nursing students

1. Perioperative Care & HE

2. • Surgery is a unique experience of a planned physical
alteration encompassing three phases: preoperative,
intraoperative, and postoperative. These three
phases are together referred to as the Perioperative
Period.
• Perioperative care is the delivery of nursing care
through the framework of the nursing process. It also
includes collaborating with members of the health
care team, making nursing referrals, and delegating
and supervising nursing care.

3. Pre, intra, and Post Operative Nursing
Management
• Preoperative Phase: The period of time that begins
from when the decision to have surgery is made; up
until the client is transferred to the operating room
table.
• Nursing activities associated with this phase
include:-
1- Assessing the client.
2- Identifying potential and actual health problems.
3- Planning specific care based on the individual’s needs.
4- providing preoperative teaching for the client, the family,
and significant others.

4. • Intaroperative Phase: Period of time that begins
when the client is transferred to the operating table
& ends when the client is admitted to the
postanesthesia care unit (PACU), also called
postanesthetic room or recovery room (RR).
• Nursing activities related to this phase include:
1- Interventions that provide for the client’s safety.
2- Maintaining an aseptic environment.
3- Ensuring proper functioning of equipment.
4- Proving the surgical team with the instruments and
supplies needed during the procedure.

5. • Postoperative Phase: the period of time that begins
with the admission of the client to the
postanesthesia area and ends when healing is
complete.
• Nursing activities related to this phase include:
1- Assessing the client response (physiological and
psychological) to surgery.
2- Performing interventions to facilitate healing and prevent
complications.
3- Teaching and providing support to the client and support
people, and planning for home care.

6. Type of surgery
• Surgical procedures are commonly grouped
according to:-
1- Purpose
2- Degree of urgency
3- Degree of risk

7. Purpose
Surgical procedures may be categorized according to
their purpose as:
• Diagnostic: confirms or establishes a diagnosis; for example,
biopsy of a mass in a breast.
• Palliative: relieves or reduces pain or symptoms of a disease, it
does not cure; for example resection of nerve roots.
• Ablative: removes a diseased body part; for example, removal
of a gallbladder (cholecystectomy).
• Construction: restores function or appearance that has been
lost or reduced; for example, breast implant.
• Transplant: replaces malfunctioning structures; for example,
kidney transplant and hip replacement.

8. Degree of urgency
• Surgyry is classified by its urgency and necessity to
preserve the client’s life, body part, or body function.
• Emergency surgery: is performed immediately to
preserve function or the life of the client e.g. Surgeries
to control internal hemorrhage or repair a fracture.
• Elective surgery: is performed when surgical
intervention is the preferred treatment for a condition
that is not immediately life threatening (but may
ultimately threaten life or well-being) or to improve
the client’s life.

9. Degree of risk.
• Surgery is also classified as a major or minor according to the
degree of risk to the client.
• Major surgery: involves a high degree of risk for a variety of
reasons: It may be complicated or prolonged, large losses of
blood may occur, vital organs may be involved, or postoperative
complications may be likely. Examples are organ transplant ,
open heart surgery, and removal of a kidney.
• Minor surgery: involves little risk, produces few complications,
and is often performed in an outpatient setting. Examples are
breast biopsy, removal of tonsils (tonsillectomy), and knee
surgery.

10. • The degree of risk involved in a surgical procedure is
affected by the client’s:-
1. Age
2. General Health
3. Nutritional Status
4. Obstructive Sleep Apnea
5. Medications
6. Mental Status

11. Preoperative Phase
• Prior to any surgical procedure, informed
consent is required from the client or legal
guardian. Informed consent must include all
information about the surgery and the risk
factors.
• Baseline evaluation
• Preparatory education

12. Nursing management
• Assessing includes collecting and reviewing physical,
psychological, and social client data to determine the
to client’s needs throughout the three perioperative
phases.
• Preoperative assessment data includes:
– Current health status.
– Allergies
– Medications
– Previous surgeries
– Mental status
– Understanding of the surgical procedure and anesthesia
– Smoking
– Alcohol and other mind-altering substances
– Coping
– Social resources
– Cultural and spiritual considerations

13. Diagnoses
• Deficient Knowledge related to:
– A lack of education about the perioperative process
– A lack of exposure to the specific perioperative experience
• Anxiety related to:
– Effect of surgery on ability to function in usual roles
– Risk of death
• Disturbed sleep pattern related to:
– Hospital routines
– Psychological stress
• Ineffective coping related to :-
– Conflicting values
– Lack of clear outcomes of the surgery

14. Plannig
• Planning should involve the client and the family.
Preoperative care planning and teaching
interventions are usually done on an outpatient basis
either in a person or via a telephone interview by the
perioperative nurse.
• Planning for home care:
discharge planning and home care incorporates an
assessment of the client’s and family’s abilities and
resources for care, their financial resources, and the
need for referrals and home health services.

16. Intraoperative Phase
• Begins when the client is transferred to the
operating room table
• Provide for the client safety
• Maintain aseptic environment
• Provide surgeon with supplies & instruments
• Documentation

17. Postoperative Phase
• Admission to PACU post anesthesia care unit
• Maintain airway clearance
• Monitor VS. 1st hr every 15 mins , 2nd hr every
30 mins then every hr for 4 hrs
• Assess effects of anesthesia
• Assess for complications of surgery
• Provide comfort & pain relief
• Ends with follow-up evaluation in clinical
setting or home

18. Preoperative Nursing Management:
I- Patient Education:
* Teaching deep-breathing and coughing
exercises.
* Encouraging mobility and active body
movement. e.g Turning (change position),foot
and leg exercise.
* Explaining pain management.
* Teaching cognitive coping strategies.

19. Preoperative Nursing Management:
* Managing nutrition and fluids.
− The major purpose of withholding food and
fluid before surgery is to prevent aspiration.
− A fasting period of 8 hrs or more is
recommended for a meal that includes fried
or fatty foods or meat.

20. Preoperative Nursing Management
Preparing the bowel for surgery.
− Enema is not commonly ordered, unless the
client is undergoing abdomen or pelvic
surgery. e.g (cleansing enema, laxative).
* Preparing the skin.
−The goal of preoperative skin preparation is to
decrease bacteria without injuring the skin.

21. Preoperative Nursing Management
III- Immediate preoperative nursing intervention:
* Administering preanesthetic medication.
* Maintaining the preoperative record.
e.g. Final checklist, consent form, identification.

22. Nursing management in the post
anesthesia care unit
I-Assessing the client
Frequent assessment of the client oxygen
saturation, pulse volume and regularity, depth
and nature of respiration, skin color, depth of
consciousness.

23. Nursing management in the post
anesthesia care unit
II- Maintaining a patent airway
− The primary objectives are to maintain
pulmonary ventilation and prevent hypoxia &
hypercapenia.
− The nurse applies oxygen, & assesses
respiratory rate & depth, oxygen saturation.

24. Nursing management in the post
anesthesia care unit
III- Maintaining cardiovascular stability
− The nurse assesses the client’s mental
status, vital signs, cardiac rhythm, skin
temperature, color & urine output.
− Central venous pressure, arterial lines &
pulmonary artery pressure.
− The primary cardiovascular complications
include hypotension, shock, hemorrhage,
hypertension & dysarrythmias.

25. Nursing management in the post
anesthesia care unit
IV- Relieving pain & anxiety
− Opioid analgesic.
V- Assessing and managing the surgical site
− The surgical site is observed for bleeding,
type and integrity of dressing and drains.
VI- Assessing & managing gastrointestinal
function
− Nausea & vomiting are common after
anesthesia.
− Check of peristalsis movement.

26. Nursing management in the post
anesthesia care unit
VII- Assessing & managing voluntary voiding
− Urine retention after surgery can occur for a verity
of reasons. Opioids & anesthesia interfere with the
perception of bladder fullness.
- Abdominal, pelvic, hip may increase the likehood
of retention secondary to pain.
VIII- Encourage activity
− Most surgical are encouraged to be out of bed as
soon as possible. Early ambulation reduces the
incidence of post operative complication as
,atelectasis, pneumonia, gastrointestinal discomfort
and circulatory problem.

27. Post Operative Complication
1- Shock
Is the response of the body to a decrease in
the circulating volume of blood, tissue
perfusion impaired, cellular hypoxia & death.
2- Hemorrhage
Is the escape of blood from a blood vessel.
3- Deep vein thrombosis (DVT)
Occur in pelvic vein or in lower extremities, &
it’s common after hip surgery.

28. Post Operative Complication
4- Pulmonary embolism
It’s the obstruction of one or more pulmonary
arterioles by an embolus originating some where
in the venous system or in the right side of heart.
5- Urinary Retention
6- Intestinal obstruction
Result in partial or complete impairment to the
forward flow of intestinal content.

29. Potential Intraoperative complication
–Nausea & vomiting
–Anaphylaxis
–Hypoxia & other respiratory
complication
–Hypothermia