NUR 300 Module 14 Perioperative Nursing

Perioperative Nursing Care Overview

Module Information

  • Title: Perioperative Nursing Care Module 14

Learning Objectives

  • Identify the three stages of Perioperative nursing.

  • Understand how comorbidities increase risks for perioperative complications.

  • Explain common perioperative assessment and teaching techniques from pre-op through post-op.

  • Apply the clinical judgement measurement model during the perioperative period, which includes assessing cues, making hypotheses, generating solutions, implementing plans, and evaluating outcomes.

Three Main Stages of Surgical Procedures

Stages

  1. Preoperative

    • Activities and considerations before the surgery.

  2. Intraoperative

    • Care provided during the surgical procedure.

  3. Postoperative

    • Recovery activities and care after the surgery.

Nurse's Role

  • Understand the involvement of clients in each stage and the nurse's responsibilities.

Communication in Perioperative Nursing

Importance

  • Essential for client well-being and successful outcomes.

Types of Communication

  • Nurse to Client and Family

  • Interprofessional Communication

    • Consistency of the nursing team across stages (pre-op, operative, PACU).

  • Time-out Procedures

    • Safety checks before procedures.

Classification of Surgical Procedures

Seriousness

  • Major

    • Involves great risk.

  • Minor

    • Involves minimal risk.

Urgency

  • Elective

    • Non-essential, can be scheduled.

  • Urgent

    • Necessary but not immediately life-threatening.

  • Emergent

    • Must be completed immediately.

Purpose

  • Types of Procedures:

    • Diagnostic, Ablative, Palliative, Reconstructive/Restorative, Transplant, Constructive, Cosmetic.

Client Risks for Surgery

Risk Factors

  • Smoking:

    • Causes delayed wound healing, aspiration risks, and breathing difficulties.

  • Age:

    • Very young or very old patients at higher risk.

  • Nutrition:

    • Malnourished or obese individuals face greater risks.

  • Immunosuppression:

    • Increased risk for infections and delayed healing.

  • Fluid and Electrolyte Imbalances:

    • Can exacerbate pre-existing conditions and lead to post-operative complications.

Postoperative Nausea and Vomiting

  • Occurs in ~30% of clients, higher in females, history of PONV, or motion sickness.

  • Increased risk for aspiration and fluid imbalances.

Risk for Deep Vein Thrombosis (DVT)

Higher Risk Factors

  • Longer surgeries (over 90 minutes or 60 minutes abdominal).

  • Active cancer, age over 55, recent surgery, historical DVT, dehydration, known clotting disorders, obesity, and smoking.

Prevention

  • Awareness of DVT risks and preventative measures are crucial as many insurances view DVT as avoidable.

Risk for Pressure Injuries

Prevention Focus

  • Intrinsic Factors:

    • Nutritional status, low albumin levels, decreased mobility, infection risks.

  • Extrinsic Factors:

    • Temperature, friction, moisture, positioning, devices used during surgery.

Physiological Factors Affecting Elderly Clients

Cardiovascular

  • Changes in myocardium, decreased output, blood pressure issues, peripheral vascular insufficiencies.

Integumentary

  • Decreased subcutaneous tissue, skin fragility, temperature control issues.

Pulmonary

  • Decreased respiratory function, chronic diseases, and risks of pneumonia.

Renal

  • Decreased function affecting acid-base balance, electrolyte imbalances.

Neurological

  • Sensory loss, increased pain tolerance, risk for confusion or falls.

Musculoskeletal

  • Decreased strength and mobility, increasing the risk for falls.

Medical Conditions That Increase Surgical Risks

  • Thrombocytopenia: Prolonged clotting times.

  • Bleeding Disorders: Increased risk for coagulation issues.

  • Heart Disease: Risk for cardiovascular events.

  • Obstructive Sleep Apnea: Risks related to anesthesia.

  • Chronic Respiratory Disease: Medication interactions can complicate.

  • Renal and Liver Diseases: Impacts on metabolism and healing.

ASA Physical Status Classification

Classification

  1. Class I: Normal healthy patient.

  2. Class II: Mild systemic disease, no functional limitations.

  3. Class III: Severe systemic disease, moderate functional limitations.

  4. Class IV: Severe systemic disease, constant threat to life.

  5. Class V: Moribund patient with expected survival only with surgery.

Medications and Surgical Risks

Common Medication Classes and Their Risks

  • Antibiotics: Can enhance anesthetic effects.

  • Anticoagulants: Increase bleeding risks.

  • Antidysrhythmic: May reduce heart function during anesthesia.

  • Antihypertensives: Can interact with anesthesia, causing hypotension.

  • Corticosteroids: Impact stress response and blood glucose levels.

  • Diuretics and NSAIDs: Risk for electrolyte imbalances and increased bleeding.

  • Herbal Supplements: Potential adverse effects on bleeding and electrolytes.

Day of Surgery Preparation

Patient Education

  • Hygiene Needs: Bathing, partial bath, wearing a hospital gown.

  • NPO Instructions: Mouth care recommendations.

  • Cosmetics Removal: Jewelry and any metal objects taken off.

  • Prostheses: Should be removed if possible.

  • Bowel and Bladder Preparation: Ensuring elimination and possible need for enemas or catheters.

Pre-Operative Nursing

The Patient Experience

  • Patient's feelings vary based on surgery urgency.

  • Addressing fears, questions about NPO, and concerns about support sources.

The Role of the Nurse

  • Detailed patient history including medical, surgical, medication, and allergies.

  • Conduct assessment, initiate IV, and document findings.

  • Monitoring vital signs regularly.

Pre-Operative Teaching

  • Explain routines, anticipated times for surgery, and communicate delays.

  • Discuss post-operative sensations and pain relief measures.

  • Surgical consults and consents should be handled by the surgeon/anesthesiologist, not the nurse.

Common Pre-Operative Labs

  • Complete Blood Count: Hemoglobin, hematocrit, platelets, and WBCs.

  • Blood Chemistry: Sodium, potassium, creatinine, glucose.

  • Coagulation Panel: INR, prothrombin time, partial thromboplastin time.

Pre-Anesthesia Care Unit

  • Holding units ready with necessary surgical attire.

  • Medications may be administered, catheter insertion, and application of warming blankets.

  • Continuous reassurance and education provided to the patient.

Intraoperative Nursing

Roles

  • Circulating Nurse: Manages patient care and activities in the OR.

    • Ensures proper positioning, antimicrobial prep, specimen collecting, and warming devices.

    • Conducts time-out procedures.

  • Scrub Nurse/Tech: Knowledge of procedures and instruments is essential.

    • Maintains a sterile field, anticipates required supplies, and conducts counts.

Handoff Communication in Intraoperative Nursing

  • Include client name, surgery details, allergies, vital signs, and cultural considerations.

Types of Anesthesia

  1. General: Total sedation with amnesia medications and intubation.

  2. Moderate (Conscious) Sedation: Short-term IV sedation where patient can breathe independently.

  3. Regional: Loss of sensation to a specific body part (e.g., spinal).

  4. Local: Anesthetic applied to a specific area (e.g., lidocaine injections).

Post-Operative Care

Phases

  1. Phase I: Assessing aftereffects of anesthesia, ABCs, vitals, fluid management.

  2. Phase II: Early postoperative, stabilization, planning for discharge.

  3. Phase III: Convalescent care for hospitalized clients.

Postoperative Phase I Nursing

Key Responsibilities

  • Handoff communication with the next care provider.

  • Continuous assessment of ABCs, temperature control, and pain management (using POSS).

Postoperative Phase II Nursing

Recovery and Assessment

  • Monitor ambulatory surgery recovery, pain management, and discharge teaching.

  • Focus on neurological status, skin integrity, metabolism, and comfort.

  • Monitor for postoperative nausea and vomiting (PONV).

Recovery Continued - Discharge Teaching

Key Instructions

  • Coughing and deep breathing exercises, precautions based on surgery type.

  • Positioning importance for skin integrity and lung function.

  • Recognizing signs of DVT and infection, and what constitutes a medical emergency.

  • Guidelines on nutrition, rest, and appropriate exercise levels.