Perioperative care involves three phases: preoperative, intraoperative, and postoperative. The preoperative phase begins with the decision for surgery and continues until the patient reaches the operating area. The intraoperative phase is the duration of the surgical procedure. The postoperative phase begins in the recovery area and continues until follow up evaluation or discharge. Perioperative care requires evaluation of the patient's history and medical optimization for surgery through tests, medications, and skin/digestive preparation depending on the type, risk level, and urgency of the procedure. Immediate postoperative care focuses on airway, respiration, circulation, fluid balance, and pain level along with ongoing assessment of the patient's general condition and recovery.
Caring for perioperative clients
Contents Outline
Objectives.
Introduction.
Phases of perioperative care.
Types of surgery.
Categories of surgery based on urgency.
Preoperative assessment.
Surgical risk factors.
Preoperative preparation.
Nursing diagnosis and intervention in preoperative phase.
Postoperative care.
Nursing diagnosis and intervention in postoperative period.
Postoperative complications.
Caring for perioperative clients
Contents Outline
Objectives.
Introduction.
Phases of perioperative care.
Types of surgery.
Categories of surgery based on urgency.
Preoperative assessment.
Surgical risk factors.
Preoperative preparation.
Nursing diagnosis and intervention in preoperative phase.
Postoperative care.
Nursing diagnosis and intervention in postoperative period.
Postoperative complications.
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Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
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This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
This PPT describes about the Metabolic response to injury as given in Bailey & Love - 26th edition. It will be very useful for Final year MBBS students.
Things to ensure and check off the list before a patient is shifted to the OR for surgery. The responsibility rests mainly with the resident doctor and the registered nurse to ensure complete preoperative preparation of the patient.
Post-Operative Managment
• The post operative period begins from the time
• The patients leaves the operating room and ends with the
follow up visit by the surgeon.
• The post operative care is provided by
-- PACU
-- SICU
Peri operative nursing is a nursing specialty that works with patients who are having injuries, invasive procedures. Peri-operative nurses work closely with surgeons, anesthesiologists, nurse anesthetist, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, post operative care primarily in the operating theater. The nurse assesses the patient data; establishing nursing diagnosis; identifies desired patient outcome; develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient
All aspects of peri operative care is described.
-preoperative care
-postoperative care
Role of nurse in pre operative nursing:
1.Pre operative assessment.
2.Obtaining informed consent.
3.Pre operative teaching.
4.Physical preparation of patients.
5.Psychological preparation
6.Informed Consent
POST OPERATIVE CARE: Post operative phase begins when the client is admitted to the post operative unit and ends with the client’s post operative evaluation in the physician’s office.
GOAL:
Restore homeostasis and prevent complication.
Maintain adequate cardio vascular and tissue perfusion
Maintain adequate respiratory function
Maintain adequate nutrition and elimination
Maintain adequate fluid electrolyte balance
Maintain adequate renal function
Promote adequate rest, comfort, and safety
Promote adequate wound healing
Promote and maintain activity and mobility
Provide adequate psychological support.
TRANSFER FROM OPERATION ROOM:
After sending the patient to operating room, prepare a bed to receive the patient undergone surgery.
Receive the patient without disturbing the devices attached to the patient.
Assessment A- Airway, B- Breathing, C- Circulation, C- Consciousness, S- Safety, D- Dressing, D- Drainage, D- Drugs , E- Elimination F- Foods, F- Fluids P- Pain.
Ask the theater staff about any complications during surgery.
Check vital signs.
Check the operation site for bleeding, discharge, etc. if drainage tube are filled.
Keep the patient well covered to prevent draught
Never leave the patient alone to prevent injury from fall
Observe the patient for swallowing reflexes
Quickly observe the functioning of all devices and make sure that they are in its functioning order.
Check the doctor’s order for other instruction and treatment.
POST OPERATIVE COMPLICATIONS:
Haematological: Hemorrhage
Respiratory: Atelectesis, Pneumonia, Pulmonary Embolism
Cardiovascular: Hypertension, cardiac dysrhythmias, venous thrombosis
Urinary: Urinary retention
Gastrointestinal: Constipation
Neurological: CVA/Stroke
Immunological: Infection
Wound healing: infection
Psychological: Body image problrms
POST OPERATIVE NURSING CARE:
Maintaining Respiratory function:
i.Encourage diaphragmatic breathing exercise at least every two hours while clients are awake
ii.Instruct to use incentive spirometers for maximum inspiration
iii.Encourage early ambulation
iv.Change position every one two hours.
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2. What is meant by perioperative?
Perioperative is a term used to describe the
entire span of surgery, including what occurs
before, during and after the actual operation.
3. Phases of perioperative care
• Preoperative : begins with decision to perform surgery and continues
until the patient has reached the operating area.
• Intraoperative: incudes the entire duration of surgical procedure, until
transfer of patient to the recovery area.
• Postoperative: begins with admission to recovery area and continues
until the patient receives a follow up evaluation at home, or is
discharged to rehabilitation unit.
4. Classifications of surgery
purpose
• Diagnostic
• Exploratory
• Curative
• Palliative
• cosmetic
Degree of risk
• Major
• Minor
Urgency
• Emergency
• Urgent
• Required
• Elective
• optional
5. Preoperative evaluation and optimisation
Each patient and each procedure require a unique set off investigation
with regards to preoperative preparations. But in general for a surgical
patient we begin with following-
1. Thorough history and physical examination- giving specific attention
to comorbidities that may affect surgical risk and require additional
pre-op workup.
2. Basic laboratory investigation-CBC, liver function test, renal function
test, serum electrolytes, coagulation study, blood grouping, albumin
level, urinalysis, pregnancy testing
3. Chest xray
4. Ecg
13. For futher study
• bailey and love’s short practice of surgery 27 th edition
• Sabiston text book of surgery 21 st edition
• Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation. BMJ
Qual Saf. 2014;23(4):299-318. doi:10.1136/bmjqs-2012-001797
• Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: Time to
change practice?. Can Urol Assoc J. 2011;5(5):342-348. doi:10.5489/cuaj.11002
