Module 1: Perioperative Nursing Care Study Guide

Describe Settings and Rationales for Surgery: Identification of why surgeries are performed and in what clinical environments they take place.
Preoperative Nursing Care and Assessments: Details regarding nursing priorities, assessments, risk evaluation, and common medications used in the preoperative phase.
Nurse's Role in Patient Preparation: Preparation of the patient's physical, psychological, and educational needs prior to the surgical procedure.
Informed Consent: Examination of the purpose, specific components, and the unique role of the nurse in the consent process.

Perioperative Definition: This term refers to the total surgical episode, encompassing the periods before, during, and after the surgery.
Rationales for Performing Surgery:
- Diagnosis: To determine the presence or extent of a pathological condition (e.g., biopsy).
- Cure or Repair: To eliminate or repair a pathological condition (e.g., removing a ruptured appendix).
- Palliation: To alleviate symptoms without providing a cure (e.g., debulking a tumor to reduce pain).
- Prevention: To reduce the risk of a condition developing (e.g., removing a mole before it becomes malignant).
- Exploration: To examine the nature or extent of a disease (e.g., laparotomy).
- Cosmetic Improvement: To enhance physical appearance (e.g., repairing a burn scar or breast reconstruction).

Emergency Surgery: Unexpected and urgent procedures required to preserve life or limb.
Elective Surgery: Planned procedures that are scheduled in advance.
Inpatient Surgery: Patients are admitted to the hospital on the day of surgery and remain in the hospital for at least one night following the procedure.
Ambulatory (Same-Day Surgery):
- The total procedure time is usually less than $2\,hours$ .
- Post-procedure stay in the post-anaesthesia care unit (PACU) is typically less than $3-4\,hours$ .
- The patient is discharged to go home on the same day the surgery is performed.

Subjective Data Collection (Table 20.2):
- Situational Changes: Identifying how the surgery impacts the patient's current life situation.
- Concerns with the Unknown: Addressing fears regarding the procedure, anesthesia, or outcome.
- Concerns with Body Image: Assessing the patient’s feelings regarding potential changes to their physical appearance.
- Past Experiences: Reviewing previous surgeries or hospitalizations that may influence the current experience.
- Knowledge Deficit: Identifying areas where the patient lacks understanding about the procedure or recovery.

Prescription and Over-the-Counter (OTC) Medications: Documenting all currently used drugs.
Herbal, Dietary Supplements, and Vitamins:
- Certain herbs are of specific concern during the perioperative period due to potential interactions with anesthesia or effects on bleeding.
- Refer to the "Complementary & Alternative Therapies" box in Chapter 20 for specific herb-related risks.
Recreational Drug Use:
- Categories include Opioids, marijuana, cocaine, amphetamines, Alcohol, and Tobacco.
- Nurses must ask specifically when the substance was last used and exactly what was used to anticipate potential withdrawal or drug interactions.

Pharmaceutical Allergies: Distinguishing between medication intolerance (side effects) and true allergies (immunological reactions).
Non-pharmaceutical Allergies: Screening for sensitivities to foods, metals, chemicals, tape, and pollen.
Latex Allergy Screening:
- Assessment for contact dermatitis and atopic immunological reactions.
- Screening for cross-sensitivities with certain foods: nuts, bananas, avocados, kiwi, chestnuts, papayas, and pitted fruit.
- Identification of patients at risk due to repeated exposures to latex.

Immune System Factors:
- Patients with a history of a compromised immune system or those taking immuno-suppressive drugs face risks such as delayed wound healing and an increased risk for infection.
- Acute Infection: Presence of an active infection (e.g., an active skin rash) will usually result in the cancellation of elective surgery.

ASA I: Healthy normal patient. Examples: Healthy, nonsmoking, no or minimal alcohol intake.
ASA II: Patient with mild systemic disease. Minimal functional limitations. Examples: Current smoker, social alcohol drinker, pregnancy, obesity, controlled diabetes, controlled hypertension, or mild lung disease.
ASA III: Patient with severe systemic disease. Substantial functional limitations with one or more moderate to severe diseases. Examples: Poorly controlled diabetes or hypertension, COPD, active hepatitis, premature infant, myocardial ischemia, or CVA.
ASA IV: Patient with severe systemic disease that is a constant threat to life. Examples: Recent ( $< 3\,months$ ) myocardial infarction (MI) or CVA, ongoing cardiac ischemia, sepsis, acute respiratory disease, or DIC.
ASA V: Moribund patient not expected to survive without surgery. Examples: Ruptured abdominal/thoracic aneurysm, massive trauma, massive intracranial bleed, or ischemic bowel combined with cardiac or multi-organ failure.
ASA VI: Brain-dead patient. Used for patients whose organs are being removed for donation purposes.

Laboratory and Diagnostic Testing: Preoperative testing (e.g., electrocardiogram) is determined by the client's medical history (refer to Table 20.6).
Nursing Responsibilities:
- Obtain and evaluate the results of laboratory tests.
- Ensure all results are documented and available on the patient's chart.
- Report any relevant or abnormal findings to the perioperative team.

Components of Proper Information: The physician is responsible for discussing the following with the patient:
- The diagnosis.
- The proposed treatment or procedure.
- The risks and consequences of the procedure.
- The probability of a successful outcome.
- The consequences if no treatment is pursued.
- Availability, benefits, and risks of alternative treatments.

Inpatient Transport: Usually transported via stretcher from their hospital room. Nurses must ensure side rails are raised and secured. The patient's chart and any required preoperative equipment must accompany them.
Outpatient Transport: May be transported by stretcher, wheelchair, or allowed to walk if accompanied.
Nursing Documentation: The nurse responsible for the transfer must document the method of transport according to hospital policy.
Family Communication: Instruct family members on where the waiting area is located so they can be provided with progress updates.

Cultural Perceptions: Nurses must be aware of and supportive of various cultural beliefs when preparing clients for surgery.
Respect for Decisions: Choices made due to cultural variations must be valued and respected.
Specific Considerations: Nurses should account for cultural differences regarding pain expression, coping mechanisms, and family expectations.