Preoperative: begins with the decision to
perform surgery and continues until the
client has reached the operating area.
Perioperative nurses are focused solely on
patient care before, during, and after
surgical procedures. In clinical and hospital
settings, these registered nurses ensure
that surgical procedures run smoothly. They
work alongside surgeons, anesthesiologists,
and nurse practitioners and relay vital
communications about patient care to other
nurses and medical staff.
The day-to-day responsibilities of a
perioperative registered nurse include:
Helping patients complete surgical
paperwork, answering their
questions, helping them understand
what will happen in the operating
room, and calming their fears before
surgery.
Monitoring patient conditions during
and after surgery.
Managing nursing care in the
operating room to maintain a safe
and comfortable environment.
Sterilizing surgical equipment and
the operating room.
Educating patients on best practices
for recovery, including how to keep
wounds clean and pain management
options and routines.
Pre-operative plan
* Gather and record all relevant information
* Optimize patient condition
* Choose surgery that offers minimal risk
and maximum benefit
* Anticipate and plan for adverse events
* Inform everyone concerned.
Steps of P.O.P's
* History
* Examinations
* Investigations
* Preoperative treatments
* Documentation
* Communications - Valid consent
Types of patients
* Out-Patient Department
* Usually seen 1-2 weeks before surgery at
pre admission clinic
* Emergency department
* Need initial assessment & immediate
resuscitation
Documentation
● History - presented logical manner
● Investigations & Mgt plan - listed for
Action
● Drug chart - routine / prophylactic
PREOPERATIVE PHASE Goals
● Assessing & correcting physiological
& psychological problems that might
increase surgical risk
● Giving the person & significant other
complete learning/teaching
guidelines regarding surgery
● Instruct & demonstrating exercise
that will benefit the person during
post op
● Planning for discharge & any
protected changes in lifestyle due to
surgery.
Classifications of Surgical Procedures
There are different classifications of surgical
procedures which can be classified as to:
urgency, purpose and risk. These
classifications can help identify the risk of
the degree of the surgery.
Diagnostic. These kinds of surgeries are
done to determine the cause of illness
and/or confirm a diagnosis. Examples
includes: biopsy, exploratory laparotomy
(explore lap)
Ablative/Curative. These kinds of surgeries
are performed to remove a diseased part or
organ. Examples include: gastrectomy
(partial or full removal of stomach),
thyroidectomy, and appendectomy.
Palliative. To relieve symptoms without
curing the disease. These include:
colostomy, debridement of necrotic tissue.
Re-constructive. These include skin graft,
plastic surgery, scar revisions. These are
done to restore function to traumatized or
malfunctioning tissue and to improve self
concept.
Transplant. To replace organs or structures
that are diseased or malfunctioning.
Constructive. To restore function in
congenital anomalies. Cleft palate repair
(palatoplasty), closure of atrial-septal defect.
Exploratory. To estimate the extent of the
disease or confirmation of diagnosis.
Examples: Exploratory laparotomy, pelvic
laparotomy.
Aesthetic. To improve physical features
that are within normal range. Example:
breast augmentation.
Based on Urgency
Elective. These are kind of surgeries
wherein they are pre-planned. Delay of
surgery has no ill-effects. These can be
scheduled in advance based on the client’s
choice. Examples: tonsillectomy, hernia
repair, cataract extraction, mammoplasty,
face lift, and cesarean section.
Urgent. Surgeries that are necessary for
the client’s health, usually done within 24 to
48 hours. Examples: Removal
gallbladder, amputation, colon resection,
coronary artery bypass, surgical removal of
tumor
Emergent. Surgeries that must be done
immediately to preserve the client's life,
body part of body function. Examples:
Control of hemorrhage, perforated ulcer,
intestinal obstruction, repair of trauma,
tracheostomy
Physiologic Assessment of the Client
Undergoing Surgery
Age
Presence of pain
Nutritional Status
Fluid & Electrolyte balance
Infection
Cardiovascular function
Pulmonary Function
Renal Function
Gastrointestinal Function
Liver Function
Endocrine Function
Neurologic Function
Use of Medication
Presence of trauma
Health habits
Psychosocial Assessment and Care
Causes of Fears of the Preoperative
Clients
1. Fear of the unknown
2. Fear of anesthesia, vulnerability
while unconscious
3. Fear of pain
4. Fear of death
5. Fear of disturbance of body image
6. Worries- loss of finances,
employment social & family roles
PHYSICAL PREPARATION
Before Surgery
Correct dietary deficiencies
Reduce & obese person’s weight
Correct fluid & electrolyte
imbalances Restore adequate blood
volume with blood transfusion
Treat with chronic disease- renal
insufficiency, DM, heart diseases,
Halt or treat any infection process
Treat an alcoholic person with
vitamin supplementation, IVF or Oral
fluid, if dehydrated
of
Preparing the Person the Evening before
the Surgery
Preparing the skin
Preparing the GI tract
Preparing for Anesthesia
Promoting rest & sleep
Preparing the Person of the Day of
Surgery
Early AM Care
Awaken 1 hour before
Morning bath, mouth wash
Provide clean gown
Remove hair pins, braid long hairs,
cover hair with cap
Remove dentures, foreign materials,
colored nail polished, hearing aid,
contact lens, wedding ring
Take v/s before pre op medications
Check ID band
Skin prep
Check for special orders Check NPO
Have client void before pre op
medication
Continue to support emotionally
Accomplish pre op care checklist
PREOPERATIVE MEDICATIONS PRE/
ANESTHETIC DRUGS
Goals:
To facilitate the administration of any
anesthetic
To minimize respiratory tract
secretions & changes in HR
To relax the client & reduce anxiety
Commonly Used Pre Op Medications
Tranquilizers
Sedatives
Analgesics
Anticholinergics
Histamine- H2 Receptor Antagonist
Patients Family
Directs proper visiting room
Doctor inform family immediately
after surgery
 Explains reason for long interval of ● maintaining the sterility of the
waiting surgical field through aseptic
Explain what to expect post op practices.
● Assist the surgeon & surgical
Teaching Preoperative Exercise assistants during the procedure by
Deep breathing exercise anticipating the instruments that will
be required
Coughing exercise
● As the operation is about to close,
Turning exercise
the scrub person & the circulator
Foot & Leg exercise counts all needles, sponges, &
instruments to be sure all are
The Surgeon accounted for & not retained as
● Performs the surgical procedure & foreign bodies in the patient.
heads the surgical team. ● Tissue specimen obtained during the
● The primary decision maker surgery must be labeled by the
regarding surgical technique to use scrub nurse/person & sent to the
during the procedure laboratory by the circulator The
● May assist in with positioning & Unsterile M
prepping the patient or may delegate
this task to other members of the
team
● He/she is a licensed physician (MD),
osteopath (DO), Oral surgeons
(DDS or DDM)
● Qualification include certification
from a specifically board,
● adherence to Joint Commission on
Accreditation of Healthcare
Organization (JCAHO) standards
Adherence to Hospital standards &
admitting practices & procedures

First Assistant to the Surgeon

● may be a resident, intern,
physician’s assistant or a
perioperative nurse practice under
direct supervision of the surgeon
● Responsible for handling tissue,
providing exposure at the operating
field, suturing, providing
homeostasis & other tasks
requested by the surgeon to
facilitate speed while maintaining
quality during the procedure.
● needs to be aware of the objectives
of the surgery, needs to have the
knowledge & ability to anticipate
needs & to work as a skilled member
of a team, and needs to be able to
handle any emergency situation in
the OR.

The Scrub Assistant

may either a nurse or a surgical technician
Activities include:
● performing a surgical had scrub,
● setting up the sterile tables,
● preparing sutures, ligatures,
sponges & special equipment