VN 235 PERIOPERATIVE NURSING

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VN 235PERIOPERATIVE NURSING

• Helen Barnes MSN, RN

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PERIOPERATIVE PHASES

• Preoperative
• Intraoperative
• Postoperative

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Perioperative Phases

• Preoperative
• Begins with decision
• ends with transfer to O.R.
• Intraoperative
• Begins with transfer to OR
• ends with admission to PACU.
• Postoperative
• Begins with admission to PACU
• ends when recovery is complete.

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Types of Surgery

• Emergent - immediate
• Urgent- needed within 24 - 30 hours
• Elective planned no time requirements
• Aesthetic- for improvement
• Diagnostic- tissue samples or oscopy
• Exploratory- confirmation of extent of condition

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Types of Surgery

• Preventive- removal before it causes a problem
• Curative- removal of diseased tissue
• Reconstructive- correction of body parts
• Palliative- alleviation of symptoms without
  curing disease

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Preoperative Phase

• Nursing Goal Identify /implement actions to
  decrease surgical risk factors.
• Emotional Responses
• Age
• Hydration/Nutrition
• Smoking/Alcohol
• Diseases

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Preoperative Assessment

• Health history
• Identify risk factors
• Client and family teaching
• Referrals to social work, support groups,
  education programs
• Lab test, ECG, chest x-ray
• Copy of advance directives

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Preoperative Assessment

• Subjective Data - Health history questions
• Demographic
• Health history
• Surgical history
• Tobacco use
• Alcohol use
• Coping techniques
• Family history
• Female patients

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Preoperative Assessment

• Objective Data - Body System Review
• Vital signs, oxygen saturation
• Height/weight
• Emotional status
• Neurological
• Skin
• Respiratory/Cardiovascular
• Gastrointestinal
• Musculoskeletal

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ABCDE Mnemonic Device

• To ascertain serious illness or trauma in
  preoperative client
• A Allergy to medications, chemicals, latex
• B - Bleeding tendencies or use of
  anticoagulants, including herbal remedies
• C Cortisone
• D Diabetes mellitus
• E Emboli previous history/prolonged
  immobility.

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Nursing Process

• Nursing Diagnosis
• Anxiety R/T potential change in body image,
  hospitalization, pain, loss of
• control, uncertainties about surgery
• Planning/Goals
• Decrease anxiety
• Increase knowledge of surgical routines and
  procedures

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Nursing Interventions

• Inform client about procedures and routine.
• Allow to express concerns.
• Notify doctor if the client expresses extreme
  anxiety or fear.
• If fear is excessive, the doctor may reschedule
  the surgery until client can cope.

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Hydration and Nutrition

• Maintain normal fluid and electrolyte balance
• Increase levels of protein ( tissue repair), Vit.
  C (collagen formation), and zinc (tissue growth,
  skin integrity, and cell-mediated immunity)
• Obese /underweight may not heal well. May have
  complications

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Medications

• Anticoagulants - stop prior to surgery
• Diabetic medications- hold or take 1/2 dose as
  ordered
• Steroids - may cause circulatory collapse if
  stopped abruptly. Can be given IV if NPO
• Cocaine, marijuana, opiods can interact with the
  anesthesia.

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Geriatric Consideration

• Preoperatively
• Reassure client/family
• Pad bony prominences
• Teach what to expect before, during, after
  surgery
• Complete preop screening lab work, radiographic,
  nutritional assessment, PFT, ECG

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Geriatric Consideration

• Intraoperatively
• Assess for hypothermia/hypoxia/ hemorrhage/output
• Postoperatively
• Pain control
• Respiratory function
• Mobility
• Bowel and urinary function
• Delirium

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Preoperative Consent

• Legal permission for surgery, invasive
  procedures, anesthesia, blood administration,
  radiation or cobalt therapy
• Protects patient from unauthorized procedures
• Protects physicians, anesthesiologist, hospital
  employees from claims of performing unauthorized
  procedures

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Informed Consent

• Criteria
• Physician must tell client in understandable
  terms about diagnosis, proposed treatment, who
  will perform it, risks, alternative treatments
  prognosis.
• Must be signed before analgesics or sedation.
• Must be voluntary
• In medical emergency, next of kin by phone, or
  court order. Physician documents need of
  treatment to save life.

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Preop Nursing Interventions

• NPO after MN. If surgery in the afternoon, may
  have clear liquids in early morning.
• May brush teeth, but not swallow water.
• Medications may be taken with small amount of
  water.
• Enemas if needed for bowel surgery.
• Teach on active participation in postop care to
  improve recovery.

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Preop Nursing Interventions

• Preop checklist
• ID, VS, signed consent form
• Remove make-up, hair pins, wigs, jewelry,
  underwear.
• Remove label dentures, prostheses, glasses,
  hearing aids.
• Check test results, H P
• Valuables- give to family member/security
• Ted hose if ordered. Void prior to preop
  medication. Side rails up.

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Preop Medications

• Narcotics - analgesia
• Antianxiety- decrease anxiety
• Anticholinergic- decrease secretions
• Antiemetic- control nausea/vomiting
• Histamine (H2) antagonist- decrease gastric acid
  secretions
• Alkalinizing agent- prevent asthma-like attack
• Antibiotic - prevent infection

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Preop Family Instructions

• Information on where to wait during surgery and
  who communicates clients status to them.
• Same day surgery clients must have a driver
  waiting.

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Postop Exercises

• Deep breathing and coughing every hour while
  awake
• Incentive spirometer every hour while awake
• Arm and leg exercises
• Turn every two hours
• Sit up, dangle and ambulate

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The End