PERIOPERATIVE NURSING
RLE
LECTURE
HONEYMEL VINCE
PERIOPERATIVE NURSING Pre-admission Testing
The care of a client or patient before, during, Initiates initial preoperative assessment.
and after and operation. It is a specialized Initiates teaching appropriate to patients to
nursing area wherein a registered patient’s needs.
nurse works as a team member of other Verifies completion of preoperative testing.
surgical health care professionals. Verifies understanding of surgeon-specific
Reasons preoperative orders (e.g. bowel preparation,
o To cure an illness or disease by preoperative shower)
removing the diseased tissue or organs. Assess patient’s need for postoperative
o To visualize internal structures during transportation and care.
diagnosis. Admission to Surgical Center or Unit
o To obtain tissue for examination. Completes preoperative assessment.
o To prevent disease or injury. Assess for risk for postoperative
o To improve appearance. complications.
Reports unexpected findings or any
o To repair or remove traumatized tissue
deviation from normal.
and structures.
Verifies that operative consent has been
o To relieve symptoms or pain.
signed.
Reinforce previous teaching.
CLASSIFICATIONS OF SURGICAL Explain phase in perioperative period and
PROCEDURES expectation.
BASED ON PURPOSE Develop a plan of care.
In Holding Area
DIAGNOSTIC – establish presence of disease;
Assess patient’s status, baseline pain and
for diagnosis such as biopsy exploratory
nutritional status.
EXPLORATORY – extent of disease;
Review chart.
confirmation of diagnosis
Identifies patient.
CURATIVE/ABLATIVE – only means is to
Verifies surgical site and marks site per
treat condition; remove a diseased part
institutional policy.
PALLIATIVE – relieve distressing surgery;
Establishes intravenous line.
temporary case; colostomy, debridement of
Administers medication if prescribed.
necrotic tissue
Takes measures to ensure patient’s comfort.
COSMETIC – performed after to repair or
Provides psychological support.
enhance appearance.
Communicates patient’s emotional status to
TRANSPLANT – replace organs that are
other appropriate members of the health care
malfunctioned
team
BASED ON URGENCY
PREOP CHECKLIST
EMERGENT– immediate attention; control of
hemorrhage, perforated ulcer, intestinal Client teaching
obstruction, repair of trauma, tracheostomy Consent Forms
URGENT – can wait (24-48 hr) need prompt NPO
attention No jewellery
REQUIRED – need to have surgery but not fatal Prior voiding
ELECTIVE – pre planned; should have surgery; Side rails after surgery
amputation, colon resection, coronary artery Contact lens off
bypass, surgical removal of tumor Dentures off
OPTIONAL – suggested but depends on Nail polish off no ingrowns
patient’s decision Skin prep
VS taken within 2 hours
Preop labwork
BASED ON RISK Allergy
ID band
Preop Meds
MAJOR – extensive prolong surgery
Chart of Patient
MINOR – less risk and few complications
History and Physical assessment
PREOP MEDICATIONS
PHASES OF OPERATION
PRE-OP PHASE – when decision is made up to
when patient is transferred to the OR. The pre-
op nurse is responsible for assessing the
patient’s physical, psychologic, and social states;
preparing the patient for surgery; and
implementing nursing interventions
PERIOPERATIVE NURSING
RLE
LECTURE
HONEYMEL VINCE
Postoperative Assessment Recovery Area
Determines patient’s immediate response to
surgical intervention.
Monitor patient’s physiologic status.
Assess patient’s pain level and administers
appropriate pain relief measures.
INTRA OP PHASE – entire duration of surgery Maintains patient’s safety(airway,
until patient is transferred to PACU; continuing circulation, prevention of injury)
the assessment of the patient’s physiologic and Administer medication, fluid and blood
psychologic status, promoting safety and component therapy, if prescribed.
privacy, preventing wound infection, and Assess patient’s readiness for transfer to in-
promoting healing. hospital unit or for discharge home based on
institutional policy.
Maintenance of Safety
Transfer to Surgical Unit/Ward
Maintains aseptic, controlled environment.
Effectively manages human resources, Continues monitoring of patient’s physical
equipment, and supplies for individualized and psychological response to surgical
patient care. intervention.
Transfer patient to operating room bed or Provides teaching to patient during
table. immediate recovery period.
Position the patient: function alignment, Assist patient in recovery and preparation
exposure of surgical site. for discharge home.
Applies grounding device to patient. Determines patient’s psychological status
Ensure that the sponge, needle, and Assist with discharge planning.
instrument counts are correct.
Completes intraoperative documentation. Home or Clinic
Physiologic Monitoring Provides follow-up care during office or
clinic visit or by telephone contact.
Calculates effect on patient of excessive Reinforce previous teaching and answer
fluid loss or gain. patients and family questions about surgery
Distinguishes normal from abnormal and follow-up care.
cardiopulmonary data. Assess patient’s response to surgery and
Reports changes in patient’s vital signs anesthesia and their effects on body image
and function.
POST OP PHASE – from recovery room and
ends with a follow-up evaluation in the clinical NOTE: monitor VS every 15 mins for 2 hrs; 30
setting or at home. mins for 2 hrs;
Some of the responsibilities entailed during Initial Assessment
postoperative phase are:
Airway patency
Nursing interventions include monitoring vital Effective respiration
signs, airway patency, and neurologic status; Presence of artificial airways
managing pain; assessing the surgical site; Ventilation
assessing and maintaining fluid and electrolyte Circulatory status & VS
balance; and providing a thorough report of the Fluid balance
patient’s status to the receiving nurse on the unit, Level of consciousness & pain
as well as the patient’s family.
Ongoing Assessment
Communicates intraoperative information
Respi function
Identifies patient by name. General condition
States type of surgery performed. VS
Identifies type of anesthetic used. Cardiovascular condition
Reports patient’s response to surgical Fluid status
procedure and anesthesia. Pain level
Describes intraoperative factors (e.g., Bowel and urinary elimination
insertion of drains or catheters,
administration of blood, analgesic agents, PRINCIPLES OF STERILITY
or other medications during surgery,
occurrence of unexpected events.
Describes physical limitations.
Reports patient’s preoperative level of
consciousness.
PERIOPERATIVE NURSING
RLE
LECTURE
HONEYMEL VINCE
You should take certain (but not all) blood
pressure medications with a sip of water as
instructed by your healthcare provider.
WHAT HAPPENS DURING?
Administers one type or a combination
of anesthetics for pain therapy, and
possibly antinausea medications.
ANESTHESIA Monitor vital signs, including blood
Treatment using drugs called anesthetics. This pressure, blood oxygen level, pulse and
drugs keep you from feeling pain. heart rate.
Anesthesiologists are medical doctors who Identifies and manages problems, such
administer anesthesia and manage pain. as an allergic reaction or a change in
vital signs.
Anesthesia temporarily blocks sensory/pain Provides postsurgical pain management
signals from nerves to the centers in the brain.
Your peripheral nerves connect the spinal cord RISKS OR BENEFITS
to the rest of your body.
Side effects
TYPES OF ANESTHESIA
LOCAL – numbs small section of body; dental Back pain or muscle pain.
procedure, biopsy; awake at this procedure Chills caused by low body temperature
(hypothermia).
REGIONAL – Block the pain in a larger part of Difficulty urinating.
your body, such as a limb or everything below Fatigue.
your chest. Can be awake or sedated thru Headache.
regional anesthetic Itching.
Nausea and vomiting.
Epidural – to ease pain Pain, tenderness, redness or bruising at
Spinal for hip or knee surgery the injection site.
Arm block for hand surgery Sore throat (pharyngitis).
GENERAL - makes you unconscious and Potential Complications
insensitive to pain or other stimuli. Used for
more invasive surgical procedures, or Anesthetic awareness
procedures of the head, chest, or abdomen. Collapsed lung (atelectasis)
Malignant hyperthermia
SEDATION - relaxes you to the point where Nerve damage
you will have a more natural sleep, but can be Postoperative delirium
easily aroused or awakened.
NURSING RSPONSIBILITES BEFORE ANES
HOW IS IT ADMINISTERED?
Delivered via Validate Informed Consent
Proper Identification of Patient
Inhaled gas – LMA, GETA Proper Positioning
Injection, including shots or Lateral Dorsal Recumbent Position – or
intravenously (IV) -- TIVA Lateral decubitus Position
Topical (applied to skin or eyes) liquid, Sitting position with curve posterior
spray or patch. back
HOW TO PREPARE FOR IT? Observed aseptic technique all
throughout the Procedure
Avoid food and drinks for eight hours before Perform skin prep
you go to the hospital unless directed
NURSING RSPONSIBILITES AFTER ANES
otherwise
Quit smoking, even if it’s just for one day Assist patient to assume supine position
before procedure Assess Vital signs
Stop taking herbal supplements for one to Assess for complication (Spinal
two weeks before the procedure as directed Hypotension) or in layman’s term spinal
by your provider. headache – manifested by sudden drop
Not take Viagra® or other medications for Of Blood Pressure
erectile dysfunction at least 24 hours before
the procedure. WHEN TO CALL THE HEALTH PROVIDER
Difficulty breathing
PERIOPERATIVE NURSING
RLE
LECTURE
HONEYMEL VINCE
Extreme itching, hives or swelling
Numbness or paralysis anywhere in your
body
Slurred speech
Trouble swallowing
