Perioperative Care

Preoperative

• Begins w/decision to undergo surgery

• Includes medical eval, pre-operative testing, informed consent, and pt education

• Optimizing the pt’s health and minimizing risks

• Advanced directives, living wills, informed consent

• Educating the pt abt procedure or surgery

Intraoperative

Occurs DURING surgical procedure

• Involves surgical team, anesthesia providers, and nurses

• Monitors pt’s V/S, admin anesthesia, performs surgery, ensures pt safety

• Time out is required to verify correct pt, procedure, and surgical site before incision is made. CRITICAL SAFETY MEASURE

Postoperative

Starts immediately after surgery and continues until the pt is discharges or transferred to another care setting

• Focuses on monitoring V/S, managing pain, preventing complications, promoting recovery, and providing discharge instructions

Postoperative Assessments and Interventions

• V/S and oxygen saturation

• Color and temp of skin (pallor, cyanosis, diaphoresis)

• LOC, IV fluids

• Surgical site + other tubes/drains

• Comfort Measures

• Position and safety

Potential Complications

• Respiratory depression

• Pneumonia - AMBULATE

• Hypoxia (decreased O2, Sx= confusion, increase BP + pulse, tachypnea)

• Urinary retention (can interfere w/tissue perfusion)

• Thrombophlebitis = inflammation of vein R/T thrombus (blood clot formation)

• Hemorrhage

• Atelectasis = incomplete expansion or collapse of alveoli, mucus, poor gas exhcange

Appendicitis

Inflammation of the appendix, a small finger-shaped organ attached to large intestine.

• Diagnosed by blood tests, exam, ultrasound, or CT scam

Appendicitis Manifestations

Pain that starts around the belly button and gradually moves towards the LOWER RIGHT abdomen.

• N/V

• Fever

• Loss of appetite

• Tenderness or swelling in RLQ

• Pain worsens with coughing or movement

Appendicitis Treatment

Appendectomy (removal of appendicitis) and antibiotics

Appendicitis Nursing Intervention

• Monitor V/S and pain levels

• Monitor for infection

• Encourage ambulation to prevent complications

• Provide dietary instructions

Appendicitis Teaching

Take pain meds PRN, keep incision dry and clean, use pillow to splint abdomen

• For laparoscopic surgery, shoulder pain is common due to the gas used during the procedure. It goes away after a few days

Cholecystitis

Inflammation of gallbladder

• Most common cause is gallstones blocking cystic duct

• Bacteria or virus can infect bladder

• Tumors present can block bile flow

Cholecystitis Manifestations

• Pain in RUQ of abdomen often radiating to back or shoulder

• N/V

• Fever

• Jaundice

• Indigestion, bloating

Cholecystitis Treatment

• Surgery to remove gallbladder (cholecystectomy)

• antibiotics

• pain relievers

• anti-nausea meds

Cholecystitis Nursing Interventions

• Pain management

• Fluid & electrolytes

• Preventing infections

• Monitor V/S and lab results

Cholecystitis Teaching

• Diet modification to manage Sx = low-fat diet

• limit on foods that cause gas or bloating

• small frequent meals

Colectomy

Surgical procedure that involves removing all or part of the colon (large intestine)

• May be used for colon cancer, IBD, or intestinal obstruction

Colectomy Maniestations

• Persistent diarrhea or constipation

• abd. pain

• bloating

• cramps

• blood in stool

• persistent weakness and fatigue

Colectomy Nursing Interventions

• Post Op care

• Pain Management

• Monitor V/S

• Early mobilization

• Psychosocial support

• Dietary management

• Monitor fluids

• Assess wound and incision

Colectomy Teaching

• Diet = start low-fiber and advance

• Incision care

• Hydration

• Monitor for Complications = signs of infection

  • fever

  • redness

  • swelling

  • bleeding