بسم الله الرحمن الرحيم

PERIOPERATIVE NURSING CARE

PREPARING BY-: ASHRAF IBRAHIM

MOHANED ABDALLNMARQ HAMDTOO

Definition of Surgery

Surgery is any procedure performed on the human body that uses instruments

to alter tissue or organ integrity.

Peroperative Nursing PhasesPreoperative phase – begins when the decision to

have surgery is made and ends when the client is transferred to the OR table.

Intraoperative phase – begins when the client is transferred to the OR table and ends when the client is admitted to the PACU.

Postoperative phase - begins with the admission of the clientto the PACU and ends when the healing is complete.

DefinitionPreoperative Nursing care

Preoperative Nursing care is the preparation and management of a patient prior to surgery. It includes both physical and

psychological preparation.

Types of SurgeriesDiagnostic :-

Determination of the presence and or extent of the pathology. Laparatomy.

Therapeutic :- Elimination or repair of the pathology Removal of the appendix when it's inflammed, removal of a localized cancer

Types of SurgeriesPalliative:- Alleviation of symptoms without curing the underlying disease

Rhizotomy (cutting of a nerve root) to decrease pain. Preventative:-

Surgery to remove tissue that has the potential to become pathologic .

Types of Surgeries

Cosmetic :-The surgery is preformed for aesthetic reasons

Repair of scars from burns or injuries, minor cleft palate repairs, face lifts, breast augmentation

Types of Elective Admissions for Surgery

Ambulatory Surgery :- Usually outside a hospital setting Special prescreening. Same-Day Surgery :-

Outpatient, can be in the hospital Go home the day of the surgery

Early Hospital Admission :- Patient comes in early (night before or

earlier)Usually patients with complex medical issues, and increased risk for poor surgical outcomes.

Type of Surgery (Degree of Risk)

Major – involves a high degree of risk. Minor – normally involves little risk. Age – very young and elder clients are greater surgical

risks than children and adult. General health- surgery is least risky when the clients

general health is good. Nutritional Status – required for normal tissue repair. Medications – regular use of certain medications can

increase surgical risk. Mental status – disorder that affect cognitive function.

assessment

assessment differs from those performed on the patient in a medical-surgical unit and requires some alterations to the formal nursing process

that can challenge new perioperative nurses. One reason for this difference is due to the brief time a peroperative nurse has contact with a conscious

patient.

Assessment (Nursing History)o Current health status.o Allergies.o Medications- list all current medications.o Previous surgeries.o Understanding of the surgical procedure and

anesthesia.o Smoking.o Alcohol and other-altering substances.o Social resources.o Cultural considerations.

Physical assessmentCardiovascular system.Respiratory system.Renal system.Neurological system.Musculoskeletal system.Nutritional status.

Psychosocial Assessme

Level of anxiety.Coping ability.Support systems.

ASSESSMENT IN EMERGENCY SURGERY

In emergency surgery, the principles of preoperative assessment is the same as in

elective surgery.

Consent Nature and intention of the surgery.Name and qualifications of the person performing

the surgery.Risks, including tissue damage, disfigurement, or

even death.Chances of success.Possible alternative measures.The right of the client to refuse consent or later

withdraw consent.

INVESTIGATIONS

CBC,Blood grouping and X-match, fasting blood sugar.Serum Creatinine, and bilirubin,Serum albumin,

and Total protein. Urinalysis, Chest X-ray,ECG.

nursing diagnosis

Anxiety:- r/t situational crisis, change in health status, fear of unknown, fear of pain and/or disfigurement.

Knowledge :-deficit r/t pre/post operative procedures.

Disturbed Sleep:- r/t anxiety about upcoming surgery.

nursing diagnosis interventions:-Diet RestrictionsHistorical guidelines to prevent aspiration were NPO

after midnight the night before. Educating the patient about the reason for NPO

status may help with adherence . Information of what to wear to the surgery  Patient will likely need to be there 1 to 2 hours prior

to scheduled procedure.

nursing diagnosis

MedicationsSedatives/hypnotics- valiumOpiate analgesics- morphineAnticholinergics-Atropine sulfateH2o blockers.- ZantacAntiemetic- Phenergan

Preoperative patient learning needsDeep breathing (incentive spirometer),

coughing, leg exercises, ambulation.Pain control and medications.Cognitive control to decrease anxiety and

enhance relaxation (deep breathing).Recovery room orientation.Probable postoperative therapies.

Final Preparation for surgery

All personal belongings are identified and secured.

Jewelry is usually removed.Dentures are removed, labeled and placed in a

denture cup.Pt. to verbally confirm the surgical procedures

and the surgical site. This verification process is documented in the medical record on the preop. checklist.

Intraoperative Phase

Intraoperative PhaseSurgical Team

Intraoperative PhaseSurgical Team

Surgeon-responsible for determining the preoperative diagnosis, the choice and execution of the surgical procedure, the explanation of the risks and benefits, obtaining inform consent and the postoperative management of the patient’s care.

Scrub nurse- (RN or Scrub tech)- preparation of supplies and equipment on the sterile field; maintenance of pt.s safety and integrity: observation of the scrubbed team for breaks in the sterile fields; provision of appropriate sterile instrumentation, sutures, and supplies; sharps count.

Intraoperative PhaseSurgical Team

Circulating Nurse - responsible for creating a safe environment, managing the activities outside the sterile field, providing nursing care to the patient. Documenting intraoperative nursing care and ensuring surgical specimens are identified and place in the right media. In charge of the instrument and sharps count and communicating relevant information to individual outside of the OR, such as family members.

Intraoperative PhaseSurgical Team

Anesthesiologist and anesthetist- anesthetizing the pt. providing appropriate levels of pain relief, monitoring the pt’s physiologic status and providing the best operative conditions for the surgeons.

Other personnel- pathologist, radiologist, perfusionist.

Intraoperative PhaseSurgical Team

Nursing Roles:Staff education.Client/family teaching.Support and reassurance.Advocacy.Control of the environment.Provision of resources.

Intraoperative PhaseSurgical Team

Maintenance of asepsis.Monitoring of physiologic and psychological

status.Ensure sterility.Alert for breaks.

Nursing Process Intraop Phase

Evaluation.Expected.Unexpected.Documented.Informing Client & Family.Surgical Waiting Room.Ongoing Updates by OR Team.

Proper Technique for scrubbing in to a surgical field

Team members fingers and hands should be scrubbed first with progression to the forearm and elbows.

The hands should be held away from the surgical attire. The hands should be held up once clean so that no suds or

other bacteria can drift down onto the clean area. When waterless gels are used for asepsis, you should first

wash you hands and forearms thoroughly with soap and water, then dry before putting on the gel.

Then you can enter the surgical area and put on the surgical gown and gloves.

Patient Positioning

SupineProneLateralSitting

Definition of AnesthesiaGreek word- anesthesis, meaning “negative sensation.” Artificially induced state of partial or total loss of sensation, occurring with or without consciousness.LEAD TO:-Blocks transmission of nerve impulses.Suppress reflexes.Promotes muscle relaxation.Controlled level of unconsciousness.

Types of Anesthesia

General- method use when the surgery requires that the patient be unconscious and/or paralyzed.A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.

Stages of General Anesthesia

Stage 1- Analgesia and sedation, relaxationStage 2- Excitement, deliriumStage 3- Operative anesthesia, surgical

anesthesiaStage 4- Danger

Complications of General Anesthesia

Overdose.Hypoventilation.Related to anesthetic agents.Malignant hyperthermia.Related to intubation.

Local or Regional Anesthesia

Temporarily interrupts the transmission of sensory nerve impulses from a specific area or region.Motor function may or may not be affected.Client does not lose consciousness.Gag reflex remains intact.Supplemented with sedatives, opioids, or

hypnotics.

Complications of Local/Regional Anesthesia

Anaphylaxis.Administration technique.Systemic absorption.Overdosage.

Spinal AnesthesiaIndications:-

-surgical procedures below the diaphragm. -patients with cardiac or respiratory disease.

Advantages:- - mental status monitoring. - shorter recovery. Disadvantages :- -necessary extra expertise. -possible patient pain.Contraindications:- -coagulopathy. -uncorrected hypovolemia.

Complications

Hypotension.Bradycardia.urine retention.postural puncture headache.

back pain.

Conscious Sedation

Produces a depressed level of consciousness.

Retains ability to maintain a patent airway.Able to respond to verbal commands or

physical stimulation.Used for relatively short procedures.

CONCLUSION

• The anticipated outcome of preoperative preparation is a patient who is informed about the surgical course, and copes with it successfully. The goal is to decrease complications and promote recovery. • When patients are adequately prepared psychologically and physically, and policies and guidelines have been followed, the risk of postoperative complications should be low, leading to a quick recovery.

Postoperative Nursing Care

Thank you