Perioperative Nursing

Daryani, Skep.Ns.M.Kep
LEARNING OBJECTIVES
On completion of this chapter, the learner will be able to:
1. Define the three phases of the perioperative period.
2. Describe a comprehensive preoperative assessment to
identify surgical risk factors.
3. Identify the causes of preoperative anxiety and describe
nursing measures to alleviate it.
4. Identify legal and ethical considerations related to
informed
consent.
5. Describe preoperative nursing measures that decrease
the risk for infection and other postoperative
complications.
6. Describe the immediate preoperative preparation of the
patient.
7. Develop a preoperative teaching plan designed to
promote the patient’s recovery from anesthesia and
surgery, thus preventing postoperative complications.
 Phases of the Perioperative
Period
□ Preoperative
□ Decision for surgery
□ Informed consent
□ Nursing assessment
□ Nursing diagnosis
□ Planning
□ Implementation
□ Intraoperative
□ Postoperative
Pre and Post Operative Nursing
Management
 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 postanesthesia care
unit.
 Postoperative Phase: Period of time that begins with
the admission of the patient to the postanesthesia care
unit and ends after follow-up evaluation in the clinical
setting or home.
 Perioperative Period: Period of the time that
constitute the surgical experience, include the
preoperative, intraoperative, postoperative phases.
 Preoperative Assessment
□ Current health status
□ Allergies
□ Medications
□ Previous surgeries
□ Mental status
□ Understanding of the surgical procedure and anesthesia
□ Smoking, alcohol and other mind-altering substances
□ Coping
□ Social resources
□ Cultural and spiritual considerations
Various Types of Surgery
 Degree of urgency  Purposes of surgical
◦ Emergency procedures
◦ Elective ◦ Diagnostic
 Degree of risk ◦ Palliative
◦ Major ◦ Ablative
◦ Minor
◦ Constructive
◦ Transplant
Physical Assessment
 “Mini” mental status
 Respiratory
 Cardiovascular
 Other systems (gastrointestinal,
genitourinary, and musculoskeletal)
 Preoperative diagnostic tests
Nursing Diagnoses
 Preoperative phase
◦ Deficient Knowledge
◦ Anxiety
◦ Disturbed Sleep Pattern
◦ Anticipatory Grieving
◦ Ineffective Coping
Nursing Diagnoses
 Intraoperative phase
◦ Risk for Aspiration
◦ Ineffective Protection
◦ Impaired Skin Integrity
◦ Risk for Perioperative-Positioning Injury
◦ Risk for Impaired Body Temperature
◦ Ineffective Tissue Perfusion
◦ Risk for Deficient Fluid Volume
Nursing Diagnoses
 Postoperative phase
◦ Acute Pain
◦ Risk for Infection
◦ Risk for Injury
◦ Risk for Deficient Fluid Volume
◦ Ineffective Airway Clearance
◦ Ineffective Breathing Pattern
◦ Self-Care Deficit: Bathing/Hygiene, Dressing/Grooming,
Toileting
◦ Ineffective Health Maintenance, and Disturbed Body
Image
Planning: Preoperative Phase
 Overall goal
◦ Ensure that the client is mentally and
physically prepared for surgery
 Preoperative teaching
 Physical preparation
 Psychological preparation
 Discharge planning
Planning: Intraoperative Phase
 Overall goals:
◦ Maintain the client’s safety
◦ Maintain homeostasis
 Planning: Perioperative Phase
 Overall goals
◦ Promote comfort and healing
◦ Restore highest possible level of wellness
◦ Prevent associated risks
 Dimensions of Preoperative Teaching
 Information

 Psychological support

 Explain roles of the client and support people in

preoperative preparation, during the surgical
procedure, and during the postoperative period

 Skills training
Preoperative Instruction
 Preoperative regimen
 Postoperative regimen
 Special instructions for outpatient surgical
clients
Dimensions of Preoperative Teaching
 Skills training
◦ Moving
◦ Deep breathing
◦ Coughing
◦ Splinting incisions
◦ Using an incentive spirometer
Skills Training
 Moving
◦ Promote venous return
◦ Mobilize secretions
◦ Stimulate gastrointestinal motility
◦ Facilitate early ambulation
 Leg exercises
◦ Promote venous return
◦ Prevent thrombophlebitis and thrombus
formation
Skills Training
 Deep breathing and coughing
◦ Enhance lung expansion
◦ Mobilize secretions
◦ Prevent atelectasis and pneumonia
Skills Training
 Preparing a Client
for Surgery
 Nutrition and fluids  Special orders
 Elimination  Skin preparation
 Hygiene  Safety protocols
 Medications  Vital signs
 Rest and sleep  Antiemboli stockings
 Valuables  Sequential
compression devices
Types of Anesthesia
 General
 Regional or local
General Anesthesia
 Loss of all sensation and consciousness
 Loss of protective reflexes
 Block awareness centers in brain
 Administered by IV or inhalation
Regional or Local
Anesthesia
 Topical or surface
 Local or infiltration
 Nerve block
 Intravenous block or Bier block
 Spinal
 Epidural or peridural
 Conscious sedation
 Nursing Care During the
Immediate Postanesthetic Phase
 Assessment (kelompok 2)
◦ Adequacy of airway
◦ Oxygen saturation
◦ Adequacy of ventilation
◦ Cardiovascular status
◦ Level of consciousness
◦ Presence of protective reflexes
◦ Activity, ability to move extremities
Nursing Care During the Immediate
Postanesthetic Phase (kelpok 3)
◦ Skin color
◦ Fluid status
◦ Condition of operative site
◦ Patency of and amount and character of
drainage from catheters, tubes, and drains
◦ Discomfort
◦ Safety
Nursing Care During the Immediate
Postanesthetic Phase
 Interventions
◦ Position client on side, with the face slightly
down
◦ Elevate upper arm on a pillow
◦ Suction as needed until cough and swallowing
reflexes return
◦ Help client to cough and deep breathe
◦ Keep the client flat for specified period of
time if the client had spinal anesthesia
Nursing Care During
Postoperative Phase (kelompok 4)
 Initial assessment
◦ Level of consciousness
◦ Vital signs
◦ Skin color and temperature
◦ Comfort
◦ Fluid balance
◦ Dressing and bedclothes
◦ Drains and tubes
 Nursing Care During
Postoperative Phase
 Nursing interventions (kelpk 5)
◦ Pain management
◦ Appropriate positioning
◦ Incentive spirometry
◦ Deep breathing and coughing exercises
◦ Leg exercises
◦ Early ambulation
◦ Adequate hydration
◦ Diet
◦ Promoting urinary and bowel elimination
◦ Suction maintenance
◦ Wound care
Potential Postoperative Complications
 Respiratory (kelopk 6)
◦ Pneumonia
◦ Atelectasis
◦ Pulmonary embolism
Potential Postoperative Complications
 Circulatory
◦ Hypovolemia
◦ Hemorrhage
◦ Hypovolemic shock
◦ Thrombophlebitis
◦ Thrombus
◦ Embolus
Potential Postoperative Complications
 Urinary
◦ Urinary retention
◦ Urinary tract Infection
 Gastrointestinal
◦ Nausea and vomiting
◦ Constipation
◦ Tympanites
◦ Postoperative ileus
Potential Postoperative Complications
 Wound
◦ Wound infection
◦ Wound dehiscence
◦ Wound evisceration
 Psychologic
◦ Postoperative depression
Management of GI Suction
 Continuous or intermittent
 Replace fluid and electrolytes
 May need to irrigate tube if lumen clogged
 Skill for GI suction
Wound Care for the
Postoperative Client
 Dressings should be clean, dry, and intact
 Assess wound for:
◦ Appearance
◦ Size
◦ Drainage
◦ Swelling
◦ Pain
◦ Drains or tubes
 See Skill 37-4: Cleaning a Sutured Wound and
Applying a Sterile Dressing
Use of Montgomery Straps
Methods of Cleaning Surgical Wounds
Evaluating Perioperative
Care
 Evaluate pre, intra, and postoperative
goals according to specific outcomes
 If not achieved, explore reasons before
modifying care plan
 PERIOPERATIVE CARE
Summary
 Specific Nursing Duties for each phase:
◦ Preoperative, Intraoperative, Postoperative

 Throughout Perioperative Care, the nurse

will always:
◦ Monitor patient’s response to therapeutic
regime, prevent complications, patient
education and promote optimum well-being
The End