Perioperative Nursing Care

1. Perioperative Nursing Care

2. Perianesthesia and Perioperative Nursing is the field of nursing that addresses the nursing roles associated with the three phases of surgical experiences : pre operative postoperative and intraoperative 

3. Preoperative Nursing Care: •  begins when the decision to proceed with surgical intervention is made and end with the transfer of patient to the operation table 

4. Examples of nursing activities in the preoperative phase include : Pre admission testing • Initial preoperative assessment • Initiate teaching appropriate to patients needs • Involve family in interview • Verify completion of preoperative testing

5. Admission to surgical unite or center • Completethe preoperativeassessment  • Assess for risk of complications • Report upnormal findings  • Verify that informed consent obtained • Answers family questions • Develop a plan of care 

6. Others also in the holding area prior to the surgery • Review patient chart • Identify patient • Verify surgical site • Establish intravenous line egcanula • Administer prescribed medications  • Provide support 

7. Intraoperative Nursing Care • Begins when patient is transferred to onto the operation table and ends with admission to the post anesthesia care unite   Main  nursing activities include  • Maintain safety  • Maintain aseptic environment  • Transfer patient to operation room or table • Position the patient in correct alignment  • Ensure that instruments count are correct  • Complete documentation 

8. Physiologic monitoring •  Calculate fluid loss or gain  • Distinguish normal and abnormal data • Report changes in vital sign  Physiologic support • Provide emotional support 

9. Postoperative Nursing Care  • Begins when patient is admitted to the post anesthesia care unite and end with follow up evaluation in home or clinical setting  Activities include  • Maintain airway  • Monitor vital sign • Assess the effect of anesthetic agents • Assess complications assess pain • Promote recovery and initiate teaching • Initiate discharge plan 

10. Surgical classification ( according to urgency) • Emergent : immediately with no delay eg sever bleeding  • Urgent: patient needs prompt attention must be done within 24 hrs eg gall bladder infection and kidney stone  • Required : patient must have surgery within few weeks or months eg cataract, Thyroid disorder  • Elective : failure to have surgery has some impact on patient life but not very dangerous eg repair of scare and simple hernia  • Optional : personal preference eg cosmetics 

11. Preparation for Surgery  Informed Consent • process for getting permission before conducting a healthcare intervention on a person. A health care provider may ask a patient  Which procedures need informed consent ? • Invasive procedure such as  need anesthesia • Non surgical procedure that carry considerable risk such as arteriography • Procedures that involve radiation 

12. Criteria for valid informed consent  • Voluntary • Must be written  • Patient must be competent and able to comprehend  • In case of incompetent patient family member or law representatives may give consent  • Should contain explanation of procedure • Instruction that patient can withdraw consent  • Explanation that all patients questions would be answered and if there is any significant notes such as change in customary procedure 

13. Assessment of health factor that affect patient preoperatively •  Nutritional and fluid status  • Drug and alcohol abuse  • Respiratory status  • Cardiovascular status  • Hepatic and renal function  • Endocrine function  • Immune function  • Previous medication use  • Psychosocial factors  • Spiritual and cultural beliefs 

14. Special situations • Ambulatory surgery : patient discharge the same day of surgery  • Obese patient  • Emergency surgery 

15. Preoperative nursing intervention  • Preoperative teaching • Deep breathing coughing exercise  • Teach patient how to promote mobility and active body movement  by frequent position  • Leg exercise  • Getting out of bed  • Pain management  • Coping strategies  • Reduce anxiety and fear 

16. Maintain patient safety  • Manage fluid status  • Prepare the bowel  • Prepare the skin 

17. Immediate preoperative nursing interventions  • Administer pre anesthetic medications  • Maintain preoperative records  • Transport patient to the operation room