1. What is Perioperative Nursing?

- Perioperative nursing is the term used to describe the role of a nurse during a
patient's surgical experience. It emphasizes the significance of continuity of
care throughout the preoperative, intraoperative, and postoperative phases.
- Perioperative nursing is a specialized field of nursing that provides care for
patients throughout the surgical process. It involves the preparation, surgery,
and recovery stages. Preoperatively, perioperative nurses ensure patients'
readiness by documenting their medical history, explaining the procedure,
ensuring compliance with preoperative instructions like fasting, and providing
emotional support. This preparatory support often helps to reduce patients'
anxiety about the procedure. During surgery, perioperative nurses maintain
the sterile field and assist the surgical team. They also monitor the patient's
vital signs, such as heart rate and blood pressure, and ensure the necessary
surgical instruments are accessible and used appropriately. Postoperatively,
these nurses manage the patient's pain, watch for complications, and
discharge them with instructions for home recovery. Their role is crucial to the
overall success of the surgery and the patient's recovery.
2. What are the phases of perioperative nursing? Explain each phase.
- There are 3 phases of perioperative nursing namely; Preoperative phase,
Intraoperative Phase, and Postoperative Phase.
- The phase before surgery, that is, the preoperative phase, includes
everything that is done as a preparation for surgery. This phase typically
begins the moment the patient is scheduled for surgery and involves a
significant number of assessments and preparations. During this phase,
perioperative nurses conduct thorough medical evaluations to understand the
patient's health status, medical history, and possible risks and complications
associated with the surgery. They provide detailed information on the surgical
procedure, what to expect, and presurgical instructions such as bowel
cleansing, fasting, and medication adjustments. They also provide an
opportunity for patients to ask questions and voice concerns. This information
is critical in reducing patient anxiety and ensuring that there are no surprises
before, during, or after surgery. The preoperative phase identifies and
mitigates risks that patients may have, giving the surgical team an opportunity
for a successful surgical experience.
- During the actual surgery, or intraoperative phase, perioperative nurses are
essential in helping the surgical team and preserving a sterile environment.
Throughout the procedure, they are in charge of positioning the patient,
making sure all surgical instruments are sterile and prepared, and keeping an
eye on the patient's vital signs. Their alertness aids in promptly recognizing
and addressing any alterations in the patient's state. In addition to managing
the surgical supplies, perioperative nurses make sure the operating room is
effective and safe. Their main priorities are keeping the patient safe and
assisting the surgical team to make sure everything goes smoothly.
 - The period after surgery is known as the postoperative phase, and it lasts
until the patient is completely healed. Perioperative nurses monitor the patient
during this phase as they wake up from anesthesia, managing pain and
keeping an eye out for any indications of complications like infections or
adverse reactions. They give thorough instructions on how to take care of
wounds, limit physical activity, and follow prescription regimens after surgery.
In order to help patients manage any discomfort or anxiety during their
recovery, nurses also provide emotional support. In order to avoid
complications, encourage healing, and guarantee a smooth transition from
hospital to home care, effective postoperative care is crucial.
3. What are the classification of Surgical Procedure according to the following?
A. According to Purpose
- Surgical procedures come into multiple categories based on their intended
purpose, including diagnostic, curative, palliative, preventive, reconstructive,
and transplant. Surgical diagnostics, like biopsies, are carried out to confirm a
diagnosis or identify the underlying cause of a medical condition. The goal of
curative surgery is to treat or correct a condition, such as a tumor removal.
Palliative surgeries are performed on patients with chronic or terminal
illnesses with the goal of improving their quality of life and relieving symptoms
rather than curing the illness. Prophylactic mastectomies are examples of
preventative surgeries that are performed to stop a condition from developing.
Reconstructive surgeries, such as reconstructive plastic surgery, aim to
restore function or appearance, frequently following an injury or disease.
Transplant procedures, like kidney transplants, entail swapping out a
damaged organ for a healthy one from a donor. Every kind of surgery serves
a unique function and is essential in the treatment of various medical
conditions.
B. According to urgency
- Surgical procedures can be divided into emergency, urgent, elective, and
optional categories based on their level of urgency. For example, emergency
surgeries for traumatic injuries or acute appendicitis are done right away in
order to save a patient's life or avoid major complications. While not as urgent
as emergency surgery, urgent surgeries still need to be performed quickly—
usually in 24 to 48 hours—to treat conditions that could quickly worsen, such
as fracture repairs or the removal of the gallbladder due to severe
inflammation. Elective surgeries, like knee replacements or hernia repairs, are
planned in advance and not life-threatening; they can be scheduled at the
patient's and surgeon's convenience. Surgical procedures that are performed
as elective procedures, such as cosmetic plastic surgery, are non-essential
and frequently of a cosmetic nature. The level of urgency needed to meet the
patient's medical needs is reflected in each category.
C. According to Degree of Risk
 - Surgical procedures can be classified according to the degree of risk into
major and minor surgeries. Major surgeries are complicated procedures
which carry a high risk because of their inherent complexity, the use of
general anesthesia, the possibility of significant blood loss, and the
involvement of vital organs. Organ transplants, open heart surgery, and
significant cancer resections are among the surgeries that usually need a
longer recovery time. On the other hand, minor surgeries are generally less
risky, require less recovery time, and are frequently done under local or
regional anesthesia. Surgery to remove skin lesions, biopsies, and cataract
operations are a few examples of minor surgeries. By ensuring that the right
safety measures and protocols are made in accordance with the expected
risk level, the classification aids healthcare providers in organizing and
managing patient care.
4. What are informed consent of surgery? Provide an example
- The process by which a patient willingly decides to have a particular surgical
procedure after being fully informed about all pertinent aspects of the surgery
is known as informed consent for surgery. This includes a thorough
explanation of the process, along with information on any possible cons,
benefits, and alternatives, as well as the anticipated results. To make sure
they comprehend all of the information given, the patient is given the chance
to ask questions and look for clarifications. Through the signing of a consent
form, which is added to the patient's medical file, this procedure guarantees
that the consent is informed and voluntary. In order to ensure that the patient
is actively involved in their healthcare decisions, this consent is essential for
both ethical and legal reasons.
For example, a patient's pregnancy complications may have led to a
scheduled cesarean section (C-section). The obstetrician and the
perioperative nurse go over the entire process, including how the baby will be
delivered via an incision made in the uterus and abdomen. They go over the
advantages, like guaranteeing the mother's and the child's safety, as well as
the possible risks, like infection, blood loss, and anesthesia-related
complications. The nurse also goes over other options, such as trying vaginal
delivery if circumstances permit, and why a C-section is the best course of
action in this case. It is recommended that the patient voice any concerns
they may have regarding the procedure and the healing process. The patient
signs a consent form authorizing the C-section after understanding all the
information and feeling secure in the choice. After that, the informed consent
is recorded on this form, which is attached to the patient's medical file. In
order to guarantee that the patient is informed and at comfortable with the
scheduled surgery, perioperative nursing includes providing a comprehensive
explanation and documentation.
5. Give at least 5 preoperative PHYSICAL preparations of a patient. Give an
example of preoperative checklist.
 - History Taking (It is necessary to take a standard history. 'Fitness' for surgery
is assessed using a series of predetermined questions. It's important to
record any symptoms specific to the surgery, including any absent features,
as well as its onset, duration, aggravating and mitigating factors.
- Fasting (To lower the risk of aspiration during anesthesia, patients are
typically required to fast for a predetermined amount of time, usually starting
at midnight the night before the procedure. This includes abstaining from
liquids and sometimes food as well.)
- Skin Preparation (To lower the risk of infection, the surgical site is cleaned
and, if needed, shaved or clipped. To ensure a sterile field for the surgery, the
area is thoroughly cleaned using antiseptic solutions.)
- Bowel Preparation (Laxatives or enemas may be required for patients
undergoing certain gastrointestinal or abdominal surgeries in order to facilitate
bowel clearance, which lowers the risk of infection and improves the
surgeon's visibility.)
- Vital Signs Monitoring (Prior to surgery, baseline readings of the patient's vital
signs—blood pressure, heart rate, temperature, and oxygen saturation—are
obtained to track their condition and identify any potential problems.)
6. Give 5 common preoperative medications and state the purpose of giving them.
- Preoperative medicine is given to patients in order to maximize their state of
health and guarantee a successful and safe surgical procedure. Antibiotics,
sedatives, anticholinergics, antiemetics, and analgesics are the five cdommon
drugs taken prior to surgery. Antibiotics, like cefazolin, are administered prior
to surgical incision to lower the bacterial load and prevent postoperative
infections. Sedatives, such as midazolam, are used to help patients feel more
at ease and relaxed prior to surgery by reducing anxiety and promoting
relaxation. Antiemetics, like ondansetron, are given to patients to stop the
nausea and vomiting that come with the anesthesia and surgery. Atropine and
other anticholinergics are used to lower respiratory and oral secretions, which
lowers the risk of aspiration and helps to maintain a clear airway during
surgery. Lastly, analgesics, like morphine or acetaminophen, are administered
to relieve pain and improve patient comfort prior to surgery. This helps with a
smoother induction of anesthesia and lessens pain following the procedure.
These drugs are carefully chosen according to the particular needs of the
patient and the guidelines for the operation.
7. Who made up the Surgical Team? Write all the responsibilities of each member.
- The success and safety of surgical procedures are ensured by the critical
roles played by the various key professionals that make up the surgical team.
As the primary physician performing the surgery, the surgeon is in charge of
preoperative evaluations, precise surgical execution, and postoperative care
decisions. The first assistant, who could be a different surgeon, a surgical
resident, or a surgical assistant with specialized training, helps the surgeon.
 This position entails providing assistance with particular procedures, such as
suturing, tissue retraction, and suction.
Throughout the procedure, the anesthesiologist or certified registered nurse
anesthetist (CRNA) is in charge of giving the patient anesthesia and keeping
an eye on their vital signs to make sure they stay stable and pain-free. The
circulating nurse manages all aspects of nursing care in the operating room,
including maintaining sterility, providing supplies and equipment as needed,
and recording the process. The surgical technologist, also known as the scrub
nurse, is in charge of setting up the sterile field, handing the surgeon's
instruments, and keeping track of the number of sponges and instruments to
make sure nothing is left inside the patient.
8. Compare and Contrast Medical Asepsis versus Surgical Asepsis.
- There are differences in the scope and application of medical and surgical
asepsis, two crucial practices in healthcare settings to stop the spread of
infections. The goal of medical asepsis, commonly referred to as clean
technique, is to lower the quantity of microorganisms and stop them from
spreading to other people or locations. This covers procedures like washing
your hands, donning gloves, sanitizing surfaces, and handling and discarding
contaminated materials the right way. In order to reduce the risk of infections,
medical asepsis is essential in routine patient care settings such as clinics
and hospital rooms as well as during routine medical procedures.
Surgical asepsis, also known as sterile technique, on the other hand,
surpasses medical asepsis by totally getting rid of microbes and keeping a
sterile environment throughout surgical operations. This calls for more strict
procedures like using sterile drapes and instruments, as well as donning
sterile gowns, gloves, and masks. The goal of surgical asepsis is to avoid
contaminating the surgical site and the patient's internal tissues, as this could
result in dangerous infections after surgery. To protect patient safety and
enhance surgical results, it is carefully used in operating rooms and during
invasive procedures like surgeries, central line implantations, and wound
care. Fundamental concepts in infection control, medical and surgical asepsis
are adapted to the unique requirements and hazards connected with various
healthcare settings and procedures.
9. State the Principle of Surgical Asepsis (Sterile Technique).
- The principle of surgical asepsis, also referred to as sterile technique, is to
keep surgical wounds and sterile areas free from microorganisms by
establishing and maintaining a sterile field and environment. Among the key
concepts are:
- Keep the unsterile objects away from the sterile field. Whenever a non-sterile
object comes into contact with a sterile field, microorganisms could be
spread.
- Keep the sterile field dry. A dry surface makes it difficult for microorganisms to
pass through.
 - The edge of the sterile field is considered unsterile. Sterility is doubtful when
one is close to a contaminated area.
- Handle liquids cautiously near the sterile field or prevent drapes or wrappers
from becoming wet. A liquid that wets create a connection between a sterile
and non-sterile field.
- Each sterile supply should be clearly labeled as to its contents, time and date
of sterilization. This is to ensure sterility.
- Never assume that an object is sterile. Always check the sterility expiration
date. Sterility of an object wrapped in paper or cloth becomes doubtful after 4
weeks.
- Avoid sweeping and dusting when the sterile objects are opened. Because
micro-organisms travel in the dust particles.
- Put on mask, wash hands, put on gowns and gloves before handling sterile
supplies. This is to prevent contamination.
10. What are the different positions during surgery.
- During surgery, the patient's positioning is essential to optimize access and
ensure their comfort and safety. The supine position is the most common and
involves the patient lying on their back. It is ideal for abdominal, chest, and
facial procedures. The patient lies on their stomach in the prone position. It is
best for surgeries of the back and spine and provides access to the backside
of the body. The patient lies on their side in the lateral position, and it is best
for procedures of the kidneys, lungs, and hips. This positioning allows the
surgeon to access the side of the body. The lithotomy position has the patient
lying on their back with their legs elevated and supported by stirrups. This
type of positioning is common for gynecological, urological, and colorectal
surgery. The Trendelenburg position places the patient on their back with their
head lower than their feet. It is good for surgeries in the pelvic organs and is
sometimes used for shock. Conversely, the reverse Trendelenburg position
has the patient's head higher than their feet. It is used to improve breathing
and reduce blood loss during surgeries involving the upper abdomen and
head. Surgical positions are chosen based on surgical needs and patient
factors, which results in the best surgical outcomes.
11. What are the types of Anesthesia?
- There are various forms of anesthesia, each appropriate to the patient's
condition and the requirements of the procedure. When used for major
surgeries, general anesthesia gives the patient total control over pain and
movement while making them unconscious and unaware of the process. It is
given by intravenous (IV) medication or inhaled gases. By preventing feeling
in a particular area of the body—such as with a spinal or epidural block—
regional anesthesia enables patients to stay conscious but pain-free in that
area. Surgery on the lower extremities or lower abdomen frequently uses it.
When total unconsciousness is not required for minor procedures like dental
work or skin biopsies, local anesthesia is frequently used to numb a small,
 targeted area. Sedation and local anesthetics are used in monitored
anesthesia care (MAC) to keep the patient comfortable and at ease while
preserving consciousness. Usually, it is used for operations such as
endoscopies. Conscious sedation, also known as sedation, is used alongside
local anesthesia for minor procedures to help patients feel more at ease and
less anxious while they remain awake. Based on the procedure, the health of
the patient, and the required level of comfort and safety, each type of
anesthesia is selected.
12. What are the responsibilities of the nurse during the Recovery Stage of the
patient at Post Anesthesia Care Unit or PACU?
- The nurse is essential to a safe and orderly transition from anesthesia's
effects to stable recovery during the recovery phase in the Post Anesthesia
Care Unit (PACU). The nurse is in charge of keeping an eye on the patient's
vital signs, such as heart rate, blood pressure, respiration rate, and oxygen
saturation, in order to identify any bleeding or respiratory problems that may
arise right away following surgery. In addition to monitoring pain and
consciousness, they also make sure the patient is comfortable by controlling
pain relief as needed. Along with giving out medication as directed by the
doctor, the nurse also keeps an eye out for any indications of complications,
such as nausea, vomiting, or allergic reactions. They also offer emotional
support, reassuring the patient and outlining expectations for their
recuperation. In addition to coordinating the patient's care with the surgical
team, the nurse makes sure that the patient and their family are fully informed
of all postoperative instructions as they get ready for the patient's discharge
or transfer to a regular hospital room. A full recovery and the avoidance of
surgical complications depend on this all-encompassing care.
13. Give at least 5 post operative complications.
- Postoperative complications are problems that may develop following surgery
and have an effect on the recuperation and general health of the patient. A
frequent implication is infection, which occurs when bacteria infiltrate the
surgical site and cause symptoms like redness, swelling, pain, and fever.
Antibiotics and other treatments may be necessary in this case. Excessive
bleeding, either internally or externally, is referred to as hemorrhage. It can
cause shock or anemia and may need to be controlled with blood transfusions
or surgery. Blood clots form in deep veins, usually in the legs, causing deep
vein thrombosis (DVT), which can be painful, swollen, and increase the risk of
a pulmonary embolism if the clots go to the lungs. When a surgical wound
reopens, either fully or partially, it is known as wound dehiscence. This
condition can hinder healing and raise the risk of infection, necessitating
further medical attention or surgery. Reduced lung function or immobility can
result in pulmonary complications, such as pneumonia or atelectasis (collapse
of lung tissue), which can cause respiratory symptoms and necessitate
respiratory therapy or medication. These side effects highlight how crucial
prompt intervention and attentive postoperative monitoring are to promoting a
speedy recovery and averting additional health problems.