Perioperative Nursing

Pre

Pre-Operative Nursing

* organize significant data relevant to assessment of clients in need of surgical intervention taking into consideration the different phases of surgical experience
* value critical thinking ability in ensuring safe & quality interventions
* adhere to ethico-legal considerations when providing safe, quality, professional perioperative nursing care

Trepanation (Burr Holing)

* first surgical techniques were developed to treat injuries and traumas.
* early surgical procedures were carried out in the Indian subcontinent.

Sushruta

father of surgery

Amniocentesis

aspirate fluid from amniotic sac

Salpingectomy

excise part of fallopian tube

Palliative

relieve distressing signs and symptoms not necessarily to cure the disease

Ex. An intestinal bypass operation may relieve the symptoms of intestinal obstruction, Gastrostomy Tube insertion

Optional

requested by the client usually for aesthetic purposes

Ex. Face lift, liposuction

General Anesthesia

* the loss of all sensation and consciousness


* protective reflexes such as cough and gag reflexes are lost
* acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur

Sterile Team

* Surgeon
* First Assist
* Registered Nurse First Assist (RNFA)
* Scrub Nurse
* RN, LPN, Surgical Technician

Circulating Nurse

coordinates activities and manages client care by continuous assessment of client’s safety; monitors aseptic technique; environment

To Reduce Anxiety

* introduce Self
* address patient by name
* verify Details
* encourage & answer questions
* pay attention to physical comfort

Surgical Asepsis

aseptic technique

Safe Transferring Practices

* (if possible), let patient do as much of transfer
* check chart for precautions (joint disease)
* watch signs of orthostatic hypertension

Antidote

Dantrolene

Hygiene Practices

* bath/shower before surgery
* trimmed fingernails, no polish/cosmetics
* remove hair pins, clips; wear surgical cap & OR gown
* skin prep (during intraop)

Special Orders

* NGT
* medications
* anti-embolic stockings

Pain

* peak on 2nd day postop
* opioids & nonopioids (early post op)
* IV drugs initially then oral
* around the clock scheduling (more effective)
* PCA (IV infusion/internal pump)
* epidural analgesia is intermittent/continuous drip
* assess with VS
* don’t assume as incisional pain only

Compazine

potentiate opioids

October 26, 1877

* 1st ever performed then-revolutionary surgery of wiring fractured patella/kneecap
* King’s College Hospital

Joseph Lister

* father of modern surgery
* developed antiseptic surgery by spraying medical instruments, catgut, & bandages w/ a 1-in-20 solution of carbolic acid

Bleeding, Pain, Infection

3 principal obstacles in surgery

Industrial Revolution

surgeons were incapable of overcoming the 3 principal obstacles which had plagues medical profession from infancy

Surgery

* cheirourgia, from the Greek "cheir" meaning "hand" + "ergon" meaning "work"
* branch of medicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment

Ambroise Paré

* 16th century French surgeon

stated that *“To eliminate that which is superfluous (inessential; in excess of what is needed), restore that which has been dislocated, separate that which has been united, join that which has been divided and repair the defects of nature.“*

Perioperative Nursing

encompasses three phases of surgical experience: pre-operative, intraoperative, post-operative

Perioperative Nursing

activities that occur in any or all 3 phases

Preoperative

begins from the **decision** for surgical intervention is made to when the patient is **transferred to OR table**

Intraoperative

begins when patient is **transferred to OR table** to when they are **admitted to PACU**

Postoperative

begins with the **admission of patient to PACU** and ends after **follow-up evaluation** in clinical setting/home

Root Word

* meaning of word
* describes body part of function
* usually Greek/Latin Origin

Lapar

abdomen

Cysto

bladder

Angio

blood vessel

Mast/Mammo

breast

Salping

fallopian tubes

Cholecysto

gallbladder

Cardio

heart

Nephro

kidney

Rhino/Nas

nose

Oophoro

ovary

Cranio

skull

Gastro

stomach

Orchio/Orchid

testicle

Hystero

uterus

Colpo

vagina

Centesis

surgical procedure

Ectomy

surgical removal

Graphy

recording/represent a specified object

Lysis

separation, destruction, loosening

Oorhaphy

surgical repair

Oscopy

direct visualization by scope

Ostomy

opening made to allow passage of drainage

Otomy

opening into

Pexy

fixation of

Plasty

plastic surgery

Tome

instrument for cut

Tripsy

crushing

Cholecystectomy

removal of gallbladder

Cystocopy

looking into the bladder

Mammoplasty

reshaping/reconstructing the breast

Mastectomy

removal of breast

Rhinoplasty

plastic repair of the nose

Adhesiolysis

separation of adhesions

Colostomy

formation of an opening of the colon onto surface of the abdomen

Colonoscopy

visualization of the colon

Colporrhaphy

repair of vaginal wall

Lumpectomy

removal of a part of the breast

Obstruction

Perforation

Erosion

Tumors

types of pathologic processes requiring surgical intervention

Obstruction

impairment of flow of vital fluids:

* blood
* urine
* bile
* CSF

Perforation

rupture of organ

Erosion

wearing (tiring) off of a surface/membrane

Tumors

abnormal new growths

Proliferation

increase in number

Ex: stone formation in prostate

Purpose

Seriousness

Urgency

classification of surgical procedures

Diagnostic

Reparative

Curative

Ablative

Reconstructive

Constructive

according to purpose

Diagnostic

establish presence of a disease

* biopsy
* exploratory laparotomy

Reparative

determine extent of damage

* multiple wound repair

Curative

treat disease condition

* excision of tumors

Ablative

removal of an organ (suffix - ectomy)

* appendectomy
* cholecystectomy

Reconstructive

involves repair of damaged organ/restoration of tissue to its original appearance & function

* plastic surgery after burns

Constructive

repair of congenitally defective organ to improve function

* cleft repair

Magnitude/Extent

according to degree of risk

Minor

* generally not prolonged
* leads to few serious complications
* lesser risk
* ex: skin biopsy

Major

* extensive & prolonged
* large amount of blood loss
* vital organs may be handled/removed
* great risk of complications
* ex: nephrectomy, radial neck dissection

Stat

Latin, “statum”; immediately

Urgency

* immediate surgery may be required
* maintain & save life
* maintain an organ/limb function
* remove damaged organ
* stop hemorrhage
* ex: severe trauma, intestinal obstruction, extensive burns, gunshot/stab wounds, perforated ulcer

Imperative/Urgent

* done within **24 - 48 hours**
* ex: severe bleeding hemorrhoids, kidney stones eroding, bleeding cancerous tumors, bleeding duodenal ulcers

Planned/Required

* necessary for well-being
* not urgent
* scheduled weeks/months in advance
* ex: cataract removal, tonsillectomy, laminectomy, cholecystectomy (if acute inflammation is not present)

Laminectomy

* remove the back of 1 or more vertebrae
* to give access to spinal cord/relieve pressure on nerves
* imperative

Imperative

necessary & unavoidable

Elective

* not absolutely necessary for survival
* delay/omission of surgery has no adverse effect
* ex: simple hernia repair, scar repair, hemorrhoids (not bleeding)

Outpatient

* ambulatory surgery
* ex: excision of cyst

Intraoperative Phase

* use nursing process to design, coordinate, deliver care to meet identified needs of clients
* protective reflexes/self-care abilities are potentially compromised due to operative/other invasive procedure

General

Regional

types of anesthesia

Anesthesia

state of narcosis (severe NCS depression produced by pharmacologic agents) analgesia, relaxation, reflex loss

Anesthesiologist or CRNA

anesthetic agents are usually administered by ______

General Anesthesia

* usually administered by IV infusion
* inhalation of gas through a mask/endotracheal tube in the trachea

Advantages of General Anesthesia

* respiration & cardiac function are readily regulated
* can be adjusted to length of operation & client’s age & physical status

Disadvantages of General Anesthesia

depresses respiratory & circulatory system