Comprehensive Study Notes: Perioperative Nursing (Pre-op, Intra-op, and Post-op)

• Definition of Perioperative Nursing: Encompasses the comprehensive care provided "around the time of surgery," ensuring the patient's physical and emotional well-being throughout all phases, and is divided into three distinct phases:
    - Pre-operative Phase: The period beginning from the moment the decision is made to have surgery, through extensive pre-surgical assessments, preparation, and while the patient is being transported to the operating room (OR). This phase involves thorough patient education regarding the procedure, risks, and potential outcomes.
    - Intra-operative Phase: The crucial period spent within the operating room, where a sterile environment is maintained, and surgical procedures are carried out under the guidance of the surgical team until the patient is safely transferred to the Post-Anesthesia Care Unit (PACU) or recovery room. This phase requires vigilant monitoring of the patient's vital signs and responses to anesthesia.
    - Post-operative Phase: The period of time following the patient's departure from the OR, where recovery is closely observed for complications and pain management is initiated. Patient education on recovery guidelines and follow-up care is emphasized during this phase, as well as emotional support for the patient and their family.

Surgical Categories and Procedural Terminology

• Definition of Surgery: A specialized field that combines the art and science of treating disease, injury, and deformity through various surgical procedures using operation and instrumentation, aiming to improve health outcomes.

• Classifications of Surgery:
    - Elective Surgery: Scheduled well in advance and is not life-threatening; postponement does not typically lead to immediate adverse effects on health.
    - Emergency Surgery: Required to address life-threatening conditions where immediate action must be taken. This type of surgery typically occurs without delay.
    - Ambulatory Surgery: Also known as outpatient surgery or "same-day" surgery, where patients can go home shortly after the procedure.
    - Laparoscopic Surgery: Utilizes small instruments and cameras inserted through tiny incisions; this minimally invasive approach often results in quicker recovery and less postoperative pain.

• Categories of Urgency:
    - Emergent: Requires immediate medical attention without delay.
    - Urgent: Necessary within a timeframe of $24-30 \, ext{hours}$.
    - Required: Necessary within several days to weeks.
    - Elective: Recommended for the patient's benefit but can be scheduled at their convenience.
    - Optional: Based on individual choice and preference, without required medical necessity.

• Complexity Categories: Evaluated based on operative duration and the intricacies involved in the surgical procedure, categorizing surgeries into minor (less invasive) and major (more complex).

• Surgical Suffixes and Meanings:
    - -ectomy: Refers to the surgical excision or removal of a specific organ or tissue (e.g., hysterectomy removes the uterus).
    - -lysis: Denotes the procedure involving destruction of tissue (e.g., lysis of adhesions, which are abnormal tissues that bind organs).
    - -orrhaphy: Involves the surgical repair or suturing of tissues (e.g., myorrhaphy repairs muscles).
    - -oscopy: Indicates the use of scopes to visually examine internal structures (e.g., bronchoscopy allows exploration of the airways).
    - -ostomy: Creation of an artificial opening into a structure (e.g., tracheostomy provides an airway).
    - -otomy: A procedure that involves making an incision into an organ (e.g., thoracotomy allows access to the chest cavity).
    - -plasty: Surgical repair or reconstruction of a part of the body (e.g., rhinoplasty for reshaping the nose).

• Primary Reasons for Surgery:
    - Diagnosis: To investigate and confirm the presence of disease.
    - Cure: To eliminate a disease or ailment.
    - Palliation: To relieve symptoms without curing the underlying disease.
    - Prevention: To avert prospective health issues.
    - Cosmetic / Reconstructive: To improve appearance or restore function.
    - Exploration: Surgical examination to understand the extent of disease.

Pre-operative Assessments and Patient History

• History and Physical (H&P): Comprehensive review of the patient's full medical and surgical history, including current medications, allergies, and any previous surgeries.
    - Joint Commission (TJC) Requirement: Ensures the H&P is accurately completed within $30 \, ext{days}$ prior to surgery to comply with healthcare regulations.

• Allergy Assessment: Detailed inquiry into known allergies, particularly to medications, foods, and environmental factors. Special attention to potential Latex Allergy Indicators: History of allergies to bananas, avocados, peaches, or eggs, as these can suggest latex sensitivities.

• Medication Reconciliation: A crucial process that guarantees the patient’s medication list is complete and up-to-date, including any supplements, herbal products, illicit drugs, over-the-counter medications, and prescriptions. This is critical due to the potential specific effects of various medications during surgery:
    - Antidepressants / Cardiac Medications: Can increase the risk of hypotension and affect cardiac stability during surgery.
    - Diuretics: Associated with heightened risk of electrolyte imbalances, which can complicate the surgical process.
    - Antidiabetic Medications: May lead to hypoglycemic episodes; careful management of blood sugar is essential.
    - Corticosteroids: Can impair wound healing, elevate bleeding risk, affect blood glucose levels, and may mask signs of infection, necessitating specific management strategies.
    - Anticoagulants, ASA (Aspirin), NSAIDs: Increase the risk of hemorrhage; careful management and coordination with the surgical team are critical to optimize safety.