This document outlines preoperative, intraoperative, and postoperative nursing care for surgical patients. It discusses the nursing assessment process including health history, physical exam, and psychosocial evaluation. Key parts of the nursing management are preoperative teaching, informed consent, preparing patients for surgery, and providing care in the operating room, PACU, and postoperative units. Potential postoperative complications are reviewed for multiple body systems along with the corresponding nursing care.

1. Preoperative CarePaulette Hamner RN, MSNNUR 1213

2. SurgeryArt and science of treating diseases, injuries, and deformities by operation and instrumentation

3. SurgeryPerformed forDiagnosisCurePalliationPreventionExplorationCosmetic improvement

4. Surgical SettingsInpatient Same day admissionAmbulatory (outpatient)Usually less than 3 to 4 hours in PACU

5. Patient InterviewCheck documented information prior to interviewAvoids repetitionOccurs in advance or on day of surgery

6. Patient InterviewPurposeObtain health informationDetermine expectationsProvide and clarify information on procedureAssess emotional state and readiness

7. Nursing AssessmentOverall goalIdentify risk factorsPlan care to ensure patient safety

8. Nursing Assessment GoalsDetermine psychological status to reinforce coping strategiesDetermine psychological factors of procedure contributing to risks

9. Nursing Assessment GoalsEstablish baseline dataIdentify medications and herbs taken that may affect surgical outcomeIdentify, document, and communicate results of laboratory/diagnostic tests

10. Nursing Assessment GoalsIdentify cultural and ethnic factors that may affect surgical experienceDetermine receipt of adequate information from surgeon in order to sign informed consent

11. Nursing AssessmentPsychosocial assessmentExcessive stress response can be magnified and recovery affected

12. Nursing AssessmentInfluencing factorsAgePast experienceCurrent healthSocioeconomic status

13. Nursing AssessmentUse common languageUse translators if neededDecreases level of anxietyCommunicate all concerns to surgical team

14. Nursing AssessmentAnxiety can impair cognition, decision making, and coping abilitiesLack of knowledgeUnrealistic expectationsInformation lessens anxiety

15. Nursing AssessmentAnxiety may arise from conflict with interventions (i.e., blood transfusions) and religious/cultural beliefs Identify beliefs and discuss with surgeon and operative staff

16. Nursing AssessmentFearsDeath or disabilityMay prompt postponementInfluence outcomePainConsult with ACPReassure drugs will be available

17. Nursing AssessmentFears Mutilation/alteration in body imageAssess concerns nonjudgmentallyAnesthesiaACP for consultAssess malignant hyperthermia risk

18. Nursing AssessmentFearsDisruption of life functioningRange from fear of permanent disability to temporary lossInclude family and financial concernsConsultations PRN

19. Nursing AssessmentHopeMay be strongest positive coping mechanismNever deny or minimizeAssess and support

20. Nursing AssessmentHealth historyDiagnosed medical conditionsPrevious surgeries and problemsMenstrual/obstetric history

21. Nursing AssessmentHealth history Familial diseasesConditionsReactions/problems to anesthesia (patient or family)

22. Nursing AssessmentCurrent medicationsPrescription and OTCHerbsVitaminsRecreationalDrugsAlcoholTobacco

23. Nursing AssessmentAllergies (drug and nondrug)Screen areas:Risk factorsContact urticariaAerosol reactionsHistory of reactions suggesting latex allergy

24. Nursing AssessmentCardiovascular systemReportProblems for effective monitoringUse of cardiac drugsPresence of pacemaker/MI

25. Nursing AssessmentCardiovascular systemVitals recorded preoperatively for baselineBleeding/clotting timesLaboratory reportsPossible prophylactic antibiotics

26. Nursing AssessmentRespiratory systemInquire about recent airway infectionsProcedure could be cancelled because of increased risk of laryngo/bronchospasm or decreased SaO2

27. Nursing AssessmentRespiratory systemHistory of dyspnea, coughing, or hemoptysis reported to operative teamCOPD or asthmaHigh risk for atelectasis and hypoxemia

28. Nursing AssessmentRespiratory systemSmokers should be encouraged to quit 6 weeks before procedureDecreases risk of complicationsGreater years and number of packs = greater risk

29. Nursing AssessmentNervous systemEvaluation of neurologic functioningVision or hearing loss can influence results

30. Nursing AssessmentNervous systemCognitive functionAssess or correct any deficits before surgeryDurable power of attorney for health care should be obtained if deficits cannot be corrected

31. Nursing AssessmentNervous systemCognitive functionPostoperative delirium (falsely labeled senility or dementia) can occur with dehydration, hypothermia, and adjunctive medications

32. Nursing AssessmentUrinary systemHistory of urinary or renal diseasesRenal dysfunction contributes toF and E imbalancesIncreased risk of infectionImpaired wound healingAltered response to drugs and their elimination

33. Nursing AssessmentUrinary system Renal function testsNote problems voiding and inform operative team

34. Nursing AssessmentIntegumentary systemHistory of skin and musculoskeletal problemsHistory of pressure ulcersExtra padding during procedureAffect postoperative healing

35. Nursing AssessmentMusculoskeletal systemIdentify joints affected with arthritisMobility restrictions may affect positioning and ambulationBring mobility aids to surgery

36. Nursing AssessmentMusculoskeletal system Report problems affecting neck or lumbar spine to ACPCan affect airway management and anesthesia delivery

37. Nursing AssessmentEndocrine systemPatients with diabetes mellitus especially at risk for:Hypo/hyperglycemiaKetosisCardiovascular alterationsDelayed wound healingInfection

38. Nursing AssessmentEndocrine systemPatients with diabetes mellitus Serum glucose tests morning of surgery (baseline)Clarify with physician or ACP if usual dose of insulin is taken

39. Nursing AssessmentEndocrine systemPatients with thyroid dysfunctionHyper/hypothyroidism are surgical risk due to altered metabolic rateVerify with ACP about giving medications

40. Nursing AssessmentEndocrine systemPatients with Addison’s diseaseAbruptly stopping replacement corticosteroids could cause addisonian crisisStress of surgery may require increased dose of corticosteroids

41. Nursing AssessmentImmune systemPatients with history of compromised immune system or use of immunosuppressive drugs can haveDelayed wound healingIncreased risk for infection

42. Nursing AssessmentFluid and electrolyte statusVomiting, diarrhea, or difficulty swallowing can cause imbalanceIdentify drugs that alter statusDiuretics Evaluate serum electrolyte levels

43. Nursing AssessmentFluid and electrolyte status NPO status May require additional fluids and electrolytes prior to surgery if dehydration occurs

44. Nursing AssessmentNutritional statusObesityStresses cardiac and pulmonary systemsIncreased risk of wound dehiscence and infectionSlower recovery from anesthesiaSlower wound healing

45. Nursing AssessmentNutritional status Provide extra padding to underweight patients to prevent pressure ulcersIdentify dietary habits that may affect recovery (i.e., caffeine)

46. Nursing Assessment: ExamFindings enable ACP to rate patient for anesthesia administrationIndicator of perioperative risk and overall outcome

47. Nursing Assessment: ExamDocument relevant findings and report to perioperative teamObtain and evaluate results of laboratory testsMonitor blood glucose for diabetics

48. Nursing ManagementPreoperative teachingPatient has right to know what to expect and how to participateIncreases patient satisfactionReduces fear, anxiety, stress, pain, and vomiting

49. Nursing ManagementPreoperative teaching Limited time availableAddress needs of highest priorityInclude information focused on safetyProvide written material

50. Nursing ManagementPreoperative teaching Several days before surgeryObserve and listen to determine amount of teaching for each sessionAnxiety and fear can hinder learningGive priority to patient’s concerns

51. Nursing ManagementPreoperative teaching Must be documented and reported to postoperative nursesAvoid duplication of informationAssess learning

52. Nursing ManagementPreoperative teachingTeach deep breathing, coughing, and moving for postopInform if tubes, drains, monitoring devices, or special equipment will be used postop

53. Nursing ManagementPreoperative teachingBasic information before arrivalTime and placeFluid and food restrictionsNeed for enemaNeed for shower

54. Nursing ManagementLegal preparationAll required forms are signed and in chartInformed consentBlood transfusionsAdvance directivesPower of attorney

55. Nursing ManagementConsent for surgeryInformed consent must includeAdequate disclosureUnderstanding and comprehension Voluntarily given consent

56. Nursing ManagementSurgeon responsible for obtaining consentNurse may obtain and witness signatureVerify patient has understandingPermission may be withdrawn at any time

57. Nursing ManagementConsent for surgeryMedical emergency may override need for consent

58. Nursing ManagementLegally appointed representative of family may consent if patient isChildUnconsciousMentally incompetent

59. Nursing ManagementDay-of-surgery preparationFinal preoperative teaching Assessment and report of pertinent findingsVerify signed consent

60. Nursing ManagementDay-of-surgery preparationLabs History and physical examinationBaseline vitalsConsultation recordsNurse’s notes

61. Nursing ManagementDay-of-surgery preparation Patient should not wear any cosmeticsObservation of skin color is importantRemove nail polish for pulse oximeter

62. Nursing ManagementDay-of-surgery preparationValuables returned to family member or locked upDentures, contacts, prostheses are removedIdentification and allergy bands on wrist

63. Nursing ManagementVoid before surgeryPrevents involuntary elimination under anesthesia or early postoperative recoveryBefore medication administration

64. Nursing Management:Intraoperative Care

65. Physical EnvironmentDepartment LayoutHolding AreaOperating Room

66. Surgical TeamRegistered NurseLicensed Practical Nurse and Surgical TechnicianSurgeon and AssistantRegistered Nurse First AssistantAnesthesia Care Provider

67. Nursing Management: Patient Before SurgeryPsychosocial AssessmentPhysical AssessmentChart ReviewAdmitting the Patient

68. Nursing Management: Patient During SurgeryRoom PreparationTransferring the PatientScrubbing, Gowning, and GlovingBasic Aseptic TechniqueAssisting the Anesthesia Care Provider

69. Nursing Management: Patient During Surgery (cont.)Positioning the PatientPreparing the Surgical SiteSafety ConsiderationsPatient After Surgery

70. Classification of AnesthesiaGeneral AnesthesiaIntravenous Induction AgentsInhalation Agents

71. Classification of AnesthesiaGeneral Anesthesia (cont.)Adjuncts to General AnesthesiaOpioidsBenzodiazepinesNeuromuscular blocking agentsAntiemeticsDissociative Anesthesia

72. Classification of Anesthesia (cont.)Local AnesthesiaMethods of AdministrationSpinal and epidural anesthesiaAdditional Anesthesia Considerations

73. Gerontologic Considerations: Patient During Surgery

74. Catastrophic Eventsin the Operating RoomAnaphylactic ReactionsMalignant Hyperthermia

75. Postoperative Care in the Postanesthesia Care Unit (cont.)Potential Alterations in Cardiovascular FunctionEtiology

76. Nursing Management:Cardiovascular ComplicationsNursing AssessmentNursing DiagnosesNursing Implementation

77. Postoperative Care in the Postanesthesia Care Unit (cont.)Potential Alterations in Neurologic FunctionEtiology

78. Nursing Management:Neurologic ComplicationsNursing AssessmentNursing DiagnosesNursing Implementation

79. Postoperative Care in the Postanesthesia Care Unit (cont.)Pain and DiscomfortEtiology

80. Nursing Management: PainNursing AssessmentNursing DiagnosesNursing Implementation

81. Postoperative Care in the Postanesthesia Care Unit (cont.)HypothermaEtiology

82. Nursing Management: HypothermiaNursing AssessmentNursing DiagnosesNursing Implementation

83. Postoperative Care in the Postanesthesia Care Unit (cont.)Nausea and VomitingEtiology

84. Nursing Management:Nausea and VomitingNursing AssessmentNursing DiagnosesNursing Implementation

85. Postoperative Care in the Postanesthesia Care Unit (cont.)Surgical-Specific Care of the Patient in the PACUDischarge from the PACUAmbulatory Surgery Discharge

86. Care of the Postoperative Patient on the Clinical UnitPotential Alterations in Respiratory FunctionEtiology

87. Nursing Management:Respiratory ComplicationsNursing AssessmentEtiologyNursing DiagnosesNursing Implementation

88. Nursing Management:Cardiovascular ComplicationsNursing AssessmentEtiologyNursing DiagnosesNursing Implementation

89. Nursing Management:Urinary ComplicationsNursing AssessmentNursing DiagnosesNursing Implementation

90. Nursing Management:Gastrointestinal ComplicationsNursing AssessmentEtiologyNursing DiagnosesNursing Implementation

91. Nursing Management:Surgical WoundsNursing AssessmentEtiologyNursing DiagnosesNursing Implementation

92. Nursing Management:Psychologic FunctionNursing DiagnosesEtiologyNursing Implementation

93. Care of the Postoperative Patienton the Clinical Unit (cont.)Planning for Discharge and Follow-Up Care