Care of the Surgical Patient

CNA 2 OSBN
Curriculum
Reasons for Surgery
 Elective Surgery

 Urgent Surgery

 Emergency Surgery
Pre-Operative Period
 Surgical Consent
 Special Tests
 Nutrition & Fluids
 Elimination
 Skin Prep
 Pre-Op Meds
 Transportation
Post-Operative Period
 PACU to Nursing Unit
 Frequent VS/policy
 Dressing
 Tubes
◦ Foley/IV /JP/NG
 Rails Up
 Call Light Handy
 Family Present
 Early Ambulation
Tissue Healing
 Healing Process
 Tissue Healing Stages
◦ Blood Clot Formation
◦ Inflammatory Phase
◦ Cellular Repair
◦ Regrowth of Bld Vessels
◦ Scar Formation
 Issues w/Healing
◦ Malnutrition
◦ Wound Infection
◦ Coexisting Conditions
 Diabetes Mellitus
 Advanced Age
 Tobacco Abuse
 Cancer
 Medication Side Effect
Wounds, Incisions, & Dressings
 Wound Created
 Portal of Entry
 Infection a Threat
 Factors Affecting Healing
◦ Type of Wound
◦ Age/General Health
◦ Nutrition
◦ Life Style
◦ Circulation
 Important for Wound Healing
◦ Smoking
◦ Anticoagulants
More on Wounds
 Wound Care Involves Prevention
◦ Infection
◦ Blood Loss
◦ Pain
 Incision
◦ Clean/Dry
◦ Well Approximated
◦ No Edema/Irritation
 Dressings
◦ Protects
◦ Absorbs
◦ Controls
Wound Closure
 Sutures
◦ Stitches
◦ Stop Bleeding
◦ Speed Healing
 Steri Strips
◦ Stretched Across Skin
 Staples
Wound Drainage
 Fluid Escapes
 Variable Amt. of Drainage
 Bleeding/Infections Affect

 Types
◦ Serous
 Clear, Watery
◦ Sanguineous
 Bloody Drainage
◦ Sero-Sanguineous
 Thin, Watery, Pink
◦ Purulent
 Thick,
 Yellow/Brown/Green
Drains
 Drain Fluid
◦ From Surgical Site
 Types
◦ Jackson Pratt: JP
 100 mls
◦ Hemovac
 400 mls
◦ Constavac/Stryker
 >400 mls
◦ Penrose
 No Container
Observation & Reporting
 Location
 Amount
 Color

CNA2 Actions
 Report Abnormals to Nurse
 Maintain Integrity
 Aseptic Technique to Empty
Wound Vac Drain
Preventing Complications
 PRIORITY
 Close Observation of Patient
 Patient Safety
 Activity Important After OR
 Pulmonary Toilet
 Emotional Support
 Encouragement
 Side Rails Up
Cardiovascular System
 Edema: Fluid Retention
 Sternal Precautions
 Orthostatic Hypotension
 DVT
 MI
CNA2 Actions
 Report Abnormals to Nurse
 Sternal Precautions
◦ Hug Pillow to Cough
◦ No Arms
 C&DB, IS
 TEDs/SCDs
 Turning
 Early Ambulation
 Pain Control
Bleeding
 Hemorrhage
◦ Excessive Loss in Short Period
◦ Death Can Result
 Internal Hemorrhage
◦ Can’t See
◦ Bleeding Inside Body
 Hematoma
◦ Check Under Things
 Shock
◦ Not enough Blood Supply to Organs
CNA2 Action
 Report Abnormals to Nurse STAT
 Remain w/Pt.
 Assist as Requested
Observation & Reporting
 Blood or Hematoma
 Lg. amt. Bloody Drainage
 Falling BP
 Rapid/Weak Pulse
 Rapid Respirations
 Cool/Moist/Pale Skin
 C/o Thirst
 Restlessness
 Decreased LOC
Capillary Refill
 Extremity Blood Flow
 How
◦ Pressure to Nail Bed until White
◦ Blanch Time
 >2Seconds Report
Observation & Reporting
 Blanch Time > 2-3 Sec.
 Pain

CNA2 Actions
 Report Abnormals to Nurse
 Elevate Extremity
Digestive System
 Increase Risk
◦ Paralytic Ileus
◦ Constipation
CNA2 Actions
 Encourage Movement
 Enemas prn
 Report

◦ N/v
◦ Excessive Thirst
◦ Choking
 Observation & Reporting
Abdomen
 Pain
 Distention
 Flatus
 Swollen Abd.
 Intestinal Gas

CNA2 Actions
 Report Abnormals to Nurse
 Increase Activity as Ordered
 Bowel Care as Ordered
Endocrine System
 Glycemic Control
◦ Hyperglycemias
◦ Increased Risk for Infection
CNA2 Actions
 Report S&S
◦ Hyper/Hypoglycemia STAT
◦ Report < 75% Meal
Integumentary System
 Increased Risk For
◦ Skin Breakdown
◦ Infection
◦ Dehiscence
◦ Evisceration
CNA2 Action
 TCDB Q2Hr
 Monitor Skin/Pressure Points
 Pallor/Cyanosis
 Bleeding
Pulmonary System
 Increased Risk
◦ Atelectasis
◦ Pneumothorax
◦ Pneumonia
◦ Inflammation/Infected Lung
◦ Fluid Pooling
CNA2 Action
 ReportAbnormals to Nurse
 C&DB Exercises
 IS
Urinary System
 Increased Risk For
◦ Urinary Retention
◦ Decreased UOP
CNA2 Actions
 Report Abnormals to Nurse
 Accurate I&O
 Quality Urine
Pain
 Expected
 Depends On
◦ Extent of OR
◦ Site of Incision
◦ Drainage Tubes
◦ Casts
◦ Pt. “Threshold”
◦ Current Med Usage
◦ Hx Chronic Pain
◦ Hx Drug Abuse
Observation & Reporting
 Painful Behaviors
◦ Moaning
◦ Grunting
◦ Crying Out
◦ Restlessness
◦ Withdrawn
◦ Furrowed Brow
◦ Grimacing
◦ Clenched Teeth
◦ Rubbing Affected Area
◦ Cursing when Repositioned
CNA2 Actions
 Report C/O Pain to Nurse
 Pain Scale
◦ Compare to Familiar Pain
 CanYou Describe It?
 Comfort Measures
 Turn Frequently
This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assist ance
Community College and Career Training Grants, as implemented by the U.S . Department of Labor’s Employment and
Training Administration. Rogue Community College is an equal opportunity employer/program. Auxiliary aids and
services, alternate form and language services are available to individuals with disabilities and limited English proficiency
free of cost upon request.

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