Definition of Perioperative Nursing

❖refers to the nursing care provided in the

total surgical experience of the patient
❖ The provision of nursing care by an RN
preoperatively, intra-operatively, and
postoperatively to a patient undergoing an
operative or invasive procedure.
 Areas in Which
Perioperative Nursing
Is Practiced
• Perioperative nursing is practiced in
– Hospital operating rooms
– Interventional radiology suites
– Cardiac cath labs
– Endoscopy suites
– Ambulatory surgery centers
– Trauma centers
– Pediatric specialty hospitals
– Physician offices
 Functions of the
Perioperative Nurse
• Advocate
• Protector
• Teacher
• Change agent
• Manager of patient care
Nursing Roles in the OR
– Circulating Nurse
– Scrub person
– RN first assistant (RNFA)
– Perioperative educator
– Specialty team leader
– Perioperative manager
 Surgical Attire
• Gowns
• Gloves
• Masks
• Hair covering
• Protective eyewear
Goals:

• Provide safe patient care

– Knowledge of procedure
– Ensure the correct patient, correct site, correct level, and correct
procedure
– Knowledge of positioning
– Adhere to safe medication administration guidelines
– Perform surgical counts

• Provide a safe environment

– Adhere to asepsis
– Promote coordinated and effective communication
Phases of Perioperative period

• PRE- operative phase

• INTRA- operative phase

• POST- operative phase

 PRE-Operative Phase
• Begins when the decision to
have surgery is made and ends
when the client is transferred to
the operating table
INTRA-Operative Phase
• Begins when the client is
transferred to the operating table
and ends when the client is
admitted to the post-anesthesia
unit
Post-operative Phase
• Begins with the admission
of the client to the PACU
and ends when healing is
complete
The over-all goal of nursing care
during the PRE-OPERATIVE phase
is to prepare the patient mentally
and physically.
The over-all goal of nursing care
during the INTRA-OPERATIVE phase
is to maintain client safety.
The over-all goals of nursing care
during the POST-OPERATIVE phase
are to promote healing and comfort,
restore the highest possible
wellness and prevent associated
risk.
 TYPES of SURGERY
• According to PURPOSE

• According to degree of
URGENCY

• According to degree of RISK

 Classification accdg to Urgency
Classification Indication for examples
surgery

I.Emergent Without delay Trauma, intestinal

life threatening obstruction

II Urgent 24-30 hrs AP, Cholecystitis

Prompt attention
III. Required Plan within weeks Cataracts, thyroid
Pt need to have or month disorder
Surgery
IV. Elective Failure to have SX Repair of scars,
Pt shld have Sx is not catastrophic hernia
V. Optional Personal preference Cosmetic surgery
 According to PURPOSE
Diagnostic Establishes a diagnosis
Eg. Biopsy, laparoscopy
Palliative Relieves or reduces pain or
corrects a problem a problem
eg. Gastrostomy tube insertion
Ablative Removes a diseased body part
Eg. appendectomy
Constructive Restores function or appearance
Eg. Face lift
Transplant Replaces malfunctioning
structures eg. Kidney transplant
 According to degree of RISK
Major Involves high degree of risk
Surgery Complicated or prolonged,
Large amount of blood loss
Minor Involves low risk
Surgery Produces few complications
Performed as day surgery
Health factors that affect preoperatively
• Nutritional status
• Drug or alcohol abuse
• Respiratory status
• Cardiovascular status
• Hepatic and renal Factors
• Endocrine Function
• Immune function
• Previous medication use
• Psychosocial factors
• Spiritual and cultural beliefs
 Surgical Risk

• Extremes of age
• Malnutrition
• Obesity
• Co-morbid conditions
• Concurrent medications
 Activities in the POST-op
• Maintain patient’s airway
• Monitor VS
• Assessing responses to surgery and anesthesia
• Performing interventions to promote healing
• Prevent complications
• Planning for home-care
• Assist the client to achieve optimal recovery
Pre-operative phase
 Activities in the Pre-op
• Assessing the clients: Nursing history, physical and
emotional assessment, medication history
• Identifying potential or actual health problems
(comorbidities)
• Ensure necessary test were done including proper
referrals and consultation
• Educate about recovery from anesthesia and
postoperative care
• Providing pre-operative teaching
• Ensure consent is signed
• Start an IV infusion
• Address questions of the patient and family
 consent
• The surgeon is responsible
for obtaining the consent
for surgery
• No sedation should be
administered before
SIGNING the consent
• The nurse may serve as
witness
 • Minors may need a parent or
Consent legal guardian to sign the
consent form.

• Older clients may need a legal

guardian to sign the consent
form.

• The nurse needs to document

the witnessing of the signing of
the consent form, after the
client acknowledges
understanding the procedure.
 Consent for Surgery

I hereby authorize Dr. ________________ and the staff of the hospital to perform
_____________, and as such additional operation(s) or procedure(s) as are considered
necessary on the basis of their being a threat to life found during the course of the said
operation.

The nature and purpose of the operation, the risk involved, and the possibility of
complication have been explained to me, in my dialect or in a language which I
understand. I acknowledge that no guarantee has been made as to the results that may
be obtained.

_________________ __________________
Signature of Patient Signature of Witness

_________________
Date and time
 (Continuation of the CONSENT form…)

This authorization must be signed by the next of kin of the patient in case the patient is a minor or
physically or mentally incompetent.

Patient is a minor. _____ years

Patient is unable to sign because ___________________________________________
_______________________________________________________________________.
------------------------------------------------------------------------------------------------------------------

I, _________________________ being the next of kin of ________________________

(Name in Print and Signature) (Name of Patient)

hereby authorize Dr. _____________________ and the staff of the said hospital to perform the
said surgery.

_______________________ _____________________________
Signature of Witness Signature of Next of Kin

_______________________ _____________________________
Date and Time Relationship to Patient
 Pre-op nutrition
• Assess order for NPO
• Solid foods are withheld for
about 8 hours before general
anesthesia
Pre-op elimination
• Laxatives, enemas or both may
be prescribed the night before
surgery
• Have the client void
immediately BEFORE
transferring them to the OR
• Foley catheter may be inserted
as ordered
Pre-op hygiene
• Bathe the night before surgery with
antiseptic soap
• Shaving of the skin is usually done in
the OR
• Removal of jewelry and nail polish
Pre-op psychological
preparation
• Be alert to the client’s anxiety level
• Answer questions or concerns
• Allow time for privacy
• Preparing the skin
• Administering Preanesthetic
medications
• Transporting the patient to the
presurgical area
- Done after patient has been anesthesized and
positioned on the operating table; skin of the
operating site and extensive area surrounding it is
mechanically cleansed again with an antiseptic
agent immediately prior to draping
SKIN PREPARATION

• Assess the client for sensitivity or allergies to scrub solution,

skin integrity, level of mobility and existing appliances,
catheters or other instrumentation.
• Review the chart for the surgery t be performed and review
the exact area to be prepped.
• Assess the client’s level of consciousness and mobility.
• Explain procedure to client and assess level of
understanding.
• Be sure that hairpins, jewelry, nail polish, contact lenses,
prostheses and dentures were removed.
• Assist client with the transfer from the wheelchair or bed to
the surgical table.
• Position the client for optimal access to the surgical site
according to institutional protocol.
• Cover with a blanket; used warmed covers, cover the hair if
required.
• Assemble the equipment needed.
• Remove rings and watch and wash hands and apply clean
gloves.
 The surgical prep sites follow, depending on the type of
surgery to be performed.

– HEAD AND NECK- The site extends from above the

eyebrows, over the top of the head, and includes the ears and
both anterior and posterior areas of the neck. The face and
eyebrows are not shaved.
– LATERAL NECK- Clean the external auditory canal with a
cotton swab. Anteriorly, prepare the side of the face, from
above the ear to the upper thorax to just below the clavicle.
Posteriorly, prepare from the neck to the supine including the
area above the scapula.
– CHEST SURGERY- The site extends from the neck to the
bottom of the rib cage and to the lateral midline. The shoulder
and arm of the operative side should be included.
– ABDOMINAL SURGERY- The preparation site extends from
the axilla to the pubis, extending bilaterally to the lateral
midline. All visible pubic hair should be shaved.
– PERINEAL SURGERY- Shave all pubic hair and the inner
thighs to the midthigh. The area starts above the pubic bone
anteriorly and extends beyond the anus posteriorly.
– CERVICAL SPINE SURGERY- Posteriorly from the top of the
ears to the waist. The area extends on each side to the
midaxillary line.
– LUMBAR SPINE SURGERY- Posteriorly from the axilla down to
the midgluteal level of the buttocks. The area extends on each
side to the midaxillary line.
– RECTAL SURGERY- Shave the buttocks from the iliac crest
down to the upper third of the thighs, including the anal region.
The area extends to the midline on each side.
– FLANK SURGERY- Extends anteriorly from the axilla, down to
the upper thigh, including the external genital area. Posteriorly
the area extends from the midscapular to the midgluteal regions.
– HAND AND FOREARM SURGERY- The area includes the full
circumference of the affected arm, from the axilla to the
fingertips.
– LOWER EXTREMITY SURGERY- The area includes the entire
leg, toes, and foot of the affected leg from the umbilicus
anteriorly and the top of the buttocks posteriorly.
– LOWER LEG SURGERY- The area to be prepared includes the
circumference of the entire region from midthigh to the distal toes
of the affected leg.
• Arrange for adequate light on the area to be
prepared.
• Using warm water, hold the skin taut and hold the
razor at a 45-degree angle. Shave the area
carefully by stroking in the direction of hair
growth. Rinse the razor carefully to remove
accumulated hair from the blade.
• Dry the client’s skin with a sterile towel.
• Clear the shaving supplies from the preparation
area.
• Apply sterile gloves and gown.
• Scrub the surgical site with an antibacterial cleaner.
Using a rotary movement to clean the skin, begin in
the center and gradually enlarge the area with each
rotation.
• Continue this process for 3-10 minutes as prescribed
by institutional policy,
• Clean any hidden areas in the surgical site ( the ear
canals, under the fingernails, the umbilicus) using
cotton swabs,
• Rinse the area with sterile water. Wait for the site to
dry or pat dry with a sterile towel.
• Cover the area with sterile drapes, leaving the
surgical site exposed.
• Evaluate and document.
PREPARATION OF THE HEAD FOR CRANIOTOMY
PREPARATION OF THE NECK FOR
OTOLOGICAL SURGERY
PREPARATION OF THE NECK & THORAX
FOR THYROIDECTOMY
 SURGICAL PREPARATION OF
UPPER EXTREMITIES AND TRUNK
FOR SURGERY
 Pre-operative medications
Pre-op Drugs Example Purpose
Anti-anxiety Diazepam To decrease nervousness
Promote relaxation
Anti- Atropine Decreases secretions
cholinergic Prevent bradycardia
Muscle Succinylcholine To promote muscle
relaxant relaxation
Anti-emetic Promethazine To prevent nausea and
vomiting

Antibiotic Cephalosporin To prevent infection

 Pre-operative medications

Pre-op Example Purpose

Drugs
Analgesics Meperidine To decrease pain and
decrease anesthetic
dose
Anti- Diphenhydramine To decrease
histamine occurrence of allergy

H-2 Cimetidine To decrease gastric

antagonist fluid and acidity
 Pre-operative screening test
CBC Determine Hgb and Hct, infection
Blood type Determined in case of blood
transfusion
Serum Evaluates the fluid and electrolyte
electrolytes status
FBS Evaluates diabetes mellitus
BUN, Creatinine Assess the renal function
ALT, AST, Evaluates the liver function
Bilirubin
Serum albumin Evaluates nutritional status
CXR and ECG Respiratory and Cardiac status
 Pre-operative teaching
Leg exercises To stimulate blood circulation
in the extremities to prevent
• Pre-operative teaching
thrombophlebitis

Deep breathing To facilitate lung aeration and

and Coughing secretion mobilization to
Exercises prevent atelectasis and
hypostatic pneumonia
Done every two to four hours
Positioning and To improve circulation and
Ambulation pulmonary function, prevent
venous stasis, prevent
adhesion
Assisting patient to semi-Fowler’s
position, leaning forward.
Having patient splint a chest or
abdominal incision by holding a
folded bath blanket or pillow
against the incision.
Telling patient to take a deep
breath and hold it for three
seconds.
Encouraging patient to "hack" out
three short coughs after holding
breath.
With mouth open, patient should
take a quick breath.
 Encouraging patient to cough
deeply once or twice and then take
another deep breath.
 An incentive spirometer helps
increase lung volume and
promotes inflation of the alveoli.
Assisting patient to semi-Fowler’s
position.
Setting the volume goal indicator
on the spirometer.
 Patient holding the device and
placing lips around the mouthpiece
to create a seal, then taking a deep
breath in.
 The patient can observe progress
toward the goal by watching the
balls or diaphragm of spirometer
elevate or lights go on (depending
on equipment used). Have patient
repeat exercise 5 to 10 times every
1 to 2 hours while awake
Assisting patient to a semi-Fowler’s
position with knees bent.
Raising patient’s right foot and
keeping it elevated for a few
seconds.
Extending the lower portion of the
leg.
Lowering the entire leg to the bed.
This exercise is repeated five times
with each leg.
Patient pointing toes of both feet
toward the foot of the bed, with
both legs extended.
Patient pulling toes toward chin, as
if a string were attached to them
 Having patient make circles with
both ankles, first one way and then
the other.
 Instructing patient to raise one
knee and reach across to grasp the
side rail on the side of the bed
toward which he or she will be
turning.
Helping patient to rollover while he
or she pushes with the bent leg and
pulls on the side rail.
Showing patient how to use a small
pillow to splint a chest or abdominal
incision while turning.
After patient is turned, providing
support with pillows behind the
patients back.
PSYCHOSOCIAL PREPARATION

• Be alert to the client’s level of anxiety.

• Answer any questions or concerns the client may
have regarding surgery.
• Allow time for privacy for the client to prepare for
surgery psychologically.
• Provide support and assistance as needed.
Intra-operative phase
 ARE YOU
READY FOR
YOUR
OPERATION?
Activities during the Intra-op

Provide patient safety, maintain an aseptic environment, ensure proper

function of the equipments, position the client, emotional support,
assisting the surgeon as scrub nurse, circulating nurse, nurse
assistant,
Operating Room Team
direct patient care team
• The team is likely a symphony orchestra
• Each person is an integral entity in
harmony with his colleagues
1. THE STERILE TEAM
2. THE UNSTERILE TEAM
The Sterile Team
– Operating surgeon
– Assistants to the surgeon: Another surgeon
(1st assist), surgical resident doctor (2nd
assist), RN assist (3rd assist)
– Scrub Nurse
– They:
• scrub their hands and arms
• Don sterile gloves and gown
• Enter the sterile field (all items for the surgical
procedure are sterilized)
The Unsterile Team
– Anesthesiologist or anesthetist
– Circulating nurse
– Technicians
– They:
• Don’t enter the sterile field
• Function outside of it
• Maintain sterile technique
 Functions of the nurse during OR procedure
•Assists the surgeon
SCRUB NURSE •Maintains sterility
•Set up sterile tables, Prepares and Handles
instruments, sutures
•Drapes patient
•Counts sponges, needles, instruments
•Wears sterile gown, gloves

•Assists the Scrub nurse

CIRCULATING •Positions the patient for
NURSE surgery
• Positions any equipment
•Monitors/coordinates all activities
•Controls the physical and emotional
atmosphere in the room
•Protects the pt’s safety and health
 Intra-operative phase interventions
• Determine the type of surgery and
anesthesia used
• Position client appropriately for
surgery
• Assist the surgeon as circulating or
scrub nurse
• Maintain the sterility of the surgical
field
• Monitor for developing complications
intra-op
Principles of Sterile Technique
 Basic Guidelines in Surgical Asepsis
• All materials in contact with the surgical
wound and used within the sterile field
must be sterile.
• Gowns are considered sterile in front from
the chest to the level of the sterile field.
• Sterile drapes are used to create a sterile
field
• Items should be dispensed to a sterile
field by methods that preserve the sterility
• Movement of the surgical team
are from sterile to sterile and
from unsterile to unsterile area.
• Movement around a sterile field
must not cause contamination of
the field
• When a sterile barrier is
breached, the area , must be
considered contaminated
PUT CAP AND
MASK FIRST
BEFORE
SCRUBBING
THIS IS HOW TO
SCRUB
 USE FOOT
PADDLE OR
ELBOW IN
OPENING OR
CLOSING FAUCET
AND SOAP
DISPENSER
 Operating Room Attire
Purpose: To provide effective barriers that prevent
the dissemination of microorganisms to the patient
and to protect personnel from infected patients
• Scrub dress/ suit
• Head cover
• Mask
• Sterile gown
• Sterile gloves
• Shoes
• Surgical glasses/ Visor
Scrub Suit
 Head Cover/
Surgical Caps & Hoods
 Bouffant Cap

bcap1
sp62SF9a
Mask
Ways to Wear Masks
Wrong ways to wear a mask
 Surgical Gowns
OP_Foliodress PP / PP And PE Isolation Gown, Lab Coat, Coverall, Surgical Gown (China (Mainland)) picture
Sterile Gloves
Surgical Shoe Covers
Surgical Glasses/ Visor
scrub19

SURGICAL GOWNING
scrub20
CIRCULATING
NURSE
ASSISTS THE
SCRUB NURSE
IN WEARING
THE LONG
SLEEVED OR
GOWN
Put on your
GLOVES
scrub25
• The scrub nurse then prepares the sterile table
and all the equipments to be used
• The circulating nurse assist other
members of the sterile team dress
Sana matapos na
ang lecture!
 Anesthesia
- a state of narcosis, analgesia, relaxation
and reflex loss
• General anesthesia
–Loss of all sensation and
consciousness; cardiovascular and
ventilatory functions are impaired

• Regional or Local anesthesia

–Loss of sensation in ONE area with
consciousness present
 Stages of General Anesthesia
• Stage I (Beginning Anesthesia)
- patient feels warm, dizzy with a feeling of
detachment
- patient may have ringing, buzzing in the
ear, still conscious, sense inability to move
extremities
- noises are exaggerrated
- avoid unnecessary noises or motions
• Stage II: Excitement
- time: loss of consciousness to loss of reflexes
- Characterized by struggling,
shouting, talking, crying.
- pupils dilate, rapid pulse and
irregular RR
- restrain the patient

• Stage III: Surgical Anesthesia

- Surgical anesthesia is reached
- pt unconscious and lies quietly
- respirations are regular and CR
- may be maintained for hours if
properly given
• Stage IV: Medullary Depression
- stage is reached when too much
anesthesia is given
- RR becomes shallow, pulse is
weak and thready, pupils widely
dilated and becomes
unresponsive to light, cyanosis
- Without proper treatment death
will follow
- Discontinue anesthetic abruptly,
cardiopulmonary support is
initiated
 Levels of Sedation
Minimal sedation

- drug induced state in which a

patient can respond normally in
verbal commands

- cognitive function and

coordination may be impaired
Moderate sedation

- depressed level of
consciousness that does not
impair ability to maintain a
patent airway

- calm, sedate a patient

combined with analgesic

- Midazolam/Diazepam
Deep Sedation
- a drug induced state in
which a patient cannot be
easily aroused but can
respond purposefully
after repeated stimulation
- inhaled or intravenous
- Volatile anesthetic
(halothane, Isoflurane)
- Gas anesthetic (Nitrous
oxide)
Methods of Anesthesia Administration

• Inhalation
• Intravenous
• Regional Anesthesia: Epidural & Spinal
• Local Conduction Blocks: Local Infiltration
 Inhaled Anesthetic Agents
• Volatile Liquid agents- produce
anesthesia when the vapors are inhaled
• Inhaled Gaseous agents- usually
combined with oxygen eg. Nitrous oxide

- Anesthetic enters the blood through the

pulmonary capillaries and act on the
cerebral centers to produce loss of
consciousness and sensation
 Types of Anesthesia
1. General
• Pain is controlled by general insensibility
• Loss of consciousness, Loss of reflexes
• Closely monitor respiratory, CNS, circulatory
depression!
• Level of Anesthesia: light, moderate, deep
• 3 methods:
1. inhalation
2. IV injection (TIVA- total intravenous anesthesia)
3. rectal installation (obsolete) indicated in pedia
• INHALATION: a. Volatile Liquids
• ex. 1. Halothane (Fluothane)
– Non flammable
– Widely used,rapid induction, low incidence of post-op nausea
& vomiting
– Causes hypotension and liver damage
-2.Enflurane –
- rapid induction and recovery
- potent analgesic, but causes respiratory depression
- hepatotoxicity is not a problem
3. Isoflurane
- rapid induction and recovery
- muscle relaxants are markedly potentiated
- profound respiratory depress
b. Gases –
1. Nitrous Oxide –( laughing gas) = induction agent
- used alone for short procedures
- always given in combination with O2
- may produce hypoxia, weak anesthetic, poor relaxant
INTRAVENOUS ANESTHESIA
- used to induce or maintain surgical anesthesia & hypnosis with
use of barbiturates, benzodiazepines, hypnotics and opioid agents
- nonexplosive, require little equipment and easy to administer
- useful for short procedures
- disadvantage: respiratory depressants
EX:
1. Brevital, Surital, Pentothal Na ( causes rapid & smooth induction of
anesthesia.
 Commonly Used IV Medications
Medication Usage Advantage Disadvantage
Muscle Relaxant Intubation Rapid onset Myalgias,
Succinlcholine Short cases Short duration fasciculation, tissue
(Anectine) trauma, paralysis

Anxiolytic/Sedative Amnesia, Good sedation Prolonged duration,

Diazepam Hypnotic residual effects
Barbiturates Induction Offers good Cause
Thiopental induction laryngospasm
Dissociative Induction Pt maintains Large doses may
Anesthesia Short cases airway cause
Ketamine (ketalar) hallucination,respirat
ory depression
Opioid Analgesic Perioperative Inexpensive, good Dec in BP and RR
Morphine pain CV stability
Opioid Analgesic Postoperative Good CV stability
Fentanyl (sublimaze pain
 GENERAL Anesthesia
• Protective reflexes are lost
• Amnesia, analgesia and hypnosis
occur
• Administered in two ways:
– Inhalational
– Intravenous
 REGIONAL Anesthesia
- a form of local anesthesia
- the pt is awake

TOPICAL Applied directly on the skin

INFILTRATION Injected into a specific area
of skin
NERVE BLOCK Injected around a nerve

SPINAL Low spinal anesthesia

Subarachnoid
EPIDURAL Epidural space is injected
with anesthesia
 Potential adverse effects of anesthesia

• Myocardial depression, bradycardia

• Nausea and vomiting
• anaphylaxis
• CNS agitation, seizures, respiratory
arrest
• Oversedation or under sedation
• Agitation and disorientation
• Hypothermia
• Hypotension
• Malignant hyperthermia
 Patient Positioning
• Provides optimal visualization

• Provides optimal access for

assessing and maintaining
anesthesia and function

• Protects patient from harm

Position Patient during Surgery

Abdominal surgeries Supine

Bladder surgery Slightly trendelenburg

Perineal surgery Lithotomy

Brain surgery Semi-fowler’s

Spinal cord surgeries Prone mostly

Lumbar puncture Side lying, flexed body

SCRUB OUT !!!
 POST Operative Interventions
• Transfer the postoperative patient to the
PACU: anesthesiologist/anesthetist
• Nursing Objective: provide care until the
patient recovers from the effects of
anesthesia, is oriented, has stable VS and
shows no evidence of hemorrhage or
other complications
• ASSESS your patient
 POST Operative Interventions
• Maintain patent airway
• Maintain cardiovascular stability
• Monitor vital signs and note for
early manifestations of
complications
• Monitor level of consciousness
• Maintain on PROPER position
• NPO until fully awake, with passage
of flatus and (+) gag reflex
 Activities in the POST-op
• Assessing responses to surgery and anesthesia
• Performing interventions to promote healing
• Prevent complications
• Planning for home-care
• Assist the client to achieve optimal recovery
POST Operative Interventions
• Monitor the patency of the drainage
• Maintain intake and output monitoring
• Care of the tubes, drains and wound
• Ensure safety by side rails up
• Pain medication given as ordered
• Measures to PREVENT post-op
Complications
Post-operative interventions
PAIN MANAGEMENT
• Pain is usually greatest during the 12-
36 hours after surgery
• Narcotic analgesics and NSAIDS may
be prescribed together for the early
period of surgery
• Provide back rub, massage, diversional
activities, position changes
 Post operative interventions
POSITIONING
• Clients who have spinal anesthesia is
usually placed FLAT on bed for 8-12
hours
• Unconscious client is placed side lying
to drain secretions
• Other positions are utilized BASED on
the type of surgery
 Post-operative Interventions
Some Examples of Position Post Op

Mastectomy Semi-fowlers’, affected

arm elevated
Thyroidectomy Semi fowlers’, head
midline
Hemorrhoidectomy Semi-prone, side-lying

Laryngectomy Fowler’s

Pneumonectomy Lateral, affected side

Lobectomy Lateral, unaffected

side
 Post-operative Interventions
Some Examples of Position Post Op

Aneurysmal repair Fowler’s 45 degrees

(abdomen)
Amputation of lower Flat, with stump
extremities elevated with pillow
Cataract surgery Fowler’s 45 degrees

Supratentorial Fowlers’
craniotomy
Infratentorial Flat on bed, supine
craniotomy
Spina bifida repair Prone
Post-operative Interventions
• Deep breathing and coughing
exercises Q2-4 hours → to remove
secretions
• Leg exercises Q 2 hours → to
promote circulation
• Ambulation ASAP→ prevents
respiratory, circulatory, urinary and
gastrointestinal complications
Post-operative Interventions
• Hydration after NPO→ to maintain
fluid balance
• Suction, either gastro or respiratory→
to relieve distention, to remove
respiratory secretions
• Diet→ progressive, usually given when
bowel sounds and gag reflex return
 Wound Care
• Inspect dressing hourly
• Change dressing daily
• Inspect for signs of infection→
redness, swelling, purulent
exudate
• Maintain wound drainage
wound drainage
Hemovac
Jackson-Pratt
Penrose drain
T-tube
Salem Sump tube
Diet
 Diet
• NPO usually immediately after surgery
• Progressive diet

• Assess the return of the bowel sounds

 Liquid Diet Vs Soft diet
Clear liquid Full liquid Soft diet
Coffee Clear liquid PLUS: All CL and FL
Tea Milk/Milk prod plus:
Carbonated Vegetable juices Meat
drink Cream, butter Vegetables
Bouillon Yogurt Fruits
Clear fruit Puddings Breads and
juice Custard cereals
Popsicle Ice cream and Pureed foods
Gelatin sherbet
Hard candy
Urinary Elimination

• Offer bedpans
• Allow patient to stand at the bedside
commode if allowed
• Report to surgeon if NO URINE output
noted within 8 hours post-op
CPT
Chest Physiotherapy
• Chest physiotherapy is based on the
fact that mucus can be knocked or
shaken form the walls of the airways
and helped to drain from the lungs.

• The usual PVD SEQUENCE is as

follows- POSITIONING, Percussion,
Vibration, and removal of secretions
by SUCTIONING or Coughing followed
lastly by oral hygiene
Chest Physiotherapy
Incentive Spirometry

• This operates on the principle that

spontaneous sustained maximal
inspiration is most beneficial to the
lungs and has virtually no adverse
effects.
• The incentive spirometer measures
roughly the inspired volume and offers
the “incentive” of measuring progress
Incentive Spirometry
Post operative complications
Atelectasis Collapsed •Assess breath
alveoli due to sounds
secretions •Repositioning
•Deep breathing
and coughing
Pneumonia Inflammation •Chest physio
of alveoli •Suctioning
•Ambulation
Thrombophlebitis Inflammation •Leg exercises
of the veins •Monitor for
swelling
•Elevated
extremities
Post-operative Complications
Hypovolemic Loss of
Shock circulatory •Determine cause and
fluid volume prevent bleeding
•O2, IVF

Urinary Involuntary •Encourage ambulation

retention accumulation •Provide privacy
of urine •Pour warm water
•Catheterize
Pulmonary Embolus •Notify physician
embolism blocking the •Administer O2
lung blood
flow
Post-operative complications
Constipation Infrequent •High fiber diet
passage of •Increased fluid
stool •Ambulation
Paralytic ileus Absent bowel •Encourage
sound ambulation
•NPO until
peristalsis
returns
Wound infection Occurs about 3 •Daily wound
days after dressing
surgery •Antibiotics
•Maintain drain
Post-operative complications
Wound Separation of •Cover the wound
dehiscence wound edges with sterile
normal saline
at the suture
dressing
line
•Place in low-
Fowler’s
•Notify MD
Wound Protrusion of •Cover the wound
evisceration the internal with saline pad
organs and •Place in low-
fowler’s
tissues
through wound •Notify MD
Wound dehiscence
Wound evisceration
PERIOPERATIVE NURSING: References

❑ Textbook of Medical Surgical Nursing 7th Edition by Joyce Black

❑ Brunner and Suddarth’s Textbook of Medical Surgical Nursing 15th

Edition by Suzanne Smeltzer

❑ Berry & Kohn’s Operating Room Technique 10th edition by Nancymarie

Philips

❑ The Lippincott Manual of Nursing Practice 7th Edition by Sandra

Nettina

❑ Mastering Medical-Surgical Nursing by Josie Udan

❑ NCLEX-RN Review Materials

I am ready to be an
OR-Nurse!!!
THANK YOU!