Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Dec 1998
ReviewPreoperative evaluation of the pulmonary patient undergoing nonpulmonary surgery.
As the human population continues to live longer, patients with chronic pulmonary disease are increasingly presenting for surgical treatment. The influences of general anesthesia and an operative procedure are well known to negatively impact pulmonary gas exchange. ⋯ Essential components in the comprehensive care of these patients are the identification of these high-risk patients and the implementation of an inclusive perianesthetic care regimen designed to decrease pulmonary complications. This article will familiarize the perianesthetic nurse with pertinent skills required to effectively assess and prepare patients with pulmonary disease for their upcoming surgery.
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Respiratory care protocols have been developed for specific therapies that include the following: oxygen titration, weaning from mechanical ventilation, sampling arterial blood gases, managing bronchospasm and secretions, treating atelectasis, endotracheal extubation, and managing the postextubation airway. Although relatively little attention has been given to using protocols in postanesthesia care, this environment lends itself to applying protocols. ⋯ As with other previously mentioned respiratory protocols, these protocols have shown efficacy for improving allocation of respiratory care services, cost savings, and favorable clinical outcomes. On this basis, while recognizing the need for further studies, respiratory care protocols implemented by respiratory therapists can be beneficial in the postanesthesia care setting.
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Postoperative ventilatory depression is common in patients who have received intravenous and inhalational anesthetic agents. Prompt assessment and treatment of ventilatory depression are essential to minimize morbidity and mortality.
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Much has been published in the medical literature concerning adverse events relating to the surgical patient. Among the notable disorders requiring the expertise of the postanesthesia care unit nurse are the diagnosis and management of respiratory dysfunction acutely attributable to the effects of surgery and anesthesia. ⋯ When patients present with preexisting respiratory disease, their care is frequently more complex and challenging. This review session will address the oxygenation component of respiration and the perioperative influences that alter it as well as treatment considerations for normalizing oxygenation.
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J. Perianesth. Nurs. · Oct 1998
ReviewPreoperative assessment criteria and patient teaching for ambulatory surgery patients.
Today's trend is to have the surgical patient return to the comfort of his or her home rather than be admitted to the hospital for expensive nursing and medical care. The perioperative team must initially assess the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity; obtain a medical and surgical history and consent; review laboratory, electrocardiogram, and radiological results; and perform preoperative teaching (e.g., which medications to take or withhold preoperatively, when to withhold food and fluids) and postoperative teaching (e.g., catheter care, dressing changes). In addition, the nurse needs to anticipate and be prepared for medical emergencies such as airway management problems and malignant hyperthermia. ⋯ Proper evaluation is the key to success for positive surgical outcomes. Given the time constraints in the ambulatory surgical setting, assessing and teaching the patient on the day of surgery is not feasible or appropriate. Reaching out to the patient a few days before surgery either in the patient's home, in the ambulatory surgery center, or by telephone is the ultimate goal.