PERIOPERATIVE

NURSING CARE
By
Purwaningsih

Surgery
The treatment of injury, disease, or
deformity through invasive operative
methods.
Surgery is a unique experience, with
no two clients responding alike to
similar operations.

From a Clients Experiences

Point
Surgery is a major stressor for all
clients.
Anxiety and fear are normal.
Fear of the unknown is the most
prevalent fear prior to surgery and is
the fear that is the easiest for the
nurse to help the client overcome.

Type of Surgery
Seriousness: Degree of risk
Major- Involves extensive reconstruction
or alteration in body parts;poses great
risks.

Minor- Involves minimal alteration in

body parts;often designed to correct
deformities;involves
minimal
risk
compared with major procedures.

Types of Surgery
Urgency: reason for procedure:

Elective-Performed on the basis of clients choice; not essential and

may not necessary for health.
Urgent- Necessary for client health,may prevent additional problem
from developing (e.g. tissue destruction);not necessarily emergency.
Emergent- Must be done immediately to save life or preserve
function of body part.
Required- Has to performed at some point;can be pre-scheduled.

Types of Surgery
Diagnostic-Allows to confirm
diagnosis.
Corrective- Excision or removal of
diseased body part.
Reconstructive-Restore function or
appearance to traumatized or
malfunctioning tissues.

Types of Surgery
Procurement
for
transplantRemoval of organs and/or tissues
from a person pronounced brain
death
for
transplantation
into
another person.
Constructive- Restores function lost
or reduced as result of congenital
anomalies.
Cosmetic- Performed to improve
personal appearance.

Types of Surgery
Extent of surgery :
Simple- Only the most overtly affected areas
involved in the surgery.
Radical- Extensive surgery beyond the area
obviously involved; is directed at finding a root
cause.
Location: Based on the area of the body on
which the surgery occurs (e.g abdominal,
heart surgery).

Informed Consent
A legal form signed by the client and
witnessed by another person that
grants permission to the clients
physician to perform the procedure
described by the physician.

Informed Consent is
Required
WHEN:
Anesthesia is used.
Procedure is considered invasive.
Procedure is nonsurgical but has
more than a slight risk of
complications.
When radiation or therapy is used.

Informed Consent
What is it?
When is it necessary?
Who can sign?
What is the responsibility of the nurse?
What are the legal implications?

What is Perioperative
Nursing?
Three Phases:
Preoperative (Preop)
Intraoperative (Intraop)
Postoperative (Postop)

Preoperative Phase
Begins when the client is scheduled
for surgery and ends at the time of
transfer to the surgical suite
3-6 months
30 days
7 days
Day before

Nursing Process in Pre-op

Phase

Preoperative Surgical Phase

Assessment:
Nursing History-key elements that pertains
to the surgical clients risks and needs.
Information
concerning
about
advance
directives. Ask if the patient has a durable
power of attorney for health care and a living
will.
Medical History- includes past illnesses and
the primary reason for seeking medical care.

Preoperative Surgical Phase

Previous surgeries- past experience
with surgery can reveal potential
physical and psychological responses to
procedure and alert you to special needs
and risk factors. Complications such as
anaphylaxis or malignant hyperthermia.
Medication History- any medications
that might predispose to surgical
complications.

Preoperative Surgical Phase

Allergies- to medications, topical agents
used to prepare the skin for surgery, and
latex can create significant risks.
Smoking Habits greater risks for
complications.
Alcohol and Controlled Substance Use
and abuse- to be prepared for adverse
reactions, such as withdrawal, that may
occur during surgery.
Client Expectations- to identify the clients
and family perceptions and expectations
regarding surgery and health care providers.

Preoperative Surgical Phase

Family Support- determine the extent of the clients support
from family members or friends.
Occupation- surgery may result in physical alterations that
hinder or prevent a person from returning from work.
Feeling- surgery causes anxiety and a feeling of loss of control
for most clients.
Cultural and Spiritual Factors- cultural differences in the use
of both verbal and nonverbal communication require you to
validate interpretation of cues with the client and family.

Preoperative Surgical Phase

Coping Resources- assessment of a
clients feeling and self-concept helps
to reveal whether the client has the
ability to cope with the stress of
surgery.
Body image-surgical removal of a
diseased
tissue
often
leaves
permanent
disfigurement
or
alteration in body function.

Laboratory and diagnostic studies

Screening tests depend on the

condition of the client and the nature
of the surgery. If test reveals severe
problems the surgery may be cancel
until the condition is stabilized.

Common Preoperative Laboratory

Tests
Hemoglobin and
hematocrit (Hgb
and Hct)
White blood cell
count (WBC)
Blood typing and
cross matching
(screening)
Serum electrolytes

Prothrombin time
(PT) and partial
thromboplastin
time (PTT)
Bilirubin
Liver enzymes
Urine analysis
Blood urea
nitrogen (BUN) and
creatinine

Nursing Diagnosis
Deficient knowledge r/t lack of
exposure
Anxiety r/t threat of a change in
health status or fear of unknown
Disturbed sleep patterns r/t internal
sensory alteration (illness & anxiety)
Ineffective coping r/t impending
surgery
Disturbed body image r/t anticipated
changes

Nursing Diagnosis
Disabled family coping r/t temporary
family disorganization and role
changes
Powerlessness r/t health care
environment, loss of independence
and loss of control of ones body

Nursing Process in Pre-op

Phase

Planning:
Correction of any abnormal labs
Blood donations
Bloodless surgery
Nutrition
Pain Management
Surgery Classes
Discharge planning

Nursing Process Pre-op

Phase
Implementation:
Explain purpose of planned
procedure
Asking questions
Adhering to NPO status
Stating understanding of preop
preparations
Demonstrating correct use of
exercises/techniques to prevent
complications

Interventions

Ensuring informed consent

Client self-determination
Implementing dietary restrictions
Administration of medications
Intestinal preparation
Skin preparation
Vascular access

Pre-operative Teaching
Tubes, drains, additional vascular
access
Post-op procedures
Post-op exercises: breathing
exercises, incentive spirometry,
coughing & splinting, leg procedures
and exercises
Early Ambulation
Range of Motion exercises (ROM)

Preoperative Chart
Review

Pre-op check list:

Surgical informed consent
Anesthesia informed consent
Blood transfusion consent
Site verification checklist
Lab results-report abnormal lab values
Current vital signs
Special Needs

Preoperative Client
Preparation
Clothing removed/don patient gown
Jewelry removed including body any
piercing
Prosthesis: dentures, wigs, limbs
Aides: hearing, glasses, cane
Arm bands: identification, code
status, blood bracelet, fall risk status
bracelet
Misc: contact lenses, hairpins
Nail polish, artificial nails

Preoperative Client
Preparation
Empty bladder
Pre-operative medications
Safe transfer to surgical suite

Pre-Operative Teaching
Reinforce physicians explanations and
instructions
Discuss what to expect
Instruct in breathing and leg exercises
Demonstrate splinting of abdomen (if appropriate)
Explain rationale for frequent position
changes
Discuss pain management
Discuss cognitive coping strategies
Imagery, distraction, optimistic self-recitation

Collaborative Management:
Assessment & Planning
Client interview
Correct person for the correct
procedure with correct preparation
on the correct anatomy
Risk for perioperative positioning
injury
Lacks normal defense mechanisms
Size, age skin integrity
Potential for hypoventilation
Potential for hemodynamic shifts
Blood loss

Purposes of Preoperative
Teaching
To answer questions and concerns
about surgery.
To ascertain clients present
knowledge of the intended surgery.
To ascertain the need or desire for
additional information.
To provide information in a manner
most conducive to learning.

Physical Preparation
Identifying the client and verifying the
operative procedure.
Preparing operative site.
Checking clients vital signs.
Assisting in putting on hospital gown, cap,
and, if ordered, antiembolic hose.
Verifying allergies.
Verifying NPO (nothing by mouth) status.
Identifying any sensory deficits in the
client.

Members of Sterile
Surgical Team
Surgeon.
First assistant (Physician or RN who assists
surgeon in performing hemostasis, tissue
retraction, and wound closure).
Scrub nurse (an LP/VN, RN, or surgical
technologist who prepares and maintains
integrity, safety, and efficiency of the
sterile field throughout the operation).

Sterile Field
The area surrounding the client and
the surgical site that is free from all
microorganisms.

Non-Sterile Members of the

Surgical Team
Anesthesia provider.
Circulating nurse (an RN responsible for
management of personnel, equipment,
supplies, environment, and
communication throughout a surgical
procedure).

Family Needs
Explain where to wait
Surgeon will talk to them after
surgey
Never judge seriousness by length of
time patient in surgery (keep family
updated)
Prepare them for what they will see
post-op
Explain post-op protocol and routines

Responsibilities related to the

Medical Record
Complete pre-operative check list
Place surgical consent form in plain
view
Send entire medical record (chart) to
surgery with patient

Evaluation:

Safety
Health promotion & maintenance
Psychosocial integrity
Physiological Integrity

Variables Affecting Surgical

Status
Age
Nutritional status
Fluid and
electrolyte status
Respiratory status
Medications

Cardiovascular
status
Renal and hepatic
status
Neurological,
musculoskeletal,
and integumentary
status
Endocrine and
immunological
status

Disease/Medication
Specific Considerations
Diabetes Mellitus:
At risk for hyperglycemia or
hypoglycemia

Long-term corticosteroid use:

At risk for adrenal insufficiency

Uncontrolled Thyroid Disease

Overactive: risk of Thyrotoxicosis
Underactive: risk of respiratory
depression

Thank you