Perioperative Nursing

Peri-Operative
Nursing
Presented by: Alrene D. Balce, RM,
RN
 Cherry May B. Olesco, RN
testicl
es
Peri - Operative Nursing
It is used to describe
the nursing care
provided in the total
surgical experience of
a patient.
The provision of
nursing care by an RN
preoperatively,
intraoperatively, and
postoperatively to a
patient undergoing an
operative or invasive
procedure
Areas in Which
Perioperative Nursing
Is Practiced
Hospital operating
rooms
Interventional
radiology suites
Cardiac
catheterization labs
Endoscopy suites
Ambulatory surgery
centers
Trauma centers
Pediatric specialty
Conditions Requiring
Surgery
 Perforation - rupture of an organ, artery
or bleb
Obstruction - blockage
Erosion - wearing away of a
surface of a tissue
 Tumor - abnormal growth

Categories of SURGERY
According
to :
üP URPOSE
üR ISK , DEGREE OF
üU RGENCY , DEGREE
OF
According to : P URPOSE
Diagnosti To verify a suspected
c diagnosis Ex. biopsy
Palliativ Relieves or reduces pain
e or symptoms
Ablative Removes a diseased body
part
Ex. Nephrectomy
Constructiv Restores function or
e appearance ; repair of a
congenitally defective
Transplant organ ex. Cleft palate
Replaces malfunctioning
structures ex. Heart
Explorato transplant
To estimate extent of a
ry disease
Ex. Exploratory
Laparotomy
Curati To remove or repair
ve damaged or diseased
organs or tissues
Types of Curative Surgery:
Ablative removal of diseased organs
e.g. nephrectomy, appendectomy
Reconstruct partial or complete restoration

of a damaged organ
ive e.g. plastic surgery after burns
Constructiv repair of a congenitally
defective organ
e e.g. plastic surgery of a cleft
Palliative to relieve
palate pain
, cheiloplasty
According to : R ISK, DEGREE
OF
Major Involves high degree of

risk
Surger Complicated or prolonged

y Large amount of blood


loss
Extensive: Vital organs
may be handled or removed

Ex: liver biopsy,
colectomy
According to : R ISK, DEGREE
OF
Minor Involves low risk

Produces few
Surger complications

y Generally not prolonged;


described as “one-day
surgery” or outpatient
surgery
Ex: cyst removal
According to : U RGENCY,
DEGREE OF
Emergenc  must be performed immediately
e.g. gunshot wound
y

Imperati  must be performed as soon as

possible within 24-48 hours
ve  e.g. severe bleeding
Planned - necessary for client well being

- e.g. tonsillectomy
Required
According to : U RGENCY,
DEGREE OF
Optional  surgery that a client requests
 e.g. face lift
Elective  should be performed for the

client’s well being but which
is not absolutely necessary
Required  necessary
e.g. herniafor the well-being of
repair
the client, usually within
weeks to months
 e. g. cholecystectomy
Other types of
Surgery
PROPHYLACTIC Prevents a more
PREVENTATIVE serious condition
from developing
INPATIENT Client has been in

SURGERY the hospital prior
to the decision to
have a surgery
OUTPATIENT Client enters the
SURGERY hospital to have
surgery done
Factors that Affects Surgical
Risk Estimation
1 . Physical and Mental Condition

of the Clien
a)Age: t
premature babies and elderly

persons are at risk
 b)Nutritional status: malnourished and
obese are at risk
c)State of fluid and electrolytes balance:
dehydration and hypovolemia predispose
a person to complications
d)General health: infectious process
increase operative risk
e)Mental health
f) Economic and occupational status
03/06/11 16
Risk Estimation
 1 . Physical and Mental Condition
of the Client
g) Types of drugs taken regularly:


1). Steroids - may improve the body’s
ability to response to the stress of
anesthesia and surgery
2). Anticoagulants and
salicylates - may increase
bleeding during surgery
3). Antibiotics - maybe incompatible
with or potentiate anesthetic agents
03 /06 /11 17
Risk Estimation
1 . Physical and Mental Condition

of the Client
g) Types of drugs taken regularly:

 4). Tranquilizers - potentiate the effect

of narcotics and can cause hypotension
5). Antihypertensives - may predispose to
shock by the combined effect of blood
pressure reduction and anesthetic
vasodilation
6). Diuretics - may increase potassium
loss
7). Alcohol - will place the surgical
client at risk when used chronically
03/06/11 18
Risk Estimation
 2 . The Extent of the Disease
 3. The Magnitude of the Required
Operation
 4. Resources and Preparation of the
Surgeon, Nurses, and the Hospital

03/06/11 19
Phases of Peri - operative
period
re Operative
Operativ
Nursing
Pre-Operative Phase
 Begins at the time of decision for
surgery and ends when the client
is transferred to the OR

 This period is used to physically

and psychologically prepare the
client for surgery

 The nurse plays a major role in

client teaching and in relieving
the client’s and the family’s
anxieties

03/06/11 22
Pre-Operative Phase
Goals:

üAssessing and correcting physiologic

and psychologic problems that might
increase surgical risk
üGiving the person and significant
others complete learning/ teaching
guidelines regarding surgery
üInstructing and demonstrating
exercises that will benefits the
person during post-op period
üPlanning for discharge and any
projected changes in lifestyle due to
surgery
 03/06/11 23
Pre-Operative Phase
 A.) PSYCHOLOGIC PREPARATION FOR SURGERY

1.Preparation for hospital admission

includes:
üExplanation of the procedure
to be done
üProbable outcome
üExpected duration of
hospitalization
üCost
üLength of absence from work
üResidual effects 03/06/11 24
Pre-Operative Phase
A.) PSYCHOLOGIC PREPARATION FOR SURGERY
2 . Nursing Diagnosis for

Preoperative Client

üAnxiety related to lack of

knowledge about preoperative
routines, physical preparation
for surgery, post operative
care and potential body image
change
03/06/11 25
Pre-Operative Phase

Preoperative Client

Causes of Fears:
üFear of the unknown
üFear of anesthesia, vulnerability
while unconscious
üFear of pain
üFear of death
üFear of disturbance of body image
üWorries: loss of finances,
employment, social and family roles
03/06/11 26
Pre-Operative Phase

Preoperative Client
Manifestations of Fears :
üAnxiousness and bewilderment

üAnger
üTendency to exaggerate
üSad, evasive, tearful, clinging
üInability to concentrate
üShort attention span
üFailure to carry out simple
directions
üDazed
03/06/11 27
Pre-Operative Phase
3. Nursing Interventions to Minimize Anxiety

üAssess client’s fears,

anxieties, support systems,
and patterns of coping
üEstablish trusting
relationship with client
and significant others
03/06/11 28
Pre-Operative Phase
3. Nursing Interventions to Minimize Anxiety

üExplain routine procedures,

encourage verbalization of
fears, and allow client to
ask questions
üDemonstrate confidence in
surgeon and staff
üProvide for spiritual care
if appropriate
00 /00 /00 00
Pre-Operative Phase
B .) LEGAL ASPECT : “ INFORMED CONSENT ”,
OPERATIVE PERMIT , SURGICAL CONSENT
This is to protect the surgeon and the

hospital against claims that
unauthorized surgery has been performed
and that the client was unaware of the
potential risks of complications
involved
Protects the client from undergoing
unauthorized surgery
03/06/11 30
Pre-Operative Phase
1 .) The Surgeon obtains operative

permit or informed consent
üSurgical procedure, alternatives,
possible complications,
disfigurements, or removal of body
parts are explained
üIt is part of the nurse’s role as a
client advocate to confirm that the
client understands information
given 03/06/11 31
Pre-Operative Phase
2 .) Minor Patients
üIf the client is minor allow
the parents or the nearest
relative to sign the consent
for the procedure
üFor EMANCIPATED CLIENTS, they
are allowed to sign the consent
03/06/11 32
Pre-Operative Phase
3 .) Adult Patients ( over 18 y / o )

üSigns own permit unless unconscious or
mentally incompetent
üIf unable to sign, relative, (spouse or
next of kin) or guardian will sign
üIn an emergency, permission via the
telephone or telegram is acceptable:
have a second listener on phone when
telephone permission being given
ü
03/06/11 33
Pre-Operative Phase
Consents are not needed for

emergency care if all four of the
following criteria are met :
1. There is an immediate threat to
life
2. Experts agree that it is an
emergency
3. Client is unable to consent
4. A legally authorized person
cannot be reached
03/06/11 34
Pre-Operative Phase
C .) PHYSIOLOGIC PREPARATION
1 ) Respiratory preparation :
- chest x-ray
2 ) Cardiovascular preparation :
- ECG, CBC, blood typing, cross-
matching,
PT/PTT (prothrombin time, partial
thromboplastin time), serum
electrolytes
3 ) Renal preparation :
- Urinalysis
ü
03/06/11 35
Pre-Operative Phase
4 . Past Medical History
A- Allergy to medications, chemicals, and

other environmental products such as
latex
üAll allergies are reported to
anesthesia and surgical personnel
before the beginning of surgery.
üIf allergy exist, an allergy band
must be placed in the client’s arm
immediately
03/06/11 36
Pre-Operative Phase
B- Bleeding tendencies or the use

of medications that deter
clotting, such as aspirin,
heparin, and warfarin sodium.
üHerbal medications may also
increase bleeding time or
mask potential blood-related
problems
03/06/11 37
Pre-Operative Phase
C- Cortisone and steroid use

üThis predisposes client
to infection
03/06/11 38
Pre-Operative Phase
D- Diabetes mellitus, a
condition that not only
requires strict control of
blood glucose levels but
also known to delay wound
healing
03/06/11 39
Pre-Operative Phase
E- Emboli; previous embolic

events ( such as lower leg
blood clots) may recur
because of prolonged
immobility
03/06/11 40
Pre-Operative Phase
D .) INSTRUCTIONAL AND PREVENTIVE
ASPECTS
üAssess the client’s level of
understanding of surgical
procedure and its implications
üAnswer questions, clarify and
reinforce explanations given by
surgeon
üExplain routine pre and post
procedures and any special
equipment to be used
üDeep breathing exercises: use of
diaphragmatic and abdominal
03/06/1 1 41
Pre-Operative Phase
ASPECTS
üCoughing exercise: deep breath,
exhale through the mouth, and then
follow with a short breath while
coughing; splint thoracic and
abdominal incision to minimize pain
üTurning exercise: every 1-2 hours
post-operative
üAssure that pain medications will
be available post-op
03/06/11 42
Pre-Operative Phase
ASPECTS
üExtremity exercise: prevents circulatory
problems and post operative gas pains or
flatus
03/06/11 43
Pre-Operative Phase
E .) PHYSICAL PREPARATION
On the night of the
surgery
1.Preparing the client’s skin: shave
against the grain of the hair
shaft to ensure clean and close
shave
03/06/11 44
Pre-Operative Phase
On the night of the
surgery
2. Preparing the GIT:
-NPO after midnight
-Note: the age of the client should
be taken in to consideration
-Infants and children has a higher
metabolic rate than adult
-This makes it essential for the
child or infant to receive CHO
regularly to prevent acidosis
from occurring
03/06/11 45
Pre-Operative Phase
On the night of the
surgery
3. Administration
of enema
4. Insertion of
gastric or
intestinal tubes
03/06/11 46
Pre-Operative Phase
On the night of the
surgery
5 . Preparing for Anesthesia
üPromoting rest and sleep : use of
drugs
-Barbiturates: Secobarbital Na
(Seconal), Pentobarbital Na
(Nembutal)
-Non barbiturates: chloral hydrate,
Flurazepam (Dalmane)
-Note : given after all pre - op
treatments have been completed .
-If a second barbiturate is
needed , it must be given at
least 4 hours before the pre - op47
03/06/11
Pre-Operative Phase
On the day of the surgery
* Early morning care: about 1 hour before
the pre-operative medication schedule
1.Vital signs taken and recorded

promptly
2.Provide oral hygiene
3.Remove jewelries and dentures
4.Remove nail polish
5.Make sure that the patient has
not taken food for the last 10
hours by asking the client
03/06/11 48
Pre-Operative Phase
PRE-OPERATIVE MEDICATIONS
Generally administered 60-90 min before
induction of anesthesia
Purpose:
üTo allay anxiety: the primary reason for
pre-operative medications
üTo decrease the flow of pharyngeal
secretions
üTo reduce the amount of anesthesia to be
given
üTo create amnesia for the events that
precedes surgery 03/06/1149
Pre-Operative Phase
Types of Pre - Operative

Medications :
1 ) Sedative :
a)Given to decrease the client’s anxiety
to lower BP and pulse
b)Reduce the amount of general
anesthesia: an overdose can result to
respiratory depression
Ex: Phenobarbital (Seconal Na, Nembutal
03/06/11 Na) 50
Pre-Operative Phase

Medications :
2 ) Tranquilizer
- lowers the client’s anxiety level
(ataractic)
- Ex: Thorazine 12.5 - 25 mg IM 1-2 hours prior to
surgery
Phenergan 12.5 - 25 mg IM 1-2 hours prior to surgery
* Note: can cause a dangerous hypotension , both during and
03/06/11 51
after surgery
Pre-Operative Phase

Medications :
3 ) Narcotic analgesia
-given to reduce patients to reduce
anxiety and to reduce the amount of
narcotics given during surgery
-Ex: Morphine sulfate 8-15 mg SC 1 hour prior to
preoperative
* Can cause vomiting , respiratory depression and postural
hypotension
03/06/11 52
Pre-Operative Phase

Medications :
4 ) Vagolytic or drying agents
-to reduce the amount of tracheobronchial
secretions which can clog the pulmonary
tree and result in atelectasis and
pneumonia
-Ex: Atropine sulfate 0.3-0.6 mg IM 45 min before surgery
* An overdose can result to severe tachycardia
03/06/11 53
Pre-Operative Phase
Recording: all final preparation and
emotional response before surgery should
be noted down
Transportation to the
OR
Woolen or synthetic blankets must never
be sent to the OR because they are
source of static electricity
03/06/11 54
Intra - Operative phase
Begins when the
client is transferred
to the operating
table and ends when
the client is
admitted to the post -
anesthesia unit
Surgical Attire
0Gowns
Gloves
Masks
Hair covering
Protective
eyewear

Intra Operative Nursing
A . ROLES OF PERIOPERATIVE

NURSES

Scrub Nurse
•Circulating Nurse
•Registered Nurse First
Assistant ( RNFA )
•Perioperative Educator
•OR Manager / Director

NURSES

üScrub Nurse
•Responsible for scrubbing for
surgery, including setting up
sterile tables and equipment and
assisting the surgeon and surgical
technicians during the surgical
procedure
•Gathering all equipment for the
procedure

NURSES

üScrub Nurse
•Preparing all supplies and
instruments using sterile
technique
•Maintaining sterility within the
sterile field during surgery
•Handling instruments and
supplies during surgery

NURSES
üScrub Nurse

•During the surgery, the scrub

nurse maintains an accurate
count of sponges, sharps, and
instruments on the sterile field
and counts the same materials
with the circulating nurse
before and after the surgery
•Cleaning up after the case

NURSES
üCirculating Nurse

•Manages the individual

operating
room and care of the patient
in
the OR
•Creates and maintains
comfortable, safe environment
•Helps all team members work
together

NURSES
üCirculating Nurse

•Works in the OR in the area

outside the sterile field
Ensuring all equipment is
working properly
Guaranteeing sterility of
instruments and supplies

NURSES
üCirculating Nurse

Assisting with
positioning
Performing with the
surgical skin
preparation

NURSES
üCirculating Nurse

•Works in the OR in the area

outside the sterile field
Ensuring all equipment is
working properly
Guaranteeing sterility of
instruments and supplies

NURSES
üCirculating Nurse

Monitoring the room and

team members for breaks in
sterile technique
Assisting anesthesia
personnel with induction
and physiologic monitoring
•

NURSES
 üCirculating Nurse
Handling specimens
Documenting care provided

NURSES
üRN First Assistant

•Directly assists
surgeon
•Controls patient ’ s
bleeding
•Provides wound exposure
and suturing
Using instruments to hold
and cut

NURSES

üRN First Assistant
Retracting and handling the
tissue
•Involved in care
before ,
during , and after
surgery

NURSES
 üPerioperative Educator
Responsible in giving
health teachings to
the client who will
undergo and already
undergone surgical
operation

NURSES
 üOR Manager / Director
Makes preoperative
assessment and documents
the intra-operative client
care plan
 INTERVENTIONS :
üDetermine the type of

surgery and anesthesia

used
üPosition client
appropriately for surgery
üAssist the surgeon as
circulating or scrub nurse
üMaintain the sterility of
the surgical field
üMonitor for developing
complications
 B . SURGICAL SCRUB

1. A sensor-
controlled or
knee- or foot-
operated faucet
allows the
water to be
turned on and
off without the
use of the
hands
2) Remove all

rings and
watches
3) Use liquid
soaps to
prevent the
spread of
organisms
4) Hold the hands

higher than the

elbows throughout
the handwashing
procedure so that
run-off goes to
the elbows
- Allows the cleanest
part of the arms to be
the hands
5) A scrub brush

facilitates the
removal of
microorganisms
- Clean all areas of
skin on the hands
and arms in sequence
starting at the
hands and ending at
the elbows
6) After rinsing,

dry the hands

with paper
towels, drying
first one arm
from the hand to
the elbow, then
using a second
towel to dry the
second hand
6) After rinsing,

dry the hands

with paper
towels, drying
first one arm
from the hand to
the elbow, then
using a second
towel to dry the
second hand
C . PRINCIPLES OF STERILE

TECHNIQUE
1. Sterile Technique

The patient is the
center of the
sterile field,
which includes the:
-areas of the
patient
-the operating
table
-furniture
covered with
sterile drapes
-the personnel

TECHNIQUE
1. Sterile Technique

Strict adherence
to sound
principles of
sterile technique
and recommended
practices is
mandatory for the
safety of the
patient. This
adherence reflects
one’s surgical
conscience

TECHNIQUE
2. Application

Preparation for
operation by
sterilization of
necessary materials
and supplies
Preparation of the
operating team to
handle sterile
supplies and
intimately contact
wound

TECHNIQUE
2. Application

Creation and
maintenance of the
sterile field,
including the
preparation and
draping of the
patient, to prevent
contamination of the
surgical wound
Maintenance of
sterility and asepsis
throughout the
operative procedure

TECHNIQUE
2. Application

Terminal
sterilization and
disinfection at the
conclusion of the
operation

TECHNIQUE

1. Sterile persons have scrubbed
and are gowned and gloved ;
Unsterile persons have not . Persons
who are sterile touch only sterile
articles . Persons who are not
sterile touch only unsterile
articles
-All supplies
. for the sterile team
members reach them by means of the
circulating nurse, through the
medium of sterile forceps or
wrappers on sterile packages.
-

TECHNIQUE
 2 . Only sterile items are used
within the sterile field .
- Some items such as linen, sponges,
or basins may be obtained from the
stock supply of sterile packages.
Others, such as instruments, may be
sterilized immediately preceding the
operation and removed directly from
the sterilizer to the sterile table.

TECHNIQUE
 2 . Only sterile items are used
- Every person who dispenses a

sterile article must be sure of its
sterility and of its remaining
sterile until used. Proper packaging,
sterilizing, and handling should
provide such assurance.

TECHNIQUE
2 . Only sterile items are used

-If you are in doubt about the
sterility of anything, consider it
not sterile. Known or potentially
contaminated items must not be
transferred to the sterile field,
for example:
1 . If sterile package is found in the
nonsterile workroom
2 . If uncertain about actual timing or
operation of sterilizer :
Items processed in a suspect load are

TECHNIQUE

for example:
3 . If unsterile person comes into
close contact with a sterile
table and vice - versa
4 . If sterile package falls to
the floor , it must then be

TECHNIQUE

for example:
5. If sterile table or unwrapped
sterile items are not under
constant observation ; if a sterile
table or sterile articles are

TECHNIQUE
3 . Gowns are considered sterile

only from the waist to
shoulder level in front , and
the sleeves .
- Sterile persons keep hands in
sight and at or above waist level
- Hands are kept away from the face .
Elbows are kept close to sides .
Hands are never folded under arms
because of perspiration in the
axillary region

TECHNIQUE

the sleeves .
- Changing table levels is avoided .
If sterile person must stand on a
platform to reach the operative
field , the area of the gown below
waist must not brush against
sterile tables or draped areas

TECHNIQUE

the sleeves .
-Items dropped below waist level are
considered unsterile and must be
discarded .
Example : when picking up a gown ,
if the top of the gown drops
below waist level , it is discarded

TECHNIQUE
4 . Tables are sterile only

at table level
-Only the top of a sterile draped
table is considered sterile .
Edges and sides of drape extending
below the table level are
considered unsterile
-Anything falling over or extending
over table edge , such as sutures
are considered unsterile and are
discarded . Scrub nurse does not
touch the part hanging below table
level

TECHNIQUE
4 . Tables are sterile only
at table level

-In unfolding sterile drape , the

part that drops below table
surface is not brought back
up to table level
-

TECHNIQUE
5 . Persons who are sterile
touch only sterile items

or areas . Persons who are

not sterile touch only
unsterile items or areas
-Sterile team members maintain
contact with sterile field by
means of gowns and gloves .

TECHNIQUE


-Nonsterile circulating nurse
does not directly come into
contact with the sterile
field

TECHNIQUE


-Supplies for sterile team
members reach them by means
of the circulating nurse who
opens wrapper on sterile
packages

TECHNIQUE
6 . Unsterile persons avoid
reaching over a sterile

field . Sterile persons

avoid leaning over an
unsterile
-The scrub area
nurse sets basin or
glasses to be filled at the
edge of the sterile table . The
circulating nurse stands near
the edge of the table to fill
them

TECHNIQUE


unsterile
-The
area
circulating nurse
stands at a distance from
the sterile field to
adjust the light over it

TECHNIQUE


unsterile area
-The surgeon turns away from
the sterile field to have
perspiration mopped from
his brow

TECHNIQUE


unsterile area
- The sterile nurse drapes a
nonsterile table toward
self first to protect gown

TECHNIQUE


unsterile
- The area
circulating nurse ,
using sterile forceps ,
drapes a table away from
her first

TECHNIQUE
7. Edges of anything that

encloses sterile contents
are considered unsterile .
Ex : the edges of wrappers
on sterile packages , caps on
solution bottles and test
tube covers
- Sterile persons lift
contents from packages by
reaching down and lifting
them straight up , holding
elbows high

TECHNIQUE

tube covers
- Steam reaches only the area
within the gasket of a
sterilizer. Instrument trays
should not touch the edge of
the sterilizer outside the

TECHNIQUE

tube covers
- The circulating nurse peels
the cover of a solution
bottle or test tube , the
edge of the cover never
touches the lip

TECHNIQUE

tube covers
- If the instruments are
boiled , the tray must not
touch the edge of the
sterilizer when lifting it
out

TECHNIQUE
8 . Sterile field is created as

close as possible to time
of use
“ Degree of contamination
is proportionate to
length of time sterile
items are uncovered and
exposed to the
environment . ”

TECHNIQUE
8 . Sterile field is created
as close as possible to

time of use
-Sterile tables are set up
just prior to the operation .
-It is difficult to uncover
a table of sterile contents
without contamination .
Covering sterile tables for
later use is not

TECHNIQUE
9. Sterile areas are
continuously kept in view

-Sterile persons face

sterile areas .
-When sterile packs are
opened in a room , or a
sterile field is set up ,
someone must remain in
the room .

TECHNIQUE
10 . Sterile persons keep
well within the sterile

area
-Sterile persons stand back
at a safe distance from the
operating table when
draping the patient .
-Sterile persons pass each
other back to back .

TECHNIQUE

area
-Sterile person turns back to
nonsterile person or area when
passing.
-Sterile person faces sterile area
to pass it.
-Sterile person asks nonsterile
individual to step aside rather
than risk contamination

TECHNIQUE

area
-Sterile persons stay within and
around a sterile field. They do
not walk around or go outside
the room.
-Movement within and around a
sterile area is kept to a
minimum to avoid contamination
of sterile items or persons

TECHNIQUE
contact with sterile

areas to a minimum
-Sterile persons do not lean on
sterile tables and on the
draped patient.
-Sitting or leaning against a
nonsterile surface is a break
in technique. If the sterile
team sits to operate, they do so
without proximity to nonsterile

TECHNIQUE
sterile areas .

-Unsterile persons maintain

at least one foot
distance from any area of
the sterile field .
-Unsterile persons face and
observe a sterile area
when passing it to be
sure they do not touch it

TECHNIQUE
sterile areas .

-Unsterile persons never walk

between two sterile areas,
eg, between sterile
instrument tables.
-Circulating nurse restricts
to a minimum activity near
sterile field

TECHNIQUE
13 . Destruction of the
integrity of microbial

barriers results in
contamination
-Unsterile persons never walk
between two sterile areas,
eg, between sterile
instrument tables.
-Circulating nurse restricts
to a minimum activity near

TECHNIQUE
 integrity of microbial
barriers results in
contamination
The integrity of a sterile package
or sterile drape is destroyed by
perforation, puncture or strike-
through (soaking of moisture
through unsterile layers to
sterile layers or vice versa- may
transport bacteria to sterile
area). To ensure sterility:

TECHNIQUE
barriers results in
contamination
-Sterile packages are laid on
dry surfaces.
-If sterile packages become damp
or wet, it is re-sterilized or
discarded. A package is
considered nonsterile if any
of it comes in contact with
moisture.

TECHNIQUE
barriers results in
contamination
-Drapes are placed on a dry
field
-If solution soaks through
sterile drape to nonsterile
area, the wet area is covered
with impervious sterile drape
or towels

TECHNIQUE
barriers results in
contamination
-Packages wrapped in muslin or
paper are permitted to cool
after removal from the
sterilizer to avoid steam
condensation and resultant
contamination
-Sterile areas are stored in
clean dry areas

TECHNIQUE
barriers results in
contamination
-Sterile packages are handled
with clean dry hands
-Undue pressure on sterile
pack is avoided to prevent
forcing sterile air out and
pulling unsterile air into
the pack

TECHNIQUE
14 . Microorganisms must be kept

to an irreducible minimum
Perfect asepsis in the
operative field is the
ideal . Although all the
microorganisms cannot be
eliminated , this does not
obviate the necessity for
sterile technique . It is
generally agreed that :

TECHNIQUE

a . Skin cannot be
sterilized
- Skin is a potential source of
contamination in every operation.
- All possible means are used to
prevent entrance of microorganisms
into wound

TECHNIQUE

b . Some areas cannot be
scrubbed
When the operative field
includes the mouth , nose , throat
or anus , the number of
microorganisms is great . Various
parts of the body , such as the
GIT and the vagina , usually are
resistant to infection from

TECHNIQUE

c . Infected areas are

grossly contaminated
- The team avoids
spreading the
contamination

TECHNIQUE

d . Air is contaminated
by dust and
droplets .
D . ANESTHESIA


1 . Levels of Anesthesia
( Sedation )
a. Minimal sedation
- drug induced state in
which a patient can
respond normally in verbal
commands cognitive
function and coordination
may be impaired
D . ANESTHESIA


( Sedation )
b. Moderate sedation
- depressed level of
consciousness that does not
impair ability to maintain a
patent airway
- calm, sedate a patient
combined with analgesic
- Midazolam/Diazepam
D . ANESTHESIA


Sedation
c. ( Deep )
Sedation
- deep sedation is a drug
induced state in which a
patient cannot easily be
aroused but can respond
purposefully after repeated
stimulation .
- inhaled or intravenously
- Volatile anesthetic ( halothane ,
Isoflurane )
D . ANESTHESIA


2 . Stages of Anesthesia
Stage Start - End - point Physical Nursing
point reactions interventi
I. Anestheti Loss of Client Close
on
Onset c Consciousnes maybe operating
administr s drowsy , or room
ation dizzy doors ,
Possible keep room
auditory quiet
and Stand by
visual to assist
hallucinat the client
ion
D . ANESTHESIA


Stage Start - End - Physical Nursing
point point reactions interventi
II . Loss of Loss of Increase Remain
on
Excitement consciousnes eyelid in quietly at
s reflexe autonomic client ’ s
s activity side
Irregular Assist
breathing anesthetis
Client t , as
may needed
struggle
D . ANESTHESIA


Stage Start - End - Physical Nursing
point point reaction intervention
s
III . Surgical Loss of Loss of Client is Begin
eyelid most unconscio preparation
reflexes reflexes us ( if indicated )
anesthesia Depressio Muscles only when
n of are anesthesia
vital relaxed indicates
functions No blink stage III has
or gag been reached
reflexes and client is
breathing
well , with
stable vital
D . ANESTHESIA


point reaction intervention
s
IV . Functions Respirator Client is If arrest occurs ,
Danger excessive y and not respond
( death ) ly circulator breathing immediately to
depressed y failure A assist in
heartbeat establishing
may or may airway , provide
not be cardiac arrest
present tray , drugs
syringes , long
needles
Assist surgeon
with closed or
D . ANESTHESIA


point reaction intervention
s
IV . Functions Respirator Client is If arrest occurs ,
Danger excessive y and not respond
( death ) ly circulator breathing immediately to
depressed y failure A assist in
heartbeat establishing
may or may airway , provide
not be cardiac arrest
present tray , drugs
syringes , long
needles
Assist surgeon
with closed or
D . ANESTHESIA


3 . Types of Anesthesia
a . General Anesthesia
-A state of analgesia , amnesia ,
and unconsciousness
characterized by the loss of
reflexes and muscle tone
-Administered by using a
combination of agents based on
the client's need with
consideration of the type of
surgery to be performed
D . ANESTHESIA

1 . Types of GA
Administration
G A : INTRAVENOUS
ADMINISTRATION
üUsually employed as
an induction prior to
administration of the
more potent
inhalation anesthetic
agents .
üUsed commonly in minor
procedure
üDental extraction
üUnconsciousness
generally occurs 30
seconds after
administration
üRapid and smooth
transition from
G A : INTRAVENOUS
ADMINISTRATION
Advantage of
IV Anesthesia :
1.Rapid pleasant
induction
2.Absence of
explosive hazards
3.Low incidence of
nausea and vomiting
G A : INTRAVENOUS
ADMINISTRATION
Disadvantage of IV
Anesthesia :
1. Laryngeal spasm and
bronchospasm
2. Hypotension
3. Respiratory arrest
Examples:
Thiopental Na
(Pentothal Na)
Ketamine (Ketalar)
Fentanyl (Innovar)
G A : INHALATION
ADMINISTRATION
üA mixture of
volatile liquids or
gas and O2 is used
üUsually used to
maintain the client
in stage III
anesthesia
following induction
ü
üThe mixture is given
through a mask or
through an
endotracheal tube
which is inserted
once the client is
G A : INHALATION
ADMINISTRATION
Administration
by a mask :
üThe gases flow
into the mask via
a finely
calibrated
vaporizer that is
controlled by a
machine
G A : INHALATION
ADMINISTRATION
Administration
by ETT :
üThe gases flow
directly into
the client’s
tracheobronchial
tree, resulting
in a quick
response
G A : INHALATION
ADMINISTRATION
Advantage :
üEase of
administration
and elimination
through the
respiratory
system
üRapid onset
üPrevention of
pain and anxiety
G A : INHALATION
ADMINISTRATION
Disadvantage:
ücirculatory
and
respiratory
depression
* Highly flammable
and explosive
G A : INHALATION
ADMINISTRATION
Two commonly
used Inhalation
Anesthetics :
- Halothane
- Isoflurane
Commonly used
Gas Anesthetic :
- Nitrous oxide ( Blue
tank )
POST GA
EFFECT
Headache
vision problems ,
including blurred
or double vision
shivering or trembling
muscle pain
dizziness ,
lightheadedness , or
faintness
drowsiness
mood or mental changes
nausea or vomiting
sore throat
nightmares or unusual
dreams
D . ANESTHESIA


3 . Types of Anesthesia
b . Regional Anesthesia
üIt is the injection or
application of a local
anesthetic agent to produce a
loss of painful sensation in
only one region of the body
üDoes not result to
unconsciousness
üBlocks the conduction of
impulses in the nerve fibers
D . ANESTHESIA

Types of Regional
Anesthesia
R A : SPINAL
ADMINISTRATION
üOften the
anesthetic
technique of
choice of older
adults
üCan be used for
almost any type of
major procedure
performed below
the level of the
diaphragm
üCholecystec
R A : SPINAL
ADMINISTRATION
üSpinal Anesthesia is
achieved by injecting
local anesthetics into
the subarachnoid space
üPosition of client : genu -
pectal or knee - chest
position
üLevel of anesthesia :
Intervertebral space
between
üL2 and L3
üL3 and L4
üAutonomic nerve fibers
are affected first and
also the last to recover
COMPLICATIONS
OF SA :
üHypotension
üParalysis of
vasomotor nerves ,
occurring shortly
after induction
of anesthesia
üRapid IVF
administration
before the
block
üAdminister O2 by
inhalation
üTrendelenburg
COMPLICATIONS
OF SA :
üNausea and
vomiting
-Occurs mainly from
abdominal surgery
because of traction
placed on various
structures within
the abdomen or from
hypotension
-Drugs used :
antiemetics
COMPLICATIONS
OF SA :
üHeadache
-Can be extremely painful and
may last a week
-CSF , which cushions the brain ,
is lost through dural hole
-Leakage of fluid with loss of
cushioning effect is
increased by :
Use of large
spinal needle
Poor hydration
- Keep client flat 6 - 8 hours
postoperatively
COMPLICATIONS
OF SA :
üRespiratory
paralysis
-Occurs when drug
reaches upper
thoracic or
cervical spinal
levels in large
amounts or in
heavy
concentrations
-Do artificial
respiration
COMPLICATIONS
OF SA :
üNeurologic
complications :
-Paraplegia
-Severe muscle
weakness in legs
-Postoperative
paralysis may be due
to :
Unsterile needles ,
syringes and
anesthetic agent
Pre - existing diseases
of the CNS
Transient response to
anesthetics
ADVANTAGES OF
SA :
üRelatively safe
üExcellent
lower - body
muscle
relaxant
üAbsence of
effect on
consciousness
üDoe not require
empty stomach
R A : EPIDURAL
ADMINISTRATION
vIntroduction of
anesthetic agent into the
epidural space
vThe needle is carefully
positioned in the
epidural space without
penetrating the dura and
without entering the
subarachnoid space
03/06/11 159
03/06/11 160
R A : EPIDURAL
ADMINISTRATION
vEpidural block produces a
blockade of the autonomic nerves
and can result to hypotension
v
vIf the level of block is too high
and respiratory muscles are
affected , respiratory depression
or paralysis may occur
v
vThe epidural space is generally
entered by a needle at a thoracic ,
lumbar , sacral , or caudal
interspace
R A : CAUDAL
ADMINISTRATION
vA variation of epidural
anesthesia
vProduced by injection
of the local
anesthetic into the
caudal or sacral canal
vThis method is commonly
used with obstetric
clients
R A : TOPICAL
ADMINISTRATION
vApplication of the
agent directly to the
skin , mucous membranes ,
or open surface to be
desensitized
vThe anesthetic may be
a solution , an
ointment , a gel , a
cream , or a powder
R A : TOPICAL
ADMINISTRATION
vA short - acting form of
anesthesia can block
peripheral nerve endings in
the mucous membranes of the
vagina , rectum , nasopharynx , and
mouth
v
vUsed in minor procedures :
rectal examination with
painful hemorrhoids , and
bronchoscopy
R A : TOPICAL
ADMINISTRATION
vCommonly used topical
anesthesia :
§Solution of 4 - 10 % cocaine
-For topical used only
primarily to
anesthetize the eye
and the mucous
membrane of nose ,
mouth , and urethra
-Highly toxic agent
R A : TOPICAL
ADMINISTRATION
Other topical anesthetic
agents :
-Tetracaine
-Procaine
-Mepivacaine
-Lidocaine ( Xylocaine )
R A : LOCAL INFILTRATION
ADMINISTRATION
üInvolves the injection of an
anesthetic agent into the skin
and subcutaneous tissue of the
area to be anesthesized
üBlocks the peripheral nerves
around the area of the incision
üDuring administration of the
agent , aspiration should be done
to ensure that the needle is not
in the blood vessel
üInadvertent intravenous
injection of the agent can
result to cardiovascular
collapse or convulsions
R A : FIELD BLOCK
ADMINISTRATION
The area proximal to a planned
incision can be injected and
infiltrated with local anesthetic
agents to produce field block .
The block forms a barrier between
the incision and the nervous system
A field block actually walls in the
area around the incision and
prevent transmission of sensory
impulses to the brain from that
area
R A : PERIPHERAL NERVE
BLOCK ADMINISTRATION
vAnesthetizes individual
nerves or nerve plexuses
Examples :
-Digital nerve block :
fingers
-Brachial plexus nerve
block : entire upper arm
-Intercostal nerve block :
chest or abdominal wall
R A : PERIPHERAL NERVE
Injection of anesthetic agents
along the nerve rather done
into the nerve in an effort to
decrease the risk of nerve
damage
Agents commonly used : lidocaine ,
bupivacaine , and Mepivacaine
Epinephrine - containing agents
are not used for surgery
involving the extremities , like
below the wrist and ankle ,
R A : REGIONAL EXTREMITY
( BIER BLOCK)
Regional anesthesia of a limb
can be achieved with an agent
when it is injected into a vein
of the limb to be anesthetized
A pneumatic dual - cuff

tourniquet applied to the
anesthetized area prevents the
lidocaine from circulating
beyond the area undergoing the
R A : REGIONAL EXTREMITY
( BIER BLOCK)
This type of anesthesia is used

most commonly for procedures of
the extremities that are of
short duration
Agent used : lidocaine
POSITIONS FOR
SURGERY
Positions for Surgery
Supine/ Dorsal – usual position for induction
of general anesthesia and for entering the
major body cavities
Modified Trendelenburg – used for lower
abdominal surgery and some lower

extremity surgery
Reverse Modified Trendelenburg – used for
upper abdominal, neck and face surgery

Lithotomy – used in operation requiring
perineal approach
Prone – used in surgery on the posterior
part of the body

Lateral – used for operation on the kidneys,
lungs or hips
Modified Fowler’s – sitting position; used
mostly in neurosurgery
Modified jacknife – for rectal surgery
Position Patient during
Surgery
Abdominal Supine
surgeries
Bladder surgery Slightly
trendelenburg
Perineal surgery Lithotomy
Brain surgery Semi - fowler ’ s
Spinal cord Prone mostly
surgeries
Lumbar puncture Side lying ,
flexed body
Abdominal Surgical
Incision
Paramedian vertical incision
( rarely used –
Longitudinal intestinal problems))
( middle laparotomy
Midline begins at the level of
Right Subcostal the
from xiphoid to the
epigastric area
( Kochers ) supra pubic region
and extends laterally &
for gastrectomy
(obliquely &
below the
intestinal
lower marginresection
– biliary) ,
spleen and liver
Abdominal Surgical
Incision
Bilateral liver transplant
subcostal –
Mc BurneyBenz or for appendectomy
Mercedes
Chevron incision
Rocky Davis for appendectomy
Pfannenstiel pelvic procedures,
hysterectomy or CS
Inguinal inguinal herniorrhaphy
Different Surgeries
According to Location
 A . ABDOMINAL SURGERY
 1 . Abdominal
Laparotomy
 2 . Herniorrhaphy
 3 . Cholecystectomy
 4.
Pancreaticoduodenectom
y ( Whipple ’ s )
 5 . Pancreatectomy
 6 . Splenectomy
 7 . Bariatric Surgery

Different Surgeries
 B . BREAST SURGERY
 1 . Mastectomy
 2 . Breast Biopsy
 3 . Mammoplasty
 4 . Breast
Augmentation ,
Breast Repair ,
Breast Lifting

Different Surgeries
 D . GENITOURINARY SURGERY
 1 . Circumcision
 2 . Vasectomy
 3 . Orchiectomy
 4 . Cystectomy
5 . Transurethral Resection
of the Prostate / Bladder

( TURP / TURB )
 6 . Nephrectomy
 7 . Ureterolithotomy
 8 . Pyelolithotomy
OK ARE YOU READY SIR FOR YOUR
Post-operative phase
Post - Operative
Phase
Begins with the
admission of the
client to the
PACU and ends
when healing is
complete
OT
PACU
Ward
Home
PACU Nurse
 Responsible for
caring for the
client until the
client :

- Has recovered from

the effects of
anesthesia
-
- Is oriented
-
- Has stable vital
signs
-
POSTANESTHESIA CARE
UNIT
§Design
§Equipment
§Staffing
§
POSTANESTHESIA CARE UNIT
 Design
- Located near the operating
rooms
Proximity to radiographic,
laboratory, and other intensive

care facilities on the same floor
- Open ward design
Each patient space should be
well lighted
Multiple electrical outlets and at
POSTANESTHESIA CARE
UNIT
Equipment

1.Pulse oximetry (SpO2)
2.Electrocardiogram (ECG)
3.Automated noninvasive
blood pressure (NIBP)
monitors
4.Capnography
5.Temperature
6.Air warming device,
 Emergency Equipment

1.Oxygen cannulas
2.Masks
3.Oral and nasal airways
4.Laryngoscopes , ndotracheal tubes,
laryngeal mask airways, and self-
inflating bags for ventilation
5.Defibrillation device
6.Tracheostomy, chest tube, and
vascular cutdown trays
Respiratory therapy

equipment

1.Continuous positive
airway pressure (CPAP)
2.Ventilators
3.Bronchoscope
Staffing

- Nurses specifically trained in the

care of patients emerging from
anesthesia
- PACU should be under the
medical direction of an
anesthesiologist
- One nurse to one patient is
often needed
- A charge nurse should be
OT
PACU
Ward
Home
<>
CARE OF THE PATIENT
 TRANSPORT FROM THE OPERATING
ROOM
 This period is usually complicated by
the lack of adequate monitors,

access to drugs, or resuscitative
equipment
Patients should not leave the operating

room unless they have a stable and


patent airway , have adequate


ventilation and oxygenation , and are

hemodynamically stable
CARE OF THE PATIENT
 TRANSPORT FROM THE
OPERATING ROOM

All patients should be taken to the
PACU on a bed or trolley that can
be placed in either:

Post-Operative Phase
A) Post Anesthetic Care

Nursing responsibilities:
 1) Maintenance of Pulmonary
Ventilation:
 Position the client to
side lying or semi-
prone position to
prevent aspiration
03/06/11 206
Oropharyngeal or

nasopharyngeal airway:
 Is left in place following administration
of general anesthetic until
pharyngeal reflexes have returned

 It is only removed as soon as the

client begins to awaken and has
regained the cough and swallowing
reflexes
03/06/11 207
All clients should received O2 at
least until they are conscious
and are able to take deep breaths
on command

Shivering of the client must be


avoided to prevent an increase in

O2, and should be administered
until shivering has ceased
03/06/11 208
 2) Maintenance of Circulation:
 Most common cardiovascular complications:
 a) Hypotension
 Causes:
 Jarring the client during
transport while moving
client from the OR to his
bed
 Reaction to drug and 03/06/11 209
C. Post-Operative Phase
 Causes:
vLoss of blood and other
body fluids
vCardiac arrhythmias and
cardiac failure
vInadequate ventilation
vPain
03/06/11 210
 b) Cardiac arrhythmias
 Causes:
 Hypoxemia
 Hypercapnea
 Interventions:
 O2 therapy
 Drug administration:
 Lidocaine
 Procainamide (Pronestyl)
03/06/11 211
3) Protection from injury

and promotion of comfort

§ Provide side rails
§ Turning frequently and placed in
good body alignment to
prevent nerve damage from
pressure
§ Administration of narcotic
analgesics to relieve incisional
pain 03/06/11 212
 B) Dismissal of client from
recovery room: Modified
Aldrete Score for Anesthesia
Recovery Criteria

The Five Physiological


Parameters:
 1. Activity
 2. Respiration
 3. Circulation
03/06/11 213
Post Anesthesia Care Unit

MODIFIED ALDRETE SCORE
After
Point Score 1 hour 2 hours 3 hours
Area of assessment
Muscle activity:
2
Moves spontaneously or on command
1
Ability to move all extremities
0
Ability to move 2 extremities
Respiration: 2
Unable to control any extremity
Ability to breath deeply and cough
1
0
Limited respiratory effort (dyspnea and
splinting)
No spontaneous effort
03/06/11 214
P o st A n e sth e sia C a re U n it
M O D IF IE D A L D R E T E S C O R E
After
Area of assessment
2
Circulation:
BP +/- 20% of pre-anesthetic level
1
0
BP +/- 20%-40% of pre-anesthetic level
 Consciousness Level: 2
BP +/- 50% pre-anesthetic level
Fully awake
1
0
Arousable on calling
Not responding
03/06/11 215
P o st A n e sth e sia C a re U n it
M O D IF IE D A L D R E T E S C O R E
After
Area of assessment
2
O2 Saturation:
Unable to maintain O2 sat >92% on room air
1
0
Needs O2 inhalation to maintain O2 sat >90%
O2 sat <90% even with O2 supplement
Required for discharge from PACU: 7-

8
Total Points
03/06/11 216
CARE OF THE PATIENT
 ROUTINE RECOVERY
a)Airway patency, vital signs, and
oxygenation should be checked
immediately on arrival
b)Blood pressure, pulse rate, and
respiratory rate measurements are
routinely made at least every 5 min
for 15 min or until stable, and every
15 min thereafter
c)Pulse oximetry should be monitored
continuously
d)Neuromuscular function should be
assessed clinically
OT
PACU
Ward
Home
Post - operative interventions
 PAIN MANAGEMENT

Pain is usually greatest during the

12 - 36 hours after surgery
Narcotic analgesics and NSAIDS may
be prescribed together for the

early period of surgery
Provide back rub , massage ,
diversional activities , position

changes


 POSITIONING
vClients who have spinal
anesthesia is usually
placed FLAT on bed for
8 - 12 hours
vUnconscious client is
placed side lying to
drain secretions
vOther positions are
utilized BASED on the
Deep
breathing
and coughing
exercises
Q2 - 4 hours
0 to remove
secretions


§ Leg exercises
Q 2 hours 0
to promote
circulation
§ Ambulation
ASAP0
prevents
respiratory ,
circulatory ,
urinary and
gastrointest
inal
Post - operative
interventions
§ Hydration after
NPO to
maintain fluid
balance
§ Suction, either
gastro or
respiratory
to relieve
distention, to
remove respi
secretions
Liquid Diet VS Soft diet
Clear liquid Full liquid Soft diet
Coffee Clear liquid PLUS: All CL and FL
Tea Milk/Milk prod plus:
Carbonated Vegetable juices Meat
drink Cream, butter Vegetables
Bouillon Yogurt Fruits
Clear fruit Puddings Breads and
juice Custard cereals
Popsicle Ice cream and Pureed foods
Gelatin sherbet
Hard candy
wound drainage
Hemovac
Jackson-Pratt
Penrose drain
T-tube
Salem Sump
tube
Chest Physiotherapy
 Chest Physiotherapy
 Chest physiotherapy is based on the
fact that mucus can be knocked

or shaken form the walls of the
airways and helped to drain from
the lungs.

 The usual SEQUENCE is as follows-

POSITIONING, Percussion,
Vibration, and removal of
secretions by SUCTIONING or
Coughing followed lastly by oral
hygiene
C h e st P h y sio th e ra p y
Incentive Spirometry
ü
ü This operates on the principle that
spontaneous sustained maximal
inspiration is most
beneficial to the lungs and
has virtually no adverse
effects .
ü The incentive spirometer
measures roughly the inspired
volume and offers the
“ incentive ” of measuring
progress
Incentive Spirometry
Post operative
complications
Atelectasis Collapsed Assess breath

alveoli due to sounds

Repositioning
secretions Deep breathing and
coughing
Pneumonia Inflammation Chest physio
Thrombophlebitis Inflammation
of alveoli
Leg exercises
Suctioning

of the veins Monitor for swelling

Ambulation
Elevated
extremities
ATELECTASIS
PNEUMONIA
DEEP VENOUS THROMBOSIS
*HOMAN’S SIGN
EMBOLUS: MIGRATION OF A
CLOT
Post-operative Complications
Hypovolemic Loss of Shock position
Determine cause and
Shock circulatory
prevent bleeding
fluid volume O2, IVF
Urinary Involuntary Encourage ambulation

Provide privacy
retention accumulation Pour warm water
of urine Catheterize
Pulmonary Embolus Notify physician

Administer O2w
embolism blocking the 
lung blood
flow
HYPOVOLEMIC SHOCK
MODIFIED TRENDELENBURG
Post-operative complications
Constipation Infrequent High fiber diet
Increased fluid
passage of Ambulation
stool
Paralytic ileus Absent bowel Encourage


sound ambulation
NPO until

peristalsis returns
Wound Occurs about 3 Daily wound

infection days after dressing

Antibiotics

surgery
Maintain drain

Maintain drain

WOUND
DISRUPTION
Post - operative
complications
Wound Separation of Cover the wound
dehiscence wound edges at with sterile normal
saline dressing
the suture line Place in low-
Fowler’s
Notify MD
Wound Protrusion of the Cover the wound


evisceration internal organs with saline pad

Place in low-

and tissues
fowler’s
through wound Notify MD

Wound
DEHISCENCE
Wound evisceration
INCISIONAL HERNIA
INCISIONAL HERNIA
Perioperative Care
Discharge Plans
•Patient/Family Education and Psychosocial Support is
throughout.
–Return MD Visit
–Dressing Care and Comfort
–Optimum respiratory,circulatory function, diet,
meds(antibiotics, analgesic)
–Adequate hydration and body temperature
–Adequate renal function, safety in ADL
DISCHARGE
INSTRUCTIONS
•CARE OF THE INCISION
•SIGNS OF COMPLICATIONS
•DRUGS FOR PAIN MANAGEMENT
•HOW TO SELF ADMINISTER
PRESCRIBED MEDICATIONS
•ACTIVITY LEVEL
•AMOUNT OF WEIGHT THAT CAN BE
LIFTED
•DIET
•RETURN FOR A MEDICAL
APPOINTMENT
Thank You!!!

Perioperative Nursing

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Perioperative Nursing

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Peri-Operative

Reconstruct partial or complete restoration

y Large amount of blood

may be handled or removed

y Generally not prolonged;

Imperati  must be performed as soon as

Planned - necessary for client well being

Elective  should be performed for the

INPATIENT Client has been in

 4). Tranquilizers - potentiate the effect

 This period is used to physically

 The nurse plays a major role in

üAssessing and correcting physiologic

1.Preparation for hospital admission

üAnxiety related to lack of

üAssess client’s fears,

üExplain routine procedures,

This is to protect the surgeon and the

1 .) The Surgeon obtains operative

3 .) Adult Patients ( over 18 y / o )

Consents are not needed for

4 . Past Medical History

A- Allergy to medications, chemicals, and

4 . Past Medical History

B- Bleeding tendencies or the use

4 . Past Medical History

C- Cortisone and steroid use

4 . Past Medical History

4 . Past Medical History

E- Emboli; previous embolic

1.Vital signs taken and recorded

Types of Pre - Operative

Types of Pre - Operative

Types of Pre - Operative

Types of Pre - Operative

•During the surgery, the scrub

•Manages the individual

•Works in the OR in the area

•Works in the OR in the area

Monitoring the room and

surgery and anesthesia

higher than the

dry the hands

dry the hands

- Every person who dispenses a

-In unfolding sterile drape , the

or areas . Persons who are

or areas . Persons who are

or areas . Persons who are

field . Sterile persons

field . Sterile persons

field . Sterile persons

field . Sterile persons

field . Sterile persons

-Sterile persons face

-Unsterile persons maintain

-Unsterile persons never walk

c . Infected areas are

A pneumatic dual - cuff

This type of anesthesia is used

abdominal surgery and some lower

upper abdominal, neck and face surgery

part of the body