Perioperative Nursing

Perioperative Care

• Provided before, during, and after surgery

• Three phases:

  • Preoperative phase

  • Intraoperative phase

  • Postoperative phase

Preoperative phase

starts when the patient and surgeon mutually decide surgery is needed and ends with the patient is transferred to the operating room (OR).

Intraoperative phase

begins when the patient is transferred to the OR bed and ends when the patient is transferred to the post anesthesia care unit (PACU).

Postoperative phase

starts with admission to PACU or recovery area ands ends with recovery from surgery and last post op appointment with the surgeon.

Surgery is classified based on..

Urgency

Degree of risk

Purpose

Based on Urgency

• Elective: surgery is preplanned and based on choice and availability.This surgery is non-urgent.

  • Examples: Tonsillectomy, hernia repair, scar revision, hip prosthesis

• Urgent: must be done within a short time frame for patient health but is not emergent.

  • Examples: colon resection, amputation, removal of gallbladder,

• Emergency: must be done immediately to preserve a patient’s life, body part, or function.

  • Examples: trauma, tracheostomy, control of hemorrhage

Based on Degree of risk

• Major

  • May require hospitalization and has a higher degree of risk

• Minor

  • Usually in outpatient setting

Surgery based on Purpose

• Diagnostic

• Ablative

• Palliative

• Reconstruction

• Transplantation

• Constructive

Anesthesia

• Anesthesia is used to make uncomfortable intervention tolerable and safe.

• Types:

  • General

  • Moderate Sedation/Analgesia

  • Regional Sedation

  • Topical and Local

General Anesthesia

• General anesthesia is typically Intravenous and inhalation of anesthetics.

• General anesthesia goal is to have loss of consciousness, analgesia, relaxed muscles and depressed reflexes.

• Risks: respiratory depression, N/V, thermoregulation.

• Can be used at any age.

• Children and young adults wake up more aggressive.

Three Phases of General Anesthesia

• Induction

• Maintenance

• Emergence

Moderate Sedation

• Used for short term and minimally sedation.

• The patient can still respond to verbal commands and maintains cardiorespiratory function.

• IV administration

Regional Anesthesia

• When anesthetic agent is injected near a nerve or nerve pathway.

• Inhibits transmission of sensory stimuli.

• Patient awake but loses sensation in that area.

• Can use major nerve blocks, spinal block, caudal, or epidural.

• Regional is also helpful in reducing risks of general anesthesia for post surgical pain, bowel dysfunction, and hospital stay.

Topical

• Injection of local anesthetics such as lidocaine and bupivacaine.

• Loss of feeling or sensation where topical anesthesia is applied.

• Examples: used for tissue biopsy

• Epinephrine may be mixed to stop bleeding.

• Can also be used during general anesthesia procedures.

Informed Consent

• A informed consent must be signed, dated and timed before surgery.

• Is a legal document.

• Informed consent is patient voluntary agreement to undergo surgery/procedure.

• Informed consent should have: description of procedure, disease process, person performing procedure, risks, patient right to refuse, and expected outcomes.

Advanced Directive

• Advances directive is a legal document that allows patient to specify health care treatment they wish to have when unable to communicate.

• Common forms are living wills and durable power of attorney.

• Important to know and document if patient wishes to be a DNR before surgery.

Preoperative Assessment

• Health History – assess medical history, risk factors, and developmental considerations, physical and psychosocial status.

  • Developmental – younger and older are at greater risk.

  • Physical – assess patient for cardiovascular diseases, respiratory diseases , kidney and liver diseases, endocrine diseases.

  • Surgical history – assess previous surgical complications

  • Nutrition Status – a malnourished patient is at risk of delay wound healing and infection.