Peri -operative Nursing

1. Peri -operative Nursing Dr. Kareema Ahmed Hussein 2017 -2018

2. Peri operative nursing • The peri operative period is the time before , during , and after an operation it encompasses three phase • Pre operative . • Intra operative . • Post operative .

3. Pre operative phase: Begins when the decision for surgical intervention is made and it ends when the client is transferred to the operating room bed . Intra operative phase Is the time of surgery . it begins when the client is transferred to the operating room bed , and it ended when she / he is admitted to the post anesthetic area • Post operative phase ( post surgical ) : Is the time following surgery it begins with admission to the post anesthesia area and ends when the client has completely recovered from she / his surgery ,

4. Type of surgery • Urgency • Risk. • Purpose .

5. 1. Degree of urgency : • Urgent: Such as removal of an inflamed appendix urgent surgery is always essential but not always an emergency • Elective surgery: straightening a bent finger • Optional surgery: Is that requested by the client through not necessary for physical health such as facial plastic being performed for psychological reasons

6. 2. Degree of risk : • Major surgery: Involves a high degree of risk produce high compilation such as open heart surgery removal of a kidney • Minor surgery: Involves little risk produce few complication , such as removal of tonsils

7. 3. Purpose : • Diagnostic surgery : To enables the surgeon to confirm ,diagnostic ,breast biopsy. • Exploratory surgery: Exploratory laparotomy . • Palliative surgery : To relieve symptoms of disease without correcting the disease such as colostomy • Reconstructive surgery : Refer the repair of tissue • Ablative surgery : Removal of disease organ such gall bladder .

8. Pre operative nursing care 1. The day of admission care : a. Physical nursing care : the nurse must take assessment for patient such as . • History( age , sex , fluid , nutrition , mental status , history of allergy , history previous ... ) . • Study and diagnostic tests such as (C.B.P , B group GUE , ESR , Bleeding time • Physical exams such as head , neck , heart , abdomen . • Nutrition and fluid . the client requires at least 1500 k cal / day . to maintain energy ( protein / vitamin ) • V.C important for increasing wound healing . • V.B important for normal gastrointestinal function . • V.K important for blood clotting and prothombin production

9. Fluids loss in body causes electrolyte imbalances and dehydration and the nurse must records all intake and out put of fluid and daily records of patient weight . 5.General hygiene . • Physiological comfort. • Skin care that decrease the number of micro organisms • 6.Check vital signs . • 7. Psychosocial nursing care , Any kind of surgical procedure always preceded by reaction . • Fear . • Anxiety

10. Causes of fear : • Fear of unknown • Fear of death. • Fear of anesthesia . • Fear of pain . • Role of the nurse to reduce fear : • Explain the important of the operation to the patient and his family • Psychological support. • Sample explaining of the operating room . • Medication order of physician such as valium .

11. 2. The night of operation care : a. Elimination . by giving cleansing enema to prevent : • Abdominal distention . • Contamination . • b.Nutrition and Fluid , Oral intake of fluid be restricted at night for 12 hours preoperatively . meal on the evening must be light in dehydrated or older patients water is given , freely up to 4 hours before operation • Checking vital signs . • Preoperative drug sedative

12. Turning = turn every 2 hours moving the patient in post operative and teach the patient to do extremity exercises to improve the circulating . • Told the patient about the tubes that he may have after operation and its important . • General personal hygiene to keep the skin free as possible of organisms . • Shaving the skin at and around the operation site to minimize the organisms that may inter the wound

13. c.Patient instruction . • Diaphragmatic breathing : instruct the client to take deep , slow breath every 2 hours to during post operative . • Placing the patient in sitting position to provide lung expansion . • Teach the patient to cough after taking short breath to goal of promoting coughing is to mobilize are remove secretion . • When coughing must splint the incision ( wound ) to minimize pressure and control the pain .

14. Operative day care : • 1.Observations : by checking vital signs for the patient to know if there is any abnormal conditions like common cold hypertension . • 2.Inspecting the mouth for dentures , they could fall to the back respiratory obstruction . • 3.Jewelry is not to be worn in the operative room • 4.Helping the patient to wear the operative clothes ( gown) • 5.Remove any hair pins and covered the hair with cup .

15. 6.Remove the make up from the face and the colors from the nails to inspect the cyanosis cases . • 7.Elimination at all the pts. Should bevoid immediately before operation to prevent balladeer distenti • 8.Pre medication like morphine or atrop • To relaxion of the pt. • To decrease with metabolic rate • To decrease the secretion .

16. Operative permitted : Before the operation is done it is necessary permission to obtain written from the patient he is over 18 years if he is child or unconscious permission must responsible family members .

17. Thank you