Transcript Perioperative Nursing

By: Omaimah Qadhi
 Perioprative
nursing: ALL nursing
functions associated with the patient`s
surgical experience.
Incorprate all the three phases:
1. Preoprative.
2. Intraoprative.
3. postoprative.
A.
B.
C.
Preoprative phase: decision for surgical
intervention is made till the patient
transferred to the OR (operating room).
Intraoprative phase: begins from patient
taken to OR and ends when the patient is
transferred to the recovery room.
Postoprative phase: begins from recovery
room and ends with the follow up
evaluation in the clinical sitting (e.g.
clinic).
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)
1.
2.
3.
4.
Emergency: NO DELAY e.g. to maintain
life, maintain function or to stop
hemorrhage from gunshot, intestinal
obstruction, or stab wound (bleeding).
Urgent: within 24- 48 hours (bleeding
from doudnal ulcer).
Planned: scheduled weeks or months.
Elective: not necessary (hernia).
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.
5.
 Assessment
 Diagnosis.
 Planning
and goals.
 Intervention.
(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.
e.g. knowledge deficit regarding
preoperative procedures, postoperative
procedure, or complications.
Give other examples !!
Mainly relief of preoprative anxiety, less
pain, decrease fear, increased
knowledge about the postoprative
experience, no complications.
 Psychological
aspect: explain
procedure (pre, intra, and postoprative,
orientation about the health care setting
(hospital, clinic)
 Providing informed consent.
 Physiologic
aspects before the
surgery day (correct diet, ↓ weight, solve
any fluid imbalance, if anemia give
blood, any chronic disease, treat
infection).
 Preoperative
teaching:
1) deep breathing and coughing (IS)
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.
2)
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.
•
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).

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.
1.
 Assist
transferring pt to OR table.
 Positions patient properly.
 Counts sponges, gauzes, needles before
using and when wound is getting closed.
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.
o
 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.
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.
o
1.
2.
3.
General anesthesia.
Regional or spinal.
Local anesthesia.
 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).
Nursing diagnosis:
 Ineffective airway clearance related to
depressing medications and anesthesia.
 Acute pain related to surgical incision.
 What else???
Planning: expected outcomes.
Immediate and long term outcomes.
 No complications.
 Healthy incision site no infection and
normal healing.
 No sever weight loss.
 No
constipation ( regular bowl motion).
 Less pain.
 At discharge patient education (home
health care, community resources,
prescribed activities, follow-up
information)