How to Help Patients Cope with A Surgical Procedure...

Whether a surgical procedure is perceived as minor or major by healthcare providers, it can be a significant, life-changing event for the patient. Nurses play an essential role in assessing and intervening to help maintain the patient's self-concept and identity after surgery. 🏥 Showing Support..

 Nurses can greatly influence how patients perceive their surgical experience, their body image, and the speed and effectiveness of their recovery. 💪

To assist patients in coping with surgery, consider the following strategies:

- Preoperative Changes: Patients must often remove their clothing, alter their usual appearance by taking off makeup, nail polish, and jewelry, and don an unfamiliar hospital gown and caps. This stark change can be disorienting. 😳

- Postoperative Appearance: After surgery, patients may look drastically different due to swelling, drooling, dry mouth, or the presence of drains and dressings. The inability to perform basic activities, like getting out of bed, can heighten feelings of vulnerability. 😓

- Emotional Impact: Surgery can be particularly hard for individuals who are generally independent and take pride in their appearance. This experience may have a lasting effect on their self-image. 😔

- Long-Term Considerations: If a patient faces long-term changes to their self-concept, nurses must stay vigilant in assessing any related behaviors. Indicators that a patient is struggling with body image issues can include avoiding mirrors, not checking their incisions, or refusing visitors. 👀

- Future Concerns: Patients may also worry about their ability to return to work, care for their families, or engage in activities they once enjoyed. Nurses need to engage patients in discussions about these concerns and refer them to social workers or psychologists if needed. 🏡

- Family Involvement: The patient’s family is crucial in evaluating and supporting the patient's self-concept throughout the recovery process. 👨‍👩‍👧‍👦

- Preoperative Assessment: Conducting thorough preoperative assessments can help nurses monitor any changes in the patient's self-concept resulting from surgery. 🔍

Here are some nursing actions to support patients in managing their self-concept:  

- Ensure the patient's privacy. 🤫  

- Maintain personal hygiene and cleanliness. 🧼  

- Regularly empty drains. 🚰  

- Keep the patient's environment tidy and organized. 🧹  

- Openly discuss any concerns with the patient. 🗣️  

- Communicate with the family to provide support as they assist their loved one. 🤝

**References**  

Source Site-https://www.learningnurse.org/index.php/e-learning/nuggetshttps://corewoodcare.com/news/supporting-loved-ones-after-surgery/  https://www.vnshealth.org/homecare/after-surgery-care/

Credit-Marcucci, L. (Ed.). (2010). Avoiding Common Nursing Errors. Lippincott Williams and Wilkins.

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Preoperative Medications.....

Overview
One of the important events during the preoperative phase of the surgical experience is the administration of preoperative medications. Not only are anesthetics administered during this time, but so as drugs that minimizes respiratory tract secretions. Medicating the client pre-procedure to reduce anxiety and promote relaxation may also be necessary.
Medication History
Before discussing about the preoperative medications that are used the nurse should obtain a medication history. This eliminates the possible life-threatening effects of drug interactions and allergic reactions to certain medications. During a medication history the following are done:

• Document any medication the patient is using or has used in the past including over-the-counter (OTC) preparations and the frequency with which they are taken.
• The anesthesiologist evaluates the potential effects of prior medication therapy and considers the length of time the patient has used the medications, the patient himself and the nature of the proposed surgery.
  

Medications that cause particular concerns are the following:
Adrenal corticosteroids

1. DO NOT discontinue these drugs abruptly before the surgery.
2. If discontinued abruptly, the patient may suffer from cardiovascular collapse is he or she has been taking steroids for some time.
3. Before and after the surgery, a bolus of steroid may be administered intravenously immediately.

Diuretics
During anesthesia administration, thiazide diuretics may cause excessive respiratory depression from an associated electrolyte imbalance.
Phenothiazines
These medications may increase the hypotensive action of anesthetics
Antidepressants
Anesthetics have a hypotensive effect on the patient. Monoamine Oxidase inhibitors or MAOIs increase the hypotensive effects of anesthetics.
Tranquilizers
If medications such as diazepam, barbiturates and chlordiazapoxide are withdrawn suddenly anxiety, tension and even seizures may result.

Insulin
When a patient undergoing a surgery is diabetic, interaction between anesthetics and insulin must be considered.
Antibiotics
Neomycin, kanamycin and other “MYCIN” drugs may present problems when these medications are combined with a curariform muscle relaxation. Interruption of nerve transmission may occur and apnea due to respiratory paralysis may result when these drugs are combined.

Additional Source: http://emedicine.medscape.com/article/284801-overview#aw2aab6b8

Neurosurgery Image......

In this photo during neurosurgery, you can see the layers of the head removed & retracted until the brain is exposed.
First, you see the retraction of the scalp. Then you can see the top of the skull cap, or calvarium. After that you can see the dura mater of the meninges peeled back (the meninges is the protective covering over the brain & consists of the dura mater, arachnoid mater, & pia mater), finally revealing the cerebral cortex of the brain. You can even see the meningeal blood vessels.

Total Hip Replacement Exercise Guide for Patient Teaching...

Regular exercises to restore your normal hip motion and strength and a gradual return to everyday activities are important for your full recovery. Your orthopaedic surgeon and physical therapist may recommend that you exercise 20 to 30 minutes 2 or 3 times a day during your early recovery. They may suggest some of the following exercises.

Early Postoperative Exercises

These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve your hip movement. You may begin these exercises in the recovery room shortly after surgery. It may feel uncomfortable at first, but these exercises will speed your recovery and reduce your postoperative pain. These exercises should be done as you lie on your back with your legs spread slightly apart.

Ankle Pumps

Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until you are fully recovered.

Ankle Rotations

Move your ankle inward toward your other foot and then outward away from your other foot. Repeat 5 times in each direction 3 or 4 times a day.

Bed-Supported Knee Bends

Slide your heel toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. Repeat 10 times 3 or 4 times a day

Buttock Contractions

Tighten buttock muscles and hold to a count of 5. Repeat 10 times 3 or 4 times a day

Abduction Exercise

Slide your leg out to the side as far as you can and then back. Repeat 10 times 3 or 4 times a day

Quadriceps Set

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds. Repeat this exercise 10 times during a 10-minute period.
Continue until your thigh feels fatigued.

Straight Leg Raises

Tighten your thigh muscle with your knee fully straightened on the bed. As your thigh muscle tightens, lift your leg several inches off the bed. Hold for 5 to 10 seconds. Slowly lower. Repeat until your thigh feels fatigued.

Standing Exercises

Soon after your surgery, you will be out of bed and able to stand. You will require help since you may become dizzy the first several times you stand. As you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.

Standing Knee Raises Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 counts and put your leg down. Repeat 10 times 3 or 4 times a day

Standing Hip Abduction Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor. Repeat 10 times 3 or 4 times a day

Standing Hip Extensions Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts. Return your foot to the floor. Repeat 10 times 3 or 4 times a day

Walking and Early Activity

Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity helps your recovery by helping your hip muscles regain strength and movement.

Walking with Walker, Full Weightbearing

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step allow your toe to lift off the floor. Move the walker again and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can. Don't hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg.

Walking with Cane or Crutch

A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch is then used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand opposite the operated hip. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker.

Stair Climbing and Descending

The ability to go up and down stairs requires both flexibility and strength. At first, you will need a handrail for support and you will only be able to go one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember "up with the good" and "down with the bad." You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than those of the standard height of seven inches and always use the handrail for balance.

Advanced Exercises and Activities

A full recovery will take many months. The pain from your problem hip before your surgery and the pain and swelling after surgery have weakened your hip muscles. The following exercises and activities will help your hip muscles recover fully.
These exercises should be done in 10 repetitions four times a day with one end of the tubing around the ankle of your operated leg and the opposite end of the tubing attached to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.

Elastic Tube Exercises

Resistive Hip Flexion Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position.

Resistive Hip Abduction Stand sideways from the door and extend your operated leg out to the side. Allow your leg to return to its previous position.

Resistive Hip Extensions Face the door or heavy object to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position.

Exercycling

Exercycling is an excellent activity to help you regain muscle strength and hip mobility. Adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Pedal backwards at first. Pedal forward only after comfortable cycling motion is possible backwards. As you become stronger (at about 4 to 6 weeks) slowly increase the tension on the exercycle. Exercycle forward 10 to 15 minutes twice a day, gradually building up to 20 to 30 minutes 3 to 4 times a week.

Walking

Take a cane with you until you have regained your balance skills. In the beginning, walk 5 or 10 minutes 3 or 4 times a day. As your strength and endurance improves, you can walk for 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain your strength.