1-4. SURGICAL EXPERIENCE
Surgery is an important event in any individual's life. It represents a serious decision involving the patient's body and his health. It also produces physical and psychological stress on the body relative to the extent of the surgery and injury to the tissue involved. The patient must understand what is proposed, understand all the risks, and give his consent.
a. Physical Stress. Surgery produces actual physical damage to tissues of the body.
(1) An incision is a cutting of the skin and other tissues. The internal organs and tissues of the body are handled by the surgeon and assistants. This could lead to bruising of tissues, injury to tissues, or inflammation of tissues that could result in pain after the anesthesia wears off.
(2) Incisions through the skin and mucous membranes penetrate the protective barriers of the internal organs. This puts a patient at risk of microorganisms entering the body and causing infection. Surgery requires strict attention to aseptic technique, use of sterile materials, and thorough disinfecting of the skin around the operative site.
(3) The effects of anesthesia and other medications tend to last well into the postoperative recovery period. These drugs could have a depressant effect on the body; they decrease pain and reduce awareness of one's surroundings. The effect on the body systems is to slow the systems down and make them hypoactive.
b. Psychological Stress. The physical stress of surgery is greatly enhanced by the psychological stress of anxiety and worry, which uses up energy that is needed for healing of tissues in the postoperative period. When surgery is needed, one's deepest and worst fears are often felt. A preoperative patient may experience a number of fears. However, the following fears are common among surgical patients:
(1) Loss of part of the body.
(2) Unconsciousness and the inability to know or control what is happening.
(5) Separation from family.
(6) Effects of surgery on home and employment.
(7) Exposure of his body to strangers.
c. Managing Preoperative Fears. Psychological preparation of the patient before surgery can not be overlooked. Along with other members of the health care team, the practical nurse must show warmth, sensitivity, and caring to the patient. Each patient may express his fears in different ways. You may find that a patient may not talk about his fears. He may be quiet and withdrawn, cry, or talk constantly. Some patients may prefer pacing, be extremely cheerful, or, on the other hand, exhibit unusual behavior. You, as a practical nurse, must recognize these fears and deal with them properly. You can help to manage preoperative fears by:
(1) Providing an opportunity for the patient to describe his reactions and feelings in the stressful situation.
(2) Providing or reinforcing patient teaching.
(3) Arranging for a clergy to visit if the patient desires. (Religious faith can be a strong source of strength.)
(4) Being truthful and honest when answering patient questions. If there are questions that you should not or are unable to answer, refer them to the Charge Nurse or physician.