Fundamenta of nursing

1. CHAPTER FOURTEEN
PERI-OPERATIVE CARE
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2. General objectives
At the end of the chapter you will be able to
Perform preoperative patient assessment
Provide preoperative care
Apply principle of infection prevention in the
intraoperative care
Position patient appropriately for the procedure
Assume responsibility of scrub nurse
Provide immediate post operative care
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3. PERI-OPERATIVE CARE
• is a period of time that constitutes the
surgical experience including preoperative,
intra-operative and post operative phases.
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4. 14.1. Pre-operative care
is a care given for a patient from the time the
decision is made for surgical intervention to the
transfer of the patient to the operating room
Purpose
• To prepare the patient emotionally, mentally for
surgery
• To prevent complication before surgery unless it
is an emergency operation
• To promote patient and family involvement in
care
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5. Equipment:
1. Blood pressure apparatus
2. Stethoscope
3. Enema equipments and solution as needed
4. Catheterization equipments
a. Flashlight
b. Preoperative checklist
c. Container for dentures, glasses
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6. Cont’d…
d. Appropriate storage for valuables and clothes
e. Information packets regarding surgery
f. Informed consent forms
g. Intravenous fluids, IV set ,syringe and needles,
and equipment as needed
h. Preoperative medication
i. Transfer cart
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7. Procedures of pre-operative care
1. Explain the procedure
2. Check whether the client has any questions regarding
the surgery and understands the procedure.
3. Wash hands
4. Verify admission orders regarding type of surgery, any
risks (including recent changes in vital signs), and client
preparation
5. Verify the client by checking name tag and asking name
6. Make the patient NPO for six to eight hours
7. Complete the preoperative checklist, including history,
physical assessment, and check of valuables.
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8. Cont’d…
8. Perform neurological assessment, including
checks for orientation, eye coordination,
handgrips, knee bends, and plantar and dorsi-
flexion of the feet
9. Perform vascular assessment including checks of
pulse, blood pressure, and apical pulse rhythm,
peripheral pulses, and temperature. Compare
with previous information. Clients over 50 may
require baseline electrocardiogram
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9. Cont’d…
10. Auscultate the lungs bilaterally front and back. If
any wheezes, rhonchi, coughs, upper respiratory
infections, or increased temperature, notify
physician or qualified practitioner
11. Assess the gastrointestinal system (time of last
meal, food allergies, bowel sounds, last bowel
movement, time of last fluids).
12. Assess the genital/urinary system (last menstrual
period, last void, state of pregnancy, estrogen
replacement therapy).
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10. …procedure
13. Assess skin and muscle tone for any skin breakdown,
redness, bruises, decreased skin integrity
14. Ascertain any allergies or adverse reactions during
previous surgeries or use of anesthesia.
15. Obtain medication history, including the time and
date of the last dose of medication
16. Ascertain any history of drugs/alcohol use and when
they were last used.
17. Check weight.
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11. Cont…
18. Check if family is available and who is present
19. .Ascertain if client has signed the surgical
consent. Determine if the client has a living will or
has designated resuscitation status.
20. Remove all valuables with the exception of
wedding rings if requested. Tape rings in place.
Check and document whether valuables are placed
in a locked area, safe storage area, or given to
family.
21. Check if eyeglasses and dentures are removed;
place in a labeled container
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12. Cont’d…
22. Maintain elimination as needed (catheterization,
enema)
23. Administer intravenous fluids according to orders
24. Administer medications according to orders.
25. Ascertain that preoperative checklist is complete.
26. Transport the client to appropriate area.
27. Inform family members where surgical waiting area
is and establish a way to contact them when surgery
is completed
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13. 14.2. Intra-operative care
Objectives:-At the end of this, you will be able to:
1. Define intraoperative care
2. Identify intra-operative activities
3. Assemble necessary equipments
4. Perform appropriate intra-operative care
Definition: intra-operative care is a care given for a
patient from when the patient is transferred to
operation room table to when the patient is
admitted to the recovery room or post anesthesia
care unit.
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14. Purpose of Intra-operative care
• To prevent risk of infection
• To reduce risk of injury related to positioning
• To reduce risk of injury related to chemical
hazards
• To reduce risk of injury related to foreign
objects left in the body
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15. Equipment
• Gloves (clean for shaving; sterile for cleaning surgical
site)
• Razor and sharp blades
• Sterile gauze (to clean the razor)
• Warm water
• Antibacterial cleansing agent
• Sterile cotton swabs
• Sterile cotton sponges
• Transfer forceps in antiseptic solution
• Solution for surgical site cleaning, such as 70% alcohol
Solution basins
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16. Procedures
1. Review chart for surgery to be performed and
determine the exact area to be prepped.
2. Wash hands.
3. Assess client’s level of consciousness and mobility
4. Explain the procedure to client.
5. Be sure that hairpins, jewelry, nail polish, contact
lenses, prostheses, and dentures were re-moved
during the preoperative preparation.
6. Assist client with transfer from wheelchair or bed to
the surgical table.
7. Position the client for optimal access to the surgical site
according to institutional protocol
8 .Cover with blanket
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17. Cont’d…
9. Cover hair if required
10. Assemble equipment needed
11. Remove ring(s) and watch. Wash hands and
apply clean gloves.
12. The surgical prep sites follow, depending on the
type of surgery to be performed.
 Head and neck: The site extends from above the
eyebrows, over the top of the head, and includes the
ears and both anterior and posterior areas of the
neck. The face and eyebrows are not shaved.
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18. Cont…
 Lateral neck: Clean the external auditory canal with a
cotton swab. Anteriorly, prepare the side of the face,
from above the ear to the upper thorax to just below
the clavicle. Posteriorly, prepare from the neck to the
spine including the area above the scapula.
 Chest surgery: The site extends from the neck to the
bottom of the rib cage and to the lateral midline. The
shoulder and arm of the operative side should be
included.
 Abdominal surgery: The preparation site ex-tends
from the axilla to the pubis extending bilaterally to the
lateral midline. All visible pubic hair should be shaved.
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19.  Perineal surgery: Shave all pubic hair and the
inner thighs to the midthigh. The area starts
above the pubic bone anteriorly and extends
beyond the anus posteriorly.
Cervical spine surgery: Posteriorly from the top
of the ears to the waist. The area extends on each
side to the midaxillary line.
Lumbar spine surgery :Posteriorly from the axilla
down to the midgluteal level of the buttocks. The
area extends on each side to the midaxillary line
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20.  Rectal surgery: Shave the buttocks from the
iliac crest down to the upper third of the thighs,
including the anal region. The area ex-tends to
the midline on each side.
 Flank surgery: Extends anteriorly from the
axilla, down to the upper thigh, including the
external genital area. Posteriorly the area ex
tends from the midscapular to the midgluteal
regions
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21.  Hand and forearm surgery: The area includes the
full circumference of the affected arm, from the
axilla to the fingertips.
Lower extremity surgery: The area includes the
entire leg, toes, and foot of the affected leg from the
umbilicus anteriorly and the top of the buttocks
posteriorly.
Lower leg surgery: The area to be prepared includes
the circumference of the entire region from
midthigh to the distal toes of the affected leg.
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22. Cont…procedure
13. Arrange for adequate light on the area to be
prepared.
14. Using warm water, hold the skin taut and
hold the razor at a 45° angle. Shave the area
care-fully by stroking in the direction of hair
growth. Rinse the razor carefully to remove ac
cumulated hair from the blade.
15. Dry the client’s skin with a sterile towel.
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23. Cont’d…
16. Clear the shaving supplies from the preparation
area.
17. Apply sterile gloves and gown.
18. Scrub the surgical site with an antibacterial
cleaner. Using a rotary movement to clean the
skin, begin in the center and gradually enlarge the
area with each rotation.
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24. ….cont
19. Continue this process for three to ten
minutes as prescribed by institutional policy.
20. Clean any hidden areas in the surgical site
(the ear canals, under the fingernails, the
umbilicus) using cotton swabs.
21. Rinse the area with sterile water. Wait for
the site to dry or pat dry with a sterile towel.
22. .Cover the area with sterile drapes leaving
the surgical site exposed
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25. 13.3. Postoperative Care
Objective: At the end of the practical session, you
will be able to:
• Define postoperative care
• Identify postoperative activities
• Assemble necessary equipments
• Perform appropriate postoperative care
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26. Definition: postoperative care is a care given for a
patient which begins with the admission of the
patient to the post anesthesia care unit and ends
after follow up evaluation in the clinical setting.
Purpose
• To prevent any complication from anesthesia
• To detect sign of post operative complications
• To rehabilitate the patient
• To re-establish physiological equilibrium
• To alleviate pain
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27. Equipments
1. Vital sign equipments
 Stethoscope
 Sphygmomanometer
 Thermometer
2. Watch
3. Oximeter
4. Blankets
5. Cardiac monitoring equipment
6. Sterile dressings as needed
7. Client’s chart with postoperative orders
8. Incentive spirometer (may be optional)
9. Supplemental oxygen, if needed
10. Sequential stockings and/or antiembolic stockings (as
ordered)
11. Gloves
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28. Procedures
1. Wash hands and apply gloves.
2. Check the client’s temperature, pulse,
respiratory rate, and blood pressure upon the
client’s arrival in the unit.
3. Identify client via armband and verify the
client’s identity with the chart.
4. Inform the client that she/he is out of the
operating room and in the recovery room.
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29. Cont’d…
5. If bedside electrocardiogram monitoring is
available, attach the leads to the client and run a
baseline electrocardiogram strip.
6. Attach the oximeter to the client and monitor the
client’s oxygen saturation
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30. Cont…
7. Check intravenous (IV) site using gloves. Check IV
solution(s), flow rate, and that the IV line is taped
as necessary
8. Check surgical dressing and site, if visible. Assess
dressings for amount and type of drainage.
Reinforce the dressings as needed.
9. Complete a total head to toe assessment
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31. …procedure
10. Encourage the client to deep breathe, cough,
and use the incentive spirometer
11. Check and implement postoperative orders.
12. Inform the client’s family or significant other
that the client is in the recovery room.
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32. 13. Turn the client every hour, maintaining
proper alignment.
14. Upon discharge by the postanesthesia care-
giver, a full report of the postanesthesia phase
and intraoperative course of events should be
given to the nurse assuming care of the client.
15. Remove gloves and wash hands.
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33. • When caring for post-surgical patient, think
of the “4 W’s”
1. Wind: prevent respiratory complications
2. Wound: prevent infection
3. Water: monitor I & O
4. Walk: prevent thrombophlebitis
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34. Thanks !!
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