This document provides an overview of caring for surgical patients, including definitions, case studies, and perioperative phases of nursing intervention. It discusses general and regional anesthesia, lists objectives for surgical patient care, and presents case studies and critical thinking questions to apply the concepts. The key aspects covered are the three perioperative phases of pre-op, intra-op, and post-op; definitions of relevant terms; types of anesthesia; and priority nursing interventions for postoperative patients.

1. Caring For the Surgical
Patient
A review of Definitions, Cases,
Perioperative Phases of Nursing
Intervention
Jeanne M. Colia, RN, MSN

2. Reference
• Potter, P.A., & Perry A.G. (2005).
Fundamentals of nursing (6th ed.). St.
Louis:Mosby.
• Note: Refer to Assigned Chapter 49 “Care
of the Surgical Patient” for reading and
review.

3. Objectives
• Discuss case studies for the surgical
patient.
• List two major types of anesthesia.
• List types of regional anesthesia.

4. Objectives (cont.)
• Identify three perioperative phases.
• Describe when interventions would be
started during the perioperative phases.
• Define pertinent terminology related to the
surgical patient.

5. Objectives (cont.)
• Identify medical orders and rationale for
implementing orders.
• Prioritize nursing interventions the nurse
would independently perform and provide
rationale for nursing interventions.
• Apply critical thinking skills to test
questions.

6. Definitions
• General Anesthesia
• Regional Anesthesia
• Thrombophlebitis
• Atelectasis
• Paralytic ileus
• PCA (Patient controlled analgesia pump)
• Pneumatic compression device (SCD’s
Sequential compression device)

7. Types of anesthesia
• List two major types of anesthesia.
1.
2.

8. Types of Anesthesia
• General anesthesia:
Administration of inhalant or IV medication
that affects the entire body and produces
loss of consciousness.
• Regional anesthesia:
Administration of an anesthetic agent or
topical agent near a nerve or nerve
pathway that inhibits the transmission of
the impulse to the CNS.

9. General Anesthesia
• List two ways to • Define affect to Neuro
administer. system (LOC)
• 1.
• 2.
• Does this effect entire
body or parts of body?

10. Regional Anesthesia
• Describe method of • List 5 types of
administered. regional anesthesia
1.______________
• How does regional 2.______________
anesthesia affect the
Central Nervous System
3.______________
(CNS) 4.______________
5.______________

11. Types of Regional Anesthesia
• Results in loss of sensation in an area
of the body.
1. Epidural anesthesia
2. Spinal anesthesia
3. Nerve block
4. Local anesthesia
5. Topical anesthesia

12. Definitions
• Define General Anesthesia
• Define Regional Anesthesia

13. Perioperative Phase Nursing
Interventions Brief Descriptions
• Pre-operative Phase
__________________________________
__________________________________
• Intraoperative Phase
__________________________________
__________________________________
• Post Operative Phase
__________________________________
__________________________________

14. Identify Perioperative Phases
Pre-op Intra-op Post-op
• Use of incentive Spirometer.
• Coughing and deep breathing.
• Splinting of surgical site.
• Prepping surgical site.

15. Identify Perioperative Phases
Pre-op Intra-op Post-op
• Changing the surgical dressing.
• Leg exercises.
• Pain Management.
• Discharge Planning Instructions.

16. Case Study
A female patient is admitted for a total
abdominal hysterectomy (TAH) this morning.
She is 52 years old and is obese.Her past
medical history indicates that she stopped
smoking 5 years ago. Both parents are
deceased. Mother died at the age of 88 and
father died from a heart attack at the age of
62.

17. The Clients vital signs are: T. 97.8- P.76-
R.18-B/P 164/92. The following laboratory
studies were done: CBC, PT, serum
electrolytes of Na+,K+,serum FBG, BUN, and
creatinine. The UA, chest xray report, and ECG
report are in the chart.

18. Post Operative Complications
• List the factors from the Case Study that
increase the patient’s risk of Postoperative
complications:
• __________________________________
• __________________________________
• __________________________________
• __________________________________

19. Interactive Activity:
• With a partner, use the follow-up case
study to:
• (1) Identify which medical order the nurse
would do first.
• (2) List the priority nursing interventions
the nurse would independently perform
and provide a rationale for each
intervention:

20. Follow-up Case Study
• NPO- May have sips of water in AM
• IV-Dextrose 5/0.9% Normal Saline infuse at
100mL/hr.
• Ambulate this evening.
• VS q30 min. for the first hour, then q1h x 2hr,
then q4h.

21. • Incentive spirometer q1h while awake.
• PCA- Morphine sulphate set at 1mg/6min (per
patient demand not to exceed 20mg/4hr).
• Antiembolic stockings and pneumatic
compression device to legs continuously.
• Indwelling urinary catheter to gravity- remove in
AM

22. First Medical Order to Implement
Priority Rationale
1. Take the Vital Signs 1.Establish a baseline
and compare to the
previous recording.

23. Priority Independent Nursing
Interventions Rationale
1.Assess LOC, skin 1. Establish baseline.
color, lungs, etc.
2.Check surgical 2. Establish baseline.
dressing/surrounding
site.
3. Assess for
3.Assess IV, IV site, infiltration/rate/amt.
PCA left.

24. Priority Independent Nursing
Interventions Rationale
4.Assess Comfort level/pain 4. Pain Management
5. Assess urinary 5. Patency of cath./color of
catheter/output urine.
6. Assess peri-pad 6. Assess for vaginal
drainage/baseline.
7. Cough and deep breath. 7. Prevent Pulmonary
complications.

25. Critical Thinking Test
Question #1
1.The client is transferred to the surgical unit
from the post anesthesia room after having
abdominal surgery. There is a J-P drainage
device in place. Which of the following
reported findings on transfer requires
immediate follow-up?

26. Answer Choices Question #1
A. Abdominal dressing reinforced in the
recovery room.
B. R.14, P.86, B/P 126/90, lethargic, but
responds to touch.
C. Bowel sounds absent in all quadrants.
D. J-P compressed with 10mL reddish
drainage.

27. Rationale to Question #1
• A. is the answer. Reinforcement of the
surgical dressing indicates excessive
drainage. This should be carefully
monitored.
• B. indicates vital signs WNL.
• C &D are expected findings for a client
who had abdominal surgery.

28. Critical Thinking Test
Question #2
• Which of the following client statements
is correct in describing the appropriate
use of incentive spirometer?

29. Question #2 Choices
A. “I will first inhale then blow into the mouthpiece.”
B. “I will put the mouthpiece in my mouth and blow
into the mouthpiece.”
C. “I will put the mouthpiece in my mouth then
inhale slowly”.
D. “I will put the mouthpiece in my mouth, inhale
and hold for 5 seconds.”

30. Rationale to Question #2
• C is the answer- This describes the
procedure appropriately.
• A & B do not describe the procedure
correctly.
• D is partially correct but the client does not
need to hold for 5 seconds.

31. Critical Thinking Skills
Question/Answers #3
• The nurse is preparing a client for
emergency surgery. Before Surgery, it is
most important for the nurse to ensure
that the:
A. pre-op checklist is completed.
B. pre-op medications are documented.
C. lab results are in the chart.
D. surgical consent is signed.

32. Rationale Question #3
D- is the answer. Although the physician is
responsible for obtaining the client’s
signature, it is most important for the nurse
to ensure that it has been signed.
A, B, and C are important but are not the
most important.