Perioperative Nursing

Perioperative Nursing

The total surgical episode

Perioperative Nurse

is a Registered nurse who uses the nursing process to design, plan and deliver care to meet the identified needs of a client whose protective reflexes o r self-care abilities are potentially compromised because of the surgery to be performed.

Preoperative Period

Intraoperative Period

Postoperative Period

3 Phases of Perioperative Nursing

Preoperative Period

Intraoperative Period

Postoperative Period

the time prior to surgery.

the time spent during the actual surgical procedure.

the period when the actual surgery is completed.

Perforation

Obstruction

Erosion

Tumor

4 General Types of Pathologic Process Requiring Surgery: POET

Perforation

Obstruction

Erosion

Tumor

the rupture of an organ

impairment to the flow of fluids

wearing off of a surface of a membrane

abnormal new growth

Purpose

Degree of risk

According to Urgency

CATEGORIES OF SURGICAL PROCEDURES

According to

Aesthetic

improvement of physical features that are within “Normal” range to begin with

Constructive

repair of a congenitally defective body part

Curative

removal or repair of a damaged or diseased tissues or organs

Diagnostic

discovery or confirmation of a diagnosis

Exploratory

estimation of the extent of a disease or confirmation of a diagnosis

Palliative

to treat and relieve symptoms but not necessarily curing underlying disease.

Reconstructive

repair of a damaged organ; it involves partial or complete restoration of a body part.

Emergent

describes procedures that must be done immediately to sustain life or maintain function

o Life-saving surgery

Urgent or imperative

performed as soon as client is stable and infection is under control

Is indicated for a problem requiring intervention within 24-48 hr

Aesthetic

Constructive

Curative

Diagnostic

Exploratory

Palliative

Reconstructive

Emergent

Urgent or imperative

CATEGORY OF SURGERY ACCORDING TO PURPOSE

Emergency

Imperative

procedures done immediately to save life and limb

done within 24-48 hrs.

Planned required

Optional

necessary for well-being, it may be scheduled for weeks to months.

requested by the client; done at the client’s discretion

Elective

Day (ambulatory surgery)

not necessary for survival; delay or omission will not cause adverse effects.

o Procedures - that are scheduled at the client’s convenience

done on an outpatient basis

Minor surgery

Major surgery

CATEGORY OF SURGERY ACCORDING TO DEGREE OF RISK

• Obesity

• Fluid, electrolyte and nutritional problems

• Age

• Presence of diseases

• Concurrent or prior pharmacotherapy

SURGICAL RISKS

I. GENERAL RISK FACTORS

• Nature of the condition,

• Location of the condition,

• Magnitude and urgency of the surgical procedure

• Mental attitude of the person toward surgery,

• Caliber of the professional staff and health care facilities

SURGICAL RISKS

OTHER FACTORS

• Stress response is elicited

• Defense against infection is lowered

• Vascular system is disrupted

• Organ function is disturbed

• Body image may be disturbed

• Lifestyles may change

EFFECTS OF SURGERY TO THE CLIENT

Body Image

• sum of a person’s conscious and unconscious attitudes about his or her body.

• how a person perceives the size, appearance, and functioning of the body and its parts.

personal identity

body image

role performance

self esteem

four components of self-concept namely:

affective

cognitive

2 aspects of body image

1. Impact Phase

2. Retreat Phase

3. Acknowledgement Phase

4. Reconstruction Phase

4 PHASES OF ALTERED BODY IMAGE

Retreat Phase

• Senses of failure in own body

• Shows despair, discouragement and passive acceptance.

• Projects guilt onto other

• Turns anger and hostility inwards

Retreat Phase

• Becomes aware of injury, illness, loss or disfigurement

• Children and elders regress

• Adolescents and adults retreat into denial

Acknowledgement Phase

• Mourning the loss

• Focus on strength

• Begins to focus on strengths than losses

Reconstruction Phase

• Adapts the changes in body image

• Tries new approaches in life.

Preoperative Period

Time the client is admitted to the surgical unit, the time he/she is prepared physically, psychologically, spiritually, and legally for the surgical procedure until he is transported to the OR.

A. Medical/Health History

B. Medication History

C. Psychological History

D. Lifestyle Habits

E. Social History

PERIOPERATIVE ASSESSMENT INCLUDES

o Cardiovascular- ECG,CBC and Blood typing

o Pulmonary system- CXR

o Elimination disturbances- U/A and S/E

o Endocrine disturbances- HGT,CBG, FBS

o Neurologic status-GCS, Reflexes, Cerebellar function

o Hematologic- CBC, Blood typing and possible cross-matching

PRE-SURGICAL SCREENING TESTS

Previous surgery

Serious illness and trauma

Cortisone or steroid use

Diabetes Mellitus

Emboli, previous embolic events

Immunosuppressed patients

Alcohol, drugs and nicotine use

Past Medical Hx includes the following

✓ (a) Reduce the possibility of vomiting and aspiration.

✓ (b) Reduce the risk of possible bowel obstruction

✓ (c) Allow visualization of intestines during bowel surgery

✓ (d) Prevent contamination from fecal material in the intestinal tract during bowel or abdominal surgery.

Prepare the GIT to:

o Restricting food and fluids (NPO 8- 10 hrs for general anesthesia)

o Insertion of gastric or intestinal tube

o Enemas

Preparations of the GIT include:

o high carbohydrate

o high intake of protein

o supplementing diet with vitamins

Nursing interventions for clients who are malnourished preoperatively include:

Surgeon

is responsible for obtaining the consent for surgery

DEEP BREATHING EXERCISES

COUGHING EXERCISE

TURNING EXERCISE

EXTREMITY EXERCISE

INSTRUCTIONAL AND PREVENTIVE ASPECTS

Hygiene and Skin Care

Elimination

Nutrition and Fluid

Rest and Sleep

ON THE NIGHT PRIOR TO SURGERY:

Diazepam (Valium)

Droperedol (Inapsine)

Commonly Used Preop Meds

Tranquilizers

Midazolam Hcl

Promethazine Hcl (Phenargan)

Secobarbital sodium (Seconal Na)

Pentobarbital sodium (Nembutal sodium)

Commonly Used Preop Meds

Sedatives

Morphine sulfate

Fentanyl citrate (sublimaze)

Meperidine Hcl (demerol)

Commonly Used Preop Meds

Analgesics

Atropine sulfate

Glycopyrrolate (Robinul)

Commonly Used Preop Meds

Anticholinergic

Cimetidine (Tagamet)

Ranitidine (Zantac)

Commonly Used Preop Meds

HISTAMINE 2 (H2) RECEPTOR ANTAGONIST