Perioperative

Nursing Process

Ns. Heri Kristianto. SKep., MKep

Part II

Standard AORN
1.
2.
3.
4.
5.
6.

Collect patient health data

Analyzes the assessment data in
determining diagnoses
Identifies expected outcomes unique
to the patient
Develops a plan of care
Implements the interventions
Evaluates the patients progress

Assesment
Nursing
Diagnosis

Evaluation

Implementation

Preoperative

Intraoperative

Planning

Postoperative

1. Assessment
Preoperative

Focus assessment:
The patients understanding of events
Any acute & chronic conditions
experienced by the patient
The patients previous surgical experiences
The patient nutritional
Fluid and electrolyte
Emotional status

Physical Examination.cont 1

Cardiopulmonary function
Bowel function
Urinary function
Nutritional status
Physical limitations

Laboratory & Diagnostic Studies....cont 1

Vital sign: temperature, pulse, respirations,
blood pressure
Hemoglobin & Hematocrit
White blood cell count
Blood typing and cross matching
Serum electrolytes
Urinalysis
Chest X ray
Electrocardiogram

Psychological assessment.cont 1
Anxiety :
Reason
Support system
Coping mechanism
Visual Analog Anxiety
The VAS measuring fear of anesthesia correlated
well with the STAI (Spielberger State-Trait
Anxiety Inventory) score (r = 0.55; P < 0.01)

Intraoperative assessment
Review preoperative assessment
Assessment during surgical procedure:
vital signs, blood loss, skin color,
drainage, sponges, instruments and
sharps nurse perioperative
Wound dressings, respiratory status,
drainage tubes for patency, collection
chambers for amounts, infusion lines

Postoperative assessment
Vital signs, color, activity level,
neurologic status
Aldrette Recovery Scoring System

Level consciousness, dressings and

drainage, pain level, parenteral
infusion, patient safety, type of
procedure

2. Nursing Diagnoses
Preoperative

Focus: specific physical disease or injury

process requiring surgical intervention, ex:
gas exchange, impaired, related to cancer of
the lung
Intraoperative
General factor: specific procedure, type of
anesthesia
Postoperative
Complications of surgery, high risk nursing
diagnoses

Preoperative
Anxiety
Body image disturbance
Intolerance activity

Sleep pattern
Knowledge deficit
High risk of injury
Skin integrity
Sedation

Intraoperative
Impaired gas

Hypothermia
Impaired skin integrity
Fluid volume

Tissue perfusion
Decreased cardiac output

High risk for injury

Neuromuscular
Nasocomial
Tissue perfusion

Postoperative
Injury

Ineffective airway
High Risk
Infection

Impaired gas exchange

Comfort

Body image disturbance

3. Planning
Focus :
1. Absence of infection
2. Maintenance of skin integrity
3. Absence of adverse effects
4. Maintenance of fluid and electrolyte
balance
5. Knowledge by the patient
6. Rehabilitation process

Implementation
Preoperative..(1)
Patient and family education
Patient preparation
Obtaining required baseline
assessment data, laboratory &
diagnostic work, and consent
for surgical procedures

Intraoperative.(2)
Performance in the scrub
persons role
Performance in the
circulating nurses role
Management of personnel,
material and environment
Maintenance of a safe,
aseptic environment

Regional Anesthesia

Local
Epidural
Infltration
Nerve Block
Spinal
Topical
Anesthetic agents
Xylocaine, Novocain,
carbocaine
Topical
Dermoplast (benzocaine)
cocaine
ethyl chloride

General Anesthesia

Inhalation or
intravenous route
3 phase:
1. Induction phase
2. Maintenance phase
3. Emergence phase

Anastesia
Geriatric concerns
Consciousness
Hepatic, cardiac respiratory and renal
decline
Heart diseases, renal, and pulmonary

Complication of Intraoperative
Hypoventilation
Oral Trauma endotracheal
intubation
Hypotension

Bradikardia, Cardiac
dysrhythmia
Hypothermia
Peripheral nerve
damage

Intraoperative - Complications
Malignant hyperthermia - due to abnormal
and excessive intracellular collection of
Ca+ resulting in hypermetabolism and
increased muscle contraction.
Signs and Symptoms - high fever,
tachycardia, muscle rigidity, heart failure,
pseudotetany, and CNS damage.

 Treatment of Malignant Hyperthermia

Discontinue inhalent anesthetic, Give
Dantrium, oxygen, dextrose 50%, diuretic,
antiarrhythmics, sodium bicarbonate, and
hypothermic measures-cooling blanket, iced
IV saline or iced saline lavage of stomach,
bladder, rectum.

Postoperative
Postoperative.(3)
Monitoring and evaluating the patients
status
Managing patient care, including pain,
fluid status, cardiopulmonary status,
positioning
Assessing nutritional status and needs
Providing rehabilitation, counseling,
and emotional support

Complication of Postoperative

Hipotensi
Dysrhythmia
Trombosis vena
Emboli Pulmonal
Distensi abdomen

Immobility with skin

integrity
Urinary retention
Urinary tract
infection
Wound infection,
dehiscence,
hemorrhage
evisceration,

Post operative Care

Psychological

Anxiety
Altered body image
Finances, Family responsibility
Future changes

Discharge Plans
Educate the client, family and
psychosocial support

Wound care
Manifestation of a wound infection
How and when to take temperature
Limitation and restriction of activity
Control of pain

Evaluation
Patient outcomes
Patients level of accomplishment for
each expected outcomes

References

Kindler, CH.(2000).The Visual Analog Scale Allows Effective

Measurement of Preoperative Anxiety and Detection of Patients
Anesthetic Concerns.IARS. Diakses dari
http://www.anesthesia-analgesia.org/content/90/3/706.full
Fairchild, S.S, et al. (1996). Perioperative Nursing: Principles and
Practices. New York: Lippincot
V. Buchh, B. Saleem, F. Reshi, A. Hashia, S. Gurcoo, A. Shora & S.
Qazi : A Comparison of total intravenous anaesthesia ( TIVA ) to
conventional general anaesthesia for day care surgery. The Internet
Journal of Anesthesiology. 2009 Volume 22 Number 1. Diakses dari
http://www.ispub.com/journal/the_internet_journal_of_anesthesiology/
volume_22_number_1/article/a-comparison-of-total-intravenousanaesthesia-tiva-to-conventional-general-anaesthesia-for-day-caresurgery.html

Thank You

sistolic

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