Periop Flash Cards

Perioperative Nursing

  • Perioperative Phase: Begins with the decision to have surgery until the patient is transferred to OR or procedural bed.

  • Intraoperative Phase: Starts when the pt is in OR bed until moved to the postanesthesia care unit (PACU).

  • Postoperative Phase: From admission to PACU or other recovery area until complete recovery from surgery and last follow-up 

Classification of Surgical Procedures

  • Urgency:

    • Elective/optional: delay has no bad effects.

      • Tonsillectomy, hernia repair, hemorrhoidectomy, hip prosthesis (can also be urgent) 

    • Urgent: within 24-48 hrs, to remove or repair body parts & preserve health

      • Cholecystectomy, CABG (coronary artery bypass graft), removing tumor, amputation.

    • Emergency: Immediately, to prevent further tissue damage & preserve life

      • Hemorrhage, trauma, perforated ulcer, intestinal obstruction, tracheostomy

  • Risk:

    • Minor: maily elective surgeries

      •  to remove lesions or correct deformities 

    • Major: can be elective, urgent or emergency surgeries

  • Purpose:

    • Diagnostic: to confirm diagnosis (biopsy, scopy, exploratory laparotomy)

    • Ablative: to remove diseased body part

    • Palliative: to reduce intensity of illness (not cure).

      • Colostomy 

      • Nerve root resection

      • Debridement 

      • Arthroscopy 

    • Reconstructive: To restore function to tissue & may improve self concept 

      • Skin graft 

      • Internal fixation of fx

      • Breast reconstruction

      • Scar revision

    • Transplantation

    • Constructive: restore function in congenital abnormalities

      • cleft  palate repair

      • Closure of arterial septal defect

Types of Anesthesia

  • General Anesthesia: Administration of drugs by inhalation or intravenous route.

  • Moderate Sedation/Analgesia: Used for short-term, minimally invasive procedures.

  • Regional Anesthesia: Anesthetic agent injected near a nerve or nerve pathway or around the operative site.

  • Topical and Local Anesthesia: Used on mucous membranes, open skin, wounds, burns.

Informed Consent Information

  • Elements of Informed Consent:

    • Description of the procedure and alternative therapies.

    • Underlying disease process and its natural course.

    • Name and qualifications of person performing the procedure.

    • Explanation of risks and their occurrence frequency.

    • Patient's right to refuse treatment or withdraw consent.

    • Expected outcome, recovery, rehabilitation plan, and course of treatment.

Outpatient/Same-Day Surgery (Ambulatory Surgery)

  • Reduces length of hospital stay and cuts costs

  • Low risk & few complications.

  • Reduces stress for the patient.

  • May require additional teaching and referral to home care services, nurse should arrange referrals prior to surgery day, especially for:

    • Older patients

    • Chronically ill patients

    • Patients with no support system.

Outcomes for the Surgical Patient

  • Receive respectful care that is developmentally and culturally appropriate.

  • Be free from injury and adverse effects.

  • Be free from surgical site infection.

  • Maintain fluid and electrolyte balance, skin integrity, and normal temperature.

  • Collaborate in pain management.

  • Demonstrate understanding of physiological and psychological responses to surgery.

  • Participate in the rehabilitation process.

Surgical Risks of Medications

  • Anticoagulants: May precipitate hemorrhage.

  • Diuretics: Can cause electrolyte imbalances and respiratory depression from anesthesia.

  • Tranquilizers: Increase hypotensive effects of anesthetic agents.

  • Adrenal Steroids: Abrupt withdrawal can cause cardiovascular collapse.

  • Antibiotics (Mycin group): Respiratory paralysis when combined with certain muscle relaxants.

Nurse’s Role in Presurgical Testing (obj data, decreases surgical complications)

  • Ensure tests are explained and understood by the patient.

  • Ensure appropriate specimens are collected.

  • Ensure results are recorded in patient records before surgery.

  • Ensure abnormal results are reported.

Presurgical Tests

  • Chest x-ray, EKG, CBC, & complete metabolic panel (electrolytes, renal function), & glucose for cardiac hx.

    • High WBC

    • Low hematocrit/hemoglobin (bleeding, anemia)

    • Long coag times (liver or meds)

    • Abnormal potassium (risks for cardiac problems)

    • High blood urea nitrogen (BUN)- kidney problems, can affect drug metabolism/excretion and impair wound healing

Preparing the Patient Through Teaching

  • Surgical Events and Sensations: Importance of understanding what to expect.

  • Pain Management: Strategies to address pain post-surgery.

  • Physical Activities:

    • Deep breathing exercises every 1-2 hours while awake for the first 24 hrs post op

    • Coughing techniques.

    • Incentive spirometry usage.

    • Leg exercises.

    • Turning in bed and early ambulation.

Error Prevention

  • Preoperative Verification Process: Includes patient identification.

  • Marking the Operative Site: Important for ensuring correct site procedure.

  • Final Verification (Time-Out): Conducted just prior to the procedure commencement.

Postoperative Assessments and Interventions (Every 10 to 15 Minutes)

  • Monitor:

    • Respiratory status (airway, pulse oximetry).

    • Cardiovascular status (blood pressure).

    • Temperature.

    • Central nervous system status (level of alertness, movement, shivering).

    • Fluid status.

    • Wound status.

    • Pain management.

    • General condition.

Cardiovascular Complications

  • Common Complications:

    • Hemorrhage.

    • Hypovolemic Shock.

    • Thrombophlebitis: in deep vein or surgical site infection

      • Deep vein thrombosis.

      • Pulmonary embolism.

  • Thromboembolism: Risk of blood clots traveling.

    • Leg exercises to increase venous return thru flexion & contraction of quads and gastrocnemius muscles.

Respiratory Complications

  • Common Complications:

    • Atelectasis: Collapse of part of the lung.

    • Pneumonia: Lung infection post-op.

    • Pulmonary embolism: Blockage in the pulmonary artery.