8. PERIOPERATIVE TEAM
1. ANESTHESIOLOGIST or NURSE
ANESTHESIST
- makes preoperative assessment to
plan type of anesthetic to be
administered
- to evaluate client’s physical status
2. PROFESSIONAL O.R. NURSE
- makes preop nursing assessments
and documents intraoperative care plan
9. PERIOPERATIVE TEAM
3. CIRCULATING NURSE
- manages the OR
- protects client’s safety and health
needs by monitoring activities of
members of the surgical team
- monitors conditions in the OR
10. PERIOPERATIVE TEAM
4. SCRUB NURSE
- responsible for scrubbing before
surgery
- sets up sterile tables & equipment
- assists surgeon and surgical assistants
during the operation itself
5. PACU NURSE
- cares for the client until he/she
recovers from the effects of anesthesia
11. PRINCIPLES OF SURGICAL
ASEPSIS
1. OR personnel must practice strict
Standard Precautions
2. All items used in the OR must be
sterile
3. All personnel must perform a
surgical scrub
12. PRINCIPLES OF SURGICAL
ASEPSIS
4. All OR personnel are required to wear
specific, clean attire – “shedding” the
environment
- must wear:
a. sterile gown
b. gloves
c. special shoe covers
d. hair cover – cap
e. mask
13. PRINCIPLES OF SURGICAL
ASEPSIS
5. Any personnel harboring pathogenic
microbes must report themselves unable
to be in the OR
6. Scrubbed personnel wearing sterile
attire should touch only sterile items
7. Sterile gown and drapes have defined
borders of sterility.
8. Unsterile personnel must stay at the
periphery of the sterile operating area
14. PRINCIPLES OF SURGICAL
ASEPSIS
9. Sterile supplies are unwrapped and
delivered by the circulating nurse
10. The utmost caution & vigilance
must be used when handling sterile
fluids
11. Anything that is used for one client
must be discarded or, in some
cases, resterilized
15. Activities in the Pre-op
Assessing the clients
Identifying potential or actual health
problems
Planning specific care
Providing pre-operative teaching
Ensure consent is signed
16. 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
17. Activities during the Intra-op
Assisting the surgeon as scrub nurse
and circulating nurse
18. Activities in the POST-op
Assessing responses to surgery
Performing interventions to promote
healing
Prevent complications
Planning for home-care
Assist the client to achieve optimal
recovery
21. According to PURPOSE
Diagnostic Establishes a diagnosis
Palliative Relieves or reduces pain or
symptoms
Ablative Removes a diseased body part
Constructive Restores function or
appearance
Transplant Replaces malfunctioning
structures
22. According to degree of urgency
Emergency Preserves function or life
surgery Performs immediately
Elective Performed when condition
surgery is not imminently life
threatening
23. According to degree of RISK
Major Involves high degree of risk
Surgery Complicated or prolonged
Minor Involves low risk
Surgery Produces few complications
Performed as day surgery
25. Pre-operative Interventions
Ensure signed consent form
Obtain nursing history, PE and lab exam
Provide pre-operative teaching as to the
nature of surgery, what to expect and
ways to manage post-operative
discomforts
Perform physical preparations- shaving,
hygiene, enema, NPO, medications
27. 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
28. Pre-op hygiene
Bath the night before surgery with
antiseptic soap
Shaving of the skin is usually done in
the OR
Removal of jewelry and nail polish
30. 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
31. Pre-operative medications
Pre-op Drugs Example Purpose
Analgesics Meperidine To decrease pain and
decrease anesthetic dose
Anti-histamine Diphenhydramine To decrease occurrence
of allergy
H-2 Cimetidine To decrease gastric fluid
antagonist and acidity
32. 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
33. Pre-operative teaching
Leg exercises To stimulate blood circulation
in the extremities to prevent
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 circulation, stimulate respiration,
Ambulation decrease stasis of gas
34.
35. 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
36.
37. Anesthesia
General anesthesia
Loss of all sensation and
consciousness
Regional or Local anesthesia
Loss of sensation in ONE area
with consciousness present
39. REGIONAL Anesthesia
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
40. Patient Positioning
Provides optimal visualization
Provides optimal access for
assessing and maintaining
anesthesia and function
Protects patient from harm
41. 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
42. Functions of the nurse during OR procedure
SCRUB NURSE Assists the surgeon
Maintains sterility
Handles instruments
Drapes patient
Counts sponges
Wears sterile gown, gloves
CIRCULATING Assists the Scrub nurse
NURSE Positions the patient for
surgery
Positions any equipments
43.
44. POST Operative Interventions
Maintain patent airway
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
45. 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
46. 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
47. 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
48. 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
49. 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 Folwers’
craniotomy
Infratentorial Flat on bed, supine
craniotomy
Spina bifida repair Prone
50. 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
51. Post-operative Interventions
Hydration after NPO to maintain
fluid balance
Suction, either gastro or
respiratory to relieve distention,
to remove respi secretions
Diet progressive, usually given
when bowel sounds and gag reflex
return
52. Wound Care
Inspect dressing hourly
Change dressing daily
Inspect for signs of infection
redness, swelling, purulent
exudate
Maintain wound drainage
62. 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 cereals
Custard
Popsicle Pureed foods
Ice cream and
Gelatin sherbet
Hard candy
63. 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
64. 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
65. 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
66. 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
67. Post-operative Complications
Hypovolemic Loss of Shock position
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 O2w
lung blood
flow
68. 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 Occurs about Daily wound
infection 3 days after dressing
surgery Antibiotics
Maintain drain
69. Post-operative complications
Wound Separation of Cover the wound
dehiscence wound edges at with sterile normal
the suture line saline dressing
Place in low-
Fowler’s
Notify MD
Wound Protrusion of Cover the wound
evisceration the internal with saline pad
organs and Place in low-
tissues through fowler’s
wound Notify MD
70. To emphasize
The over-all goal of nursing care during
the PRE-OPERATIVE phase is to
prepare the patient mentally and
physically for the surgery
71. To emphasize
The over-all goal of nursing care during
the INTRA-OPERATIVE phase is to
maintain client safety
72. To emphasize
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
