PERIOPERATIVE NURSING

TYPES OF SURGERY
ACCORDING TO
Type of Surgery

ACCORDING TO
Type of Surgery

Purpose

Indications

ACCORDING TO

THREE PHASES OF PERIOPERATIVE PERIOD

PREOPERATIVE PERIOD

Examples

Examples

INFORMED CONSENT

Elements:
o
o
o
The signed consent form is placed in a prominent place on the patients chart and
accompanies the patient to the operating room.
PREOPERATIVE TEACHING
Ideal Timing:
What to expect post-op
Notify nurse if the client experiences any pain post-op
Requesting an opioid post-op will not cause addiction
Non-invasive pain relief techniques
o
o
o
Stop smoking at least __________ before surgery
Techniques to prevent development of pneumonia and atelectasis
o
o
DEEP BREATHING AND COUGHING EXERCISES
o Breathe deeply 3x, inhale thru the nostrils and exhale thru pursed lips
o Instruct the client that the third breath should be held for 3 sec; then the client
should cough deeply 3x.
o Perform q1-2 h
INCENTIVE SPIROMETRY
o Assume sitting or upright position
o Place mouth tightly around the mouthpiece
o Inhale slowly to raise and maintain the flow rate indicator (usually between 600 and
900 marks)
o Hold breath for 5 seconds then exhale thru pursed lips
o Repeat process 10x/hr

MANAGING NUTRITION AND FLUIDS

Major purpose of withholding food and fluid before surgery:

Patients who do not have a compromised airway or coexisting diseases or disorders that
affect gastric emptying or fluid volume (eg, pregnancy, obesity, diabetes,
gastroesophageal reflux, enteral tube feeding, ileus or bowel obstruction), lengthy
restriction of fluid and food is unnecessary.
The recommendations depend on the
o
o
Fatty foods
Milk products:
Clear liquids:

PREPARING BOWEL FOR SURGERY

Goals:
o
o
ENEMAS are not commonly ordered preoperatively unless the patient is undergoing
abdominal or pelvic surgery.
o Cleansing enema or laxative may be prescribed the ______________________ and may be
repeated the __________________.
IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS
Remove _________________________________________
o If patient objects to removing a ring:

All patients (except those with urologic disorders) should

immediately before going to the OR

INTRAOPERATIVE PERIOD
THE SURGICAL TEAM
Patient
Circulating Nurse
Scrub Nurse
Surgeon
Anesthesiologist
CIRCULATING NURSE

SCRUB NURSE

THE SURGICAL ENVIRONMENT

1.
2.
3.
EIGHT BASIC PRINCIPLES OF ASEPTIC TECHNIQUE
1. All materials in contact with the surgical wound and used within the sterile field must be
sterile. Sterile surfaces or articles may touch other sterile surfaces or articles and remain
sterile; contact with unsterile objects at any point renders a sterile area contaminated.
2. Gowns of the surgical team are considered sterile in front from the chest to the level of the
sterile field. The sleeves are also considered sterile from ____________________________ to
the stockinette cuff.

3. Sterile drapes are used to create a sterile field. Only the top surface of a draped table is
considered sterile. During draping of a table or patient, the sterile drape is held well above
the surface to be covered and is positioned from front to back.
4. Items should be dispensed to a sterile field by methods that preserve the sterility of the
items and the integrity of the sterile field. After a sterile package is opened, the edges are
considered unsterile. Sterile supplies, including solutions, are delivered to a sterile field or
handed to a scrubbed person in such a way that the sterility of the object or fluid remains
intact.
5. The movements of the surgical team are from sterile to sterile areas and from unsterile to
unsterile areas. __________________ and sterile items contact only sterile areas;
_______________ and unsterile items contact only unsterile areas.
6. Movement around a sterile field must not cause contamination of the field. Sterile areas
must be kept in view during movement around the area. At least a __________ distance
from the sterile field must be maintained to prevent inadvertent contamination.
7. Whenever a sterile barrier is breached, the area must be considered contaminated. A
________________________ permitting access to an unsterile surface underneath renders the
area unsterile. Such a drape must be replaced.
8. Every sterile field should be constantly monitored and maintained. Items of
_________________ are considered unsterile. Sterile fields should be prepared as close as
possible to the time of use.
SURGICAL SKIN PREPARATION
Purpose:

o
o

TYPES OF ANESTHESIA
A. GENERAL

Stages of General Anesthesia:

B. REGIONAL

client loses sensation in an area of the body but remains conscious

Types:
o
o
o
o
o
POSITIONING

INTRAOPERATIVE COMPLICATIONS

Malignant Hyperthermia
Signs and Symptoms:
o
o Ventricular dysrhythmia
o
o
o
o Cardiac arrest
o
Management:
o
o

o
POSTOPERATIVE PERIOD

POSTOPERATIVE COMPLICATIONS
Complications
Signs and Symptoms

Interventions

Chest pain

DBCE
Incentive spirometry
Early ambulation
DBCT exercises
Incentive spirometry
Early ambulation
O2

Tachycardia
Hypotension
Weak and rapid pulse
Cold and clammy skin
Decreased urine output

Elevate extremities 30degrees

AES
Early ambulation
Anticoagulants

Bladder sounds like a drum

OFI
Early ambulation
High fiber food
Stool softeners and laxatives
Abdominal distention
Fever
Inflamed incision site
Elevated WBC

Encourage ambulation
Maintain asepsis
Change dressing
Antibiotics