This document discusses key aspects of perioperative nursing, including definitions of preoperative, intraoperative, and postoperative phases. It outlines nursing roles and responsibilities in each phase, such as obtaining informed consent, preparing patients for surgery, monitoring patients in the operating room and PACU, and promoting recovery. Nutritional needs for wound healing and risk factors for surgical complications are also summarized.

1. PERIOPERATIVE NURSING
MANAGEMENT
CHRISTIAN B. ALCANTARA

2. WORDS TO PONDER.ü
 ambulatory surgery: may include outpatient
- (or same-day) surgery that does not require
an overnight hospital stay or short stay, with
admission to an inpatient.
 informed consent: the patient’s autonomous
decision about whether to undergo a surgical
procedure; based on the nature of the
condition, the treatment options, and the
risks and benefits involved.

3. WORDS TO PONDER.ü
 intraoperative phase: period of time from
when the patient is transferred to the
operating room table to when he or she is
admitted to the postanesthesia care unit
(PACU)
 perioperative phase: period of time that
constitutes the surgical experience; includes
the preoperative, intraoperative, and
postoperative phases of nursing care

4. WORDS TO PONDER.ü
 postoperative phase: period of time that
begins with the admission of the patient to
the PACU and ends after a follow-up
evaluation in the clinical setting or home
 preadmission testing (PAT): diagnostic
testing performed before admission to the
hospital

5. WORDS TO PONDER.ü
 preoperative phase: period of time from
when the decision for surgical intervention is
made to when the patient is transferred to
the operating room table

6. Perioperative and
Perianesthesia Nursing
 The special field known as perioperative and
perianesthesia nursing includes a wide variety
of nursing functions associated with the
patient’s surgical experience during the
perioperative period. Perioperative and
perianesthesia nursing addresses the
nursing roles relevant to the three phases of
the surgical experience: preoperative,
intraoperative, and postoperative.

7. Preoperative phase
 begins when the decision to proceed with
surgical intervention is made and ends with
the transfer of the patient onto the operating
room table.
 establishing a baseline evaluation of the
patient before the day of surgery by carrying
out a preoperative interview

8. Preoperative phase
 ensuring that necessary tests havebeen or
will be performed (preadmission testing)
 arranging appropriate consultative services
 providing preparatory education about
recovery from anesthesia and postoperative
care

9. Intraoperative Phase
 begins when the patient is transferredonto
the operating room table and ends when he
or she is admitted to the postanesthesia care
unit (PACU)
 providing for the patient’s safety
 maintaining an aseptic environment

10. Intraoperative Phase
 ensuring proper function of equipment
 providing the surgeon with specific
instruments and supplies for the surgical
field, and completing appropriate
documentation

11. Intraoperative Phase
 providing emotionals upport by holding the
patient’s hand during general anesthesia
induction
 assisting in positioning the patient on the
operating room table using basic principles of
body alignment

12. Postoperative Phase
 begins with the admission of the patient to
the PACU and ends with a follow-up
evaluation in the clinical setting or at home
 maintaining the patient’s airway
 monitoring vital signs

13. Postoperative Phase
 assessing the effects of the anesthetic agents
 assessing the patient for complications
 providing comfort and pain relief

14. Postoperative Phase
 nursing activities then focus on promoting
the patient’s recovery
 initiating the teaching
 follow-up

15. GENETICS IN NURSING
PRACTICE—Perioperative
Nursing
 Nurses who are caring for patients undergoing surgery
need to take various genetic considerations into account
when assessing patients throughout the perioperative
experience. For example, surgical outcomes may be altered
by genetic conditions that may cause complications with
anesthesia, including the following:
 Malignant hyperthermia
 Central core disease (CCD)
 Duchenne muscular dystrophy
 Hyperkalemic periodic paralysis
 King-Denborough

16. Preparation for Surgery
 INFORMED CONSENT – The nurse may ask
the patient to sign the form and may witness
the patient’s signature. It is the physician’s
responsibility to provide appropriate
information.
 protects the patient from unsanctioned
surgery
 protects the surgeon from claims of an
unauthorized operation

17. Criteria for Valid Informed
Consent
 Voluntary Consent - valid consent must be
freely given, without coercion.
 Incompetent Patient - legal definition:
individual who is not autonomous and cannot
give or withhold consent (eg, individuals who
are mentally retarded, mentally ill, or
comatose)

18. Criteria for Valid Informed
Consent
 Informed Subject - 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

19. Criteria for Valid Informed
Consent
 Patient Able to Comprehend - Information
must be written and delivered in language
understandable to the patient. Questions
must be answered to facilitate
comprehension if material is confusing.

20. Categories of Surgery Based
on Urgency
 I. Emergent—
 Patient requires immediate attention; disorder
may be life-threatening
 Without delay
 Severe bleeding
 Bladder or intestinal obstruction
 Fractured skull
 Gunshot or stab wounds
 Extensive burns

21. Categories of Surgery Based
on Urgency
 II. Urgent—
 Patient requiresprompt attention
 Within 24–30 h
 Acute gallbladder infection
 Kidney or ureteral stones

22. Categories of Surgery Based
on Urgency
 III. Required—
 Patient needs to have surgery
 Plan within a few weeks or months
 Prostatic hyperplasia without bladder obstruction
 Thyroid disorders
 Cataracts

23. Categories of Surgery Based
on Urgency
 IV. Elective—
 Patient should have surgery
 Failure to have surgery not catastrophic
 Repair of scars
 Simple hernia
 Vaginal repair

24. Categories of Surgery Based
on Urgency
 V. Optional—
 Decision rests with patient
 Personal preference
 Cosmetic surgery

25. Nutrients Important for
Wound Healing
 Protein
 To replace the lean body mass lost during the
catabolic phase after stress
 To restore blood volume and plasma proteins lost
through exudates, bleeding from the wound, and
possible hemorrhage
 To replace losses resulting from immobility
(increased excretion)
 To meet the increased needs for tissue repair and
resistance to infection

26. Nutrients Important for
Wound Healing
 Calories
 To replace losses related to lack of oral intake and
hypermetabolism during catabolic phase after
stress
 To spare protein
 To restore normal weight

27. Nutrients Important for
Wound Healing
 Water
 To replace fluid lost through vomiting,
hemorrhage, exudates, fever, drainage, diuresis
 To maintain homeostasis

28. Nutrients Important for
Wound Healing
 Vitamin C
 Important for capillary formation, tissue
synthesis, and wound healing through
collagen formation
 Needed for antibody formation

29. Nutrients Important for
Wound Healing
 Thiamine, niacin, riboflavin, Folic acid,
vitamin B12
 Requirements increase with increased metabolic
rate
 Needed for cell proliferation and therefore tissue
synthesis
 Important for maturation of red blood cells
 Impaired folic acid synthesis associated with the
use of some antibiotics; impaired vitamin B12
absorption associated with the use of some
antibiotics

30. Nutrients Important for
Wound Healing
 Vitamin A
 Important for tissue synthesis, wound healing,
and immune function
 Enhances resistance to infection

31. Nutrients Important for
Wound Healing
 Iron
 To replace iron lost through blood loss

32. Nutrients Important for
Wound Healing
 Zinc
 Needed for protein synthesis and wound healing
 Needed for normal lymphocyte and phagocyte
response

33. Risk Factors for Surgical
Complications
 Hypovolemia
 Dehydration or electrolyte imbalance
 Nutritional deficits
 Extremes of age (very young, very old)
 Extremes of weight (emaciation, obesity)
 Infection and sepsis
 Toxic conditions
 Immunologic abnormalities

34. Risk Factors for Surgical
Complications
 Pulmonary disease
 Obstructive disease
 Restrictive disorder
 Respiratory infection
 Renal or urinary tract disease
 Decreased renal function
 Urinary tract infection
 Obstruction

35. Risk Factors for Surgical
Complications
 Pregnancy
 Diminished maternal physiologic reserve
 Cardiovascular disease
 Coronary artery disease or previous myocardial
infarction
 Cardiac failure
 Dysrhythmias
 Hypertension
 Prosthetic heart valve
 Thromboembolism
 Hemorrhagic disorders
 Cerebrovascular disease

36. Risk Factors for Surgical
Complications
 Endocrine dysfunction
 Diabetes mellitus
 Adrenal disorders
 Thyroid malfunction
 Hepatic disease
 Cirrhosis
 Hepatitis
 Preexisting mental or physical disability