Perioperative Nusring is the care of a client or patient before, during and after and operation.

It is
a specialized nursing area wherein a registered nurse works as a team member of other surgical
health care professionals. Perioperative nursing entails a lot of responsibilities and here are some
of them:

Preoperative Phase
Preadmission Testing
1. Initiates initial preoperative assessment.
2. Initiates teaching appropriate to patients to patients needs.
3. Verifies completion of preoperative testing.
4. Verifies understanding of surgeon-specific preoperative orders (e.g. bowel preparation,
preoperative shower)
5. Assess patient’s need for postoperative transportation and care.

Admission to Surgical Center or Unit

1. Completes preoperative assessment.
2. Assess for risk for postoperative complications.
3. Reports unexpected findings or any deviation from normal.
4. Verifies that operative consent has been signed.
5. Reinforce previous teaching.
6. Explain phase in perioperative period and expectation.
7. Develop a plan of care.

In Holding Area
1. Assess patient’s status, baseline pain and nutritional status.
2. Review chart.
3. Identifies patient.
4. Verifies surgical site and marks site per institutional policy.
5. Establishes intravenous line.
6. Administers medication if prescribed.
7. Takes measures to ensure patient’s comfort.
8. Provides psychological support.
9. Communicates patient’s emotional status to other appropriate members of the health care
team.

Intraoperative Phase
Maintenance of Safety
 1. Maintains aseptic, controlled environment.
2. Effectively manages human resources, equipment, and supplies for individualized patient
care.
3. Transfer patient to operating room bed or table.
4. Position the patient: function alignment, exposure of surgical site.
5. Applies grounding device to patient.
6. Ensure that the sponge, needle, and instrument counts are correct.
7. Completes intraoperative documentation.

Physiologic Monitoring
1. Calculates effect on patient of excessive fluid loss or gain.
2. Distinguishes normal from abnormal cardiopulmonary data.
3. Reports changes in patient’s vital signs.

Post Operative Phase

Transfer of Patient to Postanesthesia Care Unit
Communicates intraoperative information:

1. Identifies patient by name.

2. States type of surgery performed.
3. Identifies type of anesthetic used.
4. Reports patient’s response to surgical procedure and anesthesia.
5. Describes intraoperative factors (e.g., insertion of drains or catheters, administration of
blood, analgesic agents, or other medications during surgery, occurrence of unexpected
events.
6. Describes physical limitation.
7. Reports patient’s preoperative level of consciousness.

Postoperative Assessment Recovery Area

1. Determines patient’s immediate response to surgical intervention.
2. Monitor patient’s physiologic status.
3. Assess patient’s pain level and administers appropriate pain relief measures.
4. Maintains patient’s safety(airway, circulation, prevention of injury)
5. Administer medication, fluid and blood component therapy, if prescribed.
6. Assess patient’s readiness for transfer to inhospital unit or for discharge home based on
institutional policy.
Surgical Unit/Ward
1. Continues monitoring of patient’s physical and psychological response to surgical
intervention.
2. Provides teaching to patient during immediate recovery period.
3. Assist patient in recovery and preparation for discharge home.
4. Determines patient’s psychological status.
5. Assist with discharge planning.

Home or Clinic
1. Provides follow-up care during office or clinic visit or by telephone contact.
2. Reinforce previous teaching and answer patients and family questions about surgery and
follow-up care.
3. Assess patient’s response to surgery and anesthesia and their effects on body image and
function
Anesthesia, or anaesthesia has traditionally meant the condition of having sensation (including
the feeling of pain) blocked. This allows patients to undergo surgery and other procedures
without the distress and pain they would otherwise experience. The word was coined by Oliver
Wendell Holmes, Sr. in 1846. Another definition is a “reversible lack of awareness”, whether
this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a
the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia differs
from analgesia in blocking all sensation, not only pain.

Classification:

A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes such
as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness centers in the
brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial
sleep), and relaxation (rendering a part of the body less tense) occur. General anesthetics are
usually administered by intravenous infusion or by inhalation of gases through a mask or through
an endotracheal tube inserted into the trachea.

Advantages:

1. Because the client is unconscious rather then awake and anxious, respiration and
cardiac function are readily regulated.
2. The anesthesia can be adjusted to the length of the operation and the client’s age
and physical status.

Disadvantage:

1. It depresses the respiratory and circulatory systems.

2. Some clients become more anxious about a general anesthetic that about the
surgery itself. Often this is because they fear losing the capacity to control their
own bodies.

B. Regional Anesthesia - is the temporary interruption of the transmission of nerve impulses to

and from a specific area or region of the body. The client loss sensation in an area of the body
but remains conscious. Several techniques are used:

Topical (surface) Anesthesia Is applied directly to the skin and mucous

membranes, open skin surfaces, wounds, and burns.
The most common used topical agents are lidocaine
(Xylocaine) and benzocaine. Topical anesthetics are
readily absorbed and act rapidly.
Local Anesthesia (Infiltration)is injected into a specific area and is
used for minor surgical procedures such as suturing a
small wound or performng a biopsy. Lidocaine or
tetracaine 0.1% may be used.
Nerve Block Is a technique in which the anesthetic agent is

Intravenous block (Bier
block)
Spinal anesthesia
(Subarachnoid block)
Epidural (peridural)
anesthesia
injected into and around a nerve or small nerve group
that supplies sensation to a small area of the body.
Major blocks involve multiple nerves or a plexus
(e.g. the brachial plexus anesthetizes the arm); minor
blocks involve a single nerve (e.g. a facial nerve)
Is used most often for procedures involving the arm,
wrist and hand. An occlusion tourniquet is applied to
the extremity to prevent infiltration and absorption of
the injected intravenous agent beyond the involved
extremity.
It requires a lumbar puncture through one of the
interspaces between lumbar disc 2 (L2) and the
sacrum (S1). An anesthetic agent is injected into the
subarachnoid  space surrounding the spinal cord.
Categorized into Low Spinals (saddle or caudal
blocks) are primarily used for surgeries involving the
perineal or rectal areas. Mild Spinals (below the
level of the umbilicus – T10) can be used for hernia
repairs or appendectomies. High Spinals (reaching
the nipple line – T4) can be used for surgeries such
as cesarean sections.
Is an injection of an anesthetic agent into the epidural
space, the area inside the spinal column but outside
the dura mater.

Conscious Sedation may be used alone or in conjuction with regional anesthesia for some
diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of the
level of consciousness in which the client retains the ability to maintain a patent airway and
respond appropriately to commands.

Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such as
diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious
sedation. Conscious sedation increases the client’s pain threshold and induces a degree of
amnesia but allows for prompt reversal of its effects and a rapid return to normal activities of
daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon
angioplasty may be performed under conscious sedation.

Risk Factors for Complications During the Procedure:

 Current or past health problems

 Taking medications, supplements, or herbal remedies, blood thinners
 Allergies (eg, food allergies, medication allergies, latex allergies)
 Smoking
 Drinking alcohol
 Taking recreational drugs
 Personal or family history of adverse reactions to anesthesia

Possible Complications:

 Pain and tenderness around the injection site

 Bruising, infection, or bleeding of the injection site
 Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a result
of a broken blood vessel)
 Spinal headache (a severe headache that may occur after spinal or epidural anesthesia)
 Decrease in blood pressure
 Nerve damage
 Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat,
and funny taste or numbness around the mouth
 Horner’s syndrome (change of pupil size on one side)
 Ptosis (drooping of the eyelid)
 Pneumothorax (air trapped between the lung and rib cage)

Call Your Doctor If Any of the Following Occurs:

 Signs of infection, including fever and chills

 Redness, swelling, increasing pain, or discharge from the injection site
 Tingling, numbness, or trouble moving around the affected area
 Headache
 Persistent coughing
 Chest pain
 Trouble breathing or shortness of breath
 Dizziness
 Heartbeat abnormalities
 Funny taste or numbness of the mouth
 Other worrisome symptoms
LIST OF INSTRUMENTS IN THE OPERATING ROOM

babcock
allis tissue forceps
kelly (straight & curved)
metzambaum
ovum forceps
mayo forceps
needle holder
blade holder
thumb forceps
army navy retractor
richardson retractor
mosquito forceps

Read more:
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