2. Contents
• Perioperative Care
–The Preoperative Phase
–The Intraoperative Phase
–The Postoperative Phase
• Classification of Surgery - According to
the Cause
• Classification of Surgery - According to
Urgency
• INITIAL ASSESSMENT
3. Perioperative Care
• The wide variety of nursing functions
associated with the patient’s surgical
experience.
• Perioperative nursing includes the nursing
care provided during preoperative,
intraoperative and post operative phases.
4. The Preoperative Phase
• Begins with the decision or surgical
intervention is made
• Ends with the transfer of the patient to the
operating room table.
5. The Intraoperative Phase
• Begin when the patient is admitted or
transferred to the surgery department
• End when the patient is admitted to the
recovery area.
6. The Postoperative Phase
• Begins with the admission of the patient to
the recovery area
• Ends with the follow up evaluation in the
clinical setting or at home.
7. Classification of Surgery - According
to the Cause
• For diagnostic purposes
- Exploratory laporotomy, biopsy
• For curative purposes
- Appendisectomy
- Excision of a tumor
• For reparative purposes
- Repair of multiple wounds
8. Classification of Surgery -
According to the Cause
• Reconstructive or cosmetic
- Mamoplasty
• Palliative purposes
- Inserting a gastrostomy tube for
a patient with cancer
9. Classification of Surgery - According
to Urgency
• Emergency
- Patient requires immediate attention
- Disorder may be life threatening
- Surgery should be performed without delay
- Example: massive hemorrhage
intestinal obstruction
gunshot / stab injury
11. The difference between
“emergency” and “urgency”
• An emergency is an immediate threat to
the well being and urgency is threat to the
well being, in near future.
12. Classification of Surgery - According
to Urgency
• Urgent
- Patient requires prompt attention
- Surgery should be performed within 24-30hrs
- Examples:
acute gallbladder infection
kidney stones
ureteral stones
13. Classification of Surgery -
According to Urgency
• Required
- Patient needs to have operation
- Surgery can be planned within a few weeks
or months
- Example: prostatic hyperplasia without
bladder obstruction
14. Classification of Surgery - According
to Urgency
• Elective
- Patient should be operated upon.
- Example would include simple hernias and
repair of scars
- Failure to have surgery is not catastrophic
15. Classification of Surgery - According
to Urgency
• Optional
- Decision rests with the patient
- One of the example is cosmetic surgery
- Surgery can be performed according to
the personal preferences
17. Assessment
• Observe for skin lesions, rashes or other
abnormalities.
• Discuss with the patient to identify the concern
of the patient regarding hospitalization and
anticipated surgery
• Perform physical assessment to identify
potential health problems
19. Skin Lesions
Cutaneous Lesions
• May appear anywhere on the body
• Can be large or small
• Single or multiple
• Restricted to one specific area
• Spread across a large area of the skin
20. Skin Lesions
Cutaneous Lesions
• Medically described as primary and secondary
• Primary skin lesions arise spontaneously on
the skin
• Secondary skin lesions refer to any changes
due to external factors such as trauma,
scratching, rubbing, sting or infection
24. Warts
• Small hard growths on the skin
• Appear on the fingers, hands and feet or any
site.
• Belongs to the human papillomavirus (HPV)
family
• Transmitted by touch.
• Disappear on their own over a period of 1- 5
years
28. Moles
Melanocytic Naevus
• A cluster growth of pigment cells
(melanocytes)
• Present like small brown spots on the skin
• May also appear in different colors,
shapes and sizes
• Can appear anywhere on the body
30. Melasma
• Appears as brown or blue-gray patches on the
face.
• The most common sites are cheeks, nose,
forehead, chin, and upper lip
• it usually affects the face,can appear on any
part of the sun-exposed skin.
• appear between the ages of 20 and 40 years in
women.
• Caused by the overproduction of melanin
32. Haemangioma
Angioma
• Usually appear as abnormal growths of small blood
vessels.
• The most common types are cherry angiomas and
infantile proliferative haemangiomas.
• A cherry angioma is like cherry-red bump.
• Also known as senile angiomas (very common
in people over the age of 40)
• Typically occur on the trunk of the body
34. Dermatofibroma
• Usually appears as a nodule on the skin of the
lower legs, upper arms, and back
• occur at all ages and genders, but more often in
women
• The colour is pink to light brown in light skin,
and in darker skin dark brown and black
nodules
• may sometimes cause pain or itching
36. Boils
Furuncle
• A bacterial skin infection of a hair follicle
• Appears on the skin as a tender red spot, lump
or pustule which later becomes white since the
pus collects under the skin.
• Occur are on the face, trunk, arms, legs,
neck, groin and armpits
38. Blisters
• Bubble-like skin lesions filled with fluid between
the upper layers of the skin
• Caused by friction, infection and burns
• Can also be the indicator of a skin disease
(chickenpox, herpes, eczema, dermatitis etc).
• A blister smaller than 5mm is known as a
vesicle
• A larger blister is called a bulla
40. Xanthelasma
• Presented as soft yellow papules or plaques
on the upper and lower eyelids
• Usually appear on middle-aged or older people
• More common in women
• The sign of high levels of cholesterol in the
blood
42. Pyogenic granuloma
• Typically appear as small, round red lumps on
the skin
• Likely to bleed because of the many capillary
blood vessels in them
• Pyogenic granulomas can be successfully
removed
44. Keloids
• An abnormal growth of scar tissue that
normally forms over the wound after the
injury
• Usually appear in people with dark skin,
mostly after minor injuries, small insect
bites, or burns
46. Seborrheic keratosis
• Most common on the face, back, shoulders or
chest
• The colour can vary from yellow and tan to dark
brown and black.
• Seborrheic keratoses are not contagious or
harmful
• Presents as a raised or flat papule or plaque
with waxy, smooth or warty surface
48. Neurofibromas
• A type of benign nerve tumor
• May affect men and women equally
• Appears on the skin as a soft skin-colored
bump
• Usually detected in people aged 20 to 40
years.
50. Lipoma
• A fatty, non-cancerous lump
• Slowly grows under the skin over time
• Soft and easy to move under the skin when pressed
down
• Usually appear in middle-aged people
• Some people may develop more than one
• Most common on the neck, shoulders, forearms,
arms, and thighs
• Sometimes lipomas can become painful
52. Actinic Keratosis
Solar keratosis
• An early form of squamous cell carcinoma
• Appears as a dry scaly patch or bump, usually
on sun-damaged skin
• May vary from skin coloured and red to brown
• The risk that actinic keratosis develops into
squamous cell carcinoma
54. Bowen’s Disease
• Usually appears as a scaly or crusty patch that
may be flat or raised
• In red or pink colour
• A very early form of squamous cell carcinoma
• Usually considered as squamous cell
carcinoma in situ
58. Basal Cell Carcinoma (BCC)
• An invasive but non-metastasing skin cancer
• Pink or pigmented bump on the skin
• Develop on the sun-exposed skin (head, neck,
ears, arms and hands)
• Rarely a life-threatening condition
• treatment depends on different factors (type,
size, location, patient’s health status and
history)
60. Squamous Cell Carcinoma (SCC)
• Mostly occurs on sun-exposed parts of the
body as a painful red scaly, crusted patch
• can cause serious health complications by
spreading to the lymph nodes or other
organs.
64. Assessment
• Prepare the patient for various types of
diagnostic procedures after explaining the
necessity of doing those and explain how
the patient can cooperate
• Record the responses of the patient and the
results of the reports
• Assess the nutritional status of the patient
65. Assessment
• Identify risk factors and take measures to
prevent them
• Determine patient’s understanding of disease
and treatment plan
• Identify the patient’s emotional state and
coping skills
• Identify the support systems of the patient
66. Risk Factors
• Obesity
1). Explain regarding the danger of being obese
- Possbility of problem occuring surgery such as
difficulty in putting sutures, possibility of wound
dehiscence after surgery
- Increased susceptibility to infection due to
decreased resistance
2).If there is ample time for surgery plan to reduce
weight
68. Risk Factors
• Aging
1). Explain regarding the danger of being in
advanced age
- Problems related to prescribing narcotics
and sedatives
- Increased risk for side effects
for drugs
69. Risk Factors- Aging
2). Take measures to prevent adverse effects
- Take precautions when giving medication
- Anticipate complications with the disease
conditions such as anemia, diabetes
mellitus and obesity
- Ensure the fulfillment of nutritional
needs
70. Risk Factors
• Electrolyte imbalance and inadequate nutrition
1). Be familiar with the effects of these condition
upon surgery
2). Possibility of developing shock during
postoperative period
3). Problems during general anesthesia
71. What is an electrolyte imbalance?
• An electrolyte imbalance happens when electrolyte
levels in the blood are too high or too low
• Electrolytes are substances that conduct electricity
when they dissolve in water
• In food and drink, electrolytes are present in the form
of essential minerals.
72. Examples of Electrolytes
• Calcium
• Chloride
• Magnesium
• Phosphate (a form of phosphorous)
• Potassium
• Sodium
• Bicarbonate
73. Potential causes of an electrolyte
imbalance
• Intense exercise
• Vomiting or diarrhea
• Dehydration
• Eating disorders
• Kidney disease
• Severe burns
• Some medications, including diuretics
74. Signs of a serious electrolyte
imbalance
• Blood pressure changes
• Shortness of breath
• Confusion
• Fatigue
• Nausea and vomiting
• Rapid or irregular heartbeat
75. Signs of a serious electrolyte
imbalance
• Weakness or difficulty moving
• Frequent or infrequent urination
• Extreme thirst
• Fainting
• Seizure
76. How many electrolytes do you need?
• PotassiumTrusted Source: 3,400 milligrams (mg)
for adult males and 2,600 mg for adult females.
• CalciumTrusted Source: 1,000 mg for people aged
19–50 and males aged 51–70; 1,200 mg for females
aged 51 or over and males aged 71 and over.
• comes from table salt.
77. How many electrolytes do you need?
• MagnesiumTrusted Source: 400 mg for males
and 310 mg for females aged 19–30; 420 mg for
males and 320 mg for females aged 31 and over.
• PhosphorousTrusted Source: 700 mg for
people aged 19 and over.
78. How many electrolytes do you need?
• SodiumTrusted Source: A maximum of 2,300
mg, but ideally no more than 1,500 mg.
• Chloride: The Institute of Medicine set the level
of chloride at the equivalent level as sodium, as
almost all dietary chloride
79. Drinks that naturally contain
electrolytes include:
• milk, which contains calcium and potassium
• orange juice - potassium and, sometimes, calcium
• coconut water, which contains potassium, magnesium,
sodium, and calcium and is naturally low in sugar
• soy milk, which contains magnesium and potassium
• tomato juice, which contains sodium
80. Risk Factors
4). Take measures to prevent the danger
• Administer fluids and electrolytes according to
the prescription
• Maintain detailed fluid balance chart
• Provide adequate nutrition to prevent
malnutrition
• Observe for the signs of electrolyte imbalance
81. Presence of other Disease
Cardiovascular Diseases
- Avoid giving too much of fluid than the
prescribed amount
- Avoid putting restraint for longer periods
- Encourage to change the position frequently
- Observe for the signs of hypoxia
82. Presence of other Disease
Diabetes Mellitus
- Be aware that occurrence of hypoglycemia in
uncontrolled diabetes mellitus may be life
threatening event
- Identify the signs of diabetic ketoacidosis
- Reassure the patient that when diabetes is
under control patient is able to face the
surgery in a normal manner
83. Use of Alcohol
• Anticipate malnutrition as an additional
problem during preoperative period
• Severe injuries may be possible without any
warning with excessive use of alcohol
• Be aware that the tendency for post operative
complication is increased with use of
alcohol for longer periods
• Anticipate acute withdrawal syndrome
84. Pulmonary and Upper Respiratory
Tract Infections
• The presence of upper respiratory tract
infection is a contraindication for surgery
• Provide treatment and nursing management
for the conditions such as bronchiectasis
and emphysema prior surgery
• Provide frequent mouth care
• Advise to stop smoking
85. Bronchiectasis
• The airways of the lungs becoming damaged
and widened.
• The most common symptoms are a persistent
cough, shortness of breath.
86.
87. Emphysema
• A disorder affecting the alveoli (tiny air sacs)
of the lungs.
• The alveoli become abnormally inflated,
damaging their walls and making it
harder to breathe
88.
89. The use of Medication
• Instruct to inform the surgeon regarding the
use of following treatment
a). Certain antibiotics
b). Antidepressants
c). Diuretics
d). Anticoagulants
90. Nursing Diagnoses
• Fear related to surgical procedure
• Fear related to prognosis
• Knowledge deficit related to unfamiliarity with
hospital procedures/ personnel/ environment
• Sleep pattern disturbance related
to anxiety
91. Nursing Interventions
• Explain all procedures to the patient and give
reasons for them
• Allow the patient to ask questions about
procedures and surgery
• Determine the level of understanding of
operative procedure to ascertain whether
signature on permit represent informed
consent
92. Nursing Interventions
• Tell the patient what to expect in the
operating room, recovery and/ or intensive
care units, including use of anticipated
equipment
• Provide opportunity to fulfill the spiritual
needs according to the desire of the
patient and family members
93. Nursing Interventions
• Consider the needs of the family when
discussing the surgery
• Perform nutritional assessment to identify and
correct any nutritional deficiencies before
surgery
• Inform the patient to expect some discomfort
after surgery and teach the importance of
requesting medication for pain
94. Nursing Interventions
• Teach the patient the activities related to
ventilation function after surgery
- Deep breathing
- Coughing
- Intensive spirometry
- Splinting
- Turning
95. Nursing Interventions
• Teach the patient physical exercises:
- Leg exercise
- Isometric exercise
• Emphasize the need for early ambulation for
the early recovery
Promote circulation
after surgery
96. Isometric exercises
• Tightening (contractions) of a specific
muscle or group of muscles.
• Help maintain strength.
• Side plank, Low squat, Glute bridge.
97. Nursing Interventions
• Make certain that:
- history
- physical examination results
- recent laboratory test results
- chest x- ray reports
• are entered to the chart
98. Nursing Interventions
• Inquire regarding the history of allergy and
inform the medical team if necessary
• Take measures to minimize the risk of post
operative infection by proper skin
preparation
• Remove nail polish from fingers and
toes if present
99. Nursing Interventions
• Administer prescribed sleeping medication
to ensure a sound sleep the previous night
• Inform the patient not to take anything by
mouth after 10 o’clock the night before
surgery
100. • Provide immediate preoperative care for the
patient
- In the morning check and record the vital signs
of the patient
- Assess overall physical condition of the
patient; record and report any deviation from
normal
- Have the patient void
Nursing Interventions
101. • Assisst to fulfill hygienic needs and to get
ready for the surgery by wearing suitable
garment for surgery
• Remove any prosthetics such as dentures
• Ensure that all the reports are available
• Arrange for insertion of tubes such as
nasogastric tube or indwelling urinary
catheter as ordered
Nursing Interventions
102. Nursing Interventions
- Complete the preoperative check list
- Arrange for insertion of intravenous line if
ordered
- Make arrangements to store any
valuables of the patient if necessary
- Make sure identification band is on
patient’s wrist
103. Nursing Interventions
- Administer preoperative medications:
• Antianxiety agents
• Sedatives
• Narcotic analgesics or anticholernergic drugs
as prescribed
- Put side rails up after administering
medication to ensure safety of the patient
104. Nursing Interventions
- Transfer the patient to a strecher when
operating room calls; ensure the safety of the
patient when transferring
- Hand over the patient to the theatere staff in
the theatere
- Consider the emotional need of the patient
and the family members on the day of surgery
