REST

The primary reason for prescribing rest as a therapeutic measure for the medical patient is to prevent further damage to the body or a part of the body when the normal demand of use exceeds the ability to respond. However, prolonged or indiscriminate use of rest, particularly bed rest, is potentially hazardous. Some of the common complications occurring as a result of prolonged bed rest are:

Circulatory problems, such as development of thrombi and emboli, and subsequent skin problems, such as decubiti.

Respiratory problems, such as atelectasis and pneumonia.

Gastrointestinal problems, such as anorexia, constipation, and fecal impactions.

Urinary tract problems, such as retention, infection, or the formation of calculi.

Musculoskeletal problems, such as weakness, atrophy, and the development of contractures.

Psychological problems, such as apathy, depression, and temporary personality changes.

The key concept in the therapeutic management of the patient on prolonged bed rest is the prevention of complication resulting from this one aspect of the total care regimen. Awareness of the potential hazards is the first step in prevention. Alert observations of skin condition, respirations, food and fluid intake, urinary and bowel habits, evidence of discomfort, range of motion, and mood are critical elements that provide data indicating impending problems. When this data is properly reported, the health care team has time to employ measures that will arrest the development of preventable complications.

THE SURGICAL PATIENT

Surgical procedures are classified into two major categories: emergency and elective. Emergency surgery is that required immediately to save a life or maintain a necessary function. Elective surgery is that which, in most cases, needs to be done but can be scheduled at a time beneficial to both the patient and the provider. Regardless of the type of surgery, every surgical patient requires specialized care at each of four phases. These phases are classified as preoperative, operative, recovery, and postoperative. The following discussion will address the basic concepts of care in each phase.

PREOPERATIVE PHASE

Before undergoing a surgical procedure, the patient must be in the best possible psychological, spiritual, and physical condition. Psychological preparation begins the moment the patient learns he or she is going to have an operation. The physician is responsible for explaining the surgical procedure to the patient, including the events that can be expected afterward. Since other staff personnel reinforce the physician’s explanation, all members of the team must know what the physician has told the patient. In this manner, they are better able to answer the patient’s questions. All patients approaching surgery are fearful and anxious. The staff can assist in reducing this fear by instilling confidence in the patient regarding the competence of those providing care. The patient should be given the opportunity and freedom to express any feelings or fears concerning the proposed procedure. Even in an emergency, it is possible to give a patient and the family psychological support. Often this is accomplished simply by the confident and skillful manner in which the administrative and physical preoperative preparation is done.

People who face operations are often afraid. This fear can be related to fear of anesthesia, body disfigurement, pain, and even death. Frequently, religious faith is a source of strength and courage for these patients. If a patient expresses a desire to see a clergyman, every attempt should be made to arrange a visit.

Except in emergencies, the administrative preparation usually begins the day before surgery. Since the step-by-step procedure is clearly delineated in the Nursing Procedures Manual, in the section titled “Preoperative Care,” the entire procedure will not be repeated here. The Request for Administration of Anesthesia and for Performance of Operations and Other Procedures (SF 522) will be addressed here. This document identifies the operation or procedure to be