The main arenas coveted shortly before during and post operative periods

1. Perioperative Nursing

2. Introduction
 Surgery is any procedure performed on the human
body that uses instruments to alter tissue or organ
integrity

3. Perioperative Nursing
Perioperative Nursing- is the delivery of patient care
in the
preoperative
intraoperative
postoperative

4. Perioperative Nursing
The nurse assesses the patient-
 collecting,organizing, and prioritizing patient
data
 identifies desired patient outcomes
 develop and evaluates that care in terms of
outcomes achieved by the patient.

5. Perioperative Nursing
Phases
Preoperative phase – begins when the decision to
have surgery is made and ends when the client is
transferred to the OR table.
Intraoperative phase – begins when the client is
transferred to the OR table and ends when the
client is admitted to the PACU.
Postoperative phase - begins with the admission
of the client to the PACU and ends when the
healing is complete.

6. Type of Surgery (Purpose)
 Diagnostic-Allows to confirm or establishes diagnosis.
 Corrective- Excision or removal of diseased body part.
 Reconstructive-Restore function or appearance to
traumatized or malfunctioning tissues.
 Ablative – Removes a diseased body parts
 Palliative – Relieves or reduces pain or symptoms of a
disease; it does not cure
 Transplant – Replaces malfunctioning structures
 Cosmetic- Performed to improve personal appearance.

7. Types of Surgery (Urgency)
Emergency- performed immediately to preserve
function or the life of the client.
Elective – is performed when surgical intervention
is the preferred treatment for a condition that is
not imminently life threatening or to improve the
client’s life.
Urgent – Necessary for client’ health to prevent
additional problem from developing; not
necessarily an emergency.
Required – has to be performed at some point; can
be pre-scheduled.

8. Preoperative Nursing
Consent
Nature and intention of the surgery
Name and qualifications of the person performing
the surgery.
Risks, including tissue damage, disfigurement, or
even death
Chances of success
Possible alternative measures
The right of the client to refuse consent or later
withdraw consent.

9. Assessment (Nursing History)
Current health status
Allergies
Medications- list all current medications
Previous surgeries
Understanding of the surgical procedure and
anesthesia
Smoking & Alcohol and other-altering substances
Coping
Social resources
Cultural considerations

10. Pre anaesthesia checklist

11. Preoperative Nursing Care
Preanesthesia Management Physical Status Categories
ASA 1: Healthy patient with no disease
ASA 11: Mild systemic ds without fx limitations
ASA 111:Severe systemic ds associated with definite fx
limitations
ASA 1V: Severe systemic ds that is a constant threat to
life.
ASA V: Moribund pt. Who is not expected to survive
without the operation.
ASA V1: A declared brain-death whose organ are
being recovered for donor.
E: Emergency

12. Preoperative Nursing Care
Psychosocial considerations
 Level of anxiety
 Coping ability
 Support systems

13. Preoperative Nursing Care
Laboratory and diagnostic studies
 Screening tests depend on the condition of the client and the nature of
the surgery. If test reveals severe problems the surgery may be cancel
until the condition is stabilized.
 Routine screening test-CBC,Blood grouping and X-match, Lytes, fasting
blood sugar, BUN & Creatinine, ALT,AST, and bilirubin,Serum albumin,
and Total protein, Urinalysis, Chest X-ray,ECG

14. Preoperative Nursing Care
Common nursing diagnosis
 Knowledge deficit
 Anxiety
 Risk for ineffective airway clearance
 Fear related to
 Disturbed sleep pattern
 Anticipatory grieving related to

15. Preoperative Nursing Care
Preop. teaching
 Assessment including baseline knowledge of the
patient and family.
The content focuses on information that will
increase patient’s familiarity with procedure.

16. Preoperative Nursing Care
Anxiety
 The nurse must consider the pt’s family and friends when planning psychological
support.
 Empowering their sense of control. Activities that decreasing anxiety are deep
breathing, relaxation exercises, music therapy, massage and animal-assisted
therapy.
 Use of medication to relieve anxiety.

17. Preoperative Nursing Care
Final Preparation for surgery
 All personal belongings are identified and secured.
 Jewelry is removed.
 Dentures are removed.
 Patient to verbally confirm the surgical procedures and the surgical site. This
verification process is documented in the medical record on the preop. checklist.

18. Preoperative Nursing Care
Pre-op. medications
 Purpose: Allay anxiety
 Decrease pharyngeal secretions
 Decrease gastric secretion
 Decrease side effects of anesthesia
 Induce amnesia

19. Preop checklist

20. Intraoperative Phase
Surgical Team
Surgeon
Anaesthesiol
ogist
Scrub nurse
Circulating
nurse
OT
Technician

21. Intraoperative Nursing Care
Surgical asepsis
 Ensure sterility
 Alert for breaks

23. Intraoperative Phase
Anesthesia
 Greek word- anesthesis, meaning “loss of sensation.” Artificially induced state
of partial or total loss of sensation, occurring with or without consciousness.
 Blocks transmission of nerve impulses
 Suppress reflexes
 Promotes muscle relaxation
 Controlled level of unconsciousness

24. Intraoperative Phase
Anesthesia
Factors influencing dosage and type:
1. Type and duration of the procedure
2. Area of the body being operated on
3. Whether the procedure is an emergency
4. Options of management of post. Op. pain
5. How long it has been since the client ate, had any liquids, or any medications
6. Client position for the surgical procedures

25. Intraoperative Phase
Types of Anesthesia
General Anaesthesia
Spinal Anaesthesia
Epidural Anaesthesia

26. Intraoperative Phase
Stages of General Anesthesia
 Stage 1- Analgesia and sedation, relaxation
 Stage 2- Excitement, delirium
 Stage 3- Operative anesthesia, surgical anesthesia
 Stage 4- Danger

27. Intraoperative Phase
Complications of General Anesthesia
 Overdose
 Hypoventilation
 Related to anesthetic agents
 Malignant hyperthermia
 Related to intubation

28. Types of Regional Anesthesia
Topical (surface)
Local
Nerve Block
Intravenous (Bier Block)
Spinal
Epidural (peridural)

29. Intraoperative Phase
Complications of Local/Regional
Anesthesia
 Anaphylaxis
 Administration technique
 Systemic absorption
 Overdosage

30. Spinal Anesthesia
 Indication
 surgical procedures below the diaphragm
 patients with cardiac or respiratory disease
 Advantages
 mental status monitoring
 shorter recovery
 Disadvantages
 necessary extra expertise
 possible patient pain
 Contraindications
 coagulopathy
 uncorrected hypovolemia

31. Spinal Anesthesia
Complications
 hypotension
 bradycardia
 urine retention
 postural puncture headache
 back pain

32. Examples of location for Spinal and Epidural
Anesthesia.

33. Intraoperative Phase
Conscious Sedation
Administration of IV sedative, hypnotic, and opioid medications.
 Produces a depressed level of consciousness
 Retains ability to maintain a patent airway
 Able to respond to verbal commands or physical
stimulation
 Used for relatively short procedures

34. Post operative nursing care

35. Nursing assessment in the PACU
 Vital signs- presence of artificial airway, 02 sat,BP
,pulse, temperature.
 LOC- ability to follow command, pupillary response
 Urinary output
 Skin integrity
 Pain
 Condition of surgical wound
 Presence of IV lines
 Position of patient

36. Postoperative Nursing Care
Nursing Diagnosis
 Ineffective airway clearance- increased secretions 2 to anesthesia, ineffective
cough, pain
 Ineffective breathing pattern- anesthetic and drug effects, incisional pain
 Acute pain
 Urinary retention
 Risk for infection

37. Postoperative Phase
Assessment of the Postanesthesia Client
 Airway
 Vital signs
 Cardiac monitoring
 Peripheral vascular assessment
 Level of consciousness (LOC)
 Fluid and electrolytes
 GI system
 Integumentary system
 Discomfort/pain

38. Perioperative Nursing Care
Postoperative Management
Maintain a patent airway
Stabilize vital signs
Ensure patient safety
Provide pain
Recognize & manage complications

39. When caring for post-surgical patient, think of
the “4 W’s”
Wind: prevent respiratory complications
Wound: prevent infection
Water: monitor I & O
Walk: prevent thrombophlebitis

40. Complications
Respiratory- atelectasis, pulm. Embolus
Cardiovascular- venous thrombosis
Gastrointestinal-Hiccoughs, N/V,abd. Distention,
paralytic ileus, stress ulcer.
GU- urinary retention
Hemorrhage-slipping of a ligature(suture)
Wound infection-
Wound dehiscence and evisceration-