PERIOPERATIVE

NURSING CARE
PROCESS FLOW
PREOPERATIVE NURSING
INTERVENTIONS
• Preoperative Visit at ward
• Endorsement of patient from ward or ER to Operating Room
• Right patient, surgery, surgeon, site (right or left)
• Consent for procedure and anesthesia
• NPO time (8 hours prior)
• Perioperative check upon receiving the patient (jewelries, dentures, nail polish, contact
lenses, prosthesis etc)
• Preop medications (sedatives, antibiotics, side drip or incorporated meds)
• Diagnostics results (HbsAg, AIDS etc.)
• Proper attire (patient’s gown, diaper)
• Contraptions
• Reviewing patient’s chart (diagnosis, chief complaint, procedure, specimen to be collected,
meds, labs, IVF etc.
• Assessment regarding patient’s mental and physical status. Vital signs.
INTRAOPERATIVE NURSING
INTERVENTIONS
• Transferring patient to OR theatre/OR table
• Hooked to cardiac monitor and oxygen therapy
• Positioning ( what kind of surgery )
• Kind of Anesthesia including Anesthesia medications.
• Abdomen, abdominoperineal, skin preparation
• Instrument set/individual (long or short), anticipated sutures to be use, sponges,
• Sterile drapings
• Surgical Safety Checklist
• Time documentation
• Specimen Labelling
• Counting of instruments, sponges and needles
• OR dressing
• Anesthesia Care
• Urine output, Blood transfusion, intra op vital signs
POSTOPERATIVE NURSING
INTERVENTIONS
• Transferring patient to recovery room.
• Hooked to cardiac monitor and oxygen therapy as ordered
• Post op anesthesia positions and interventions
• Thermoregulation
• Contraptions
• Post op meds
• Carrying doctor’s orders
• Urine output, OR dressings, vital signs, consciousness
• Assessment upon transferring patient back to room
• Informing all attending physicians
• Health Teachings postoperatively
CEASARIAN SECTION
• Right patient, attending physician (OB, anesthesiologist and Pediatrician), Age of
Gestation, Chief Complaint, indication for CS, patient’s history prior, diagnostics
(in patient or OPD basis), co-morbidities, maintenance medications, meds given at
the ward or at the ER
• Vital signs, FHT, Contractions, Duration, Interval, Internal Examination result
upon endorsement\
• Low Transverse/Pfannensteil
• Anesthesia
• Skin preparation
• Catheterization
• Instruments and sutures
• OR dressing, abdominal binder
• Vaginal discharge post op
• Post op Health Teachings
CEASARIAN SECTION (instruments)
• Sutures (OB preferences)
• Kelly curve • Vicryl 1-0 round 1st layer uterus and
• Mosquito curve fascia or muscle and subcutaneeous
• Allis • Vicryl 0 round 2nd layer uterus and
• Needle Holder subcutaneous
• Tissue and Thumb Forcep • Vicryl 3-0 round 3rd layer uterus and
• Russian Forcep peritoneum
• Blade holder #3 and #4 • Vicryl 4-0 cutting skin
• Army Navy
• Richardson • Chromic 1 1st layer of uterus
• Bladder Retractor • Chromic 1 2nd layer of uterus
• Kidney Basins • Chromic 3-0 or Episiotomy set
• Mayo Scissors (round) 3rd layer
• Metz Scissors • Chromic 3 or episiotomy set round for
• Bandange Scissors peritoneum
• Ovum Forcep (optional) • Vicryl 1 fascia
• Chromic 3./1 for subcutaneous
• Vicryl 4 cutting for skin
• Lap Sponges usually 3-5 pcs
• Blade #2pcs for skin and for uterus
1. Blade Holder or scalpel with Blade No. 20 or 22 for skin
2. Scalpel or Cautery Pencil for subcutaneous
3. Two allis with 2 army navy and Mayo scissors or cautery pencil for fascia or muscle
4. Two Kelly curve with 2 army navy and Metz scissors or cautery pencil for peritoneum
5. Richardson and bladder retractor
6. Thumb forcep and metz scissors for the 3rd layer of the uterus
7. Scalpel or second knife for the 2nd layer up to the 3rd layer of the uterus simultaneously retracted by
bladder retractor and Richardson (upon exposing both sides of the uterus)
8. Standby suction
9. Bandage scissors still with Richardson and bladder retractor
10. Upon seeing the head of the baby remove the bladder retractor and Richardson
11. Cord cutting: 2 Kelly curve or 2 Kelly straight then Mayo scissors or the Cord clamp then Kelly
curve then Mayo scissors
12. Placenta: prepare the kidney basin for the placenta then give Kelly curve.
13. Allis (6-8pcs)
14. Bladder retractor and richardson
15. Prepare suture for the first layer. Always put mosquito curve at the end of every suture or upon
giving it to the OB.
16. When you see it that the OB is tying always anticipate to give Mayo scissor to cut the suture
17. Same goes up to the 3rd layer of uterus. See corresponding sutures in each layers of the uterus.
18. 1st counting
19. Four Kelly curve, two army navy and the corresponding suture for the peritoneum