Bulacan State University City of Malolos, Bulacan College of Nursing

Perioperative Nursing

9/19/12

Preoperative Phase: The period of time from when decision for surgical intervention is made to when the patient is transferred to the operating room table. Intaroperative Phase: Period of time from when the patient is transferred to the operating room table to when he or she is admitted to the post anesthesia care unit. Postoperative Phase: Period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow-up evaluation in the clinical setting or home.
9/19/12

Goals:

Preoperative Phase

Assessing and correcting physiologic and psychological problems that might increase surgical risk. Giving the person and significant others complete learning/teaching techniques. Instructing and demonstrating exercises that will benefit the person during post-op period Planning for discharge and any projected changes in lifestyle due to surgery

Nursing Responsibilities:

Assess the client. Such as Age, Nutritional deficiency, drugs and alcohol use, respiratory function, cardiovascular function, immune system, hepatic function, endocrine function and neurologic function. Secure informed consent to ensure that the client understands the nature of the treatment including the potential complications and that the clients decision was made without force. Prepare the client physically. Educate the client with post op exercises, night before the surgery and the day of the surgery. Prepare the pre-op medications. direct the family to the visiting room and explain the reason for long interval of waiting. Explain what to expect after the surgery.

9/19/12

Intra-operative Phase Members of the Surgical Team

I. Scrub Team
a. Operating Surgeon - Does the operation b. Assistant Surgeon

Responsibilities:

Hold retractors Exposes surgical area Clamps all the bleeders or sutures bleeders Tying clamped vessels Assist surgeons in ligating bleeders

c. Scrubbed Nurse (Instrument and Suture Nurse) Responsibilities:

Prepares and arrange instruments and supply Checks the completeness of instruments and preliminary count Passes sponges Assist scrub team during gowning and gloving Assist II. Unscrubbed Team in draping the patient a. Anesthesiologist (either MD or RN)

Responsibilities:

Monitor VS during the surgical procedure Keeps the surgeon aware of the patients condition Determines if the patient is viable to be transferred to PACU Consulted by the surgeon on the diagnosis of the removed tissue or organ 9/19/12 Consulted for possible treatment

b. Pathologists Responsibilities:

c. Circulating Nurse Responsibilities:

Overseer of the OR Maintains the sterility of the OR Assist all scrubbed for their needs Checks the completeness of the chart Ties the gowns of members stoop and swing method Maintain lightings Provide footstools for the team Carries and open lap packs

Post-operative Phase
Goals: To maintain adequate body system functions Restore Homeostasis Alleviate pain and discomfort Prevent post-op complications Ensure adequate discharge planning and teaching

Nursing Responsibilities:
I.
a.

Transport of client from OR to RR

Assessment: Appraise air status and note skin color. Verify identity, operative procedure, surgeon. Assess neurologic status (LOC) Determine VS and skin temperature if with fever, suspect infection Examine operative site and check dressing Position for good body alignment Side rails 9/19/12

b. Interventions

Ensure patent airway and adequate respiratory function keep airway in place until fully awake suction secretions Oxygen therapy Assess status of circulatory system Observe for signs of shock and hemorrhage Continuous care until patient is completely out of anesthesia

II. Transfer of client from RR to the Surgical Unit Nursing Responsibilities:

Maintain adequate fluid and electrolytes Maintain adequate renal function Promote rest, comfort and safety Promote adequate wound healing Promote and maintain activity and mobility Provide adequate psychological support

9/19/12