1. 3 = Sometimes demonstrated Source: American Society of PeriAnesthesia Nurses: Perianesthesia nursing standards and practice recommendations 2010-2012, Cherry Hill, NJ, 2010, The Society. • Level of consciousness Patients at high risk include those who have had general anesthesia; are older; have a smoking history; have obstructive sleep apnea or lung disease; are obese; or have undergone airway, thoracic, or abdominal surgery. • Monitor for abnormal serum electrolyte levels to determine need for replacements. • Reports pain controlled ___ Any evidence of inadequate circulatory status requires prompt intervention. jQuery( document.body ).on( 'click', 'a.share-twitter', function() { Differentiate discharge criteria from Phase I and Phase II postanesthesia care. Several disorders affect the biliary system and interfere with normal drainage of bileinto the duodenum. Possibly evidenced by • Surgeon • Administer prescribed supplemental electrolytes to maintain electrolyte balance. Assessment of the urinary system focuses on intake, output, and fluid balance. Compliance Behavior Complications of Thyroid Surgery: How to Avoid Them, How to Manage Them, and Observations on Their Possible Effect on the Whole Patient. HISTORY Term 'thyroid' was coined by Thomas Warton in 17th century Emil Theoder Kocher is considered as the Father of Modern Thyroid surgery First thyroidectomy is considered to be done more than 1000 years ago by Abu-al-Qasim The earliest account of thyroidectomy was probably given by Roger Frugardi, 1170. Thyroidectomy for Nursing Students 1. Chapter 20 Experiences reduced or no episodes of nausea and vomiting • Oral or nasal airway Allergic drug reaction Needs oxygen to maintain saturation > 92% • Institute and modify pain control measures on the basis of the patient’s response to individualize care. Taking care of patients with a thyroidectomy. 1 = Severely compromised Maintains fluid and electrolyte balance required for metabolic needs, Demonstrates no signs of hypovolemia or hypervolemia, Obtain laboratory specimens for monitoring of altered fluid or electrolyte levels (e.g., hematocrit; blood urea nitrogen; protein, sodium, and potassium levels), Monitor for abnormal serum electrolyte levels, Maintain IV solution containing electrolyte(s) at ordered flow rate, Keep an accurate record of intake and output and weigh patient daily, Administer prescribed supplemental electrolytes, Consult physician if signs and symptoms of fluid and/or electrolyte imbalance persist or worsen. Nursing Diagnosis Possible intubation Intraoperative fluid totals are part of the anesthesia report. Nutrition Management • Abnormal breath sounds 0 Nursing Diagnosis NURSING MANAGEMENT 41. The patient may be awake, drowsy but arousable, or asleep. Maintains fluid and electrolyte balance required for metabolic needs • Respiratory rate ___ 1 = Severe O2 therapy windowOpen.close(); • Identify factors (e.g., medications, procedures) that may cause or contribute to nausea. The surgeon would always try to preserve a portion of the thyroid gland whenever it’s possible to facilitate continuous production of the thyroid hormones, and in the hope that it could avert predicaments with hypothyroidism … Get more Nursing Care plans at 1nurses.com you Free Nursing Resource. Another accelerated system of care is fast-tracking, which involves admitting ambulatory surgery patients directly to Phase II care.1 Although both RPP and fast-tracking can potentially result in time and cost savings, the patient’s safety is the primary determining factor of where and at what level postoperative care is provided.2,3. • Pupil size and reaction jQuery( document.body ).on( 'click', 'a.share-facebook', function() { • Monitor vital signs regularly from q15min to q2-4h as indicated to detect signs of hypovolemia. • Provide the patient optimal pain relief with prescribed analgesics to relieve acute pain. How patients move through the phases of care in the PACU is determined by their condition. Measurement Scale Diuretics • Position patient to maximize ventilation potential. • Confusion • Consult physician if signs and symptoms of fluid and/or electrolyte imbalance persist or worsen to intervene in a timely manner. Thyroid Gland: Your thyroid gland is in the front lower part of your neck. • Other medications received preoperatively or intraoperatively Urinary retention related to supine positioning, pain, fear, analgesic and anesthetic medications, or surgical procedure, • Report deviation from acceptable parameters. • Assess for abdominal distention, presence of flatus or stool, bowel sounds, or nausea and vomiting to determine if postoperative ileus is present. Note and evaluate deviations in electrocardiographic (ECG) results from preoperative findings. Outcomes (NOC) No extremities Outcomes (NOC) Measurement Scale • Abnormal arterial blood gases Consciousness If you continue browsing the site, you … Differentiate discharge criteria from Phase I and Phase II postanesthesia care. Remove secretions by encouraging coughing or by suctioning, Encourage slow, deep breathing as well as turning and coughing, Administer skin care at the tube or drain insertion site, Inspect the area around the tube or drain insertion site for redness and skin breakdown, Monitor amount, color, and consistency of drainage from tube or drain, Obtain cultures of any suspicious drainage, Inspect the incision site for redness, swelling, or signs of dehiscence or evisceration, Cleanse the area around the incision with an appropriate cleaning solution, Cleanse the area around any tube or drain site last, Change the dressing at appropriate intervals, Determine, in collaboration with dietitian, number of calories and type of nutrients needed, Encourage calorie intake appropriate for body type and lifestyle, Describes home management of surgical wound and pain, Identifies signs and symptoms that must be reported to a health care professional, Discusses prescribed treatment regimen with health care professional ___, Performs treatment regimen as prescribed ___, Reports changes in symptoms to health care professional ___, Performs activities of daily living as prescribed ___, Appraise the patient’s current level of knowledge and understanding of content, Tailor the content to the patient’s cognitive, psychomotor, and/or affective abilities/disabilities, Provide time for the patient to ask questions and discuss concerns, Document the content presented, the materials provided, and the patient’s understanding of the information or patient behaviors, Teach the patient and/or the caregiver how to care for the incision, including signs and symptoms of infection (e.g., redness, swelling, purulent drainage, Instruct the patient on how to care for the incision, Teach patient and caregiver about signs and symptoms of infection (e.g., increased temperature) and when to report them to the health care provider, Monitor operative site for signs of hemorrhage, Report deviations from acceptable parameters, Carry out appropriate medical and nursing interventions, Observe surgical site and dressings regularly, including dependent sites (q1hr for 4 hr, then q4h), Monitor vital signs regularly from q15min to q2-4h as indicated, Report abnormalities such as decreasing blood pressure; rapid pulse and respirations; cool, clammy skin; pallor; and bright red blood on dressing. • Teach the use of nonpharmacologic adjunctive techniques (e.g., relaxation, guided imagery, music therapy, distraction, massage) before, after, and, if possible, during painful activities; before pain occurs or increases; and along with other pain relief measures for patient to use in conjunction with analgesics to obtain pain relief. Monitor for changes in mental status, such as restlessness and sense of impending doom, as indicators of inadequate cerebral perfusion. • Performs treatment regimen as prescribed ___ Risk for imbalanced fluid volume related to stress response to surgery and abnormal fluid losses and gains throughout the perioperative period 5 = Consistently demonstrated • Care during the immediate postanesthesia period Nursing Diagnosis: Airway Clearance, risk for ineffective Risk factors may include. • Delayed capillary refill • Determine the need for suctioning by auscultating for crackles and rhonchi over major airways. Three skills •Intellectual skill, •Human skill , •Technical Skill. IV hydration This should begin as soon as the patient can take p.o. • Provide frequent oral hygiene to promote comfort unless it stimulates nausea. This chapter focuses on the common features of postoperative nursing care of the surgical patient. _stq = window._stq || []; 1 THYROIDECTOMY. Uses pain relief techniques effectively, • Uses nonanalgesic relief measures _____, • Reports changes in pain symptoms to health care professional ___. Thyroidectomy or those procedures involving the removal of a part of the thyroid gland, although relatively straightforward, may be associated with serious complications. }); Oxygen Saturation return false; • Encourage calorie intake appropriate for body type and lifestyle to facilitate adequate nutrition, Readiness for enhanced self-health management as evidenced by verbalized desire to manage postoperative care and to reduce risk factors for complications, 1. However, respiratory problems may occur with any patient who has been anesthetized. postoperative ileus, p. 359 This collaborative effort fosters a smooth transfer of care to the PACU and helps determine the phase to which the patient is assigned. Fluid overload • Institute and modify pain control measures on the basis of the patient’s response to individualize care.
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