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Nursing
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Perioperative Care and the Perioperative Care and the Nursing ProcessNursing Process
ObjectivesObjectives Review learned concepts related to Review learned concepts related to
Perioperative carePerioperative care Utilize the nursing process during Utilize the nursing process during
perioperative care of an adult individual perioperative care of an adult individual AssessmentAssessment Nursing diagnosisNursing diagnosis PlanningPlanning ImplementationImplementation EvaluationEvaluation
Perioperative PeriodPerioperative Period
Preoperative Intraoperative
Postoperative
Perioperative phasesPerioperative phases Preoperative Preoperative
From decision to have surgery to From decision to have surgery to the OR tablethe OR table
IntraoperativeIntraoperative From the OR table to PACUFrom the OR table to PACU
Post operativePost operative From PACU until client reach full From PACU until client reach full
healinghealing
Types of SurgeryTypes of Surgery
PurposePurpose DiagnosticDiagnostic PalliativePalliative Ablative (removal of a part Ablative (removal of a part
of a tissue)of a tissue) ConstructiveConstructive Transplant Transplant
Types of Surgery Types of Surgery
Degree of urgencyDegree of urgency Emergency Emergency ElectiveElective
Degree of riskDegree of risk Major Major Minor Minor
Factors affecting Degree of Factors affecting Degree of RiskRisk
AgeAge General healthGeneral health Nutritional statusNutritional status MedicationsMedications Mental statusMental status
Pre Operative PhasePre Operative Phase
Preoperative PhasePreoperative Phase Informed Informed ConsentConsent
Surgeons responsibility to acquire Surgeons responsibility to acquire thisthis
Nurse secures if consent is Nurse secures if consent is availableavailable
Following is given before consentFollowing is given before consent Nature and reason for the surgeryNature and reason for the surgery All available options and riskAll available options and risk Risk of surgery and potential outcomeRisk of surgery and potential outcome Surgeons informationSurgeons information Right to refuse consent or later Right to refuse consent or later
withdrawalwithdrawal
Pre opt AssessmentPre opt Assessment
Nursing HistoryNursing History
Nursing HistoryNursing History
Pre opt AssessmentPre opt Assessment
Physical AssessmentPhysical Assessment Baseline physical status Baseline physical status
(Body system)(Body system) Vital signsVital signs Level of consciousnessLevel of consciousness
Pre opt AssessmentPre opt Assessment
Screening tests and Diagnostic Screening tests and Diagnostic examinationsexaminations
Nursing Diagnosis Nursing Diagnosis
Deficient knowledge Deficient knowledge AnxietyAnxiety Disturbed sleep patternDisturbed sleep pattern Anticipatory grievingAnticipatory grieving Ineffective copingIneffective coping
PlanningPlanning
Major goalMajor goal To ensure client that the client is To ensure client that the client is
mentally and physically prepared mentally and physically prepared for surgeryfor surgery
NOC/NICNOC/NIC
Nursing Diagnosis: Nursing Diagnosis: Knowledge deficit regarding post opt deep breathing exercises r/t lack of exposure as manifested by: Verbalization of not knowing the procedure
well Performed inappropriate deep breathing
technique
NOCNOC NOC 1: Knowledge: Treatment Procedure NOC 1: Knowledge: Treatment Procedure
(1814)(1814) Extent of understanding conveyed about Extent of understanding conveyed about
procedure required as part of a treatment procedure required as part of a treatment regimenregimen
NICNIC Teaching: Preoperative (5610)Teaching: Preoperative (5610)
Assisting of patient to understand the mentally Assisting of patient to understand the mentally prepare for surgery and the postoperative prepare for surgery and the postoperative recovery recovery
Example ActivitiesExample Activities Instruct client on the technique of splinting Instruct client on the technique of splinting
incision during coughing and deep breathingincision during coughing and deep breathing Provide time for the client to ask questions and Provide time for the client to ask questions and
discuss concernsdiscuss concerns Evaluate the clients ability to return demonstrate Evaluate the clients ability to return demonstrate
deep breathing and coughing exercises deep breathing and coughing exercises
ImplementationImplementation
Preoperative Health TeachingPreoperative Health Teaching Four dimensions Four dimensions of preoperative of preoperative
teaching:teaching: Information: what and when (happen and Information: what and when (happen and
experience)experience)Psychosocial supportPsychosocial supportRoles of the client and support systemRoles of the client and support systemSkills trainingSkills training
Preoperative Preoperative Instructions/PreparationInstructions/Preparation
Explain needs for screening Explain needs for screening teststests
Bowel preparationBowel preparation
Skin preparationSkin preparation
Preoperative medsPreoperative meds
Therapies needed (IV, Therapies needed (IV, catheter, NGT, O2)catheter, NGT, O2)
Food and fluid restriction before Food and fluid restriction before surgerysurgery
Time of surgeryTime of surgery
Removing jewelry, make up etcRemoving jewelry, make up etc
Deep breathing, coughing, splinting, Deep breathing, coughing, splinting, leg exerciseleg exercise
Pre opt checklistPre opt checklist
Adequate rest and sleepAdequate rest and sleep
Pre opt MedicationsPre opt Medications
Special ordersSpecial orders
Intra Operative PhaseIntra Operative Phase
Intraoperative CareIntraoperative Care
Types of anesthesiaTypes of anesthesia General AnesthesiaGeneral Anesthesia
Is the loss of consciousness and all Is the loss of consciousness and all sensationsensation
Regional/Local AnesthesiaRegional/Local Anesthesia Is the temporary interruption of the Is the temporary interruption of the
transmission of nerve impulse to and transmission of nerve impulse to and from a specific area of the bodyfrom a specific area of the body
Intra Opt AssessmentIntra Opt Assessment
Nurse confirms the following in the as Nurse confirms the following in the as the client enters the OR:the client enters the OR: Confirms clients identityConfirms clients identity Assess the clients physical and Assess the clients physical and
emotional statusemotional status Verifies info in the pre operative Verifies info in the pre operative
checklistchecklist Evaluates knowledge of the surgeryEvaluates knowledge of the surgery
Response to pre operative medications is Response to pre operative medications is assessedassessed
Assess placement of tubes or any Assess placement of tubes or any contraptions contraptions
Intra Opt AssessmentIntra Opt Assessment
Vital signsVital signs ECG ECG O2 saturationO2 saturation Fluid intake and outputFluid intake and output OthersOthers
Nursing DiagnosisNursing Diagnosis Risk for AspirationRisk for Aspiration Ineffective ProtectionIneffective Protection Impaired skin integrityImpaired skin integrity Risk for Peri operative Position InjuryRisk for Peri operative Position Injury Risk for Imbalanced Body Risk for Imbalanced Body
TemperatureTemperature Ineffective Tissue PerfusionIneffective Tissue Perfusion Risk for Deficit Fluid Volume Risk for Deficit Fluid Volume
PlanningPlanning
Major goalMajor goal To maintain clients safety To maintain clients safety
and homeostasisand homeostasis
Intra Opt Nursing ActivitiesIntra Opt Nursing Activities
Proper Proper positioningpositioning Skin preparationSkin preparation Preparing and maintaining Preparing and maintaining
a a sterile fieldsterile field Open and dispense Open and dispense sterile sterile
suppliessupplies
Provision of Provision of medication and medication and solutions solutions
Aseptic environmentAseptic environment prep and prep and maintain maintain
Manage Manage contraptionscontraptions Perform Perform instrument countsinstrument counts DocumentDocument nx care provided nx care provided
and clients responseand clients response
ImplementationImplementation
Types of OR nurse based on Types of OR nurse based on activities/responsibilitiesactivities/responsibilities Scrub nurse: assist the surgeon by Scrub nurse: assist the surgeon by
draping the sterile field and handle draping the sterile field and handle sterile instruments sterile instruments
Circulating nurse: coordinates activities Circulating nurse: coordinates activities and manages client care and manages client care
Concepts to Remember!Concepts to Remember! Prepare and maintain Prepare and maintain
SURGICAL ASEPSISSURGICAL ASEPSIS Instrument countingInstrument counting Proper positioning forProper positioning for
Optimal visualization and Optimal visualization and accessaccess
Optimal access to IV and Optimal access to IV and monitoring devicesmonitoring devices
Protection of client to harmProtection of client to harm
Post Operative PhasePost Operative Phase
Immediate Post Opt Immediate Post Opt AssessmentAssessment
Adequacy of airwayAdequacy of airway O2 SaturationO2 Saturation Adequacy of VentilationAdequacy of Ventilation Cardiovascular statusCardiovascular status Level of consciousnessLevel of consciousness
Presence of protective reflexesPresence of protective reflexes Activity and ability of the extremitiesActivity and ability of the extremities Skin colorSkin color Fluid statusFluid status Condition of the operative siteCondition of the operative site
Patency and characteristic of the Patency and characteristic of the drainagedrainage
Discomfort, nausea, vomitingDiscomfort, nausea, vomiting SafetySafety
Indicators for discharged in Indicators for discharged in PACUPACU
Conscious and orientedConscious and oriented Maintain a clear airwayMaintain a clear airway Manage deep breathing and Manage deep breathing and
coughing coughing Vital signs stableVital signs stable Presence of protective reflexesPresence of protective reflexes
Move all extremitiesMove all extremities Adequate I/OAdequate I/O Normal temperatureNormal temperature Dry and intact dressingDry and intact dressing
Ongoing Post Opt CareOngoing Post Opt Care
AssessmentAssessment Level of consciousnessLevel of consciousness Vital signsVital signs Skin color and temperatureSkin color and temperature ComfortComfort Fluid balance Fluid balance Dressing Dressing Drains and tubesDrains and tubes
Glasgow Coma ScaleGlasgow Coma Scale
15 indicates alert and completely oriented15 indicates alert and completely oriented 7 or less comatose7 or less comatose
Ongoing Post Opt CareOngoing Post Opt Care
Usual Post Opt Rx Orders Usual Post Opt Rx Orders Oral intake permittedOral intake permitted IV solutions and medsIV solutions and meds PositionPosition MedicationsMedications Lab testsLab tests I/OI/O Activities permitted Activities permitted
Nursing DiagnosisNursing Diagnosis
Acute PainAcute Pain Risk for InfectionRisk for Infection Risk for InjuryRisk for Injury Risk for Deficient Fluid Volume Risk for Deficient Fluid Volume Ineffective Airway ClearanceIneffective Airway Clearance
Ineffective Breathing PatternIneffective Breathing Pattern Self Care DeficitSelf Care Deficit Delayed Surgical RecoveryDelayed Surgical Recovery Disturbed Body imageDisturbed Body image
NOC/NICNOC/NIC
Nursing Diagnosis: Ineffective Breathing Nursing Diagnosis: Ineffective Breathing PatternPattern Inspiration and Expiration that does not Inspiration and Expiration that does not
provide adequate ventilationprovide adequate ventilation As manifested by:As manifested by: Compromised RR, rhythm and ease of Compromised RR, rhythm and ease of
breathingbreathing Presence of adventitious breath soundsPresence of adventitious breath sounds
NOCNOC NOC1: Respiratory Status: Ventilation NOC1: Respiratory Status: Ventilation
(0403)(0403)
Movement of air in and out of the lungs Movement of air in and out of the lungs
NICNIC NIC1: Respiratory Monitoring (3350)NIC1: Respiratory Monitoring (3350)
Collection and analysis of patient data to Collection and analysis of patient data to ensure airway patency and adequate gas ensure airway patency and adequate gas exchange exchange
Sample NIC ActivitiesSample NIC Activities Monitor rate, rhythm, depth, and effort of Monitor rate, rhythm, depth, and effort of
expirationsexpirations Auscultate breath sounds, noting areas of Auscultate breath sounds, noting areas of
decreased/absent ventilation and presence decreased/absent ventilation and presence of adventitiuos soundsof adventitiuos sounds
Monitors ability to cough effectivelyMonitors ability to cough effectively
ImplementationImplementation
ImplementationImplementation
Pain managementPain management Positioning: depending on the type of Positioning: depending on the type of
surgerysurgery Deep breathing and Coughing exerciseDeep breathing and Coughing exercise Leg exerciseLeg exercise Moving and AmbulationMoving and Ambulation
HydrationHydration DietDiet Urinary eliminationUrinary elimination SuctionSuction Wound careWound care
Perioperative Care and the Nursing ProcessObjectivesPerioperative PeriodPerioperative phasesTypes of SurgeryTypes of Surgery Factors affecting Degree of RiskPre Operative PhasePreoperative PhasePre opt AssessmentSlide 11Slide 12Slide 13Nursing Diagnosis PlanningNOC/NICSlide 17Slide 18ImplementationPreoperative Instructions/PreparationSlide 21Slide 22Intra Operative PhaseIntraoperative CareIntra Opt AssessmentSlide 26Slide 27Nursing DiagnosisSlide 29Intra Opt Nursing ActivitiesSlide 31Slide 32Concepts to Remember!Post Operative PhaseImmediate Post Opt AssessmentSlide 36Slide 37Indicators for discharged in PACUSlide 39Ongoing Post Opt CareGlasgow Coma ScaleSlide 42Slide 43Slide 44Slide 45Slide 46Slide 47Slide 48Slide 49Slide 50Slide 51Slide 52