Perioperative Nursing RNSG 1413

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Perioperative NursingRNSG 1413

• Amy C. Chavarria, RN, MSN, MBA, HCM, CCE

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Phases of the Perioperative Period

• Preoperative
• Decision for surgery
• Informed consent
• Nursing assessment
• Nursing diagnosis
• Planning
• Implementation
• Intraoperative
• Postoperative

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Preoperative Assessment

• Current health status
• Allergies
• Medications
• Previous surgeries
• Mental status
• Understanding of the surgical procedure and
  anesthesia
• Smoking, alcohol and other mind-altering
  substances
• Coping
• Social resources
• Cultural and spiritual considerations

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Various Types of Surgery

• Degree of urgency
• Emergency
• Elective
• Degree of risk
• Major
• Minor

• Purposes of surgical procedures
• Diagnostic
• Palliative
• Ablative
• Constructive
• Transplant

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Physical Assessment

• Mini mental status
• Respiratory
• Cardiovascular
• Other systems (gastrointestinal, genitourinary,
  and musculoskeletal)
• Preoperative diagnostic tests

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Nursing Diagnoses

• Preoperative phase
• Deficient Knowledge
• Anxiety
• Disturbed Sleep Pattern
• Anticipatory Grieving
• Ineffective Coping

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Nursing Diagnoses

• Intraoperative phase
• Risk for Aspiration
• Ineffective Protection
• Impaired Skin Integrity
• Risk for Perioperative-Positioning Injury
• Risk for Impaired Body Temperature
• Ineffective Tissue Perfusion
• Risk for Deficient Fluid Volume

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Nursing Diagnoses

• Postoperative phase
• Acute Pain
• Risk for Infection
• Risk for Injury
• Risk for Deficient Fluid Volume
• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Self-Care Deficit Bathing/Hygiene,
  Dressing/Grooming, Toileting
• Ineffective Health Maintenance, and Disturbed
  Body Image

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Planning Preoperative Phase

• Overall goal
• Ensure that the client is mentally and physically
  prepared for surgery
• Preoperative teaching
• Physical preparation
• Psychological preparation
• Discharge planning

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Planning Intraoperative Phase

• Overall goals
• Maintain the clients safety
• Maintain homeostasis

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Planning Perioperative Phase

• Overall goals
• Promote comfort and healing
• Restore highest possible level of wellness
• Prevent associated risks

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Dimensions of Preoperative Teaching

• Information
• Psychological support
• Explain roles of the client and support people in
  preoperative preparation, during the surgical
  procedure, and during the postoperative period
• Skills training

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Preoperative Instruction

• Preoperative regimen
• Postoperative regimen
• Special instructions for outpatient surgical
  clients

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Dimensions of Preoperative Teaching

• Skills training
• Moving
• Deep breathing
• Coughing
• Splinting incisions
• Using an incentive spirometer

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Skills Training

• Moving
• Promote venous return
• Mobilize secretions
• Stimulate gastrointestinal motility
• Facilitate early ambulation
• Leg exercises
• Promote venous return
• Prevent thrombophlebitis and thrombus formation

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Skills Training

• Deep breathing and coughing
• Enhance lung expansion
• Mobilize secretions
• Prevent atelectasis and pneumonia

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Skills Training
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Preparing a Client for Surgery

• Nutrition and fluids
• Elimination
• Hygiene
• Medications
• Rest and sleep
• Valuables

• Special orders
• Skin preparation
• Safety protocols
• Vital signs
• Antiemboli stockings
• Sequential compression devices

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Types of Anesthesia

• General
• Regional or local

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General Anesthesia

• Loss of all sensation and consciousness
• Loss of protective reflexes
• Block awareness centers in brain
• Administered by IV or inhalation

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Regional or LocalAnesthesia

• Topical or surface
• Local or infiltration
• Nerve block
• Intravenous block or Bier block
• Spinal
• Epidural or peridural
• Conscious sedation

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Nursing Care During theImmediate
Postanesthetic Phase

• Assessment
• Adequacy of airway
• Oxygen saturation
• Adequacy of ventilation
• Cardiovascular status
• Level of consciousness
• Presence of protective reflexes
• Activity, ability to move extremities

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Nursing Care During the Immediate Postanesthetic
Phase

• Skin color
• Fluid status
• Condition of operative site
• Patency of and amount and character of drainage
  from catheters, tubes, and drains
• Discomfort
• Safety

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Nursing Care During the Immediate Postanesthetic
Phase

• Interventions
• Position client on side, with the face slightly
  down
• Elevate upper arm on a pillow
• Suction as needed until cough and swallowing
  reflexes return
• Help client to cough and deep breathe
• Keep the client flat for specified period of time
  if the client had spinal anesthesia

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Nursing Care During Postoperative Phase

• Initial assessment
• Level of consciousness
• Vital signs
• Skin color and temperature
• Comfort
• Fluid balance
• Dressing and bedclothes
• Drains and tubes

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Nursing Care During Postoperative Phase

• Nursing interventions
• Pain management
• Appropriate positioning
• Incentive spirometry
• Deep breathing and coughing exercises
• Leg exercises
• Early ambulation
• Adequate hydration
• Diet
• Promoting urinary and bowel elimination
• Suction maintenance
• Wound care

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Potential Postoperative Complications

• Respiratory
• Pneumonia
• Atelectasis
• Pulmonary embolism

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Potential Postoperative Complications

• Circulatory
• Hypovolemia
• Hemorrhage
• Hypovolemic shock
• Thrombophlebitis
• Thrombus
• Embolus

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Potential Postoperative Complications

• Urinary
• Urinary retention
• Urinary tract Infection
• Gastrointestinal
• Nausea and vomiting
• Constipation
• Tympanites
• Postoperative ileus

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Potential Postoperative Complications

• Wound
• Wound infection
• Wound dehiscence
• Wound evisceration
• Psychologic
• Postoperative depression

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Management of GI Suction

• Continuous or intermittent
• Replace fluid and electrolytes
• May need to irrigate tube if lumen clogged
• See Skill 37-3

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Wound Care for the Postoperative Client

• Dressings should be clean, dry, and intact
• Assess wound for
• Appearance
• Size
• Drainage
• Swelling
• Pain
• Drains or tubes
• See Skill 37-4 Cleaning a Sutured Wound and
  Applying a Sterile Dressing

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Use of Montgomery Straps
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Methods of Cleaning Surgical Wounds
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Precut Gauze Around Drain
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Evaluating Perioperative Care

• Evaluate pre, intra, and postoperative goals
  according to specific outcomes
• If not achieved, explore reasons before modifying
  care plan

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