Week 8: perioperative care

● Preoperative Care
○ Informed consent
■ The surgeon is responsible for explaining the surgical procedure to the
patient and answering questions
■ The nurse is typically responsible for obtaining the patient’s signature on
the consent form; the patient MUST understand the surgeon’s explanation
of the surgery
■ If the patient isn’t well informed, the nurse should not allow them to sign
and should call the surgeon to further explain to the patient
■ Patients under 18 years old need a parent or legal guardian to sign the
consent form
○ Nutrition
■ Check the surgeon’s orders regarding NPO - it is typically 6-8 hours prior
to anesthesia or NPO after midnight
■ Insert an IV to administer IV fluids
○ Elimination
■ The patient should void immediately before surgery
■ If prescribed, insert an indwelling urinary catheter
○ Surgical site
■ Clean the surgical site with a mild antiseptic or antibacterial soap on the
night before surgery, as prescribed
■ Shave the operative site, as prescribed
○ Teaching
■ Inform the pt about what to expect postoperatively
■ Instruct the pt about pain - it is normal and some degree of pain is
expected; pain medication can be requested and given
■ Teach the pt about deep-breathing and coughing techniques, incentive
spirometry and ambulation to prevent pneumonia
○ Psychosocial preparation
■ Assess pt’s level of anxiety
■ Provide support & assistance as needed
○ Preoperative checklist
■ Pt wearing ID band, assess for allergies, lab work, consent signed, history
& physical exam completed & documented, consultation requests
completed, ECG and chest radiography reports are documented in records,
blood type, screen & crossmatch are performed, remove jewelry, makeup,
dentures, hairpins, nail polish, glasses and prostheses, document valuables
given to family or locked, document last time when pt ate or drank,
 document pt voiding before surgery, document administration of pre-op
meds, monitor & document vital signs
● Postoperative
○ Respiratory
■ Monitor vital signs, airway patency and ensure adequate ventilation
■ Monitor for secretions; symmetrical chest movement and use of accessory
muscles
■ Monitor pulse ox and oxygen administration if prescribed
■ Encourage deep-breathing and coughing exercises
○ Cardiovascular
■ Monitor circulatory status (skin color, peripheral pulses, cap refill, edema,
numbness, tingling)
■ Monitor for bleeding; assess pulse
■ Monitor for signs of hypertension & hypotension; cardiac dysrhythmias
■ Encourage use of antiembolism stockings and sequential compression
devices
○ Musculoskeletal
■ Assess pt for movement of the extremities
■ Review orders for positioning or restrictions
■ Encourage early ambulation if prescribed
■ Place pt in low fowler’s
■ Avoid supine position
■ If pt cannot get out of bed, turn the pt every 1-2 horus
○ Neurological
■ Assess LOC; make frequent attempts to awaken the pt; orient the pt to the
environment; sepak in a soft tone
■ Maintain the pt’s body temp and prevent heat loss with warm blankets
○ Temperature control
■ Monitor temperature
■ Monitor for signs of hypothermia that may result from anesthesia, cool
operating room or exposure of the skin and internal organs during surgery
■ Apply warm blankets, continue oxygen and administer medication
○ Integumentary system
■ Assess surgical site, drains and wound dressings
■ Assess skin for redness abrasions, or break-down that may have resulted
from surgical positioning
■ Monitor body temp and wound for signs of infections
■ Maintain dry, intact dressing, change dressings as prescribed
■ Wound drains should be patent, prepare to assist with the removal of
drains
○ Fluid & electrolyte balance
■ Monitor IV fluid administration as prescribed
■ Record intake and output
■ Monitor for signs of fluid or electrolyte imbalances
○ Gastrointestinal system
■ Monitor intake and output & for nausea and vomiting
■ Maintain patency of the NG tube if present and monitor placement and
drainage
■ Monitor for abdominal distention
■ Monitor for passage of flatus and return of bowel sounds
■ Administer oral care, at least every 2 hours
■ Maintain NPO status until gag reflex and peristalsis returns
■ Ensure that when the client advances to clear liquids then to regular diet as
prescribed and as tolerated
○ Renal system
■ Assess bladder for distention
■ Monitor urine output (at least 30mL/hr)
■ Pt is expected to void within 6-8 hours of the procedure and at least
200mL without an urinary catheter
○ Pain management
■ Assess for pain and inquire about type, location, and severity
■ Monitor for objective data related to pain: facial expressions, body
gestures, increased HR, increased BP, and increased RR
■ Administer pain medication as prescribed
■ If pt has a PCA, ensure that the pt knows how to use it
■ Monitor pt if administering opioids
■ Use noninvasive measures to relieve postop pain - guided imagery,
distraction, relaxation, backrubs, positioning