NCM 112: Perioperative Nursing Management

Perioperative Nursing

Nursing specialty that works with patients having operative and other invasive procedures

Perioperative nurse

• surgical or operating room nurse

• specialized nurse caring for patients before, during, and after surgery

3 phases of perioperative nursing

• preoperative

• intraoperative

• postoperative

Preoperative phase

Begins when the decision to proceed with surgical intervention is made and ends with the transfer of patient onto the OR bed

Intraoperative phase

Begins when the patient is transferred onto the OR bed and ends with admission to the post anesthesia care unit (PACU)

Postoperative phase

Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home

Classification of surgery

• purpose

• urgency

• degree of risk

surgeries based on purpose

• diagnostic

• curative

• reparative

• reconstructive or cosmetic

• palliative

Diagnostic surgery

Surgical intervention is done to know more what diseases the patient may have

Biopsy or exploratory laparotomy

Examples of diagnostic surgeries

Curative surgery

Aiming to cure patients with surgery

Excision of a tumor, colectomy

Examples of a curative surgeries

Reparative surgery

Multiple wound repair

Reconstructive or cosmetic surgery

Mammoplasty or a facelift

Palliative surgery

To relieve pain or correct a problem

Example of palliative surgery

• Debulking: removing a part of a stage IV tumor (cannot be cured anymore) that already stuck itself to the spine

Surgery based on urgency

• emergent

• urgent

• required

• elective

• optional

Emergent surgery

• immediate attention needed; disorder may be life threatening

• without delay

• e.g: severe bleeding; bladder or intestinal obstruction; fractured skull; gunshot or stab wound; extensive burns; cannot urinate or defecate leading to bloating infection or abdominal bursting

Urgent surgery

• requires prompt attention with 24-30 hours

• e.g acute gallbladder infection; kidney or ureteral stones leading to a very painful experience

• e.g. closed fractures; infected wound; exploration/irrigation

Required surgery

• patient needs to have surgery

• planned within a few weeks or months

• e.g. prostatic hyperplasia; thyroid disorders; cataracts

elective surgery

• surgery that is recommended but can be omitted or delayed without catastrophe

• e.g repair of scars; simple hernia; vaginal repair

optional surgery

• decision rests with the patient

• personal preference

• e.g cosmetic surgery

Surgery based on degree of risk

• major

• minor

Major surgery

• usually extensive and warrant an overnight or extended stay in the hospital

• include extensive work such as entering a body cavity, removing an organ, or altering the body’s anatomy

• usually require anesthesia or respiratory assistance and sometimes even both

Minor surgery

• generally superficial and do not require penetration of a body cavity

• do not involve assisted breathing or anesthesia and are usually performed by a single doctor

PhilHealth’s related value unit

• surgeries have a relative value unit or points

• 80+ points = major surgery

Informed consent

• the patient's autonomous decision about whether to undergo a surgical procedure

• legal mandate (no surgery unless consent is given)

• should be voluntary

• necessary before non-emergent surgery

Informed consent

• protect the patient from unsanctioned surgery

• protect the surgeon from claims of an unauthorized operation

Circumstances when informed consent is necessary

• invasive procedures

• procedures requiring sedation and/ or anesthesia

• a non-surgical procedure that carries slight risk to the patient (e.g. arteriography)

• procedures involving radiation (causes complications and side effects)

• blood product administration

Validity of an informed consent

• voluntary consent

• incompetent patient

• informed subject/ patient

• patient able to comprehend

Voluntary consent

• must be freely given, without coercion

• must be at least 18 years of age unless patient is an emancipated minor

• physician must obtain consent, and a professional staff member must witness patient’s signature

Emancipated minor

• a person who is under the legal age in a given state but, because of other circumstances, is legally considered an adult

Incompetent patient

• individuals who are not autonomous and cannot give or withhold consent

• e.g. cognitively impaired, mentally ill, or neurologically incapacitated

Informed subject

• should be in writing

• should contain explanations of procedures & its risks

• description of benefits and alternatives

• an offer to answer questions about procedure

• Instructions that the patient may withdraw consent

• A statement informing the patient if the protocol differs from customary

  procedure

Patient able to comprehend

• if patient is non-English speaking, it is necessary to provide comsent in a language that is understandable to the client

• A trained medical interpreter may be consulted

• Alternative formats of communication (e.g., Braille, large print, sign interpreter) may be needed if the patient has a disability that affects vision or hearing

• Questions must be answered to facilitate comprehension if material is confusing.