Perioperative nurses provide care to patients before, during, and after surgery. Their responsibilities include preparing patients physically and psychologically for surgery, monitoring patients' condition and vital signs during procedures, and assisting surgeons with tasks like passing instruments. Effective preoperative teaching helps reduce patients' anxiety and promotes recovery. Nurses obtain informed consent, ensure patients understand the surgery and what to expect, and provide instructions on exercises and wound care post-operation. The goal of perioperative nursing is optimal patient outcomes and safety throughout all phases of surgical care.

1. PERI-OPERATIVE NURSING
LECTURE ONE

2. PERIOPERATIVE NURSING
• Perioperative nurses, provide nursing care for patients
before, during and after they undergo surgery or a non-
surgical procedure. They provide assistance to the surgical
team during the operation, and in making sure each patient’s
needs are met pre and post operation.
• Perioperative nurses use a comprehensive, multidisciplinary
approach to patient care, assisting surgeons and surgical teams
to care for a patient before, during, and after surgery.

3. responsibilities and duties of a perioperative nurse
 Working with patients prior to surgery to help answer
questions or calm fears about surgery
 Monitoring a patient’s condition during and after surgery
 Selecting and passing instruments and supplies to the
surgeon during operation

4. CONT.
 Managing the overall nursing care in the operating room to
help maintain a safe and comfortable environment
 Educating patients on best practices for recovery, including
pain management and keeping wounds clean
 Cleaning surgical equipment and operating rooms to
maintain a sterile environment

5. PERIOPERATIVE PATIENT FOCUSED MODEL
• The Perioperative Patient Focused Model is the
conceptual framework for perioperative nursing
practice and the perioperative data set
• The Model illustrates the relationship between the
patient, designated support person(s), and care
provided by the perioperative nurse

6. CONT.

7. PATIENT CENTERED
•The patient is at the center of the Model, which
clearly represents the true focus of perioperative
patient care
•there is nothing more important to the
perioperative nurse than the patient

8. FOUR DOMAINS
The Model is divided into four parts:
• patient safety
• patient physiologic responses to operative and other invasive
procedures
• patient and designated support person(s) behavioral
responses to operative and other invasive procedures
• The health system domain designates administrative
concerns and structure elements essential to successful
perioperative

9. OUTCOME FOCUSED
•Perioperative nurse should have a unique
knowledge base that supports high quality patient
outcomes
•An individualized patient assessment guides the
identification of nursing diagnoses and selection
of nursing interventions for each patient

10. CONT
• The care provided by perioperative nurses is directed
toward achieving high quality patient outcomes,
promote patient safety, and optimal physiological and
behavioral responses in perioperative patients

11. Perioperative Nursing Data Set
The Perioperative Nursing Data Set (PNDS) was
developed and is maintained by the Association of
perioperative Registered Nurses (AORN).
Purpose
PNDS is a standardized nursing language designed to
support evidence-based perioperative nursing practice.
Description
PNDS contains terminology for nursing assessments,
evaluations, implementation, outcomes and problems.

12. CONT.
•The PNDS enables the perioperative nurse to
document perioperative care in a standardized
manner and allows the collection of reliable and
valid comparable clinical data to evaluate the
effectiveness of nurse-sensitive interventions and
the relationship between these interventions and
patient outcomes

13. Benefits of PNDS
• Allow precise and complete data analysis
• Allow costing based on activity
• Support standardized nursing documentation
• Guide the development of policies and procedures
• Facilitate clinical based research activities

14. CONT.
• Offer valid clinical data for decision making and
healthcare policy development
• Assist in the measurement and evaluation of patient
care outcomes
• Enhance the continuity of patient care
• Implications for Managers

15. PERIOPERATIVE PHASES
• Pre-operative phase ---before
• Intra-operative phase---during
• Post-operative phase---after

16. preoperative assessment
• Preoperative assessment establishes that the patient is
fully informed and wishes to undergo the procedure. It
ensures that the patient is as fit as possible for the
surgery and anesthetic
• It minimizes the risk of late cancellations by ensuring
that all essential resources and discharge requirements
are identified and coordinated

17. Goals
•Although the surgeon is responsible for
explaining the surgical procedure to the patient,
the patient may ask the nurse questions about the
surgery.
•There may be specific learning needs about the
surgery that the patient and support persons
should know.

18. Preoperative goals include
• Assessing and correcting physiological and psychological
problems that may increase surgical risk.
• Giving the patient and significant others complete learning
and teaching guidelines regarding the surgery.
• Instructing and demonstrating exercises that will benefit the
patient postoperatively.
• Planning for discharge and any projected changes in lifestyle
due to the surgery.

19. Detailed Patient History
• Interviewing the patient will provide loads of information, such as
allergies, current medications, past medical history, and past surgical
experiences
• Special attention should be paid to current medical issues, especially
those that could adversely affect the outcome of the surgery, like heart
disease, chronic respiratory disease, diabetes, or renal dysfunction
• Also, certain lifestyle factors can adversely affect surgical success, like
obesity or smoking. Making note of these factors helps better prepare
the surgical team for possible complications

20. Complete Physical Exam
 Electrocardiogram
 Chest X-ray
 Complete blood count
 Chemical metabolic panel
 Coagulation screening
• A nurse should be familiar with a patient's history, examination, and test
results. Knowing this information allows a nurse to be aware of a patient's
vulnerabilities and anticipate which complications are more likely to arise

21. Patient Education
The preoperative education includes:
 Giving instruction related to preoperative preparations, such as bowel
evacuation or the need to be fasting
 Providing realistic expectations regarding the pre-, intra-, and postoperative
periods
• For example, if a patient is accustomed to having a cup of tea every
morning to steady her nerves, and she may not have that cup of tea on the
morning of surgery, then this may lead to increased anxiety. The nurse needs
to coach the patient in alternative ways to decrease anxiety. Otherwise, the
patient will have high anxiety before even entering the operating room

22. The principles of preoperative assessment
• Promote and apply the principles of good communication
• Demonstrate a holistic approach to patient care pre, intra and
post-operatively when assessing the individual patient needs
when planning patient care and evaluating outcomes
• Recognize the importance of patient identification and apply
accurate attention to detail

23. CONT.
• Manage all individual patient needs during the perioperative
period
• Ensure patient safety in respect of psychosocial and physical
parameters in the respect of the person and his/her rights,
beliefs and wishes
• Support the principles of effective multi-professional team
working
• Take part in the administration and organization of the theatre
and in the management of a multidisciplinary team

24. CONT.
• Qualified and experienced perioperative nurses working within the
multidisciplinary team should be expected to perform in a competent
manner, completing clinical tasks safety and effectively in a timely
manner whilst displaying an understanding of the evidence-base and an
awareness of current developments in research and knowledge relating
to the operating department and perioperative practice.

25. Informed consent
An informed consent is necessary to be signed by the patient before the
surgery.
• The following are the purposes of an informed consent
• Protects the patient against unsanctioned surgery.
• Protects the surgeon and hospital against legal action by a client who
claims that an unauthorized procedure was performed.
• To ensure that the client understands the nature of his or her treatment
including the possible complications and disfigurement.
• To indicate that the client’s decision was made without force or
pressure.

26. Criteria for a Valid Informed Consent
• Consent voluntarily given. Valid consent must be
freely given without coercion.
• Ascertain that the consent form has been signed
before administering psychoactive premedication.
Informed consent is required for invasive procedures

27. CONT.
• Minors (below 18 years of age), unconscious, mentally
retarded, psychologically incapacitated
• permission is required from a responsible family
member who could either be apparent or a legal
guardian
• The information in the consent must be written and be
delivered in language that a client can comprehend.
• Should be obtained before sedation

28. physical preparation of patient the night before surgery
• NPO- 6-8hrs (general and spinal anesthesia)
• 2-4hrs (local anesthesia)
• Bowel Prep- for major abdominal surgery
• Skin prep- shower with antibacterial soap

29. PREOPERATIVE TEACHING/VISIT
• Physical Preparation
• Psychological Preparation

30. PSYCHOLOGICAL PREPARATION
•Regardless of the type of operation, whether it is
major or minor, under local anesthetic or general
anesthetic, people are often nervous and anxious
at the thought of having surgery

31. Psychological Assessment
Psychological nursing assessment during the preoperative period:
• Fear of the unknown
• Fear of death
• Fear of anesthesia
• Concerns on threat of permanent incapacity
• Spiritual beliefs
• Cultural values and beliefs
• Fear of pain

32. Psychological Nursing Interventions
•Explore the client’s fears, worries and concerns.
•Encourage patient verbalization of feelings.
•Provide information that helps to allay fears and
concerns of the patient.
•Give empathetic support.

33. CONT.
The five most distressing occurrences for preoperative
patients are:
• waiting to be collected for theatre;
• not being allowed to drink;
• not being able to wear their dentures;
• going inside theatre;
• and being taken on a trolley to theatre

34. CONT.
• These fears are normal, and the nurse caring for the
surgical patient must develop strategies to reassure
patients, and empower them with appropriate
knowledge to enable them to cope with the forthcoming
anesthesia and surgery.

35. CONT.
• The benefits of reducing anxiety in the surgical patient
are not disputed; if a patient is nervous, they may
experience more pain following surgery, as increased
anxiety leads to increased muscle tension, which in
turn leads to increased pain as well as to an increase in
blood pressure
• research has shown that reducing anxiety by giving
information to patients prior to surgery has potential
benefits to the patient

36. Methods of relieving anxiety in the surgical
patient
GIVING INFORMATION
• all elective patients are assessed prior to admission and given the
information they need prior to their surgery taking place
• Be a good listener, be empathetic, and provide information that helps
alleviate concerns
• During preliminary contacts, give the patient opportunities to ask
questions and to become acquainted with those who might be providing
care during and after surgery.

37. PSYCHOSOCIAL ASSESSMENT
• Psychosocial assessment involves assessing both the
patient’s and their family members’ level of
knowledge concerning the perioperative experience
and ability to adhere to the prescribed therapeutic
regime,
• implement self-care activities, handle fear, deal with
anticipatory anxiety, recognize and resolve a body
image disturbance, grieve successfully, and effectively
cope with the stress associated with surgery

38. CONT.
• Be a good listener, be empathetic, and provide information
that helps alleviate concerns
• give the patient opportunities to ask questions and to become
acquainted with those who might be providing care during
and after surgery
• Acknowledge patient concerns or worries about impending
surgery by listening
• Explore any fears with patient, and arrange for the assistance
of other health procedure

39. PREOPERATIVE TEACHING
• Each patient is taught as an individual, with consideration for
any needs be based on the individual’s learning needs
• Multiple teaching strategies should be used (e.g, verbal,
written, return demonstration), depending on the patient’s
needs and abilities.
• Preoperative teaching is initiated as soon as possible. It
should start in the ward and continue until the patient arrives
in the operating room.

40. CONT.
• teaching sessions are combined with various
preparation procedures to allow for an easy and timely
flow of information
• The nurse should guide the patient through the
experience and allow ample time for questions
• Some patients may feel too many explanations will
increase their anxiety level, and the nurse should
respect their wish for less detail

41. DEEP-BREATHING AND COUGHING EXERCISE
• One goal of preoperative nursing care is to teach the patient
how to promote optimal lung expansion and consequent
blood oxygenation after anaesthesia
• The patient assumes a sitting position to enhance lung
expansion. The nurse then demonstrates how to take a deep,
slow breath and how to exhale slowly
• After practicing deep breathing several times, the patient is
instructed to breathe deeply, exhale through the mouth, take a
short breath, and cough from deep in the lungs

42. CONT.
• The nurse also demonstrates how to use an incentive
spirometer, a device that provides measurement and feedback
related to breathing effectiveness. In addition to enhancing
respiration, these exercises may help the patient to relax
• The patient should put the palms of both hands together,
interlacing the fingers snugly. Placing the hands across the
incisional site acts as an effective splint when coughing

43. CONT.
• The goal in promoting coughing is to mobilize
secretions so they can be removed
• Deep breathing before coughing stimulates the cough
reflex
• If the patient does not cough effectively, atelectasis
(lung collapse), pneumonia, and other lung
complications may occur

44. PREOPERATIVE TEACHING
• We should teach the patient to increase his health by
giving advices like (a) stop smoking, (b) maintain
personal hygiene, (c) deep breathing and coughing
exercises: active and passive exercise

45. Surgical Preparation of the Skin
• Skin preparation helps reduce the number of
microorganism present on skin and thus reduce the
possibility of wound infection.
• Shave the area and clean the area will spirit/swab

46. EVENING BEFORE OPERATION
• Remove all jewelry and hand over them to the relatives
• Remove the lipstick and nail polish
• Shave the area to be operated
• Ask shaving, ask the patient to have a through bath and dress
in clean clothes
• The patient should be reassured to prevent anxiety and fear of
operation

47. ON THE DAY OF SURGERY
• Help the patient to go to toilet and for mouth care
• Remove hair pins, clips, ornaments, false teeth, etc
• Comb and tie hair with a ribbon
• Remind the patient and his relative about the fasting before surgery
• Check the orders for bowel preparation
• Clean the operation site with soap and water thoroughly, dry the area with
clean towel
• Cover the site with sterile towel and fix it by means of bandages
• Introduce nasogastric tube, urinary catheter if ordered
• Stop all medications unless specifically ordered by the surgeon

48. SENDING THE PATIENT TO OPERATING ROOM
• Administer the premedication to the patient one hour before surgery
• Check the vital signs
• Ask the patient on to void just before sending to operating room
• Transfer the patient on to a patient trolley and cover him with clean
sheets to prevent draught
• Never leave the patient alone on trolley
• Always send the patients charts with all reports
• Always send the patient with an attended up to the operation theatre

49. THANK YOU
ANY QUESTIONS