This document discusses perioperative nursing. It describes the three phases of perioperative care - preoperative, intraoperative, and postoperative. In the preoperative phase, the responsibilities of the operating room nurse include assessing the patient physically and emotionally, ensuring understanding of the surgery and consent, completing legal documentation, and providing teaching. Key considerations in preoperative nursing include assessment, determining readiness for surgery, and ensuring availability of the healthcare team. The roles and responsibilities of team members like the circulating nurse and scrub nurse are also outlined.

1. PERI-OPERATIVE NURSINGPERI-OPERATIVE NURSING
UNIVERISTY OF NORTH FLORIDA
SCHOOL OF NURSING
M. Catherine Hough, PhD, RN, Associate Professor
Linda K. Connelly, ARNP, MSN, CNOR

2. Introduction to Perioperative NursingIntroduction to Perioperative Nursing
Phases of Perioperative Care
 Pre OperativePre Operative - begins with the patient’s decision to have
surgery, ends with entry into the operating room
 Intra OperativeIntra Operative - begins with entry into the operating room and
ends with admission to the recovery room
 Post OperativePost Operative - begins with admission to recovery room, and
ends with discharge from care (varies but usually 6 weeks post
op) by physician

3. PERIOPERATIVE NURSING

4. Informed ConsentInformed Consent

5. Pre-OperativePre-Operative
Responsibilities of Operating Room Nurse:
 Patient Assessment
 Physical Problems
 Emotional Aspects
 Understanding of surgery/consent
 Legal requirements for chart completion
 Read and interpret lab results
 PeriOperative Teaching

6. PREOPERATIVE NURSING
CONSIDERATIONS
 COMPLETE PHYSICAL ASSESSMENT
 Physical & psychological needs
 Medical & surgical history
 Completion of required documents
 DETERMINE READINESS & MODE OF
TRANSPORTATION TO OR
 ACCESS HEALTH CARE TEAM AVAILABILITY
 Surgeon
 Anesthesia personnel
 Circulating nurse
 Scrub person
 Other personnel

7. PRE-OP MEDS
 Pharmacologic preparation as necessary &
psychological support
 Facilitates induction of anesthesia & reduces
anesthetic requirement
 Determinants of drug choice
 Age
 Weight
 Level of anxiety
 Drug allergies
 Inpatient/outpatient
 Timing of administration

8. PREOPERATIVE NURSING
CONSIDERATIONS
 COMPLETE PHYSICAL ASSESSMENT
 Physical & psychological needs
 Medical & surgical history
 Completion of required documents
 DETERMINE READINESS & MODE OF
TRANSPORTATION TO OR
 ACCESS HEALTH CARE TEAM AVAILABILITY
 Surgeon
 Anesthesia personnel
 Circulating nurse
 Scrub person
 Other personnel

9. Intra-OperativeIntra-Operative
 Provide for quiet environment during induction
 Assist during intubation
 Observe aseptic technique
 Safe operation of equipment (lasers, electrosurgery unit)
 Position patient safely - CV, nervous, respiratory system
 Document events, patient care given,
 Provide all supplies, equipment, to team during surgery
 Provide for a safe transfer to recovery room

10. Unsterile Team MemberUnsterile Team Member
 Responsible for nursing care in the operating room
 Responsible for the organization of the workload
 Responsible for the maintenance of policy and
procedures
 Responsible for signing and documentation
 The Circulating Nurse is the professional staff
member in the operating room, representing the
patient (Patient Advocate) and the hospital
administration

11. Surgical Nurse 1889
 A level head & keen eyes, ever watchful for
all that may be required, a mind not easily
irritated or confused, combined with the
facility of keeping out of the way & still being
of the greatest help……..Thoroughness,
speed, gentleness especially fit the surgical
nurse.
(Asepsis for the Nurse, Clemons, 1889)

12. 1945
Discussion of the role of the OR Nurse
 “In charge of the operating room, taking care of the
needs of the room assigned to her. It is her
responsibility to watch the aseptic technique of her
team.”
 “A surgery nurse must have many good qualities; but
first of all, she must be conscientious of sterile
technique. Speed & efficiency are of no avail if a
surgical wound breaks down due to an infection
received in the OR. “
Crawford, 1945

13. SCRUB PERSON
 May be a:
 RN
 LPN
 Surgical Tech
 Duties:
 Usually confined to
the intraoperative
phase of the
patient’s surgical
experience, may also
be involved in
gathering surgical
supplies &
equipment

14. SCRUB NURSE
“ The nurse who is the immediate
assistant to the surgeon is often called
the “scrub” or “sterile” nurse. She first
scrubs her hands and arms the required
length of time, puts on sterile gown &
gloves, and handles only sterile
material.”
Crawford 1945

15. SCENARIO #1
 A. Smith, RN & D Jones, RN are assigned to scrub &
circulate for a 0800 gastrostomy on WW, a 79 year
old emaciated male. Since his hospitalization 3 days
ago, he has managed to remove his IV and NG tube
several times. Consequently he has been restrained
even on the stretcher during his transport to the OR.
His medical DX is chronic alcoholism with dementia.
WW seems to acknowledge D Jones’s presence with
a half glance, however he will not respond to the
anesthesia provider’s questions. WW is supported
on the stretcher in a semi-flower’s position with
several pillows. Further assessment reveals that WW
has contractures of his hips and knees.

16. SURGICAL POSITIONING
 Facilitated through the nursing process
 Patient’s body must remain in physiologic alignment
 Dependent Upon:
 The surgical procedure
 Exposure at the surgical field
 Surgeon’s preference and idiosyncrasies
 Patient’s condition
 Special Considerations:
 Geriatric patients
 Obese patients
 Malnourished patients

17. SURGICAL POSITIONING
EQUIPMENT
 Pillow or headrest
 Arm boards
 Safety belt/strap
 Footboard
 Padding
 Gel pads
 Egg crate
 Donut rolls
 Foam
 Padded Shoulder
braces
 Stirrups (candy canes,
Allen, or knee)
 Laminectomy Frame
 Olympic vac pac
(suction beanbag)
 3” adhesive tape

18. POSITIONING DEVICES

19. SCENARIO #2
 WH is a 36 year old black male who had been
scheduled for a hemorrhoidectomy on an outpatient
basis. He is 5’ 11”tall and weighs 250 lbs. His HBG is
low (12g/dL) secondary to rectal bleeding. WH has a
HX of asthma since age 5. He has episodes of
difficulty breathing 6X/year, treated with an inhaler at
the time of each episode. He does not smoke; ETOH
2 glasses of beer per week. WH’s current BP is
138/96, which he controls by taking a daily
antihypertensive med. WH is a high school teacher.
He spends most of his days standing and
occasionally sitting. His evenings and weekend are
spent working on a master’s degree in education. He
does not participate in a regular exercise program.

20. SETTINGS:SETTINGS:
 Ambulatory Surgery - In and Out in same
day
 Pre-op teaching
 T&A, Cyst removal, D&C, Cataract removal
with lens implants, Biopsy
 Heart cath
 scopes

21. SETTINGS…SETTINGS…
 Same Day General Surgery - Admitted to
inpatient unit or special same day surgery unit
 Pre-Op teaching prior to day of
surgery
 Nurses especially trained in Pre-Op
assessment (Hysterectomy, Lap
Chole, Appendectomy,
Mastectomy, C-Section)

22. SETTINGSSETTINGS ……
 Main OR SurgeryMain OR Surgery - Patient admitted to hospital prior
to surgery OR DAY OF SURGERY
 Prep and assessment and teaching done in
hospital
 Patient stays @ least overnight, and rehab
begins before discharge
 Major heart surgery such as CABG’s, Bowel
Resections, Large tumor removal or Brain
surgery

23. PURPOSE of SURGERYPURPOSE of SURGERY
 Diagnostic - Determines cause of symptoms (Exploratory
laparotomy and biopsy)
 Curative - Removal of diseased part (Appendectomy, Ovarian
Cyst, Cancerous Tumors)
 Restorative or Reconstructive - Strengthens a weakened part
(Herniorrhaphy or cervical rings) rejoins disconnected areas
(orthopedic surgeries), corrects deformities, (MVR, joint
replacement, etc)
 Palliative - Relieves symptoms without curing (some lower back
surgeries, tumorectomies)
 Cosmetic - Repairing a burn scar or changing breast shape,
altering physical appearance

24. Patients @ High risk for ComplicationsPatients @ High risk for Complications
 Smokers
 Obese
 Chronic Lung Diseases
 Elderly
 HTN
 Thoracic or Abdominal
Surgeries
 Immobilizing Surgery
 UTI
 Diabetes
 Poor Nutritional Status
 Dehydration
 Heart Disease
 Self-fulfilling Prophecy
 Inhalant Anesthesia

25. PREVENTING COMPLICATIONSPREVENTING COMPLICATIONS
DVT, UTI, Aspiration,
Wound Infection, Shock, Constipation
 Identify those @ risk
 Provide adequate hydration/nutrition
 NPO after MN
 Leg exercises
 Breathing exercises and IS
 I&O

26. Preventing Complications…Preventing Complications…
 Splint Incision to cough
 Anticoagulant Therapy - Heparin
 Ambulate and OOB to BRP - ASAP
 Discourage smoking
 Fluid and fiber ASAP, laxatives. Enemas
 Clean Hands
 Instruct in proper wound care
 Sterile bowel prep and skin prep
 Sleep/Rest

27. PREPPING THE PATIENTPREPPING THE PATIENT
TEACHING
 Name and purpose of the surgery
 NPO after MN and why early awakening, shower,
remove all jewelry, makeup, etc
 Anesthesia, Cold Room, Smells, Drowsy Feeling
 Recovery Room
 Post-op care - TCDB, leg exercises, pain
management, DVT< OOB ASAP
 Begin discharge planning

28. WAYS TO DECREASE ANXIETYWAYS TO DECREASE ANXIETY
COMMUNICATION
 Early teaching and counseling
 Diversional activities
 Encourage family support
 Encourage verbalization of fears/loss of control
 Deep breathing, medications, imagery, music

29. Ways to Decrease Anxiety…Ways to Decrease Anxiety…
 Spiritual support (communion, bible reading,
prayers, rituals, chants)
 Inform family where to wait, buy food,
bathroom, phone, overnight and visiting
policy
 Possible use of sedative or tranquilizer or
PRN medications
 Dolls/favorite toy for children

30. NURSING ASSESSMENTNURSING ASSESSMENT
 Assessment Data Base - vital signs, weight,
height
 Review of Systems
 Past history of illnesses (i.e. HTN,
pneumonia) that may predispose client to
complications
 Past experience with hospitalization or
surgery
 Allergies to medications or foods, tapes,
surgical scrubs

31. Nursing Assessment…Nursing Assessment…
 Intellectual ability to understand teaching
 Language differences, social, spiritual or cultural
considerations, anxiety level
 Labs: CBC; U/A; Chemistry (electrolytes:
K,CL,NA,CA,BS,BUN,Creatine), total bilirubin,
albumin, alkaline phosphatase, SGOT, HCO3, HIV,
Pregnancy
 Other: Chest X-Ray, EKG if > 40 years old

32. PRE-OP NURSING DIAGNOSESPRE-OP NURSING DIAGNOSES
 Knowledge Deficit R/T Unfamiliar Planned or
Unplanned Surgery
 Ineffective individual or family coping R/T Unfamiliar
Planned or Unplanned Surgery
 Anticipatory Grieving R/T Potential for Loss of Life or
Body Part

33. NURSING RESPONSIBLITIESNURSING RESPONSIBLITIES
 Informed Consent Form/Patient Advocacy
 Secure personal belongings: Dentures, glasses,
rings, money
 Administration of pre-op medications on call to
OR - i.e. Demerol, Valium, Atropine
 Complete Pre-op Checklist @ clinical site -
remove hair pins, loose teeth, dentures, nail
polish, bath, urinate, NPO, VS taken within 15
minutes of going to OR, Ted Hose or compression
devices

34. NURSING RESPONSIBLITIES ...NURSING RESPONSIBLITIES ...
 Report anything of note that needs to be brought to the attention
of the anesthesiologist, surgeon, or OR nurse

low potassium,

fever,

arrthymias,

loose teeth,

chest pain, or

anything unusual
 Assure patient has ID bracelet on; Send current chart and any
old medical records with the patient;
 EVALUATE patients level of understanding, physical stability,
emotionally prepared, fulfilled hospital pre-op policies

35. TYPES OF SURGERYTYPES OF SURGERY
 MAJORMAJOR -- Present a real threat to life
 MINORMINOR -- Present little threat to life
NOTE: ****NOTE: **** All patients consider their
surgery a major thing ********

36. BLOODLESS SURGERY
 a term that has evolved in the medical
literature to refer to a perioperative team
approach to avoid allogeneic transfusions
and improve patient outcomes
 utilizing combinations of the numerous blood
conservation techniques and transfusion
alternatives available

37. BENEFITS OF BLOODLESS SURGERY
 Decreased costs
 Less risk for blood
contamination for
patients
 Reduce risk of post op
fevers and infections
usually associated with
blood transfusions
 Promotes better quality
patient care
 At times decreased
death rate
 Can decrease time
spent in ICU

38. Catastrophic Events in the ORCatastrophic Events in the OR
AnticipatedAnticipated:
 Cardiac Arrest in an unstable patient
 Massive Blood Loss - during trauma surgery
 Loss of ability to ventilate a patient

39. Catastrophic Events in OR ...Catastrophic Events in OR ...
Unanticipated:Unanticipated:
 Latex Allergy ReactionLatex Allergy Reaction - reactions can range from
urticaria to anaphylaxis
 Maligant HyperthermiaMaligant Hyperthermia - rare, life-threatening
disorder that can be triggered by anesthesia drugs -
Is an autosomal dominant trait

40. Peri-Operative Standards of Care (example)Peri-Operative Standards of Care (example)
 All Policy & Procedures of the medical and surgical nursing division
will be followed.
 Patients shall ALWAYS wear a legible identification band
 Operative permit(s) must be signed and witnessed according to
hospital policy, The procedure documented on the operative permit
MUST MATCH what is scheduled on the OR schedule
 The history and physical shall be completed according to policy and
be part of the medical record prior to surgery
 All ordered lab work shall be collected and results placed in the
medical record in accordance with the physician’s orders
 Dentures, hairpins, jewelry, wigs, contact lenses, nail polish, make-up
and prosthesis shall be removed as requested by the physician
 Any jewelry not removed shall be secured with tape and documented
as such

41. Peri-Operative Standards of Care …
 Pre-operative skin prep shall be done without abrading, cutting or
irritating the patient’s skin
 Patient privacy shall be provided at all times
 Any pre-operative drainage tubes shall be placed without tissue trauma
and be completed utilizing sterile techniques when indicated
 All IV infusions shall be monitored to maintain the appropriate flow rate
and type of solution and remain patent without signs of inflammation or
swelling
 The patient shall be provided emotional and educational support to
reduce pre-operative anxiety
 The patients shall be provided a safe and normothermic environment in
the pre-op waiting area
 The patient shall be transferred safely to the OR table and safety straps
appropriately applied

42. Expected Outcomes:Expected Outcomes:
 Demonstrate knowledge of physiologic &
psychological responses to surgical
intervention
 Absence of infection
 Maintenance of skin integrity
 Freedom from injury R/T positioning,
equipment
 Maintenance of fluid and electrolyte balance
 Satisfaction with pain relief
 Participation in the rehab process

43. AORN a tradition of excellence
 Formally organized between 1949 – 1954
 A professional organization of periOperative
registered nurses whose mission is to provide quality
patient care by providing its members with education,
standards, services and representation.
 Membership 340 chapters, 12 specialty assemblies,
25 state councils and 41,000 members

44. PERIOPERATIVE NURSING
If you or your family came
through surgery in good shape,
thank a perioperative nurse.

45. If someone listens, or stretches out a
hand, or whispers a kind word of
encouragement, or attempts to
understand a lonely person, extraordinary
things begin to happen
Loretta Gizarlis (1920)
American writer and educator

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