King Saud University

College of Nursing

Adult Nursing (NUR 316)

Pre, Intra and Post Operative

Nursing Management
 Pre, Intra and Post Operative
Nursing Management
• Perioperative Period: The time that constitute the
surgical experience, include the preoperative,
intraoperative, postoperative phases.

• Preoperative Phase: The 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.
 Purposes of surgery
-Diagnostic→e.g. Biopsy
Exploratory→e.g. laparotomy

Curative →e.g. excision of a tumor or an inflamed

appendix

- Reconstructive or cosmetic → e.g.mammoplasty

- Palliative→ relieve of symptoms as pain

 Categories of surgery
1- Emergency:
Must be performed immediately:
1)Maintain life
2)Maintain organ or limb function
3)Stop hemorrhage (Intestinal obstruction/Gunshot & stab
wounds).
2- Urgent:
Must be performed within 24 to 48 hours(Bleeding of duodenal
ulcer)
3- Planned
Scheduled weeks or months ahead of the
proposed operation (cataract removal)
4- Elective
Not absolutely necessary (hernia)
5- Optional
Requested by the person (Mammoplasty)
 Risk factors for surgical
complications:
- Age, obesity, malnutrition, immobility , hypovolemia ,
infection, pregnant, diabetes mellitus, hepatic
cardiovascular disease, renal disease and disease,
pulmonary disease.
- Nature of condition (Malignant)
- Location of condition (Heart/Brain)
 IV-Nursing intervention
I- Psychological Aspect:
• Provide explanations or printed information about health
care facility routines & visiting hours & meal times
• Explain the procedures involved in the upcoming surgery
(Complete idea of what the • pre, intra & post operative
course entails).
• Introduce the person who is to undergo a major surgical
procedure to people who have successfully recovered from
this operation.
 Helps to relieve anxiety
2. Informed Consent :
• Anyone undergoing surgery must sign an operative permit. It
protects the health care facility staff from legal action
3. Physiologic Aspects
Before the day of surgery
• Correct any dietary deficiencies
• Reduce an obese person's weight.
• Correct fluid & electrolyte imbalances.
• Restore adequate blood volume with blood transfusion.
• Treat chronic disease.
• Cure infections process
Preparing the person the evening before
surgery.
• Hygienic care ( bathing or scrubbing )
• Skin preparation( shaving)
• Document observation of the surgical site. (note cuts or
breaks)
• Restricting food & fluid eight to ten hours preop. NPO
after midnight.
• intravenous infusions may receive for debilitated or
malnourished patient
• Enemas not routinely ordered except for G.I.T s
• NG tube sometimes is inserted the evening before or the
morning of surgery
• Remove colored nail polish
• Assist the person in donning a hospital gown, cap
• Check for laboratory record
• Blood available
• Pre-anesthetic medication given e,g. 1 gram claforan
• Pre-operative teaching:
• Deep breathing and coughing exercises To prevent
pneumonia
• Incentive spirometer
• Turning & moving, leg exercise to prevent DVT
• Getting out of bed
• Pain management
Preoperative Preparations
 Intraoperative Phase
• Begins when patient is transferred to
operating room table
• Provide for patient safety
• Maintain aseptic environment
• Provide surgeon with supplies and
instruments
• Documentation
Surgical Team
 Intraoperative nursing
management:
I-Nurse's roles in the operating room a. Circulating
nurse b. Scrub nurse
A-Circulating nurse
.Prepares operating room with necessary equipment and
supplies and ensures that equipment is functional.
.Arrange sterile and nonsterile supplies; opens sterile
supplies for scrub nurse.
.Sends for client at proper time.
.Visits with client preoperatively; explains role, verifies
operative permit, identifies client, and answers
any questions.
.Confirms client's allergies.
.Checks medical record for completeness.
.Assists in safe transfer of client to operating room table.
.Positions client on operating room table in accordance with
type of procedure, and surgeon's preference.
.Counts sponges, needles, and instruments with scrub nurse
before surgery.
.Assists scrub nurse and surgeons by tying gowns and
preparing client's skin.
.Assists scrub nurse in arranging tables to create sterile field.
.Maintains continuous observations during surgery to
anticipate needs of client, scrub nurse, surgeons, and
anesthesiologist.
.Provides supplies to scrub nurse as needed.
.Observes sterile field closely for any breaks in aseptic
technique and reports.
.Cares for surgical specimen.
.Documents operative record and nurses' notes.
.Counts sponges, needles, and instruments when closure
of wound begins.
.Transfers client to stretcher for transport to recovery area
.Accompanies client to a recovery room and provides a
report.
b. Scrub nurse
.Performs surgical hand scrub.
.Dons sterile gown and gloves aseptically.
. Arranges sterile supplies and instruments in manner
prescribed for procedure.
.Checks instruments for proper functioning.
.Counts sponges, needles, and instruments with circulating
nurse.
.Gowns and gloves surgeons as they enter operating
room.
• Assists with surgical draping of client.
• Maintains sterile field.
• Recognizes and corrects breaks in aseptic technique.
• Observes progress of surgical procedure.
• Hands surgeon instruments, sponges, and necessary
supplies during procedure"
• Identifies and handles surgical specimens correctly.
• Watches sponges, needles, and instruments so none
will be misplaced or lost in wound.
Postoperative Phase
• Admission to the recovery room
• Maintain airway
• Monitor vital signs
• Assess effects of anesthesia
• Assess for complications of surgery
• Provide comfort and pain relief
• Ends with follow-up evaluation in clinical
setting or home
Nursing management in the post
anesthesia care unit:
I-Assessing the patient:
Frequent assessment of the patient oxygen saturation,
pulse volume and regularity, depth and nature of
respiration, skin color ,depth of consciousness.
II- Maintaining a patent airway:
− The primary objectives are to maintain pulmonary
ventilation and prevent hypoxia and hypercapenia.
− The nurse applies oxygen, and assesses respiratory
rate and depth, oxygen saturation.
Nursing management in the post
anesthesia care unit:
III- Maintaining cardiovascular stability:
− The nurse assesses the patient’s mental
status, vital signs, cardiac rhythm, skin
temperature, color and urine output.
− Central venous pressure, arterial lines and
pulmonary artery pressure.
− The primary cardiovascular complications
include hypotension, shock, hemorrhage,
hypertension and dysarrythmias.
Nursing management in the post
anesthesia care unit:
IV- Relieving pain and anxiety:
− Opioid analgesic.
V- Assessing and managing the surgical site:
− The surgical site is observed for bleeding, type and
integrity of dressing and drains.
VI- Assessing and managing gastrointestinal function:
− Nausea and vomiting are common after anesthesia.
− Check of peristalsis movement.
Nursing management in the post
anesthesia care unit:
VII- Assessing and managing voluntary voiding:
− Urine retention after surgery can occur for a verity of reasons.
Opioids and anesthesia interfere with the perception of bladder
fullness.
- Abdominal, pelvic ,hip may increase the like hood of retention
secondary to pain.
VIII- Encourage activity:
− Most surgical are encouraged to be out of bed as soon as
possible. Early ambulation reduces the incidence of post
operative complication as ,atelectasis ,pneumonia,
gastrointestinal discomfort and circulatory problem.
Post Operative Complication:
1- Shock:
Is the response of the body to a decrease in the circulating volume of
blood, tissue perfusion impaired, cellular hypoxia and death.
2- Hemorrhage:
Is the escape of blood from a blood vessel.
3- Deep vein thrombosis. (DVT).
Occur in pelvic vein or in lower extremities, and it’s common
after hip surgery.
 Post Operative Complication:
4- Pulmonary embolism.
It’s the obstruction of one or more pulmonary
arterioles by an embolus originating some where in the
venous system or in the right side of heart.
5- Urinary Retention.
6- Intestinal obstruction.
Result in partial or complete impairment to the forward
flow of intestinal content.
Potential Intraoperative
complication:
–Nausea and vomiting
–Anaphylaxis
–Hypoxia and other respiratory
complication
–Hypothermia