pre op
Perioperative Care Overview Definition and Phases • Perioperative care = all care given before, during, and after surgery • Consists of three distinct phases: Preoperative Phase (Before Surgery) • Preparing the patient physically and mentally • Nurse checks allergies • Patient teaching on deep breathing techniques • NPO status (nothing by mouth) implemented • "Nurse checks allergies, teaches deep breathing, makes patient NPO (nothing by mouth)" Intraoperative Phase (During Surgery) • Care provided inside the operating room • Patient is unconscious under anesthesia • Surgical team performs the procedure • Nurse ensures sterile environment maintenance Postoperative Phase (After Surgery) • Recovery period after surgical procedure • Nurse monitors oxygen saturation • Incision assessment and management • Pain control implementation
Classification of Surgery by Urgency Emergency Surgery • Timeline: Immediate • Indication: Life or death situation • Example: Internal bleeding from car accident → straight to surgery Urgent Surgery • Timeline: Within 24–30 hours • Indication: Quick treatment needed but not immediately life-threatening • Example: Appendicitis requiring surgery within a day Required Surgery • Timeline: Within weeks or months • Indication: Needed for patient health but not immediate • Example: Tumor removal for cancer Elective Surgery • Timeline: Planned/scheduled • Indication: Needed but can wait • Example: Hernia repair Optional Surgery • Timeline: Patient discretion • Indication: Not medically necessary • Example: Cosmetic surgery (nose job)
Types of Surgery by Purpose Diagnostic • Purpose: To determine what is wrong • Example: Biopsy to check for cancer Exploratory • Purpose: Investigation by direct visualization • Example: Opening abdomen to find source of pain Curative/Reparative • Purpose: Fix or remove problem • Example: Appendectomy (removal of appendix) Palliative • Purpose: Relief of symptoms without cure • Example: Removing part of tumor to reduce pain Cosmetic • Purpose: Improve appearance • Example: Breast augmentation Preventative (Prophylactic) • Purpose: Prevent disease development • Example: Removing breasts due to high genetic cancer risk Reconstructive • Purpose: Restore function and/or appearance • Example: Skin graft after burn injury
Types of Anesthesia General Anesthesia • Definition: Patient is completely unconscious • Administration: • IV drugs or inhaled gases • Inhalation Anesthesia: Gas breathed in via mask or tube (example: Sevoflurane) • Injectable Anesthesia: Given through IV line (example: Propofol for rapid induction) • Example use: Open heart surgery Regional Anesthesia • Definition: Blocks pain in specific region; patient remains awake • Spinal Anesthesia: Injected into spinal fluid, numbs lower body (example: C-section) • Epidural: Blocks pain in specific region (example: During childbirth) Local Anesthesia • Definition: Numbs a small, specific area • Example: Dental procedures Topical Anesthesia • Definition: Applied directly to skin surface • Example: Numbing cream before IV insertion
Inpatient vs Outpatient Surgery Inpatient Surgery • Patient stays overnight in facility • Example: Hip replacement Outpatient (Same-Day Discharge) • No overnight stay required • Patient goes home same day • Example: Colonoscopy Advantages of Outpatient Surgery • Lower cost • Faster recovery time • Reduced infection risk Disadvantages of Outpatient Surgery • Less monitoring and observation • Must have someone available at home for support • Challenge: Difficult to manage complications at home (example: bleeding)
Anesthesia Personnel Anesthesiologist • Credentials: Medical Doctor (MD) • Administers anesthesia during surgery CRNA • Credentials: Advanced practice nurse (Certified Registered Nurse Anesthetist) • Administers anesthesia during surgery • Works under supervision or independently depending on regulations Both can provide anesthesia during surgical procedures
Surgical Technologies Laser Surgery • Definition: Uses focused light beam to cut tissue • Advantages: • Minimal bleeding • Very precise cutting • Faster healing time • Example: Eye surgery (LASIK)
Informed Consent • Definition: Patient must fully understand and agree to surgical procedure • Nurse's Role: • Witness signature on consent form • Ensure patient comprehension • Clarification of patient understanding • Important: Nurse does NOT explain surgical risks in detail (provider responsibility) • Critical Action: If patient states "I don't understand this surgery" → DO NOT proceed with surgery
Blood Management Autologous Transfusion • Definition: Patient uses their own blood • Procedure: Patient donates blood before surgery and receives it back during/after procedure • Benefit: Eliminates need for donor blood
Preoperative Care Assessment Components • Complete history and physical examination • Laboratory tests • Vital signs Teaching Requirements • Deep breathing techniques • Coughing exercises • Leg exercises for circulation • Pain control methods • Example: Patient practices coughing with pillow before surgery Physical Preparation • NPO status (8 hours typical) • Jewelry and valuables removal • IV line insertion • Skin preparation
Preoperative Medications Anticholinergics • Purpose: Reduce salivary and respiratory secretions • Benefit: Prevents aspiration during anesthesia induction H2 Blockers • Purpose: Reduce stomach acid production • Benefit: Prevents aspiration pneumonia Opioids • Example: Morphine • Purpose: Pain relief and anxiety reduction Benzodiazepines • Examples: Versed (midazolam), Lorazepam • Purpose: Relax patient and cause anterograde amnesia • Benefit: Patient doesn't remember perioperative events
Postoperative Care Priority: ABC (Airway, Breathing, Circulation) Airway First • Critical Action: Always prioritize airway management • Example: Patient not breathing well → give oxygen immediately • "AIRWAY FIRST (ABC)" Early Postoperative Complications • Hypoxia: Low oxygen levels • Bleeding: Hemorrhage at surgical site • Hypotension: Dangerously low blood pressure Later Postoperative Complications • Infection: Wound or systemic infection • DVT (Deep Vein Thrombosis): Blood clot in legs • Pneumonia: Respiratory infection Postoperative Diet Progression 1. NPO (nothing by mouth) 2. Clear liquids → water, broth 3. Full liquids → milk, pudding 4. Soft foods → mashed potatoes 5. Regular diet • Example: Patient starts with ice chips and progresses slowly based on tolerance
Wound Complications Dehiscence • Definition: Wound opens or separates • Appearance: Incision splits slightly • Nursing Action: • Cover with saline dressing • Notify provider immediately Evisceration (🚨 EMERGENCY) • Definition: Abdominal organs protrude through wound opening • Appearance: Intestines or organs visible • Nursing Actions: • Cover with sterile saline dressing • CRITICAL: DO NOT push organs back into abdomen • Call for emergency assistance immediately • "Organs come out = EMERGENCY"
Safety Procedures Time-Out (Surgical Safety) • Definition: Final verification check performed immediately before surgery begins • Purpose: Prevent wrong patient surgery, wrong surgical site, or wrong procedure • Team Confirmation: • Patient name verification • Type of surgery verification • Body part/surgical site verification
DVT (Deep Vein Thrombosis) Prevention Preventative Measures • Patient leg movement and exercises • Sequential Compression Devices (SCDs) application • Early mobilization when appropriate
Memory Aids and Quick References Perioperative Phases • Pre = Prepare • Intra = Inside OR (operating room) • Post = Recover Postoperative Priorities • ABC = Airway first • Ensure airway patency before addressing other concerns DVT Prevention • Move legs + SCDs (Sequential Compression Devices) Evisceration Response • Organs OUT = EMERGENCY • Cover with sterile saline dressing • DO NOT push organs back • Call for emergency help immediately