Professional Documents
Culture Documents
Perioperative Phases
Preoperative
Begins with the decision to perform surgery and continues
until the client reaches the operating area
1. Preoperative Assessment
Review preoperative orders:
Preoperative lab & diagnostic studies
Medications
Nutritional restrictions
Client’shealth history
Assess physical needs
Assess psychological needs
Assess cultural needs
Check consents
Preoperative teaching needs
Review of Preoperative Orders
What lab work and diagnostic studies would you expect the
doctor to have ordered?
Client’s Health History
Use this time to evaluate the client for any stress, anxiety or cultural
barriers
History of present illness and reason for surgery
Review of body systems examining past
Medical History:
Medical conditions: acute and chronic
Previous hospitalizations
Any previous problems with anesthesia
Allergies
Present / Recent medications
Surgical Consent
Operative permit
Physician responsibility
Explain risk and benefits of surgery
Nurse may witness
Patient consents to operation
Patient understands explanation given by MD
Must be signed prior to giving pre-op sedatives
There are 3 elements of Informed Consent
1. Capacity
2. Comprehension
3. Voluntariness
Criteria for Valid Informed Consent
Always check facility policy and procedure first!
Must be voluntary without coercion
Signature of competent patient or LEGALLY authorized
person
Informed subject
Preoperative Teaching
TEACH
T- Turn cough and deep breathe
E- Exercises to perform after surgery
A- Administration of medication for pain and nausea
C- Client concerns should be addressed
H-Healing of the wound
Medication administration
Nutritional restrictions
Physical Preparation of Patient
Continued….
Elimination
Care of valuables
Attire/grooming
Preoperative Medications
6. Preoperative Medications
Purpose: is for the patient comfort and reduced risk of
complications
Types:
Reduce mucous secretions
Reduce anxiety – aids in induction of anesthetic
Decrease gastric secretions
Sedatives – promote sleep
Antibiotics – destroy enteric microorganism
Surgical Team
Anesthesiologist
Anesthetist
Surgeon
Surgical assistants
Scrub nurse
Circulating nurse
Anesthesia
The partial or complete loss of the sensation of pain with or
without the loss of consciousness
Types of Anesthesia
General
Regional
Local
Conscious Sedations
General Anesthesia
Acts on the central nervous system to produce loss of
sensation, reflexes, and consciousness
Characterized by loss
of consciousness
Regional Anesthesia
Uses local anesthetics to block the conduction of nerve
impulses in a specific region
Loss of sensation and decreased mobility to the specific
anesthetized area
No LOC change unless sedation also given to promote
relaxation / reduce anxiety
Local Anesthesia
Loss of feeling or sensation in a small ‘local’ area
Conscious Sedation
Used for diagnostic or short procedures
The client is free of pain, fear, and anxiety and can tolerate
unpleasant procedures while maintaining independent
cardiorespiratory function and ability to respond to verbal commands
and tactile stimulation
Usually given IV push
LPNs may monitor the patient who is recovering from conscious
sedation
Surgical Asepsis
Possible Intraoperative Complications
Infection
Fluid volume excess or deficit
Injury related to positioning
Hypothermia
Malignant Hyperthermia
Postoperative
Begins with admission to the recovery area and continues
until the client receives a follow-up evaluation at home or is
discharged to a rehabilitation unit
PACU or RECOVERY ROOM
Recovery Position
Side-lying position is used until the patient is awake from anesthesia
Positioning
Semi-Fowlers position is usually used after a patient is awake from
anesthesia
Initial Postoperative Assessment
Airway patency
Circulatory status
Wound / Dressing condition
Fluid balance
LOC
Pain
Check Settings of Equipment
Nursing Standards for Care of the
Postsurgical Client
Respiratory function is maintained
Circulatory function is maintained
Pain and discomfort are recognized and effectively treated
Client safety is maintained
Wound healing is promoted and wound management is provided
Complication potential is continuously assessed, and any complications are immediately and
effectively treated
Wound Complications
Most likely 7-10 days after surgery
Dehiscence
Evisceration
Dehiscence
Separation of wound edges without the protrusion of organs
Evisceration
Thewound completely separates and organs protrude
Emergent condition
Place sterile dressing moistened with NS-keep moist until surgery
Later Postoperative Assessments
Activity
Ambulate as soon as possible
Monitor for numbness with regional anesthesia
Nursing Implications
Applicable Nursing
Diagnoses: