Periop Nursing (Student Version) 2

PERIOPERATIVE NURSING

  • Instructor: Anthony Carney, DNP, APRN

Phases of Perioperative Care

  • Pre-operative/Pre-anesthesia

  • Intraoperative

  • Postoperative/Post-anesthesia-PACU and beyond

Preoperative Phase

  • Assessment

    • Nursing and anesthesia provider assessment

    • Planning of care

    • Interventions to prepare for surgical procedures

Intraoperative Phase

  • Description

    • Begins when the patient is wheeled into the OR

    • Ends when transferred to immediate postoperative recovery area

  • Nursing Roles

    • RNFA (Registered Nurse First Assistant)

    • Scrub nurse

    • Circulating nurse

Postoperative Phase

  • Immediate Care

    • Usually spent in PACU (Post Anesthesia Care Unit)

    • Focused on recovery from general anesthesia, airway management, pain management, and close observation of vital signs

  • Ongoing Care

    • In ICU, step-down, or med-surg units

Purposes of Surgery

  • Diagnosis

  • Cure

  • Palliation

  • Prevention

  • Exploration

  • Cosmetic improvement

Types of Surgery

  • Ambulatory

    • Surgery and discharge on the same day

  • Same-Day Admit

    • Patient admitted for post-operative care

  • Inpatient

    • Hospital admission before and after surgery

Timing of Surgery

  • Elective Surgery

    • Non-urgent, improves quality of life; low risks of morbidity and mortality

  • Semi-Elective Surgery

    • More time-sensitive but not required within 24 hours; generally low risks

  • Urgent Surgery

    • Required within 24 hours; prevent possible complications

  • Emergency Surgery

    • Must occur immediately; critical medical condition requiring urgent intervention

Preoperative Patient Assessment

  • Patient Interview/History

    • Pre-surgery review of health information, expectations, and emotional readiness

  • Steps in Patient History

    1. Explore understanding of the need for surgery.

    2. Review previous surgeries and anesthesia history.

    3. Discuss family health history.

    4. Current medication use (prescription, OTC, herbal).

    5. Medication allergies/intolerances.

    6. Recreational drug use or addiction history.

    7. Tobacco use and its impact on surgery.

    8. Determine possible pregnancy; date of last menstrual period.

Review of Systems (ROS) Assessment

  • Pulmonary Problems

    • Risks for atelectasis, infection, respiratory failure, etc.

  • Cardiac Problems

    • Assess for increased myocardial oxygen demands.

  • Neurologic Problems

    • Evaluate baseline cognition (hearing, vision).

  • GU Problems

    • Assess renal function and pregnancy status.

  • Hepatic Problems

    • Clotting and metabolism issues.

  • Integument Problems

    • Check for pressure ulcers or rashes.

  • Musculoskeletal Problems

    • Mobility restrictions during intra/postoperative phases.

  • Endocrine Problems

    • Review diabetes, thyroid, and adrenal function.

  • Immune Problems

    • Assess for steroid therapy history.

  • Fluid & Electrolyte Problems

    • Examine hydration status, especially in older patients.

Legal Concerns - Informed Consent

  • Provider Responsibility

    • Complete disclosure of diagnosis, surgery purpose, risks, alternatives, consequences of inaction, surgeon's details, costs.

  • Role of the Nurse

    1. Witness patient signature.

    2. Advocate for the patient.

  • Special Circumstances

    • Minors, unconscious patients, or mentally incompetent individuals require consent from a legal representative.

  • Medical Emergencies

    • In emergency situations, consent may be waived.

Preoperative Requirements - Checklist

  • Vital Signs

    • Initials on chart review (temperature, pulse, BP).

  • Documentation

  • Preparation Tasks

    • Surgical site marking, patient identification bands, preoperative medications.

Summary of Nursing Problems Pre-op

  • Knowledge deficit

  • Anxiety

  • Fear

  • Ineffective coping

  • Risk for latex allergy response

Intraoperative Phase - General Concepts

  • Patient Safety

    • Patient identification, surgical site marking, time-out verification process.

  • Positioning

    • Proper extremity and body positioning to avoid injury.

  • Asepsis

    • Maintaining a sterile surgical environment.

Anesthesia Classifications

  • General Anesthesia

    • Loss of sensation and consciousness via inhalation or injection.

  • Regional Anesthesia

    • Nerve blocks or spinal anesthetic techniques.

  • Local Anesthesia

    • Temporary loss of sensation in specific body parts.

  • Monitored Anesthesia Care

    • Similar to general anesthesia without inhaled agents.

Postoperative Phase - Potential Complications

  • Neuropsychological

    • Delirium, fever, cognitive dysfunction.

  • Gastrointestinal

    • Nausea, vomiting, constipation, ileus.

  • Respiratory

    • Airway obstruction risks, hypoxemia, pneumonia.

  • Cardiovascular

    • Dysrhythmias, hemorrhage, thrombosis.

  • Urinary Issues

    • Retention and infection risks.

  • Integumentary

    • Wound-related issues like infection and dehiscence.

Nursing Interventions Post-Op

  • Respiratory Focus

    • Monitor oxygen saturation, effective coughing, incentive spirometry.

  • Circulatory Focus

    • Monitor pulse, perform leg exercises, use anti-embolic stockings.

  • Pain Management

    • Address acute pain through vigilant assessment and treatment.

  • Urinary Elimination

    • Monitor output and assess for urinary retention and infection.

  • GI Elimination

    • Prevent nausea, facilitate early ambulation, maintain hydration.

  • Wound Healing

    • Nursing assessments to prevent infection and maintain dressing integrity.

Conclusion

  • Engage in OR nursing by shadowing professionals and pursuing additional education or courses.