Perioperative Nursing By: Omaimah Qadhi

Definitions Perioprative nursing: ALL nursing

functions associated with the patient`s surgical experience.

Incorprate all the three phases:1. Preoprative.2. Intraoprative.3. postoprative.

PhasesA. Preoprative phase: decision for surgical

intervention is made till the patient transferred to the OR (operating room).

B. Intraoprative phase: begins from patient taken to OR and ends when the patient is transferred to the recovery room.

C. Postoprative phase: begins from recovery room and ends with the follow up evaluation in the clinical sitting (e.g. clinic).

Purposes or reasons

Of surgery? May be for diagnosis ( e.g. biopsy).May be exploratory (e.g. laparotomy).May be for reconstruction (e.g.

mammoplasty).May be palliative to relieve pain

(give example)

Categories or kinds

1. Emergency: NO DELAY e.g. to maintain life, maintain function or to stop hemorrhage from gunshot, intestinal obstruction, or stab wound (bleeding).

2. Urgent: within 24- 48 hours (bleeding from doudnal ulcer).

3. Planned: scheduled weeks or months.

4. Elective: not necessary (hernia).

Contd,

5. optional: requested by the patient e.g. plastic surgery.

What are RISK factors: Patient`s: age, obesity, malnutrition,

immobility, hypovolemia, ……. Nature of the patient`s condition

e.g. malignancy. Location of the condition e.g. heart.

Preoprative nursing manegment

Assessment Diagnosis. Planning and goals. Intervention.

1. Assessment

(physiological and psychological).a) Psychological nursing assessment:

stress response, pain, disturbance of body image, anxiety of unknown, ……., dependency).

b) Physiological nursing assessment: demographic data, pain, infection, ………, lab results.

2. Diagnosis

e.g. knowledge deficit regarding preoperative procedures, postoperative procedure, or complications.

Give other examples !!

3. Planning

Mainly relief of preoprative anxiety, less pain, decrease fear, increased knowledge about the postoprative experience, no complications.

4. Intervention Psychological aspect: explain

procedure (pre, intra, and postoprative, orientation about the health care setting (hospital, clinic)

Providing informed consent.

Contd, Physiologic aspects before the

surgery day (correct diet, ↓ weight, solve any fluid imbalance, if anemia give blood, any chronic disease, treat infection).

Contd, Preoperative teaching: 1) deep breathing and coughing (IS)

Contd,

2) Turning and moving, leg exercise. 3) Transferring from bed.4) Pain management.Preparing the patient the evening before the surgery.• Hygiene Includes: bath or scrubbing, Shaving ??, observe and document the surgical site, NPO, IVFs.

Contd, • enema for GI surgeries, NGT may be

needed.• Patient will be seen by the

anesthetist for Res, cardio, neuro examination.

• Relaxing measurements (quite environment, clean bed

Provide sleeping measures, may be sleeping meds.

Preoprative chicklist V/S ID band. Skin preparation. Special stat orders. Confirm NPO status. Empty bladder

(amount if indicated).

No rings, earrings, bracelet, NO NEWLLERY.

NO nail polish (WHY.??) .

Donning hospital gown.

LAB results (WHY) ECG for old and cardiac pts (why??).

Available packed red blood cells (PRBCs).

Pre-anesthesia medication.

Checklist (why).

Intraoprative nursing manegement

1. Circulating nurse:Prepares the OR, equipments, supplies

and ascertain its working.Call for patient on time. Verifies the pt, explains and reassures

the pt. Allergies ??Complete MR.

Contd, Assist transferring pt to OR table. Positions patient properly. Counts sponges, gauzes, needles

before using and when wound is getting closed.

Contd, o Assist the scrub nurse and the surgeon

by tying gowns. assist the scrub nurse in maintaining

sterile field, in arranging the table. OBSERVE the sterile field cautiously and

REPORT any breaking. Cares for any surgical specimen. Document operative record. Prepares the skin on the operating sign.

Contd, Scrub nurse: Performs surgical hand scrub. Dons sterile gown and gloves

aseptically. Arrange sterile supplies and

instruments, check for functionality. Counts sponges, needles with the

circulating nurse.

Contd, o Gowns gloves the surgeon when

entering the room.o Assist with surgical draping of the

patient. o Maintain sterile field. o Observe and correct for any breakage

in the aseptic technique. o Handles instruments to the surgeon

correctly.

Types of anesthesia

1. General anesthesia.2. Regional or spinal.3. Local anesthesia.

Post operative nursing management

Assessment: Respiratory.Circulatory.Neurologic.Urinary status.Comfort.Drainage (surgical

site, tubes, drains).Safety (side rails,

securing drains, tubes, IVs).

Mobility (leg, body).IVFs (site, rate, type).psychological.Equipments (function

e.g chest tube, foly`s catheter).

Contd,

Nursing diagnosis: Ineffective airway clearance related

to depressing medications and anesthesia.

Acute pain related to surgical incision.

What else???

Contd,

Planning: expected outcomes.Immediate and long term outcomes. No complications. Healthy incision site no infection and

normal healing. No sever weight loss.

Contd, No constipation ( regular bowl

motion). Less pain. At discharge patient education (home

health care, community resources, prescribed activities, follow-up information)