Professional Documents
Culture Documents
Perioperative Nursing Practice- includes those activities performed by the registered nurse
during the preoperative, intraoperative and postoperative phase of the patients surgical
experience. It encompasses the patient’s total experience when surgical intervention is accepted
Perioperative- refers to events during the entire surgical period, from preparation for surgery to
recovery from the temporary effects of surgery and anesthesia. This period is divided into
Preoperative phase- starts when the patient is admitted to the surgical floor and prepare him
physically, psychologically, spiritually and legally for the surgical procedure until he is transported
Intraoperative phase- is when the patient is transferred to the operating room where he is
Postoperative phase- is the time during which the patient is transferred to the recovery
room/post anesthesia unit where the nurse assist and observes the patient as he recovers from
anesthesia and from the stress of surgery itself; to the time he is transferred back to the surgical
Obesity
Presence of diseases
Nature of condition
GENERAL CONSIDERATIONS:
Obstruction
Perforation
Erosion
Tumors
1) Purpose
Diagnostic
Curative
• Ablative
• Constructive
• Reconstructive
Palliative
Major Surgery
Minor Surgery
3) Urgency
• stop hemorrhage
Imperative or Urgent
Planned Required
Elective
Optional
Goals
Assessment & Correction of physiologic & psychological problems that may increase
surgical risks.
Giving the person & significant others complete learning/teaching guidelines regarding
surgery.
Instructing & demonstrating exercises that will benefit the person during the postoperative
period.
Planning for discharge & any projected changes in lifestyle due to surgery.
Physiologic Assessment
Age
Presence of pain
Nutritional Status
Infection
Cardiovascular Function
Pulmonary Function
Liver Function
Gastrointestinal Function
Liver Function
Endocrine Function
Neurologic Function
Hematologic Function
Use of Medication
Fear of Anesthesia
Fear of pain
Fear of death
Worries
Manifestations of Fear
Anxiousness
Bewilderment
Anger
Tendency to exaggerate
Inability to concentrate
Consider the person’s religious preferences and arrange for visit priest/minister as
desired
To ensure that the patient understands the nature of the treatment including the
potential complications and disfigurement.
To protect the surgeon and the hospital against legal action by a client who claims
A witness is desirable.
Physical Preparation
Before Surgery
dehydrated.
Incentive spirometry
Coughing exercises
Turning exercises
Preparing the skin – have full bath to reduce microorganisms in the skin.
Preparing for anesthesia – avoid alcohol and cigarette smoking for at least 24 hours
before surgery.
Remove dentures, foreign materials, colored nail polish, hearing aid, contact lens,
wedding ring – tie with gauze and tie around the wrist.
A. Goals:
1. To allay anxiety
1. Tranquilizers
2. Sedatives
3. Analgesics
4. Anticholinergics
C. Recording – all final preparation and emotional responses before surgery are noted
down.
Patient’s Family
INTRAOPERATIVE PHASE
Goals
Asepsis
Homeostasis
Hemostasis
The surgeon
The Anesthesiologist
Dorsal Recumbent (Supine) – coronary artery bypass, hernia repair, explor lap,
Trendelenburg – head and body are flexed by “breaking the table”. This position
permits displacement of the intestines into the upper abdomen and is often used
Lithotomy – thighs and legs are flexed at right angles and then simultaneously
placed to stirrup. This position exposes the perineal area and is ideal for perineal
Nursing Management:
Skin closure (sutures) are used to approximate wound edges until wound healing is
complete or to occlude the lumen or a blood vessel. A contaminated wound may be left open or
partially open.
Sutures
Staples
Retention sutures
Zipper-like devices
Absorb drainage.
If healing progresses without complications, the sutures, clips, and staples are
ASSESSING DRAINAGE
A drain is placed in the incision to drain blood, serum and debris from the operative site.
Drains may be free draining, attached to suction or self-contained drainage with suction.
Nursing Interventions:
Suction secretions.
• Maintenance of circulation
anesthesia.
Recognize stress factors that may affect the patient and minimize these factor.
RESPIRATION- able to breath deeply and cough freely with easy and noiseless
breathing.
POSTOPERATIVE PHASE
Goals
Restore homeostasis.
Avoid exposure.
o Side rails.
When the patient returns from RR to the surgical unit; directed towards
Initial assessment
Respiratory Status.
Cardiovascular status
Position
Goals
Aspirated mucus/vomitus
Bronchospasm.
Causes of hypoventilation:
Medications
Pain
Obesity
Restlessness
Air hunger
Interventions
Activity Limitation
Possible Complications
Post Discomfort
Thirst
Constipation
Pain
POSTOPERATIVE COMPLICATIONS
SHOCK- response of the body to a decrease in the circulating blood volume, which results to
Clinical Manifestations:
Apprehension
Management:
Ligation of Bleeders
Pressure Dressings
lower abdomen or during the course of septic conditions as ruptured ulcer or peritonitis.
Causes:
Hemorrhage
Prolonged Immobility
Obesity/ Debilitation
Clinical Manifestations:
Pain
Redness
Swelling
Heat/ warmth
Nursing Interventions:
• Prevention
Avoid any restricting devices that can constrict and impair circulation.
• Active Interventions
PULMONARY COMPLICATIONS
Atelectasis
Bronchitis
Bronchopneumonia
Lobar Pneumonia
Hypostatic Pneumonia
Pleurisy
Nursing Interventions:
Incentive spirometry.
URINARY DIFFICULTIES
• Retention- occurs most frequently after operation of the rectum, anus, vagina, lower
• Incontinence – 30-60 ml every 15-30 minutes, the bladder is over distended, there is
Clinical Manifestations:
Nursing Interventions:
NGT insertion
HICCUPS- intermittent spasms of the diaphragm causing a sound (“hic”) that result from the
vibration of closed vocal cords as air rushes suddenly into the lungs------ caused by irritation of
the phrenic nerve between the spinal cord and terminal ramifications on the undersurface of the
diaphragm.
Nursing Interventions:
Plasil as ordered.
WOUND INFECTIONS
Clinical Manifestations:
Wound care.
Antibiotic therapy.
WOUND COMPLICATIONS
Nursing Management: