PERI OPERATIVE NURSING

5. 


6. PREOPERATIVE PHASE

7.  The intraoperative phase is the period during
which the patient is undergoing surgery in the
operative room
 It ends when the patient is transferred to the
post anesthesia room

8.  The postoperative phase lasts from the
patient’s admission to the recovery room
through the complete recovery from the
surgery.
 After the patient ‘s condition has been
stabilized in the recovery room ,a physician
will order the patient’s transfer to another
area of facility

10. 


12.  Collect history regarding
a)Presence of hypertension
b)Angina
c)Heart failure
d)Palpitations
e)MI
f)Pace maker
g)Dysrhhythmias
h)Nurse should monitor BP,pulse,ECG,of the
patient and collect baseline data

13.  1)Collect the history of previous health
problems like dyspnea
,COPD,hemoptysis,T.B,
 2)History of smoking
 3)monitor ABG SpO2 and PFT
 4)Assess the patient for cyanosis and
clubbing of nail fingers

17. INTEGUMENTARY SYSTEM
 Assess the skin condition at incision
site for presence of any
rash,ulcer,lesions,boils

18. MUSCULOSKELETAL SYSTEM
 Mobility and stiffness of body
especially neck and lumbar area
should be assessed as it may affect
the initiation of the anesthesia

19. ENDOCRINE SYSTEM
 Assess the patient for presence
of DM type 1&2,thyroid
disorders,adrenal
disorders,pitutary disorders as
these disorders puts the patient
in metabolic alterations

20. IMMUNE SYSTEM
Ask the patient about
occurrence of repeated
infections and use of
immunosuppressive and
corticosteroid drugs

21. NUTRITIONAL STATUS
 Assess the nutritional status of patient-
obesity and under nutrition
 Assess the dietary habits of patient –
vegetatrian or non vegetarian

22. COMMON PREOPERATIVE
DIAGNOSTIC TESTS
 1)BLOOD
TESTS:CBC,hb,glucose,RFT,LFT,Coagulati
on tests,blood grouping and cross
matching,blood tests for
HIV,HCV,electrolyte evaluation.
 2)chest x ray
 3)ECG
 4)Radiological examination
 5)ultrasound studies

24.  Pre operative care is the preparation and
management of the patient prior to the
surgery
 It includes both physical and psychological
preparation

25. PHYSICAL PREPARATION
 1)It consists of patients complete medical
history and physical exam
 Bowel clearance may be orderedif patient is
having surgery
 Some patient may benefit from a sleeping pilll
the night before the surgery
 The night before the surgery
-skin preparation is ordered
-

26. PSYCHOLOGICAL PREPARATION
 Patients are often fearful and anxious
about having surgery.
 The family needs to be included in
psychological preparation .
 Pastoral care should be offered.
 Procedure may be postponed until the
patient feels more secured

28. INFORMED CONSENT
 The patient or guardians informed consent
for surgery is of vital portion for
preoperative care
 Physicians who will perform the procedure
must explain the risks and benefits of the
surgery

29. PREOPERATIVE TEACHING
 It includes teaching about the surgery and
the post operative period.
 The day before the surgery explain the
patient how to prepare
 Explain patient must not eat or drink for 8-
12 hrs before the surgery
 Ask the patient to bathe in the morning
,remove all the
jewellary,makeup,eyeglasses,dentures etc.

30.  Explain the patient how the operating
room and recovery room set up are.
 Teach the patient deep breathing and
coughing exercises
 Show the patient how to turn on bed,
holding small pillow against the incision to
support it

31. IMMEDIATELY BEFORE SURGERY
 Patients should empty the bladder
 They should take out false teeth ,hairpins,
takeoff glasses,rings ,nail polishes,lipstick etc
 1) wash the skin around the site of incision
and clean it with an antimicrobial
 2)usually an intravenous line with saline
solution is started before surgery
 3)prepare the family for surgery

32. INTRAOPERATIVE CARE
 Intraoperative refers to the time during
surgery
 Activities such as patient’s vital signs, blood
oxygenation levels ,fluid therapy, medication
transfusion,aneasthesia,radiography,and
retrieving samples for laboratory tests .

33. SURGICAL TEAM
 Intraoperative care is provided by nurses
,anestheologists ,nurse ansthetists,surgical
technicians ,surgeons and residents ,all
working as a team.
 1)SURGEON
 2)ANESTHETIST
 3)SCRUB NURSE
 4)CIRCULATING NURSE

34. ANESTHESIA
 Anesthesia is a state of narcosis,
used to produce
unconciousness,analgesia,muscle
relaxation and reflexes loss during
surgical procedure

35. TYPES OF ANESTHESIA
 There are various forms of anesthesia.
 The type of anesthesia depends upon type of
surgery and medical condition
1)General anesthesia
2)Local anesthesia
3)Regional anesthesia

36. GENERAL ANESTHESIA
 Two types of anesthesia:
1)inhalation anesthesia
2)intravenous anesthesia

37.  INHALATION ANESTHETICS:
 Halothane
Enflurane
Isoflurane
Sevoflurane
Desflurane
Nitrous oxide

38. INTRAVENOUS ANESTHETICS:
Ketamine
Sodium thiopental
Fentanyl
Propofol
Methohexital
Etomidate
Propofol

39. STAGES OF ANESTHESIA

40. LOCAL ANESTHESIA
 Local anesthesia is an anesthetic
agent given to temporarily stop the
sense of pain in a particular area of
the body

41. REGIONAL ANESTHESIA
 Regional anesthesia is a form of
local anesthesia in which the
anesthesia in which an
anesthetic agent is injected
around nerves so that the area
supplied by these nerves is
anesthetized

42. TYPES OF REGIONAL ANESTHESIA
 1)Spinal anesthesia
 2)epidural anesthesia
 3)local nerve infilteration
 4)topical anesthesia

43. THE NURSE’S ROLE DURING AND
IMMEDIATELY AFTER SURGERY
 Before surgery: check the vitals get
the patient ready for the surgery,
help to prepare the sterile field.
 During surgery: nurses open
supplies and pass them out, surgical
asepsis and a sterile field, counting
needles, and gauze swabs used
during the surgery

44.  AFTER SURGERY:The patient
usually goes to a recovery room
,check how the patient is and take
care of him
 Nurses keep a careful watch on the
patients airway ,breathing rate and
depth and the colour of the mucous
membranes and nail beds.

45.  Patient’s wake up from the
anesthesia and get back their
reflexes at different speeds.To help
them wakeup ,the nurse can call
their name and repeatedly tell them
that the surgery Is finished

46. POST OPERATIVE CARE
 The post operative care is the management of
a patient after surgery.
 THE GOALS OF POSTOPERATIVE CARE ARE:
 1)Promoting respiratory function
 2)promoting cardiovascular function
 3)promoting renal function
 4)promoting nutrition and elimination
 5)promoting fluid and electrolyte balance
 6)promoting wound healing

47. POST OPERATIVE CARE
UNIT(PACU)
 Post operative care unit also called post
anesthesia recovery room.
 Post anesthesia care unit is divided into two
phases:
 Phase 1: it is immediate recovery phase,
requires intensive nursing care.
 Phase 2:post anesthesia care is reversal for
patients who require less frequent
observation and less nursing care

48. ADMITTING PATIENT TO PACU
The patient is transferred to the PACU after the
surgical procedure,anesthesia reversal,and
extubation.
 transferring the patients is responsibility of
the anesthesiologist .
 In PACU anesthetist or nurse reports on the
condition of the patient ,type of surgery
performed ,type of anesthesia
given,estimated blood loss ,input and output
of fluids and liquids.

49. THE FOLLOWING ARE LIST OF
ASSESSMENT CATEGORIES:
 1)surgical site
 2)patency of drainage tubes
 3)body temperature
 4)rate of intravenous fluids.
 5)circulation in the extremities
 6)level of sensation in the regional anesthesia
site
 7)pain status
 8)nausea and vomiting

50. CARE OF PATIENT IN SURGICAL
PACU
 1)assess patients oxygen saturation,pulse
volume and regularity ,skin color and level of
consciousness.
 2)respiratory status should be assessed
regularly
 3)check surgical site for drainage
 4)turn the patient to one side allows the
collected fluid to escape from the side of
mouth

51. CHECKLIST FOR PREOPERATIVE
CARE

52. CHECKLIST FOR POST OPERATIVE
CARE

53. CARE OF THE PATIENT AFTER
SURGERY
 1) assess patients airway and breathing
 2)monitor patients vital signs
 3)check the patients bandages and sheets
under the patient’
 4)monitor intake and output
 5)recheck the flow rate and operation of IV
line every hour
 6)monitor the potential complications

54. CARE OF SURGICAL PATIENT FOR
THE EARLY RECOVERY
Control the post operative pains by back rubs
and other comfort measures
Make sure fluid intake is adequate,check any
signs of dehydration like dry mucous
membrane,distended neck veins,sounds or
crackles in lungs.
Check urinary output,low intake of fluids and
continued catheterisation can lead to urinary
infections

55.  Turn and exercise the patient ,patient should
be turned every two hours ,they should get up
to walk as soon as possible.
 Encourage coughing and deep breathing
exercises very two hours
 Provide adequate diet,from fluids to a soft diet
and then to a regular diet.
 Check bowel functions,check for the signs of
constipation-abdominal swelling ,pain and no
stool or hard stool.

56. COMPLICATIONS AFTER THE
SURGERY
PNEUMONIA / ATELECTASIS
The signs of pneumonia include fever shortness
of breath,chest pain,cough,bloody or
infected sputum,and decreased breath
sounds
MANAGEMENT:
1)POSITIONING:lateral recovery position is
given

57.  Conscious patient: supine position is given and
head of the bed should be elevated
 O2 therapy is given as prescribed
 Deep breathing exercises and incentive
spirometry should be encouraged
 Effective coughing is recommended for
mobilizing secretions
 Change of position 2 hourly done.early
ambulation is done

58.  HAEMORRHAGE: The signs of hemorrhage
include bloody bandages and bed clothes.The first
sign of hemorrhage is increased breathing. later
signs include weak pulse ,low blood pressure, cold
,clammy ,pale skin, and reduced amount of urine.
 MANAGEMENT:
 Observe incision site regularly
 Monitor vital signs regularly
 Monitor hb ,hematocrit values
 Assess for any change in mental status

59. URINARY PROBLEMS
 The signs of urinary retention are ;the
inability to urinate or urinating in small
amounts ,a stretched bladder ,and
discomfort in the bladder region.
 SIGNS OF UTI ARE:
 Burning when urinating
 A sense of urgency
 Pain in the lower abdomen
 Cloudy urine and sometimes fever

60. WOUND INFECTION
 Caring the wound and helping it heal are the
major responsibilities of the nurse .
 Signs of infection include:
 Redness, tenderness ,infected discharge, a bad
smell in the wound and fever.
MANAGEMENT:
1)Wash your hands before caring for the wound.
2)Use sterile dressing and sterile techniques if
possible
3)Use sterile instruments to remove the sutures