Perioperative (Week #7)

Student Learning Outcomes

  • Discuss measures to protect the patient from injury and infection during the perioperative period.

  • Correlate laboratory and clinical data to surgical patient risks.

  • Develop an individualized plan of care for patients undergoing surgical procedures.

  • Discuss implementation of nursing interventions necessary to minimize assessed risks in perioperative patients.

Surgical Settings

  • Elective Surgery

    • Carefully planned surgeries, scheduled in advance.

  • Emergency Surgery

    • Arises with unexpected urgency, requiring immediate action.

  • Inpatient Surgery

    • Requires admission to the hospital before the procedure.

  • Same-Day Admission

    • Patients are admitted on the same day as their surgery.

  • Ambulatory Surgery

    • Same-day or outpatient procedures; patients return home the same day.

  • Minimally Invasive Surgery

    • Techniques like endoscopy or those performed in surgical clinics to reduce recovery time and pain.

  • Hospital Outpatient Surgery Clinics

    • Facilities designed for outpatient surgical procedures.

Reasons for Surgery

  • Diagnostic

  • Curative

  • Palliative

  • Prevention

  • Cosmetic Improvement

  • Exploration

  • Restorative/Reconstruction

Urgency, Degree of Risk & Extent of Surgery

  • Urgency

    • Elective

    • Urgent

    • Emergent

  • Degree of Risk

    • Minor

    • Major

  • Extent

    • Simple

    • Radical

    • Minimally Invasive (MIS)

Three Phases of the Perioperative Period

  • Preoperative Phase

    • Begins with the decision to have surgery, lasts until patient is transferred to the operating room.

  • Intraoperative Phase

    • Extends from admission to the surgical department until transfer to recovery room.

  • Postoperative Phase

    • Lasts from admission to the recovery room until the complete recovery from surgery.

Preoperative Phase Nurse’s Role

  • Have knowledge of the nature of the disorder requiring surgery.

  • Identify the individual patient’s response to the stress of surgery.

  • Have knowledge of the results of preoperative diagnostic tests.

  • Identify potential risks and complications associated with surgery.

Nursing Assessment Goals

  • Establish baseline data for comparison intraoperatively and postoperatively.

  • Determine psychologic status to reinforce coping strategies.

  • Determine physiological factors of the procedure contributing to risks.

  • Identify drugs, OTC medications, and herbs that may affect surgical outcome.

  • Review results of preoperative diagnostic studies.

  • Identify and document the surgical site.

  • Identify cultural and ethnic factors that may affect the surgical experience.

Psychosocial Assessment

  • Stress Response

  • Anxiety

  • Common Fears

  • Hope

Nursing Assessment Health History

  • Medical History

    • Including familial diseases.

  • Previous Surgical Procedures

    • Including anesthesia history.

  • Current Medications

    • Prescription, herbs, dietary supplements.

  • Recreational Drugs

    • Alcohol and tobacco use.

  • Allergies

    • Includes drug and latex allergies.

Nursing Assessment - Specific Systems

  • Cardiovascular

    • Assess for HTN, angina, dysrhythmias, MI, CHF.

    • Cardiac medications use, pacemaker/ICD assessment, EKG results.

  • Respiratory

    • Assess for recent/chronic respiratory diseases such as asthma, COPD.

    • Advise stopping smoking 6 weeks prior to surgery.

    • Assess pulmonary function via tests like ABG.

Patients at Risk for VTE

  • Obesity

  • Hx of CHF or COPD

  • History of cancer

  • Decreased mobility/immobility, spinal cord injuries.

  • History of VTE, PE, varicose veins, edema.

  • Oral contraceptives usage.

  • Smoking history.

  • Hip fracture, total hip/knee surgery.

VTE Prevention

  • External Pneumatic Compression Devices

    • Utilized to maintain blood flow and prevent clot formation.

Nursing Assessment - Additional Systems

  • Nervous System

    • Determine baseline: LOC, cognitive abilities, vision/hearing loss.

  • Genitourinary System

    • History of renal or urinary tract diseases.

    • Increased risks with renal dysfunction should be reported.

  • Hepatic System

    • The liver detoxifies many anesthetics; risk increases with dysfunction.

  • Integumentary System

    • Previous skin/musculoskeletal issues, skin assessment.

  • Musculoskeletal System

    • Identify affected joints and impact on positioning and activity.

  • Endocrine System

    • Risks for patients with diabetes or thyroid dysfunction.

  • Immune System

    • Delayed wound healing and increased infection risks.

  • Fluid & Electrolyte Status

    • Assess preoperative bowel preparations, diuretics, NPO status.

  • Nutritional Status

    • Risks with deficiency or obesity, emphasizing the importance of protein and vitamins A, C, and B for wound healing.

Laboratory & Diagnostic Assessment

  • Urinalysis

  • Blood Type and Crossmatch

  • Complete Blood Count (CBC)

    • Including hemoglobin level and hematocrit.

  • Clotting Studies

    • PT, INR, aPTT, and platelet count.

  • Electrolyte Levels

    • Including sodium, potassium, chloride, bicarbonate.

  • Blood Glucose

  • **Serum BUN and Creat