Perioperative nursing care

perioperative Nursing

is the care of a client or patient before, during, and after operation

reasons for surgery

 To cure an illness or disease by removing the diseased tissue or organs.

 To visualize internal structures during diagnosis.

 To obtain tissue for examination.

 To prevent disease or injury.

 To improve appearance.

 To repair or remove traumatized tissue and structures.

 To relieve symptoms or pain

phases of perioperative care

• pre op

• intra op

• post op

when does periop phase bein

when the decision for surgical intervention is made and ends when the patient is transferred to the operating room

Pre op physiologic assessment

• health hx obtained - age and health hx

• physical examination

• assess level of functioning and typical daily activites

• assess mouth

• nutrition status and needs

• immunologic function

• endocrine function

• fluid and electrolyte

• infection

Nutrition assessment pre op

• determined by measuring the patient’s height and weight, triceps skin fold, upper arm circumference, serum protein levels and nitrogen balance.

• Obesity greatly increases the risk and severity of complications associated with surgery

Mouth assessment

dental caries, dentures, and partial plates

issues with decayed teeth and dental prostheses

may become dislodged during intubation for aesthetic delivery and occulde the airway

immunologic function

existence of allergies, previous allergic reactions, sensitivities to certain medications, past adverse reactions to certain drugs, immunosuppression

endocrine function

diabetes, corticosteroid intake, amount of insulin administered.

fluid and electrolyte imbalance

Dehydration, hypovolemia and electrolyte imbalances should be carefully assessed and documented

Nursing diagnosis

• anxiety related to surgical experience

• fear

• deficient knowledge

diagnostic test

• X-ray studies

• MRI and CT scans (with or without myelography)

• Electro-diagnostic studies

• Bone scan

• Endoscopies

• Tissue biopsies

• Stool studies

• Urine studies

psychological assessment

• Fear of pain

• Fear of the unknown

• Fear of death

• Fear of anesthesia

• Concerns about loss of work, time, job and support from the family

• Concerns on threat of permanent incapacity

• Spiritual beliefs

• Cultural values and beliefs

Psychological Nursing Interventions

 Explore the client’s fears, worries and concerns.

 Encourage patient verbalization of feelings.

 Provide information that helps to allay fears and concerns of the patient.

 Give empathetic support

Who can give consent if the patient is a minor or unconscious or incompetent

family member or legal guardian

Preop nursing interventions

 Reducing Anxiety and Fear

 Managing Nutrition and Fluids

 Promoting Optimal Respiratory and Cardiovascular Status

 Providing Preoperative Patient Education

 Preparing the Bowel for Surgery

 Preparing Patient for Surgery

 Remove jewellery, including wedding rings

 Transporting Patient to Operating Room

 Attending to Special Needs of Older Patients

 Attending to the Family’s Needs

When does the intra op phase begin and end?

when the patient is admitted or transferred to the surgery department and ends when he or she is admitted to the recovery area.

Goals of intraop

 Promote the principle of asepsis.

 Homeostasis.

 Safe administration of anesthesia

key members in the surgical team

• surgeon

• anesthesiologist or anesthetist

• scrub nurse or assistant

• circulating nurse

Nursing responsibilities during intra op

• Safety is the highest priority.

• Simultaneous placement of feet. This is to prevent dislocation of hip.

• Always apply knee strap.

• Arms should not be more than 90°

• Prepare and apply cautery pad. Cautery is used to stop bleeding

when does post op care begin and end?

begins with the admission of the patient to the recovery area and ends with a follow-up evaluation in the clinical setting or at home.

Phase I of postanesthesia care

• care during immediate post anesthesia period

• ECG and more intense monitoring

Goal of Phase I of postanesthesia care

prepare patient for transfer to phase II level of care an inpatient unit or intensive care unit

Phase II of postanesthesia care

• ambulatory surgery pt

• fast-tracking

Goal of Phase II of postanesthesia care

prepare pt for transfer to extend observation, home, or extended care facility

extended observation post anesthesia care

extended care or observation after transfer/discharge from phase I and II levels

Goals of extended observation post anesthesia care

prepare patient for self care

blended levels of care post anesthesia

various levels of care offered in the same enviornment

phase I priorities

• stable airway with adequate ventilation and oxygenation

• hemodynamic stability

• manage analgesia and PONV

• oral intake

• discontinue or adapt IV

Phase II priorities

• mobility

• oral intake

• adequate analgesia

• education for discharge

• prescriptions

phase I potential complications

• airway compromise

• cardiovascular depression

• pain

• delirium

• procedure specific considerations

phase II complications

• pain

• nausea

• vomiting

discharge from phase I considerations

• adequate airway and ventilatory status

• cardiac and hemodynamic stability

• ability to move extremities

• fully awake

• adequate o2 on room air

discharge from phase II considerations

• pain relief and comfort

• hemodynamic stability

• nausea addressed

• takes fluid

• ambulate

Nursing consideration post op positioning

patients are moved slowly and carefully during immediate postop phase

Safety checks when transferring the patient from OR to RR

• s - securing restraints for IV fluid and blood transfusion

• a - assist patient to position appropriate for them

• f - fall precaution

• e - eliminating possible sources of injuries and accident when moving

promoting patient safety

pt when transferred to the stretcher pt should be covered with blankets and secured with straps above knees and elbows