Perioperative Nursing and Surgical Nursing Fundamentals

Definition of Perioperative: The term is spelled with an "i" (Perioperative). It represents the entire span of the surgical experience.
Scope of Time: It is the period of time that constitutes the totality of the surgical experience, encompassing three distinct phases:
- Pre-operative (Pre-op): This phase begins exactly when the decision for surgery is made.
- Intra-operative (Intra-op): The phase during the actual surgical procedure.
- Post-operative (Post-op): The phase occurring after the surgical procedure is completed.
Educational Objective: The primary goal of the lesson is to ensure students do not become "clueless nurses" by mastering the complexities of the surgical environment.

Reconstructive Surgery: This type of surgery is performed to repair damaged or diseased tissue, or to repair a specific area (referred to as the "bed").
Palliative Surgery:
- Definition: Surgery performed to reduce distressful signs and symptoms.
- Context: This is often associated with "end of life" care where the surgery does not provide a cure but supports the patient's comfort.
Categories of Urgency:
- Emergency Surgery: Operations that must be performed immediately with no delay. Examples include:
  - Inflammation of the peritoneal organs.
  - Untreated septic shock.
- Urgent Surgery: This is ranked second in urgency behind emergency surgery.

Requirement for Progression: A student cannot proceed to "piercing" (instrumentation/scrubbing) without completing a minimum of three (3) circulating nurse cases.
Ethical Mandate: The fundamental role is to serve and care for others.
The Whiteboard in the OR: Even in mobile Operating Rooms (ORs), documentation is vital. Whiteboards are used to track specific data, including:
- Case number.
- Patient number.

Informed Consent:
- Described as the "Bible of the OR."
- It is a legal and valid document that provides the principle-based authority for the surgery.
- Rule of Commencement: A nurse or surgeon must not commence any surgery without a completed informed consent.
- Correction of Errors: The classroom/clinical learning environment is the best place to make and correct mistakes. Instructors will intervene to help students correct errors before they reach professional practice.

Case Scenario: Reviewing the pre-operative laboratory results of a patient scheduled for an Exploratory Laparotomy (XLAP).
Laboratory Values Mentioned:
- Hemoglobin: A value of $14$ ( $14\,g/dL$ ) is considered normal for a pre-operative evaluation.
- INR (International Normalized Ratio):
  - The transcript identifies a finding of $INR = 4.2$ .
  - Priority Action: This finding must be reported to the surgeon as a priority.
  - Implication: A high INR of $4.2$ poses a significant risk and is grounds for the potential cancellation or postponement of the surgery due to bleeding risks.

Question regarding Mental Health and Consent: The instructor posed a question: "Who said MTT [likely MDD], major depression disorder? Can't they sign informed consent on their own?"
- Context: This relates to the legal capacity of patients with psychiatric diagnoses to provide valid informed consent.
Nursing Student Error Example: A scenario was discussed where a nursing student is about to administer a tablet medication that accidentally falls on the floor.
- Outcome: If the student grabs it back and attempts to administer it, this constitutes a breach of protocol (and relates back to the four components of consent/safe practice).
Board Exam Strategy: The instructor emphasizes "substance over style" and "plain over designs." Highlighted information in study materials is intended to emphasize critical points for the board exam.