Perioperative Nursing

Perioperative Nursing
Mr Christian Steve C. Valenzuela, R.N
Lecturer
Medical-Surgical Nursing:

Perioperative nursing
- nursing care provided in the total surgical
experience of the patient.
Preoperative phase:
extends from the time of admission to the
surgical unit, to the time the patient is prepared
for surgical procedure, until he/she is transported
to the OR.
Intraoperative phase:
extends from the time the patient is admitted to
OR, to the time of administration of anesthesia,
surgical procedure is done, until he/she is
transported to PACU.
Postoperative phase:
extends from the time of admission to the PACU,
to the time the patient is transported back to
surgical unit, discharged from the hospital until
follow up care.
2

Perioperative Nursing 3
SURGERY
- use of instruments during an operation to treat injuries,
dses, and deformities.
- branch of medicine concerned with diseases and trauma
requiring operative procedures.

INpatient OUTpatient
Settings

Does this man need
medical ninjutsu,
Lady Tsunade?
Hmm. His chakra points
are already damaged up
to cellular level, Sakura.
There is nothing we can
do. :’(
Does this man need
surgical intervention,
Doc?
Yes! He needs
emergency surgery!
T
O
P
E

Classifications of Surgical
Procedure:
PURPOSE URGENCY
DEGREE of RISK
Diagnostic
Exploratory
Curative
Palliative
Cosmetic
Emergent
Urgent
Required
Elective
Optional
Major
Minor

patient requires prompt treatment.
According to URGENCY:
Emergent:
patient requires immediate
attention, life threatening condition.
Urgent:
Required:
patient needs to have surgery.

surgery rests on the patient’s
decision.
According to URGENCY:
Elective:
patient should have surgery.
Optional:

to determine the extent of dse
condition.
According to PURPOSE:
Diagnostic:
to establish the presence of a dse
condition.
Exploratory:

Curative:
to treat the dse condition.
Ablative
Constructive
Reconstructive

Palliative:
to relieve distressing s/sx.
Cosmetic:
performed primarily to alter or
enhance personal appearance.

According to DEGREE of RISK:
MAJOR:
High risk; extensive; prolonged;
large amount of blood loss, vital
organ maybe handled or removed.
minor:
Less risk; not prolonged; few
complication.

DRILL: Categorize the following acc.to surgery urgency, purpose
of surgery and to the degree of risk.
Pathology/Procedure Urgency Purpose Degree of Risk
Pap Smear
Skin Grafting for
extensive burn
Cholecystectomy
Osteoplasty
Gunshot/ Stab wound
Severe bleeding
Scar repair
Fractured skull
Thyroidectomy
Cataract extraction
Optional Diagnostic Minor
Urgent Curative Major
Urgent Curative Major
Required Curative Minor
Emergent Curative Major
Elective Cosmetic Minor
Required Curative Major
Required Curative Minor

Surgical Risks

Surgical Risk:
AGE
Nsg. Considerations:
1. Anticipate lesser dosage of meds.
2. Anticipate problem from c.dses.
3. Diet:
4. SAFETY!

Surgical Risk:
NUTRITIONAL Status
1. Weigh the aeg before surgery.
2. Diet:
3. Encourage wt. reduction.
4. Instruct aeg. about proper wound
splinting.
5. Drugs should be dosed accordingly!
6. Recommend repair of dental caries
and proper mouth hygiene.

Surgical Risk:
FLUID and ELECTROLYTE IMBALANCE
1. Correct any imbalances.
2. MIO

Surgical Risk:
Chronic COMORBID diseases
1. Avoid fluid overload.
2. Assess v/s.
3. Encourage position changes.
4. Monitor blood glucose.

Surgical Risk:
ALCOHOLISM
1. Anticipate acute withdrawal
symptoms.

Surgical Risk:
SMOKING
1. Encourage vitamin intake.

Surgical Risk:
Concurrent or prior PHARMACOTHERAPY
1. Obtain medication history.
2. Stop ALL medications!

PREOPERATIVE
PHASE

PREOPERATIVE
PHASE
GOALS:
 Assessing and correcting physiologic and
psychological problems that might increase
surgical risk.
 Giving the person and SOs complete learning/
teaching guidelines regarding surgery.

PREOPERATIVE
PHASE
GOALS:
 Instructing and demonstrating exercises that will
benefit the person during postop period.
 Planning for discharge and any projected
changes in lifestyle due to surgery.

PREOPERATIVE
PHASE
Routine Pre.op Screening Tests
CBC X matching Serum Electrolytes
PT, PTT FBS
BUN, Crea
ALT, AST S.albumin, total CHON
U/A
C-XR
ECG

45/M with Rectal CA. Plan: Abdomino-
perineal surgery. Timing of hair removal?
a. Night before surgery
b. 3 hours before surgery
c. Early a.m on the day of the surgery
d. At the operating threatre
DRILL

Informed Consent
- permission obtained from a patient to perform a specific test or
procedure.
Purposes:
1. To ensure that the client understands the nature of
the treatment.
2. Indicate that the client’s decision was made without
pressure.
PREOPERATIVE
PHASE

Purposes:
3. To protect the client against unauthorized procedure.
4. To protect the surgeon and hospital against legal
actions by a client who claims that unauthorized procedure
was performed.
PREOPERATIVE
PHASE

Under what circumstances
is informed consent
required?
1. Any surgical procedure where scalpels,
scissors, suture, hemostats of
electrocoagulation may be used.
2. Entrance into body cavity.
3. Radiologic procedures, i.e with contrast
media.
4. General anesthesia, local infiltration and
regional block.
PREOPERATIVE
PHASE

PREOPERATIVE
PHASE
Requisites in obtaining and ensuring the validity of informed
consent:
Who should be able
to obtain the consent
from the patient?
Who can be a
desirable witness?
When is the ideal
time to obtain a
consent?
Can minors give
an informed
consent?
How about in a state
of mental illness or
unconsciousness?
My patient does not
know how to write but of
legal age, can he give
consent?
In emergency
situation, is consent
necessary?

PREOPERATIVE Teachings:

Preoperative Teaching: PREOPERATIVE
PHASE
INCENTIVE SPIROMETRY

PHASE
DIAPHRAGMATIC BREATHING
Procedure:
1. Position in Semi-Fowler’s.
2. Breathe out gently and fully.
3. Take a deep breath through nose and
mouth.
4. Hold breath.
5. Exhale through your nose and mouth.

PHASE
COUGHING EXERCISES
Procedure:
1. Interlace fingers and place
hands over the proposed incision
site.
2. Lean forward slightly while sitting
in bed.
3. Breath with mouth slightly open.
4. Let out 3-4 sharp hacks.
5. Take in deep breath with mouth open
and quickly give 1-2 strong coughs.

PHASE
TURNING
Procedure:
1. Place the uppermost leg in a
more flexed position than lower leg.
2. Place a pillow in between the legs.
3. Make sure that the patient is turned
from one side to back and v.v
every 2 hours.

PHASE
FOOT AND LEG EXERCISES
Procedure:
1. Ask the patient to lie
supine.
2. Instruct the patient to
bend a knee and raise
a foot.
3. Repeat 5 times with
one leg and the other
every 3-5 hours.

PREOPERATIVE Preparations:
PREOPERATIVE
PHASE

Preparing the Patient the Evening Before Surgery
Skin Preparation:
- FULL Bath
- Hair removal: within 1-2 mm of skin, use electric clipper.
GIT Preparation:
- NPO
- Cleansing enema
PREOPERATIVE
PHASE

Liquid and Food
Intake
Minimum Fasting
Period (Hrs.)
Clear Liquids
Breast Milk
Nonhuman Milk
Light Meal
Regular/Heavy
Meal
PREOPERATIVE
PHASE

 Preparing for Anesthesia:
- Avoid alcohol and cigarette smoking.
 Promoting Rest and Sleep:
- Adm.sedatives as ordered.
Preparing the Patient the Evening Before Surgery
PREOPERATIVE
PHASE

Preparing the Patient the Day Before Surgery
- Awaken 1 hour before
preop meds.
- Remove hairpins, braid
long hair, cover hair
with cap
- Remove hearing aid,
contact lenses
- Check for special
orders
- Have client void before
preop meds.

PREOPERATIVE
PHASE
PREOPERATIVE MEDICATIONS
Tranquilizers and Sedatives
diazepam
midazolam
lorazepam
diphendydramine

PREOPERATIVE
PHASE
Analgesics
nalbuphine
fentanyl
meperidine
Morphine SO4

PREOPERATIVE
PHASE
Anticholinergics
AtSO4

PREOPERATIVE
PHASE
Antiemetics
odansetron
metoclopramide
promethazine Hcl
scopolamine

PREOPERATIVE
PHASE
H2 antagonists and Proton pump inhibitors
cimetidine
ranitidine
famotidine
omeprazole

PREOPERATIVE
PHASE
Antibiotics
amoxicillin
cefazolin
ampicillin

Let me help you
review the
colours of IV
cannula...

A client has returned from surgery with a fire,
reddened rash noted around the area where
betadine prep has been applied prior to
surgery. Nursing documentation in the chart
should include:
a. Time & circumstances under which the
rash was noted.
b. Explanation given to the client and Sos
for the occurrence of the rash.
c. Notation on an allergy and notification
of the doctor.
d. The reason for corticosteroids
application.
DRILL

INTRAOPERATIVE
PHASE

INTRAOPERATIVE
PHASE
GOALS:
 Homeostasis
 Asepsis
 Safe administration of anesthesia
 Hemostasis

INTRAOPERATIVE
PHASE
SURGEON
Preoperative medical Hx and P.A
Performs operative procedure
Primary decision maker
May assist with positioning and
prepping the patient or may
delegate.

INTRAOPERATIVE
PHASE
ASST.SURGEON
Assists with retracting, hemostasis,
suturing and other tasks requested by
the surgeon.

INTRAOPERATIVE
PHASE
ANESTHESIOLOGIST
Selects and administers the
anesthesia.
Intubates the patient as necessary.
Manages technical problems r/t
anesthesia.

Reviews A&P, and the surgical
procedure.
Assists with room prep.
Scrubs, gowns and gloves self and
other members of the team.
Prepares instrument table and
organizes sterile equipment.
Assists with the draping procedure .
SCRUB NURSE
INTRAOPERATIVE
PHASE

Passes anticipated/requested
instruments to the surgeon and
assistant.
Counts sponges, needles and
instruments.
Monitors the consistency of aseptic
practices.
Keeps track of irrigations used for
calculations of blood loss.
SCRUB NURSE
INTRAOPERATIVE
PHASE

INTRAOPERATIVE
PHASE
Manages personnel equipment,
supplies and the environment.
Ensures all equipment are working
properly.
Guarantees sterility of equipment and
supplies.
Assists with positioning.
CIRCULATING NURSE

INTRAOPERATIVE
PHASE
Handles specimen.
Coordinator, patient advocate, teacher,
research consumer, leader and role
model.
Documents care provided.
Monitor the room and team members
for break in the sterile technique.
CIRCULATING NURSE

Aseptic Techniques

Basic Principles of Aseptic Technique:
Sterile objects remain sterile only when touched
by another sterile object.A sterile object or field out of range of vision or an
object held below a person’s waist is contaminated.When a sterile surface come is contact with a wet,
contaminated surface, the sterile object or field is
considered contaminated.The edges of sterile field/container are
considered to be contaminated.
Gowns are considered sterile from chest to the level
of the sterile field, and the sleeves to 2 inches above
the elbows.When in doubt, consider it UNSTERILE!
STERILE – STERILE, UNSTERILE – UNSTERILE!

Sequence in Removing Soiled Gowns & Gloves at the End of
the Procedure

Position During Surgery
Dorsal Recumbent
INTRAOPERATIVE
PHASE
Procedures:
 Hernia repair
 Bowel resection
 Bartholins Cyts Removal

Supine
INTRAOPERATIVE
PHASE
Procedures:
 Abdominal surgery
 Chest/Breast surgery
 Neck surgery
 Ear surgery
 Abdomino-thoracic surgery
 Lower extremity procedures

Trendelenburg
INTRAOPERATIVE
PHASE
Procedures:
 Lower abdomen surgery
 Pelvic Surgery

Lithotomy
INTRAOPERATIVE
PHASE
Procedures:
 Perineal Repair
 Vaginal Repair
 D & C

Prone
INTRAOPERATIVE
PHASE
Procedures:
 Laminectomy
 Surgery of the posterior surface
of the body
 Surgery involving buttocks
 Spinal Surgery

Lateral
INTRAOPERATIVE
PHASE
Procedures:
 Hemithorax
 Kidney surgery
 Hip surgery

Jack Knife
INTRAOPERATIVE
PHASE
Procedures:
 Rectal procedures

Reverse Trendelenburg
INTRAOPERATIVE
PHASE
Procedures:
 Thyroidectomy
 Upper abd’l surgery
 Head and Neck surgery
 Facial surgery

Positions During
Surgery
INTRAOPERATIVE
PHASE
Procedures:
 NGT Insertion
 Bronchoscopy
 Thoracentesis
 Otorhinologic
procedures
Procedure:
 Rectal Procedures

ANESTHESIA
- produces muscle relaxation, block transmission of pain
nerve impulses and suppress reflexes.
- decreases temporarily the memory retrieval and recall.

TYPES OF ANESTHESIA
INTRAOPERATIVE
PHASE
GENERAL
REGIONAL
- covers the entire body
- covers a specific area of
the body

General Anesthesia
• reversible state consisting of complete loss of
consciousness and sensation.
• protective reflexes such as cough and gag are
lost.
• Produces amnesia and hypnosis.
• Can be administered through IV or inhalation.
INTRAOPERATIVE
PHASE

Intravenous Anesthesia: Inhalation Anesthesia:
- prepares the client for smooth
transition to surgical anesthesia.
- effects are extremely rapid; requires
artificial airway
Ex.
thiopental Na (Pentothal Na)
methohexical Na (Brevital)
fentanyl (Sublimaze)
diazepam (Valium)
midazolam (Versed)
- comprises of volatile liquids or
gas and oxygen.
Ex.
nitrous oxide
halothane (Fluothane)
enfluorane (Ethrane)
isoflurane (Forane)
INTRAOPERATIVE
PHASE

GENERAL ANESTHESIA
I
• Stage: ONSET
• Time: Adm. of anesthesisa to loss of consciousness
• Aeg Response: drowsy, dizzy, decreased pain sensation
• Nsg. Action/s:
II
• Stage: EXCITEMENT
• Time: Loss of consciousness to loss of lid reflex
• Aeg Response: loss of lid reflex, inc.muscle tone, dilated pupils, inc. RR and PR
• Nsg. Action/s:
III
• Stage: SURGICAL
• Time: Loss of lid reflex to loss of most reflex
• Aeg Response: Normal/ near normal vitals
• Nsg. Action/s:
IV
• Stage: MEDULLARY DEPRESSION
• Time: depressed vitals
• Aeg Response: cardica/resp. arrest
• Nsg. Action/s:

GENERAL
ANESTHESIA

Complications and Discomforts of Anesthesia:
INTRAOPERATIVE
PHASE
Aspiration
Hypoventilation
Oral trauma
Malignant hyperthermia
HTN
Cardiac Dysrhythmias
Hypothermia/ Hyperthermia
N/V
Headache
Urinary retention

Regional Anesthesia
• achieved by injecting local anesthetics in close
proximity to appropriate nerves.
• reduce all painful sensation in one region of
the body without inducing unconsciousness.
INTRAOPERATIVE
PHASE

Topical Anesthesia:
- applied directly to the skin and mucous membrane, open
skin surfaces, wounds and burns.
Ex: lidocaine ointment/ spray, benzocaine, EMLA
REGIONAL ANESTHESIA

Spinal Anesthesia:
- lumbar puncture.
- ROI:
- procaine, tetracaine,
lidocaine and bupivacaine
Epidural Anesthesia:
- achieved by injecting local
anesthetic into epidural space.
- chloroprocaine, lidocaine
and bupivacaine
REGIONAL ANESTHESIA

Peripheral Nerve Block:
REGIONAL ANESTHESIA
- anesthetic is injected around a nerve that
supplies sensation to a small area of the body
- chloroprocaine, lidocaine and bupivacaine
Intravenous Block:
- arm, wrist and hand procedure
- involves IV injection of a local agent and the
use of an occlusion tourniquet.

Caudal Anesthesia:
REGIONAL ANESTHESIA
- anesthetic is injected into caudal/sacral canal.
Field Block Anesthesia:
- the area proximal to a planned incision can
be injected and infiltrated with local
anesthetic agent.

Surgical Skin Preparation:
- an aseptic procedure that is used to
reduce the resident and transient flora
naturally present on the skin surface.
- accomplished by application of anti-
microbial agents.
INTRAOPERATIVE
PHASE

Abdominal Prepping
INTRAOPERATIVE
PHASE
Chest and Beast Prepping

Lower Leg Prepping
INTRAOPERATIVE
PHASE
Lower Extremity Prepping

Upper arm prepping
INTRAOPERATIVE
PHASE
Lower arm prepping

Rectoperineal/Vaginal Skin Prep.
INTRAOPERATIVE
PHASE

Surgical Incisions
Butterfly
INTRAOPERATIVE
PHASE
Limbal

Surgical Incisions
INTRAOPERATIVE
PHASE
Halstead Subcostal

INTRAOPERATIVE
PHASE
Pfannensteil Lumbotomy
Surgical Incisions

Surgical
Incisions

Wound Closure
INTRAOPERATIVE
PHASE

Common methods of suturing:
Everting Suture Inverting Suture
Retention Suture Traction Suture

Common methods of
suturing:
Everting Suture

Common methods of
suturing:
Inverting Suture

Common methods of
suturing:
Retention Suture

Common methods of
suturing:
Traction Suture

SUTURE CLASSIFICATIONS
Absorbable
Behavior in tissue:
Structure:
Non-absorbable
Monofilament
Multifilament

SURGICAL NEEDLES
Traumatic Needle
- needles with holes or eyes
which are supplied to the
hospital separate from their
suture thread.
- this type of suture rips the
tissue to a certain extent.
Atraumatic Needle
- comprise an eyeless needle
attached to a specific length of
suture thread.
INTRAOPERATIVE
PHASE

INTRAOPERATIVE
PHASE

Point and Body Shape:
SURGICAL NEEDLES
Tapercut/Cutting
- small triangular cutting point and flat
body (cross section)
- fascia, ligaments, tendon, uterus, skin, oral
cavity and etc.
Taperpoint
- taper point and round or quadrangular
body (cross section)
- intestines, muscles, nerves, liver, kidneys,
peritoneum, blood vessels, valves.

Point and Body Shape:
Blunt point
- blunt point and flat body (cross section)
- bowels, kidney, spleen, liver.
Triangular
- triangular point and flat or quadrangular
body (cross section).
- skin, sternum, fascia, ligaments, tendons.
SURGICAL NEEDLES

Basic Surgical Instruments

Cutting and Dissecting:
Metzenbaum
Mayo Scissor
Suture Scissor

Cutting and Dissecting:
Bandage Scissor Blade holder

Grasping and Holding:
DeBakey Tse Forcep
Russian Tse Forcep
Adson Tse Forcep

Tenaculum
Backhaws towel clip
Allis

KocherRandall Stone Forcep
Babcock

Foester

Retracting and Exposing:
Richardson
Senn
US Army Navy

Deaver
Vein Retractor
Malleable

Weitlaner
Green Goiter
Volkmann Rake

Langenback
Skin Hooks
Vaginal Speculum

Clamping and Occluding:
Mosquito Mixter
Straight & Curved
Kelly

A female client, 23 y.o was admitted for
the first time at WVSUMC. She was
diagnosed to have ruptured appendicitis.
She was scheduled to have emergency
Ex-Lap under G.A. Preop instructions
include all but one:
a. Deep breathing & coughing
b. Explaining the procedure
c. Turning to side
d. Foot and leg exercises
DRILL

During induction of anesthesia, what is
your nursing priority action?
a. Secure informed consent
b. Close OR door and keep voice to
minimum
c. Ensure safety
d. Anticipate for CPR.
DRILL

Compared to patients with simple
appendicitis, patients with ruptured
appendicitis have more tubes like NGT
and foley catheter and require closer
monitoring….
Why?
DRILL

POSTOPERATIVE
PHASE

POSTOPERATIVE
PHASE
GOALS:
 Maintain adequate body system functions.
 Restore homeostasis.
 Alleviate pain and discomfort.
 Prevent postop complication
 Ensure adequate discharge planning and teaching.

Initial Nursing Assessment:
 Verify patient’s identity, operative procedure
and the surgeon who performed the procedure.
 Evaluate vital sings: respiratory status,
circulatory status, pulses, temp., O2 sat.,
 Determine vital reflexes, LOC and response
to stimuli.
 Evaluate drainage patency.
 Ensure safety!
POSTOPERATIVE
PHASE

Immediate Stage
- period of 1 to 4 hours after surgery.
Intermediate Stage
- period of 4 to 24 hours after surgery.
Extended Stage
- period of 1 to 4 days after surgery.
POSTOPERATIVE
PHASE

IMMEDIATE STAGE:
Nursing Interventions:
 Monitor v/s.
 Monitor airway patency and adequate ventilation.
 Encourage coughing & deep breathing q1-2h.
 MIO
 Watch out for s/sx of shock
 Assess for Homan’s sign
 Proper positioning
 Monitor for return of gag reflex/ bowel sounds.
 Provide comfort measures to relieve pain.
POSTOPERATIVE
PHASE

INTERMEDIATE STAGE:
 Monitor v/s.
 Before ambulation, instruct the client to sit
at the edge of the bed with the feet
supported.
 Avoid wound infection.
 Maintain NPO status until gag reflex and
peristalsis return.
 MIO
POSTOPERATIVE
PHASE

EXTENDED STAGE:
 Monitor for signs of infection.
 Encourage ROM exercises.
 Continue to encourage ambulation.
 Encourage food rich in CHON and vit.C.
POSTOPERATIVE
PHASE

Wound dressing:
POSTOPERATIVE
PHASE

Drains:
POSTOPERATIVE
PHASE

COMMON POSTOPERATIVE
COMPLICATIONS

Respiratory
• inflammation of the alveoli.
• etio: infection, immobility, aspiration
• onset:
• S/Sx:
Pneumonia Atelectasis
• collapse of the alveoli.
• etio: mucous plug
• onset:
• S/Sx:
Dyspnea
Fever
Tachycardia
Dec. O2 Saturation
Cyanosis
Hemoptysis
Dull/absent lung
sounds

POSTOPERATIVE
PHASE
Nursing Interventions: Pneumonia/ Atelectasis
1. Assess lung and breath sounds.
2. Reposition the client.
3. Promote lung expansion and airway patency.
4. Encourage fluid intake.
5. Encourage early ambulation.

Cardiovascular
Hemorrhage
• loss of large amount of blood externally or internally in a short
period of time.
• etio: disruption of sutures, insecure ligation of vessels
• S/Sx:
cold, moist, pale skin
tachycardia & tachypnea
HTN
Restlessness
Bruising/swelling around incision

POSTOPERATIVE
PHASE
Nursing Interventions: Hemorrhage
1. Provide pressure to the dressing.
2. Notify physician immediately!
3. Adm. O2 a.d
4. Adm. IV and blood products a.d
5. Prepare client for surgical procedure as
necessary.

Cardiovascular
Thrombophlebitis
• inflammation of the vein usually of the legs and associated with a
blood clot.
• etio: immobility, increased blood coagulability
• S/Sx:
elevated temperature
pallor on the affected extremity
vein feels hard
Vein is swollen, red and hard to vein
Homan’s sign

Nursing Interventions: Thrombophlebitis
1. Elevate the extremity without pressure on the
popliteal area.
3. Encourage the use of antiembolism stockings a.p
4. Encourage leg exercises.
5. Hydrate adequately.
6. Initiate anticoagulant therapy a.p
7. AVOID massaging the affected calf!!!
POSTOPERATIVE
PHASE

Urinary
Urinary Retention
• inability to empty the bladder with excessive urine accumulation.
• etio: anesthesia, bladder sphincter spasm
• S/Sx:
inability to void
Distended bladder
Restlessness
Suprapubic pain
HPN

Nursing Interventions: Urinary retention
1. MIO.
2. Encourage ambulation.
3. Assist in voiding.
POSTOPERATIVE
PHASE

Gastrointestinal
Paralytic Ileus
• Lack of bowel peristalsis
• etio: anesthesia, immobility
• S/Sx:
n/v
abdominal distention
abdominal pain
(-) bowel sounds

Nursing Interventions: Paralytic Ileus
1. Monitor bowel sounds.
POSTOPERATIVE
PHASE

Wound
Wound Infection
• Inflammation and infection of incision or drain site.
• etio: poor aseptic technique
• S/Sx:
fever and chills
pus or foul discharge on wound site
s/sx of infection

Nursing Interventions: Wound Infection
1. Keep wound clean and dry.
2. Surgical aseptic technique when changing
dressing.
3. Administer antibiotic a.p.
POSTOPERATIVE
PHASE

Wound
• separation of the suture lines.
• S/Sx:
Dehiscnce Evisceration
• extrusion of internal organs/tses.
• S/Sx:
increased wound drainage
Obesity/ malnutrition
Excessive strain on suture line
Opened wound
edges
(+) protrusion of
abdominal contents

POSTOPERATIVE
PHASE

POSTOPERATIVE
PHASE
Nursing Interventions: Dehiscence & Evisceration
1. Cover the wound with a sterile NS dressing.
2. Semi-Fowler’s position with knees bent.
3. Notify the physician.
4. Administer antiemetics a.p
5. Encourage diet: High CHON, vit. C
6. Splinting when coughing/ abdominal binders.

The RN is preparing to insert a Foley catheter
into a patient. It would be most important for
the RN to take which of the ff .actions?
a. Place all supplies closed to the edge of
the table.
b. Keep the field holding the supplies in
front of the nurse.
c. Set up a field below the nurse’s waist
level.
d. Add clean supplies to the field.
DRILL

A nurse instructs a preoperative client in the
proper use of incentive spirometer.
Postoperative assessment of the effectiveness
of its use is determined by:?
a. Coughing
b. Shallow breaths
c. Wheezing in one lung field
d. Unilateral chest expansion
DRILL

“A diffused light has little power or impact.
A focused light can set grass or paper on fire.
When focused even more,
it can cut through steel.”
- Rick Warren

- Sir Cstive

Perioperative Nursing

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