stress response and type of surgery – In surgical trauma apart from compensating for the direct effect of anesthesia and surgical tissue manipulation, rnetabolic and endocrine changes, the body has to compensate for the specialized trauma. A person convalescing after surgeryusually undergo following four phases:
Soon after injury tissue loose protein mostly from skeletal muscles and fat. This is called catabolic stage. This loss of protein is reflected in an increase in secretion of urinary nitrogen and causes negative nitrogen balance. Accumulation of fluid and electrolytes associated with injury increases the extra cellular fluid space and reducing functional capacity of the cells. This change may reduce or halt the periostitic movements of’ the bowel.
Usually after 3rd day of the injury or operation the protein loss from the tissues lessons, urinary nitrogen level significantly decreases. Peristalsis begins to return and diuresis of salt and water begins.
SEE ALSO : Pain and theory of pain transmission
This phase is described as anabolic stage. Rebuilding of protein by skeletal muscles begins. In this stage provision of nutritious diet is important to supply necessary protein and vitamins specially Vitamin C and B.
‘This is all extended convalescence period. In this phase nitrogen balance become normal, body fluid balance stabilizes. Maximum wound strength is obtained within three weeks after. surgery. Patient continues to gain weight during later weeks and months after surgery. In addition lo these phases patient’s body image in some cases may also get altered because of the physiological changes after surgery or trauma. This threatens one’s sell-concept, causing tension and anxiety. You may recall your knowledge of psychology in which you have learnt that body image is so firmly established that adoption to any change in this regard is very slow. You might have come across patients aster limb amputation who sometime get sensation of having limb. A person who lost eyesight sometime feels flushes of light coming to the eyes. Your role as a nurse in such situation is to allow opportunities to individual to get used to altered body image and experiments with new self.
stress response and type of surgery –Timing and types of SURGERY
- Optional surgery is scheduled completely at the preference of the patient, e.g., cosmetic surgery.
- Elective surgery is planned one and at the convenience of patient. e.g., removal of small superficial cyst.
- Required -The condition Required surgery within a few week eg. Eye catract
- Urgent-Surgery within 24-48 hrs, e.g., cancer
- Emergency requires immediate surgical attention without delay, eg. intestinal obstruction.
There may be emergency or elective operation as follows:
The purpose of emergency operation is either to save life or prevent the development of any serious complication. You may recall examples of emergency operations from your experience viz. acute appendicitis, ruptured peptic ulcer, laceration, fracture etc. These be performed to prevent shock, haemorrhage and infection, pre-operative period is very short.
Elective surgery allows enough time to study the patient’s condition thoroughly and prepare adequately for the operation. However, all operations produce certain degree of trauma and can be dangerous to patient. Hence, every possible precautions should be taken for hypertension, diabetes, infection, anxiety, etc., before posted for operation.