PERIOPERATIVE NURSING CARE

 Definition-

Perioperative nursing describes the wide variety of

nursing functions associated with the patient’s surgical
management. Perioperative Nursing is the care of a client or patient
before, during, and after and operation. It is a specialized nursing area
wherein a registered nurse works as a team member of other surgical
health care professionals.
 REASON
 To cure an illness or disease by removing the diseased tissue or
organs.
 To visualize internal structures during diagnosis.
 To obtain tissue for examination.
 To prevent disease or injury.
 To improve appearance.
 To repair or remove traumatized tissue and structures.
 To relieve symptoms or pain.
 PHASES OF PERIOPERATIVE CARE

 Preoperative nursing care

 Intraoperative nursing care

 post operative nursing care

 Preoperative nursing care
 DEFINITION-
The patient who consents to have surgery, particularly surgery
that requires a general aesthetic, renders himself dependent on the
knowledge, skill, and integrity of the health care team. In accepting this trust,
the healthcare team members have an obligation to make the patient’s
welfare their first consideration during the surgical experience.
The preoperative phase begins when the decision for surgical intervention is
made and ends when the patient is transferred from the operating room.
GOALS

1. PHYSIOLOGIC ASSESSMENT-
Before any treatment is initiated, a health history is obtained
and a physical examination is performed during which vital signs
are noted and a data base is establish for future comparisons.
• The following are the physiologic assessments necessary during
the preoperative phase:
• Age
• Obtain a health history and perform a physical examination to
establish vital signs and a database for future comparisons.
• Assess patient’s usual level of functioning and typical
daily activities to assist in patient’s care and recovery or
rehabilitation plans.

• Assess mouth for dental caries, dentures, and partial plates.

Decayed teeth or dental prostheses may become dislodged during
intubation for aesthetic delivery and occlude the airway.

• Nutritional status and needs – determined by measuring the

patient’s height and weight, triceps skin fold, upper arm
circumference, serum protein levels and nitrogen balance.
Obesity greatly increases the risk and severity of complications
associated with surgery.
• Immunologic function – existence of allergies, previous allergic
reactions, sensitivities to certain medications, past adverse reactions
to certain drugs, immunosuppression

• Endocrine function – diabetes, corticosteroid intake, amount

of insulin administered

• Fluid and Electrolyte Imbalance – Dehydration, hypovolemia and

electrolyte imbalances should be carefully assessed and documented.

• Infection.
Nursing Diagnosis-

 The following are possible nursing diagnosis during the preoperative

phase:
 Anxiety related to the surgical experience (anaesthesia, pain) and the
outcome of surgery
 Risk for Ineffective Therapeutic Management Regiment
related to deficient knowledge of preoperative procedures and
protocols and postoperative expectations
 Fear related to perceived threat of the surgical procedure and
separation from support system
 Deficient Knowledge related to the surgical process
 Diagnostic Tests-

 These diagnostic tests may be carried out during the perioperative

phase:
 Blood analyses such as complete blood count, sedimentation rate,
c-reactive protein, serum protein electrophoresis with
immunofixation, calcium, alkaline phosphatase, and chemistry
profile
 X-ray studies
 MRI and CT scans (with or without myelography)
 Electrodiagnostic studies
 Bone scan
 Endoscopies
 Tissue biopsies
 Stool studies
 Urine studies
Psychological Assessment

 Fear of pain Psychological nursing assessment during the

preoperative period:
 Fear of the unknown
 Fear of death
 Fear of anesthesia
 Concerns about loss of work, time, job and support from the
family
 Concerns on threat of permanent incapacity
 Spiritual beliefs
 Cultural values and beliefs

 Psychological Nursing Interventions

 Explore the client’s fears, worries and concerns.

 Encourage patient verbalization of feelings.

 Provide information that helps to allay fears and concerns of the

patient.

 Give empathetic support.

Informed consent-
 Reinforce information provided by surgeon.
 Notify physician if patient needs additional information to make
his or her decision.
 Ascertain that the consent form has been signed
before administering psychoactive premedication. Informed
consent is required for invasive procedures, such as incisional,
biopsy, cystoscopy, or paracentesis; procedures
requiring sedation and/or anesthesia; nonsurgical procedures that
pose more than slight risk to the patient (arteriography); and
procedures involving radiation.
 Arrange for a responsible family member or legal guardian to be available to give
consent when the patient is a minor or is unconscious or incompetent (an emancipated
minor [married or independently earning own living] may sign his or her own surgical
consent form).
 Place the signed consent form in a prominent place on the patient’s chart.
 NURSING INTERVENTIONS-

• Reducing Anxiety and Fear

• Managing Nutrition and Fluids
• Promoting Optimal Respiratory and Cardiovascular Status
• Providing Preoperative Patient Education
• Preparing the Bowel for Surgery
• Preparing Patient for Surgery
• Remove jewellery, including wedding rings
• Transporting Patient to Operating Room
• Attending to Special Needs of Older Patients
• Attending to the Family’s Needs
INTRAOPERATIVE

NURSING
CARE
 DEFINITION
The intraoperative phase extends from the time the client is admitted to
the operating room, to the time of anaesthesia administration,
performance of the surgical procedure and until the client is transported
to the recovery room or postanesthesia care unit (PACU).
The intraoperative phase begins when the patient is admitted or
transferred to the surgery department and ends when he or she is
admitted to the recovery area.
 GOALS
 Promote the principle of asepsis asepsis.
 Homeostasis.
 Safe administration of anaesthesia.
 Hemostasis.
 The Surgical Team

The intraoperative phase begins when the patient is received in the

surgical area and lasts until the patient is transferred to the recovery area.
Although the surgeon has the most important role in this phase, there are
key members of the surgical team.

o Surgeon

o Anesthesiologist or anesthetist

o Scrub Nurse or Assistant

o Circulating Nurse
 NURSING RESPONSIBILITIES
 Here are the nursing responsibilities during intraoperative phase:
 Safety is the highest priority.
 Simultaneous placement of feet. This is to prevent dislocation of
hip.
 Always apply knee strap.
 Arms should not be more than 90°
 Prepare and apply cautery pad. Cautery is used to stop bleeding.
POST OPERATIVE CARE
Definition-

The postoperative phase of the surgical experience extends from the

time the client is transferred to the recovery room or postanesthesia
care unit (PACU) to the moment he or she is transported back to the
surgical unit, discharged from the hospital until the follow-up care.

The postoperative phase begins with the admission of the patient to

the recovery area and ends with a follow-up evaluation in the
clinical setting or at home.
Goals-
• During the postoperative period, reestablishing the patient’s
physiologic balance, pain management and prevention of
complications should be the focus of the nursing care. To do these
it is crucial that the nurse perform careful assessment and
immediate intervention in assisting the patient to optimal function
quickly, safely and comfortably as possible.
• Maintaining adequate body system functions.
• Pain and discomfort alleviation.
• Preventing postoperative complications.
• Promoting adequate discharge planning and health teaching.
The “POSTOPERATIVE” may also be helpful:

 P – Preventing and/or relieving complications

 O – Optimal respiratory function
 S – Support: psychosocial well-being
 T – Tissue perfusion and cardiovascular status maintenance
 O – Observing and maintaining adequate fluid intake
 P – Promoting adequate nutrition and elimination
 A – Adequate fluid and electrolyte balance
 R – Renal function maintenance
 E – Encouraging activity and mobility within limits
 T – Thorough wound care for adequate wound healing
 I – Infection Control
 V – Vigilant to manifestations of anxiety and promoting ways of
relieving it
 E – Eliminating environmental hazards and promoting client
safety
Patient Assessment-

 Assess air exchange status and note patient’s skin color

 Verify patient identity. The nurse must also know the type of
operative procedure performed and the name of the surgeon
responsible for the operation.
 Neurologic status assessment. Level of consciousness (LOC)
assessment and Glasgow Coma Scale (GCS) are helpful in
determining the neurologic status of the patient.
 Cardiovascular status assessment. This is done by determining
the patient’s vital signs in the immediate postoperative period and
skin temperature.
 Operative site examination. Dressings should be checked.
Positioning-

Moving a patient from one position to another may result to serious

arterial hypotension. This occurs when a patient is moved from a
lithotomy to a horizontal position, from a lateral to
a supine position, prone to supine position and even when a patient
is transferred to the stretcher. Hence, it is very important that
patients are moved slowly and carefully during the immediate
postoperative phase.
Promoting Patient Safety

When transferred to the stretcher, the patient should be covered with

blankets and secured with straps above the knees and elbows. These
straps anchor the blankets at the same time restrain the patient
should he or she pass through a stage of excitement while
recovering from anesthesia. To protect the patient from falls, side
rails should be raised.
Safety checks when transferring the patient from OR to
RR:

 S – Securing restraints for I.V. fluids and blood transfusion.

 A – Assist the patient to a position appropriate for him on her
based on the location of incision site and presence of drainage
tubes.
 F – Fall precaution implementation by making sure the side rails
are raised and restraints are secured well.
 E – Eliminating possible sources of injuries and accidents when
moving the patient from the OR to RR or PACU.
Nursing responsibilities

 Airway
 Breathing
 Circulation
 Thermoregulation
 Fluid Volume
 Safety
 GI Function and Nutrition
 Comfort
 Drainage
 Skin Integrity
 Assessing and Managing Voluntary Voiding
 Encouraging Activity
 Gerontologic Considerations
 Evaluation
 ABSTRACT

 The perioperative care of patients who have diseases of the nervous system
provides the setting for challenging ethical issues. In the preoperative period,
these issues include obtaining informed consent for surgery and its
complications, surrogate decision making for the neurologically incapacitated
patient, the use of advance directives for medical care, and the temporary
suspension of do-not-resuscitate orders during the perioperative period.
During postoperative care, ethical issues include establishing and
communicating prognosis in patients who are brain damaged, a trial of
therapy when prognosis remains uncertain, surrogate consent and refusal of
life-sustaining therapy in the neurologically impaired patient, and the
management of brain death.
Bibliography

 https://www.surgeryencyclopedia.com/Pa-St/Preoperative-
Care.html
 https://nurseslabs.com/intraoperative-phase/
 https://www.surgeryencyclopedia.com/Pa-St/Postoperative-
Care.html
 https://nurseslabs.com/perioperative-nursing/
 https://nurseslabs.com/postoperative-phase/
 https://nurseslabs.com/preoperative-phase/