PERIOPERATIVE

NURSING
BRYAN JOVEN C. ONG,RN,MSN
 PRE TEST

Arrange the following in chronological order/ in

sequence of events during patients surgery
 Anesthesia surgery
 Preparation for surgery
 Admission to OR
 Admission to RR/PACU
 Discharge
 Follow-up
 Back to surgical unit
 Transport to Operating Room
 Admission to the surgical unit
 PHASES OF PERIOPERATIVE

PREOPERATIVE PHASE

INTRAOPERATIVE PHASE

POSTOPERATIVE PHASE
 PRE-OPERATIVE CARE

Conditions requiring surgery

O- Obstruction
P- Perforation
E- Erosion
T- Tumors
 CLASSIFICATION OF SURGICAL
PROCEDURES

According to PURPOSE
1. Diagnostic
2. Exploratory
3. Curative
Types of Curative
-Ablative
-Constructive
-Reconstructive
 CLASSIFICATION OF SURGICAL
PROCEDURES

4. Palliative
5. Preventive
6. Cosmetic Improvement
 CLASSIFICATION OF SURGICAL
PROCEDURES

According to degree of
RISK/MAGNITUDE/EXTENT
1. Major Surgery
2. Minor Surgery
 CLASSIFICATION OF SURGICAL
PROCEDURES

According to URGENCY
1. Emergency
2. Imperative
3. Planned Required
4. Elective
5. Optional
 CLASSIFICATION OF SURGICAL
PROCEDURES

According to SURGICAL SETTING

1. Inpatient Surgery
2. Ambulatory Surgery
 THE SURGICAL RISKS

1. Aging
2. Obesity
3. Poor Nutrition
4. Fluid and Electrolyte Imbalances
5. Presence of Disease
6. Presence of Diabetes Mellitus
7. Presence of Alcoholism
8. Presence of Pulmonary and Upper
Respiratory Disease
9. Concurrent or Prior Pharmacotherapy
 OTHER RISK FACTORS

Nature of the disease condition

Magnitude and urgency of the
surgical procedure
Mental health of the person toward
surgery
Caliber of the professional staff and
health care facilities
 EFFECTS OF SURGERY TO PATIENTS

1. Stress response is elicited.

a) Sympathoadrenomedullary response (fight-
or-flight response)
b) Adrenocortical stimulation
2. Defense against infection is lowered.
3. Vascular system is disrupted.
4. Organ functions are disturbed.
5. Body image may be altered.
6. Lifestyles may change.
 GOALS OF CARE DURING THE
PREOPERATIVE PERIOD
Assessing and correcting physiologic and
psychologic problems that might increase
surgical risk.
Giving the person and significant others
complete learning and guidelines regarding
surgery.
Instructing and demonstrating exercises that
will benefit the person during postoperative
period.
Planning for discharge and any projected
changes in lifestyle due to surgery.
 PREOPERATIVE NURSING ASSESSMENT

Physiologic Assessment of the Client

Undergoing Surgery
a) Age
b) Presence of pain
c) Nutritional status
d) Fluid and electrolyte balance
e) Infection
f) Cardiovascular Function
 PREOPERATIVE NURSING ASSESSMENT

f) Pulmonary Function
g) Renal Function
h) Gastrointestinal Function
i) Liver Function
j) Endocrine Function
k) Cognitive and Neurologic Function
l) Hematologic Function
 PREOPERATIVE NURSING ASSESSMENT

m)Cognitive and Neurologic Function

n) Hematologic Function
o) Use of Medications and Allergies
p) Presence of Trauma
 COMMON PREOPERATIVE DIAGNOSTIC
TESTS

a) Urinalysis
b) Chest X-ray
c) Blood Studies
d) Electrolytes
e) ABG’s
f) PT, PTT, INR, Platelet Count
g) Blood Glucose
 COMMON PREOPERATIVE DIAGNOSTIC
TESTS

h) Creatinine
i) Blood Urea Nitrogen
j) Serum Albumin
k) Electrocardiogram
l) Pulmonary Function Tests
m)Liver Function Test
n) Blood Typing and Crossmatching
o) hCG
 PSYCHOSOCIAL ASSESSMENT OF THE
CLIENT UNDERGOING SURGERY
 The most common psychologic factors that may
affect surgical are fears, anxiety, and hope.
Common causes of fears
a) Fear of the unknown
b) Fear of anesthesia
c) Fear of pain
d) Fear of death
e) Fear of disturbance of body image
f) Fear and worries from loss of finances,
employment, social and family roles.
 PSYCHOSOCIAL ASSESSMENT OF THE
CLIENT UNDERGOING SURGERY
 Anxiety
due to knowledge deficit/conflict to religious and
cultural belief
 Hope
strongest coping mechanism
 THE LEGAL ASPECTS OF SURGICAL
INTERVENTIONS
The purposes of the written informed consent are as follows:
1. To ensure that the client understands the nature of the
treatment including the potential complications and
disfigurement. These are explained by the surgeon.
2. To indicate that the client decision was made without
pressure.
3. To protect the client against unauthorized procedure.
4. To protect the surgeon and the hospital against legal action
by a client who aims that an unauthorized procedure was
performed.
 THE LEGAL ASPECTS OF SURGICAL
INTERVENTIONS
The circumstances requiring written informed consent are as
follows:
1. Any surgical procedure where scalpel, scissors, suture,
hemostats or electrocoagulation may be used.
2. Any invasive procedure, or any procedure that involves entry
into a body cavity
3. Any procedure that involves general anesthesia, local
anesthesia or regional block anesthesia.
 THE REQUISITES FOR VALIDIT Y OF
WRITTEN INFORMED CONSENT
 Written consent is best and is legally acceptable.
 The physician is responsible for obtaining consent.
 Patients signature is obtained with the complete
understanding of what is to occur, what is the
treatment to be done and possible consequences,
alternative treatments, risks and benefits of each
treatment options. Adults sign their own consent
unless he/she is physically and mentally
incapacitated. If the patient is a child or minor
(below 18 years old), the parent or legal guardian
should sign
 THE REQUISITES FOR VALIDIT Y OF
WRITTEN INFORMED CONSENT

Consent is obtained before sedation.

The patient is not under the influence of drugs
or alcohol.
The consent is secured without pressure or
duress.
Signature of witness is required. The nurse,
physician, or other authorized person may sign
as witness.
 THE REQUISITES FOR VALIDIT Y OF
WRITTEN INFORMED CONSENT

In emergency situation, to preserve life or to

prevent serious impairment to life and the
individual patient is in capable of giving
consent, the next kin may give consent, if
reaching the next kin is not possible the
physician may institute treatment without
consent from the patient or relative. Two
physicians may sign the consent and
document the necessity of the suture.
 THE REQUISITES FOR VALIDIT Y OF
WRITTEN INFORMED CONSENT

Emancipated minors are allowed to sign

written consent
The patient is aware that consent, even when
signed can be withdrawn at any time.
 PHYSICAL PREPARATION

NUTRITION AND HYDRATION

Diet orders: NPO 6-12 hours prior to OR
Monitor input and Output
ELIMINATION
Catheter insertion
Bowel Preparation
 PHYSICAL PREPARATION

REST AND SLEEP

Hygiene
Bath
Remove cosmetics and nailpolish
Remove hairpins and clips
Remove dentures
Provide an OR gown
 PHYSICAL PREPARATION

MEDICATIONS
Discontinue medications that are advised to
be discontiued
Administer preoperative medications.
SPECIAL ORDERS
Insertion of NGT
Remove all body prosthesis
 PSYCHOSOCIAL PREPARATION

REDUCING ANXIETY AND FEAR

Promote positive coping strategies
Provide preoperative teaching
Provide opportunity for visits from family and
friends
 PREOPERATIVE TEACHING

LUNG EXERCISES
Deep breathing
Coughing
Incentive spirometry
 PREOPERATIVE TEACHING

BODY EXERCISES
LEG EXERCISES
TURNING-TO-SIDES EXERCISES
GETTING OUT OF BED EXERCISES
SPIRITUAL PREPARATION FOR SURGERY

Provide time for prayer

Arrange for visit from a spiritual adviser/
clergyman as desired
Take into consideration religious beliefs in the
operative care
 PREOPERATIVE MEDICATIONS

PURPOSE OF PREOPERATIVE MEDICATIONS

To facilitate the administration of any
anesthetic.
To minimize respiratory tract secretions and
changes in heart rate
To relax client and reduce anxiety
 PREOPERATIVE MEDICATIONS

TYPES OF PREOP MEDICATIONS

Opiates
Anti-cholinergics
Benzodiazepines
Prophylactic antibiotic
Histamine receptor antagonist
Anti-emetics