PERIOPERATIVE CARE

ARIANTI, M.KEP., NS.,

SP.KEP.MB
SURGERY (OPERATIVE)
Surgery is medical treatment in
which someone’s body is cut
open so that doctor can repair,
remove, or replace a diseased
or damage part

TYPES OF SURGERY
Emergency
 Performed immediately
to preserve function or
the life of the client
Elective
Non-emergency surgery,
which is medically
necessary, but can be
delayed for at least 24
hours.
Urgent
 Necessary for client
health to prevent
additional problem from
developing

MAJOR V.S MINOR

SURGICAL PROCEDURS
Minor surgery is any
invasive operative
procedure in which only
skin or mucus membranes
and connective tissue is
resected
ex: vascular cutdown for
catheter placement,
implanting pumps in
subcutaneous tissue.

Major surgery is any

invasive operative
procedure in which a
more extensive resection
is performed, e.g. a body
cavity is entered, organs
are removed, or normal
anatomy is altered. In
general, if a mesenchymal
barrier is opened (pleural
cavity, peritoneum,
meninges), the surgery is
considered major.
PERIOPERATIVE
PERIOPERATIVE
PREOPERATIVE
PRE-OPERATIVE
PRE-OP ASSESSMENT
History
Indication of surgery,
allergies, side effect to
medications, medical
problems, surgical history,
major trauma, and
current medication

Physical examination
General system
examination:
cardiovascular,
gastrointestinal, previous
surgical scars, skeletal
malformations
Heart rate, blood pressure
Investigations
Chest radiographs,
electrocardiograms (<60
y.o with asthmatic or a
smoker, and >80y.o)
Full blood count
 Suspected for anemia,
major surgery, >60y.o,
baseline for comparison
with post-operative
testing.
Biochemistry
Urea-creatinine (renal
function >40y.o with
major surgery, liver
function test (alcohol
intake, cirrhosis),
electrolytes, natrium
Coagulation screening
History of bleeding
disorder, liver disease,
malnutrition, patients om
anticoagulant

PSYCHOSOCIAL PRE-OP
CARE
Understanding and
perception of the
procedure to be
performed
Coping ability/support
system
Ability to comprehend
Readiness to learn
Anxiety related to the
surgical intervention or
surgical outcome
Knowledge of
perioperative routines
Cultural; or spiritual;
beliefs relevant to surgical
intervention
Preparing Patient for
Surgery
Nursing Diagnoses
Knowledge deficits
Anxiety
Fear
Anticipatory grieving r.t
possible changes in body
image

Confirm the consent,

describe the expected
 sequence of events,
express feeling about the
surgical experience,
indicate knowledge of
expected surgical
outcomes, confirm
procedures to be followed
upon discharge

INTRA-OPERATIVE
Operative Team
Surgeon
Anesthesiologist
Certified registered nurse
anesthetist (CRNA)
Scrub nurse (optional)
Circulating nurse (OR
Nurse)

INTRA-OPERATIVE
Patient is transferred to
the operating room (OR)

End – Patient is
transferred from OR to
Post Anasthesia Care Unit
(PACU)
SCRUB
STERILE GOWN
SKIN PREPARATION
DRAPPING
Nursing Activities intra-
operative

Transfer Room
Recovery Room (PACU)
 POST-OPERATIVE:
Discharge form recovery
room to the ward

First Post-Operative
Assessment
Intraoperative history
Post-operatives
instructions
Circulatory volume status
Respiratory status
Cognitive state

Monitoring:
Temperature, pulse rate,
blood pressure,
respiratory rate, urine
output, peripheral oxygen
saturation, pain scores

Cardiovascular Monitoring
Heart Rate and Blood
Pressure
Hypertension is a
common in Post-op. It
caused from pain, anxiety,
and discontinuing
antihypertensive
medication
Hypotension is also
common in post-op. It
caused from hypovolemia
due to bleeding or
dehydration, or drug
therapy
Myocardial ischemia in
the first 48 hours post-
op serious cardiac
event
Respiratory Monitoring
Common cause of post-op
morbidity and mortality
Risk factors:
High BMI, smoking, COPD,
mechanical ventilation in
the post-op care
Indicators:
RR<10 or >25breaths/min
Pulse rate >100 beats/min
Fluid and Electrolytes
FLUID BALANCE IN THE
POST-OP  EARLY ORAL
INTAKE

 Check vital sign

regularly
 Fluid balance
(hemorrhage, fluid loss
 via drains, vomiting,
diarrrhoea)
Hypotension,
tachycardia, oliguria,
confusion, and
tachypnea --?
hypovolemia
Pain Control
Pain is often the patient’s
presenting symptom
Manage pain as soon as
possible
Prevention of
Complications
Encourage early
mobilization
Ensure adequate nutrition
Prevent skin breakdown
dan pressure sores
Provide adequate pain
control
EARLY NUTRITION

Thank You