PRE AND POST OPERATIVE CARE ASPECTS

1. MODERATOR :
Dr. Shilpi Sarkar,
Tutor, RCON, JH

2. INTRODUCTION:
• Communication, teamwork, and patient assessment are
crucial to ensuring good patient outcomes in the
perioperative setting.
• Professional perioperative standards encompass the
domains of behavioral response, physiologic response,
and patient safety and are used as guides toward
development of nursing diagnoses, interventions, and
plans.

3. DEFINITION:
Perioperative nursing, which spans the entire surgical experience, consists
of three phases.
Preoperative phase begins with decision to proceed with surgical
intervention and ends with the transfer of patient to the OR .
Intraoperative phase begins when the patient is transferred to
OR bed and ends with admission to Post Anaesthesia Care Unit.
Postoperative phase begins with the admission of the patient to
the PACU and ends with a follow-up evaluation in the clinical
setting or home.

4. PREOPERATIVE PHASE
• Initial assessment
• Education for patient needs.
• Verifies completion of preoperative diagnostic
testing
• Verifies understanding of surgeon-specific
preoperative orders
Pre-
admission
Testing (PAT)
• Completes preoperative assessment
• Assesses for risks for postoperative complications
• Reports unexpected findings
• Verifies that operative consent
• Answers patient's and family's questions
Admission to
Surgical
Center

5. • Identifies patient
• Assesses patient's status, baseline pain, and
nutritional status
• Reviews medical record
• Verifies surgical site
• Establishes IV line
• Administers medications if prescribed
• Takes measures to ensure patient's comfort
In the
Holding
Area

6. INTRAOPERATIVE PHASE:
A.Maintenance of Safety
• Maintains aseptic, controlled environment
• Transfers patient to operating room bed or table
• Positions patient based on functional alignment and exposure of
surgical site
• Ensures that the sponge, needle, and instrument counts are
correct
• Completes intra-operative documentation

7. B.Physiologic Monitoring
• Distinguishes abnormal cardiopulmonary data
• Reports changes in patient's vital signs
C.Psychological Support (Before Induction When
Patient Is Conscious)
• Provides emotional support to patient
• Continues to assess patient's emotional status

8. POSTOPERATIVE PHASE
A.Transfer of Patient to Postanesthesia Care Unit
Communicates intraoperative information:
a. Identifies patient by name
b. States type of surgery performed
c. Reports patient's vital signs and response to surgical procedure and
anesthesia
d. Describes intraoperative factors (e.g., insertion of drains or catheters,
administration of blood, medications during surgery, or occurrence of
unexpected events)
e. Reports patient's preoperative level of consciousness
f. Communicates presence of family or significant others

9. B.Postoperative Assessment Recovery Area
• Monitors patient's vital signs and physiologic status
• Assesses patient's pain level and administers appropriate
pain-relief measures
• Maintains patient's safety (airway, circulation,
prevention of injury)
• Administers medications

10. C.Surgical
Nursing Unit
Continues close
monitoring of
patient
Assesses patient's
pain level and
administer pain-
relief measures
Provides
education to
patient
Assists patient
in recovery
Assists with
discharge
planning
D.Home or
Clinic
Provides
follow-up care
.
Reinforces
previous
education
Answers
patient's and
family's
questions
Determines family's
perception of
surgery and its
outcome

11. PREOPERATIVE CARE
ASPECTS

12. 1.Informed Consent
2. Preoperative Assessment
3.Pre operative nursing interventions:
4.Providing Psychosocial Interventions
5.Maintaining Patient Safety
6.Managing Nutrition and Fluids
7.Preparing the Bowel
8.Preparing the Skin
9.Immediate Preoperative Nursing Interventions

13. 1.Informed Consent
• Informed consent is the patient's autonomous decision about
whether to undergo a surgical procedure.
• Protect the patient from unsanctioned surgery and protect the
surgeon from claims of an unauthorized operation or battery.
Informed consent is necessary in the following circumstances:
• Invasive procedures
• Procedures requiring sedation and/or anesthesia or a
nonsurgical procedure
• Procedures involving radiation

14. Informed consent should be in writing. It should contain the
following:
Explanation of procedure and
its risks
Description of benefits and
alternatives
An offer to answer questions
about procedure
Instructions that the patient
may withdraw consent
A statement informing the patient
if the protocol differs from
customary procedure

15. 2. Preoperative Assessment
• Before any surgical treatment is initiated, a health
history is obtained, a physical examination is
performed during which vital signs are noted, and
a database is established for future comparisons .
• Activity level should be determined.
• Known allergies to drugs, foods, and latex
• Blood tests, x-rays other diagnostic tests are
prescribed

16. 2.1 Nutritional and Fluid Status
• Assessment of a patient's nutritional status identifies
diseases that can affect the patient's surgical course, such
as deficiencies in specific nutrients, metabolic
abnormalities, and the effects of medications on
nutrition.
• Dehydration, hypovolemia, and electrolyte imbalances
can lead to significant problems in patients who are
older.

17. 2.2 Dentition
• Dental caries, dentures are significant to the
anesthesiologist because decayed teeth or dental
prostheses may become dislodged during intubation and
occlude the airway.

18. 2.3 Drug or Alcohol Use
• Ingesting even moderate amounts of alcohol prior to
surgery can weaken a patient's immune system
• The person with a history of chronic alcoholism often
suffers from malnutrition and other systemic problems
or metabolic imbalances that increase surgical risk.

19. 2.4 Respiratory Status
The patient is
educated in
breathing
exercises and the
use of an
incentive
spirometer
Surgery is
usually
postponed for
elective cases
if the patient
has a
respiratory
infection.
Patients with
underlying
respiratory
disease are
assessed
carefully for
current threats to
their pulmonary
status.

20. 2.5 Cardiovascular Status
• Ensuring that the cardiovascular system can
support the oxygen, fluid, and nutritional needs of
the perioperative period.

21. 2.6 Hepatic and Renal Function
• The presurgical goal is optimal function of the liver and
urinary systems so that medications, anesthetic agents,
body wastes, and toxins are adequately metabolized and
removed from the body.

22. 2.7 Endocrine Function
The patient with diabetes who is undergoing
surgery is at risk for both hypoglycemia and
hyperglycemia.
Hypoglycemia may develop during anesthesia or
postoperatively from inadequate carbohydrates or
excessive administration of insulin.
Hyperglycemia, which can increase the risk of
surgical wound infection, may result from the
stress of surgery.

23. 2.8 Immune Function
• To determine the presence of allergies.
• Identify and document any sensitivity to medications
past adverse reactions .
• Look for previous allen reactions, including
medications, blood transfusions, latex, and food
products.

24. 2.9 Previous Medication Use
• A medication history is obtained because of the possible
interactions with medications
• Any medications the patient is using or has used in the
past is documented, including OTC preparations and
herbal agents, as well as the frequency with which they
are used.

25. 2.10 Psycho-social Factors
The nurse anticipates that most patients have emotional
reactions prior to surgery-obvious or veiled, normal or
abnormal.
• Fear may be related to the unknown, lack of control, or
of death and may be influenced by anesthesia, pain,
complications, cancer, or prior surgical experience.
• Preoperative anxiety can be a preemptive response to a
threat to the patient's role in life, a permanent incapacity
or body integrity, increased responsibilities or burden on
family members, or life itself.

26. 2.11 Spiritual and Cultural Beliefs
• Spiritual beliefs play an important role in how people
cope with fear and anxiety.
• Regardless of the patient's religious affiliation, spiritual
beliefs can be as therapeutic as medication.
• Every attempt must be made to help the patient obtain
the spiritual support that he or she requests.

27. 3.Pre operative nursing interventions:
• Nurse should guide the patient and allow ample time
for questions.
Providing patient education
• To promote lung expansion and resulting blood oxygenation
after anaesthesia. Deep breathing before cough stimulates
cough reflex which in turn prevent atelectasis.
Deep breathing, coughing, and
incentive spirometry
• To improve circulation, prevent venous stasis
Mobility and Active Body
Movement
• A pain intensity scale should be introduced and explained to
the patient to promote more effective postoperative pain
management.
Pain Management
• Cognitive strategies may be useful for relieving tension, over
coming anxiety, decreasing fear, and achieving relaxation.
Cognitive Coping Strategies
• Preoperative education for the same-day or ambulatory surgical patient
comprises all previously discussed patient education as well as collaborative
planning with the patient and family for discharge and follow-up home care.
Education for Patients
Undergoing Ambulatory Surgery

28. 4.Providing Psychosocial Interventions
4.1 Reducing Anxiety and Decreasing Fear
• Self introduction and explaining patient their role helps to calm
anxiety.positive nurse patient relationship is maintained.
4.2 Respecting Cultural, Spiritual, and Religious Beliefs
• Identify and showing respect to patient’s cultural,spiritual and
beliefs and if any needs should be communicated to the
appropriate personnel.

29. 5.Maintaining Patient Safety
• Protecting patient from any injury.
6.Managing Nutrition and Fluids
• Major purpose of withholding fluids is to prevent aspiration .
7.Preparing the Bowel
• Enemas are not commonly prescribed preoperatively unless the patient is
undergoing abdominal or pelvic surgery.
8.Preparing the Skin
• To decrease bacteria without injuring the skin.

30. 9.Immediate Preoperative Nursing Interventions
• The patient changes in a hospital gown that is left untied and open in the
back.
• The patient with long hair may braid it, and cover the head completely
with a disposable paper cap.
• The mouth is inspected, and dentures or plates are removed.
• Jewelry is not worn to the OR.
• All articles of value, including assistive devices, glasses, and prosthetic
devices, are given to family members
• All patients (except those with urologic disorders) should void
immediately before going to the OR
• Administering Preanesthetic Medication
• Maintaining the Preoperative Record - Preoperative checklists contain
critical elements that must be checked and verified preoperatively . The
nurse completes the preoperative checklist .

31. PRE-OPERATIVE CHECKLIST

32. • The completed medical record accompanies the patient to the
OR with the surgical consent form attached, along with all
laboratory reports and nurses records.
Transporting the Patient to the Presurgical Area
• The patient is brought to the holding area or presurgical suite
about 30 to 60 minutes before the anesthetic is to be given.
• The use of a standard process to verify patient identification,
the surgical procedure, and the surgical site is imperative to
maximize patient safety .
Attending to Family Needs
• Most hospitals and ambulatory surgery centers have a waiting
room

33. INTRAOPERATIVE CARE
ASPECTS

34. INTRAOPERATIVE CARE ASPECTS:
Surgical
team
Surgical
environment
Surgical
experience
Potential
intraoperative
complications

35. 1.Surgical team
• Intraoperative surgical team includes patient, the
circulating nurse, the scrub nurse, the surgeon, the
registered nurse first assistant, the anesthesiologist.

37. 2.The surgical environment
Basic Guidelines for Maintaining Surgical Asepsis
• All materials in contact with the surgical wound or used within the
sterile field must be sterile.
• Gowns of the surgical team are considered sterile in front
• Sterile drapes are used to create a sterile field
• Items are dispensed to a sterile field by methods that preserve the
sterility of the items and the integrity of the sterile field.
• Sterile supplies, including solutions, are delivered to a sterile field
in such a way that the sterility of the object or fluid remains intact.
• The movements of the surgical team are from sterile to sterile
areas and from unsterile to unsterile areas.
• Scrubbed people and sterile items contact only sterile areas;
circulating nurses and unsterile items contact only unsterile areas.

38. 3.The surgical experience
It includes type of anesthesia and sedation.
I.General anesthesia-
Can be provided by
inhalation e.g Halothane,
isoflurane or by iv
adminstration e.g
benzodiazepines,
barbiturates,
II.Regional
anaesthesia -
Can be provided
by epidural or
spinal (L4-L5)
III.Moderate
sedation - IV
adminstration of
anesthetic agent
to reduce pain.
IV.Local
anesthesia-
injection at
planned incision
site.

39. 4.Potential intraoperative complications
i.Anesthesi
a
awareness
ii.Nausea
and
vomiting
iii.Anaphy
laxis
iv.Hypoxia
and
respiratory
complicati
ons
v.Hypoth
ermia

40. POST OPERATIVE CARE
ASPECTS:

41. POST OPERATIVE CARE ASPECTS:
• The post anesthesia care unit (PACU), formerly referred
to as the recovery room or postanesthesia recovery
room, is located adjacent to the OR suite.
• Patients still under anesthesia or recovering from
anesthesia are placed in this unit for easy access to
experienced, highly skilled nurses, anesthesiologists or
anesthetists, surgeons, advanced hemodynamic and
pulmonary monitoring and support, special equipment,
and medications.

42. Phases of
post
anesthesia
care
I PACU - used
during the
immediate recovery
phase, intensive
nursing care is
provided.
II PACU- the
patient is prepared
for self-care or care
in the hospital or an
extended care
setting.
III PACU - the
patient is
prepared for
discharge.

43. 1.Admitting the Patient to the Postanesthesia
Care Unit
• Transferring the postoperative patient from the OR to
the PACU is the responsibility of the anesthesiologist or
any other licensed member of the OR team.
• The nurse who admits the patient to the PACU reviews
essential information with the anesthesiologist and the
circulating nurse.
• Oxygen is applied, monitoring equipment is attached,
and an immediate physiologic assessment is conducted.

44. 2.Nursing Management in the Postanesthesia
Care Unit
• The nursing management objectives for the patient in the
PACU are to provide care until the patient has recovered
from the effects of anesthesia , is oriented, has stable
vital signs, and shows no evidence of hemorrhage or
other complications .

45. 2.1 Assessing the Patient
• Frequent, skilled assessments of the patient's airway, respiratory
function, cardiovascular function, skin color, level of
consciousness.
• The nurse performs and documents a base line assessment, then
checks the surgical site for hemorrhage and makes sure that all
drainage tubes & monitoring lines are connected and
functioning.
• After the initial assessment, vital signs are monitored and the
patient's general physical status is assessed and documented at
least every 15 minutes

46. 2.2 Maintaining a Patent Airway
The primary objective is
to maintain ventilation
and thus prevent
hypoxemia and
hypercapnia .
The nurse assesses
respiratory rate and
depth, ease of
respiration, oxygen
saturation, and
breath sounds.
Patient is assessed for
hypopharyngeal obstruction
which includes signs of
occlusion include choking,
noisy and irregular
respiration; decreased
oxygen.

47. 2.3 Maintaining Cardiovascular Stability
• To monitor cardiovascular stability, the nurse assesses
the patient's mental status; vital signs; cardiac rhythm;
skin temperature, color, and moisture; and urine output.
• The primary cardiovascular complications seen in the
PACU include hypotension and shock, hemorrhage,
hypertension, and dysrhythmias.

48. 2.4 Relieving Pain and Anxiety
• The PACU nurse monitors the patient's physiologic
status, manages pain, and provides psychological
support in an effort to relieve the patient's fears and
concerns.

49. 2.5 Controlling Nausea and Vomiting
• Nausea and vomiting are common issues in the PAC
• Many medications are available to control postoperative
nausea and vomiting (PONV) without over sedating the
patient; they are commonly administered during surgery
as well as in the PACU.

50. 2.6 Gerontological Considerations
The older patient is
transferred from the
OR table to the bed or
stretcher slowly and
gently.
Special attention is
given to keeping the
patient warm,
(hypothermia.)
With careful
monitoring, detect
cardiopulmonary
deficits .
Postoperative
confusion and delirium

51. 2.7 Determining Readiness for Post anesthesia
Care Discharge
• A patient remains in the PACU until fully the anesthetic
agent.
• Indicators of recovery includes blood pressure, adequate
respiratory function, and a oxygen saturation level
compared with baseline.

52. 3.Preparing the Postoperative Patient for Direct
Discharge
• Ambulatory surgical centers frequently only have a step
down PACU similar to a phase II PACU.
• Patient seen in this type of unit are usually healthy, and
the plan is to discharge them directly to home.
• Prior to discharge, the patient will require verbal and
written instructions and information about follow-up
care.

53. 3.1 Promoting Home and Community-Based
Care
• To ensure patient safety and recovery, expert patient
education and discharge planning are necessary when a
patient undergoes same-day or ambulatory surgery

54. 3.2 Discharge Preparation
The patient and caregiver are informed about expected outcomes
and immediate postoperative changes anticipated.
Identifies important educational points
Prescriptions are given to the patient.

55. 3.3 Continuing Care
• Some patients require referral for home care.
• These may be older patients, those who live alone, and
patients with health care problems or disabilities that
might into self-care or resumption of usual activities.

56. 4. Care of the Hospitalized Postoperative Patient
• Surgical patients who require hospital such as trauma
patients, acutely ill patients, patients under major
surgery, patients who require emergency surgery and
patients with a concurrent medical disorder may be
admitted to specialized ICUs for close monitoring and
advance ventilation and support.

57. 4.1.Receiving the Patient in the Clinical Unit
• The patient's room is readied by assembling the
equipment and supplies: IV pole, drainage, oxygen,
emesis basin, tissues, disposable pads, blankets, and
postoperative documentation forms.
• The receiving nurse reviews the postoperative orders,
admits the patient to the unit, performs an initial
assessment, and attends to the patient's immediate needs
.

58. 4.2 Nursing Management After Surgery
During the first 24 hours after surgery, involves continuing to help
the patient recover from the effects of anesthesia
Frequently assessing the patient's physiologic status, monitoring
for complications, managing pain,successful management the
therapeutic regimen, discharge to home, and full recovery.
In the initial hours after admission to the clinical unit, adequate
ventilation, hemodynamic stability, incisional pain, surgical site
integrity, nausea and vomiting, neurological status, and spontaneous
voiding are primary concerns.

59. A) Preventing Respiratory Complications :
▪Respiratory depressive effects of opioid medications, lung
expansion secondary to pain, and decreased combine to put the
patient at risk for respiratory complications, particularly
atelectasis , pneumonia, and hypoxemia
▪To clear secretions and prevent pneumonia, the nurse encourages
the patient to turn frequently, take deep breaths, cough and
spirometery at least every 2 hours.
▪Analgesic agents are administered to permit more effective
coughing, and oxygen administered .
▪Chest physical therapy may be prescribed if indicated.

60. B) Relieving Pain
• Opioid analgesic agents are commonly prescribed
for pain and immediate postoperative restlessness.
C) Signs and symptoms of shock
• IV fluid replacement may be prescribed for up to
24 hours after surgery or until the patient is stable
and tolerating oral fluids

61. D) Encouraging Activity
Early ambulation prevents stasis of blood, a thromboembolic events occur less frequently.
Bed exercises consist of the following.
Arm exercises (full range of motion, with specific attention to abduction and external
rotation of the shoulder)
Hand and finger exercises
Foot exercises to prevent DVT, footdrop, and toe deformities and to aid in maintaining
good circulation Leg flexion and leg-lifting exercises to prepare the patient for ambulation
Abdominal and gluteal contraction exercises

62. E) Caring for Wounds
With shorter hospital stays,
much of the healing takes
place at home, and both the
hospital and home care nurse
should be informed about the
principles of wound
Ongoing assessment of the
surgical site involves
inspection for wound edges,
integrity of sutures or staples,
discoloration, warmth,
swelling, unusual tenderness,
or drainage.

63. F) Maintaining Normal Body Temperature
• The patient is still at risk for malignant hyperthermia
and hypothermia in the postoperative period.
• Treatment includes oxygen administration,adequate
hydration, and proper nutrition.
• The risk of hypothermia is greater in older adults and in
patients who were in the cool OR environment for a
prolonged period.

64. G)Managing Gastrointestinal Function and
Resuming Nutrition
Taking food by mouth
stimulates digestive
juices and promotes
gastric function and
intestinal peristalsis.
The return to normal
dietary intake should
proceed at a pace
set by the patient.

65. H) Promoting Bowel Function
• Constipation is common after surgery
• Decreased mobility, decreased oral intake, and opioid
analgesic medications contribute to difficulty having a
bowel movement.

66. I) Managing Voiding
Urinary retention after surgery can occur for various reasons.
Anesthetics, anticholinergic agents, and opioid interfere with the
perception of bladder full now and the urge to void and inhibit
the ability to initiate voiding and completely empty the bladder.
Bladder distention and the urge to void should be assessed at
the time of the patient's arrival on the unit and freed thereafter

67. J ) Maintaining a Safe Environment
• During the immediate postoperative period, the patient recovering
from anesthesia should have three and rails up, and the bed should
be in the low position.
• The nurse assesses the patient's level of consciousness and
orientation and determines whether the patient can resume wearing
assistive devices as needed (e.g.. eyeglasses or hearing aid).
• Impaired vision, inability to hear postoperative instructions, or
inability to communicate verbally places the patient at risk for
injury.
• All objects the patient may need should be within reach, especially
the call light.

68. K ) Providing Emotional Support to the Patient
and Family
• Many factors contribute to this stress and anxiety,
including pain, being in an unfamiliar environment,
inability to control one's circumstances or care for
oneself, fear of the long-term effects of surgery,
• Fear of complications, fatigue, spiritual distress, altered
role responsibilities, ineffective coping, and altered body
image, and all are potential reactions to the surgical
experience.

69. L ) Managing Potential Complications
Serious
potential
complications
of surgery
include DVT.
Prophylactic
treatment is
common for patients
a DVT and PE Low-
molecular-weight
heparin and low-
dose warfarin are
other an that may
be used .

70. M ) Promoting Home and Community-Based
Care Patient
• Self-Care Patients have always required detailed
discharge instructions to become proficient in special
self-care need after surgery .

71. RESEARCH
Associations between Pre-, Post-, and Peri-operative Variables and Health
Resource Use Following Surgery for Head and Neck Cancer.
By Badr Hoda , Sobrero Maximiliano, Chen Joshua , Kotz Tamar , Genden Eric
,Sikora Andrew G. , Miles Brett .
Published on : 2019 Feb 11
Objective:
• To examine associations between pre-, post-, and peri-operative variables and health
resource use in head and neck cancer patients.
Methods:
• Patients (N=183) who were seen for a pre-surgical consult between January, 2012
and December, 2014 completed surveys that assessed medical history, a patient-
reported outcome measure (PROM) of dysphagia, and quality of life (QOL).
• After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative
(e.g., complications) variables were abstracted from patients’ medical records.

72. Results
• Multivariate regression models using backward elimination showed that
pre-surgical University of Washington Quality of Life Inventory and
M.D. Anderson Dysphagia Inventory composite scores, documented
surgical complications, and having a tracheostomy, were significant
predictors of hospital length of stay.
• Male gender, psychiatric history, and lower pre-surgical MDADI scores
significantly predicted thirty-day unplanned readmissions .
• Pre-surgical MDADI composite scores also significantly predicted ED
visits within 30 days of hospital discharge
Conclusions:
• Assessment of PROMs and QOL in the pre-surgical setting may assist
providers in identifying patients at risk for prolonged Length of stay and
increased health resource use after hospital discharge.

73. 2.The Effect of Implementation of Preoperative and Postoperative Care Elements of a
Perioperative Surgical Home Model on Outcomes in Patients Undergoing Hip
Arthroplasty or Knee Arthroplasty
By : Vetter Thomas R , Barman Joydip , Jr Hunter James M , Jones Keith A , Pittet Jean-
Francois
Published on :2017 May
Aim:
(1)clinical, quality, and patient safety outcomes
(2) operational and financial outcomes, in patients undergoing total hip arthroplasty (THA)
or total knee arthroplasty (TKA).
Methods:
A 2-group before-and-after study design, with a nonrandomized preintervention PSH (PRE-
PSH group, N = 1225) and postintervention PSH (POST-PSH group, N = 1363) data-
collection strategy, was applied in this retrospective observational study.
• The 2 study groups were derived from 2 sequential 24-month time periods. Conventional
inferential statistical tests were applied to assess group differences and associations,
including regression modeling.

74. Results:
• Compared with the PRE-PSH group, there was a 7.2% increase in day of surgery on-
time starts ; a 5.8% decrease in day of surgery anesthesia-related delays ; and a 2.2%
decrease in ICU admission rate in the POST-PSH group.
• There was a 0.6 decrease in the number of ICU days in the POST-PSH group compared
with the PRE-PSH group however, there was no significant difference in the total
hospital length of stay between the 2 study groups
• There was also no significant difference in the all-cause readmission rate between the
study groups .
• Compared with the PRE-PSH group, the entire POST-PSH group was associated with a
$432 decrease in direct nonsurgery costs for the THA and a $601 decrease in direct
nonsurgery costs for the TKA patients.
Conclusions:
On the basis of our preliminary findings, it appears that a PSH model with its expanded role of
the anesthesiologist as the "perioperativist" can be associated with improvements in the
operational outcomes of increased on-time surgery starts and reduced anesthesia-related delays
and day-of-surgery case cancellations, and decreased selected costs in patients undergoing

75. SUMMARY
Through this topic we came to know about
perioperative nursing , its phases , preoperative
care aspects , intraoperative care aspects and
post operative care aspects.

76. CONCLUSION
• Professional perioperative and peri-anesthesia nursing
standards encompass the domains of behavioral
response, physiologic response, and patient safety and
are used as guides toward development of nursing
diagnoses, interventions, and plan

77. BIBLIOGRAPHY
• Hinkle Janice L., Cheever Kerry H. , Brunner and
suddarth’s textbbok of medical surgical nursing, volume
1, 13th edition, 2014, Wolters Kluwer (India) pvt ltd,
New Delhi, page no-402-447.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC641073
3/
• https://pubmed.ncbi.nlm.nih.gov/27898510/