Surgery is a significant intervention that addresses a wide range of health conditions, but it also presents unique challenges and potential complications for patients. Effective nursing care is paramount in ensuring patient safety and promoting optimal recovery throughout the surgical journey. A cornerstone of this care is the accurate identification and management of nursing diagnoses for surgery. These diagnoses are clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes in the perioperative setting. Understanding and addressing these diagnoses is crucial for nurses to develop personalized care plans that facilitate positive patient outcomes. This article will explore common nursing diagnoses associated with surgical patients, focusing on the principles of care and interventions that enhance recovery and minimize risks.
Understanding Nursing Diagnoses in Surgical Settings
Nursing diagnoses provide a standardized framework for nurses to communicate patient needs and guide care planning in the complex surgical environment. Unlike medical diagnoses, which focus on disease pathology, nursing diagnoses describe a patient’s response to illness or health conditions, including the surgical experience itself. In the context of surgery, nursing diagnoses are essential for anticipating potential problems, addressing existing issues, and promoting wellness in patients undergoing surgical procedures. They encompass the patient’s physical, psychological, and emotional responses to surgery, ensuring a holistic approach to care. By utilizing nursing diagnoses, healthcare teams can create individualized care plans that prioritize patient needs and optimize recovery.
Common Nursing Diagnoses Related to Surgery
The surgical experience can be broadly divided into pre-operative, intra-operative, and post-operative phases, each presenting distinct nursing considerations and potential diagnoses.
Pre-operative Nursing Diagnoses
The pre-operative phase is critical for preparing patients physically and emotionally for surgery. Common nursing diagnoses in this phase include:
Anxiety related to the surgical procedure, anesthesia, potential outcomes, pain, and changes in body image or lifestyle. Patients facing surgery often experience significant anxiety stemming from fear of the unknown, concerns about pain management, and the potential impact of surgery on their lives.
Deficient Knowledge regarding the surgical procedure, pre-operative routines, post-operative expectations, pain management strategies, and discharge instructions. Lack of understanding can increase anxiety and hinder patient cooperation with the treatment plan.
Fear related to potential surgical outcomes, pain, anesthesia, or death. Fear is a natural emotional response to the perceived threat of surgery and needs to be acknowledged and addressed by the nursing staff.
Intra-operative Nursing Diagnoses
During the intra-operative phase, the focus shifts to maintaining patient safety and physiological stability throughout the surgical procedure. Key nursing diagnoses during surgery include:
Risk for Perioperative Positioning Injury related to prolonged immobility, anesthesia, and positioning during surgery. Surgical positioning, while necessary for procedure access, can compromise circulation and nerve function if not carefully managed.
Risk for Infection related to the invasive nature of surgical procedures and potential breaks in skin integrity. Maintaining a sterile environment and adhering to strict aseptic techniques are paramount in preventing surgical site infections.
Risk for Imbalanced Body Temperature related to anesthesia, exposure of body cavities, and the surgical environment. Anesthesia can disrupt thermoregulation, and prolonged surgical procedures can lead to hypothermia, increasing the risk of complications.
Post-operative Nursing Diagnoses
The post-operative period focuses on recovery, managing complications, and facilitating the patient’s return to optimal function. Frequently encountered post-operative nursing diagnoses include:
Acute Pain related to surgical incision, tissue manipulation, inflammation, and potential nerve damage. Post-operative pain is expected, and effective pain management is crucial for patient comfort, mobility, and overall recovery.
Impaired Physical Mobility related to surgical procedure, pain, weakness, and musculoskeletal impairment. Surgery, particularly orthopedic procedures like knee replacement, often leads to temporary limitations in mobility.
Risk for Infection related to surgical incision, invasive devices (drains, catheters), and impaired skin integrity. Surgical site infections remain a significant post-operative concern, requiring vigilant monitoring and preventative measures.
Risk for Deep Vein Thrombosis (DVT) related to immobility, surgical trauma, and hypercoagulability associated with surgery. DVT is a serious post-operative complication, especially following orthopedic surgeries, and requires prophylactic interventions.
Ineffective Airway Clearance related to anesthesia, pain, decreased mobility, and potential effects of pain medications. Post-operative patients may experience respiratory complications, especially those with pre-existing respiratory conditions or after surgeries involving general anesthesia.
Disturbed Body Image related to surgical scarring, alterations in body function, or presence of ostomies or prostheses. Surgery can impact a patient’s perception of their body, leading to concerns about appearance and self-esteem.
Deficient Self-Care related to pain, decreased mobility, weakness, and post-operative restrictions. Patients recovering from surgery often require assistance with activities of daily living due to physical limitations and discomfort.
Specifically in the context of knee replacement surgery, which is detailed in the original article, the primary nursing diagnoses highlighted are:
- Acute Pain: Directly related to the surgical trauma and inflammation.
- Impaired Physical Mobility: A key concern due to the nature of the surgery and the joint involved.
- Risk for Infection: Always a relevant diagnosis with any surgical procedure involving implants.
These diagnoses are thoroughly explored in the original article with detailed related factors, assessment criteria, expected outcomes, and nursing interventions. Let’s briefly revisit the nursing care plan examples for knee replacement surgery from the original text, focusing on the core elements:
Acute Pain (Post-Knee Replacement)
Related to: Effects of surgery, inflammatory process, surgical intervention, muscle spasms, nerve damage, presence of prosthesis, joint tenderness.
As evidenced by: Altered physiological parameters, diaphoresis, facial expressions of pain, reports of pain, guarding behavior.
Expected outcomes: Patient will report decreasing pain, demonstrate pain relief interventions.
Nursing Interventions: Pain assessment, vital signs monitoring, proper positioning, pain medication administration, non-pharmacologic pain relief techniques, pre-medication before physical therapy.
Impaired Physical Mobility (Post-Knee Replacement)
Related to: Musculoskeletal impairment, joint pain, surgical intervention, presence of prosthesis, joint stiffness.
As evidenced by: Altered gait, decreased range of motion, difficulty ambulating, postural instability, slowed movement.
Expected outcomes: Patient will demonstrate independence in ambulating, participate in physical therapy.
Nursing Interventions: Mobility assessment, cause of impaired mobility assessment, proper joint positioning, continuous passive motion (CPM) use, assistive device utilization, physical therapy referral, encouragement of rehabilitation adherence.
Risk for Infection (Post-Knee Replacement)
Related to: Inadequate primary defenses, impaired skin integrity, invasive procedure, prosthesis implantation, decreased mobility.
Expected outcomes: Patient will remain free from infection, demonstrate wound healing, demonstrate infection prevention interventions.
Nursing Interventions: Infection signs assessment, laboratory value review, risk factor assessment, aseptic technique for wound care, patient education on infection symptoms, surgical site pain assessment, antibiotic administration, follow-up consultation emphasis.
Nursing Care Planning and Interventions Based on Diagnoses
Nursing diagnoses are not merely labels; they are the foundation for developing individualized nursing care plans. Once nursing diagnoses are identified, nurses can formulate specific, measurable, achievable, relevant, and time-bound (SMART) goals for patient outcomes. These goals then guide the selection of appropriate nursing interventions aimed at resolving the identified problems, preventing potential complications, and promoting the patient’s return to optimal health.
For example, for a patient with the nursing diagnosis of “Anxiety related to surgery,” interventions might include: providing detailed pre-operative education, offering emotional support and reassurance, utilizing relaxation techniques, and facilitating communication with the surgical team. For “Risk for Infection,” interventions would focus on meticulous wound care, aseptic technique during invasive procedures, monitoring for signs of infection, and patient education on hygiene and wound care at home.
The nursing process—Assessment, Diagnosis, Planning, Intervention, and Evaluation—is cyclical. Nurses continuously assess the patient’s condition, refine diagnoses as needed, adjust the care plan based on the patient’s response to interventions, and evaluate the effectiveness of care in achieving desired outcomes.
Conclusion
Nursing diagnoses for surgery are indispensable tools for perioperative nurses. They provide a structured and patient-centered approach to care, ensuring that the unique needs of surgical patients are recognized and addressed throughout their surgical journey. By accurately identifying and managing these diagnoses, nurses play a critical role in promoting patient safety, minimizing complications, enhancing recovery, and ultimately contributing to positive surgical outcomes. The focus on patient-specific responses to surgery, rather than just the medical procedure itself, underscores the vital contribution of nursing to the holistic care of individuals undergoing surgical interventions.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Knee Replacement. NHS. Reviewed: August 2, 2019. From: https://www.nhs.uk/conditions/knee-replacement/
- Knee Replacement Surgery Procedure. Johns Hopkins Medicine. 2022. From: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/knee-replacement-surgery-procedure
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, Ph.D., FAADN, CNE. 2020. Elsevier, Inc.
- Total Knee Replacement. OrthoInfo. Jared R. H. Foran, MD, FAAOS. Reviewed: June 2020. From: https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/
- NANDA International, Inc. (2018). Nursing diagnoses: Definitions and classification 2018-2020. Eleventh edition. New York, NY: Thieme Medical Publishers, Inc. (Added for more authority on nursing diagnoses).
