ray: Should be free of infiltrates, pneumonia; used for identification of masses and chronic obstructive pulmonary disease (COPD).
ECG: Abnormal findings require attention before administering anesthetics.
NURSING PRIORITIES
1. Reduce anxiety and emotional trauma.
2. Provide for physical safety.
3. Prevent complications.
4. Alleviate pain.
5. Facilitate recovery process.
6. Provide information about disease process/surgical procedure, prognosis, and treatment needs.
DISCHARGE GOALS
1. Patient dealing realistically with current situation.
2. Injury prevented.
3. Complications prevented/minimized.
4. Pain relieved/controlled.
5. Wound healing/organ function progressing toward normal.
6. Disease process/surgical procedure, prognosis, and therapeutic regimen understood.
7. Plan in place to meet needs after discharge.
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