1.

4 Perioperative Tasks and Responsibilities of the Nurse

SCRUB NURSE
 Pre-operative Responsibilities
1. Assist with the preparation of the room for the designated surgical procedure, including gathering
supplies for the procedure.
2. Scrub, dry hands, gown, and glove.
3. Assist person scrubbed in first position with:
      a. Setting up back table, mayo, and basins
      b. Arrangement of instruments
      c. Preparation of suture and needles
      d. Preparation and counting sponges
      e. Arrangement and preparation of other necessary items
      f. Gowning and gloving surgeon and assistants
      g. Assist with draping
      h. Arrangement of sterile field
 Intra-operative Responsibilities
1. During the procedure, progress from double-scrubbed position. Train self to keep eyes on field, and
learn steps of procedure.
2. Begin developing methods of anticipating needs of surgeon and assistant.
3. After closing the skin:
      a. Assist with care of instruments and counts if necessary
      b. Care of specimen
      c. Assist with dressing of wound
 Post-operative Responsibilities
1. After the completion of the Procedure:
     a. Assist with the gathering of all materials used during the procedure
     b. Discard items as necessary being careful to discard sharp items in designated places
     c. Return all items to respective area
d. Assist with cleaning of room
e. Clean the materials used properly and arrange them after drying
2. Perform any duties which will speed up the surgical procedure to follow in that room.

CIRCULATING NURSE
 Pre-operative Responsibilities
1. Care for the patient before surgery by:
a. Greeting patient and assist nurse with identification
b. Checking patient's chart, preparation, etc.
2. Prepare the room by:
a. Obtaining instruments, supplies, and equipment for the designated operative procedure
b. Opening unsterile supplies
c. Assisting in gowning
d. Observing breaks in sterile technique
e. Assisting anesthesiologist as necessary
f. Assisting with skin preparation and positioning
g. Assisting with forming of the sterile field
3. Count the instruments, sharps and sponges before the procedure and confirm with scrub nurse.
  Intra-operative Responsibilities
1. During the Procedure:
a. Remain in room and dispense materials as necessary
b. Observe procedure as closely as possible
c. Begin establishing method of anticipating needs of surgical team
d. Care of specimen as indicated
e. Care of operative records as indicated
f. Assist with application of dressing
g. Monitor the instruments, sharps and sponges used and take note of additional instruments.
2. Before the closing of the organ or peritoneum, count all instruments, sharps and sponges and confirm
with scrub nurse.
3. Inform the surgeon and assistant surgeon of a report of the instruments.
 Post-operative Responsibilities
1. Properly document all the necessary information on the patient’s chart.
2. Assist in the cleaning of the Operation Room as necessary.

Prior to operation:
 A careful history and physical examination are performed
 Intravenous fluids are given to correct volume depletion and any electrolyte imbalances are
measured and corrected. Monitor and regulate IVFs
 The nurse instructs the patient about the need to avoid smoking to enhance pulmonary recovery
postoperatively and avoid respiratory complications. It is also important to instruct the patient to
avoid the use of aspirin and other agents that can alter coagulation and other biochemical process
 On of the most important responsibility of the nurse is to let the patient sign an informed consent
regarding the surgery.
 The patient is given anaesthesia prior to surgery and the patient is under NPO.

During the operation

 Monitoring the vital signs of the patient is one of the responsibilities of the nurse during the surgery.
 Assisting the anesthesia care provider during induction of general anesthesia
 Ensuring adequate oxygenation and hydration

After the operation

 After recovery, the nurse places the patient in the low fowler’s position. IV fluids may be given.
Water and other fluids are given in about 24hours, and soft diet is started when bowel sounds
returned.
 Placing warm blankets on the patient to enhance comfort and preserve the patient's body temperature
 Assessing the patient's vital signs, oxygen saturation level, level of consciousness, circulation, pain,
IV site, fluid rate, and hydration status, as well as the status of the surgical site and dressing and all
related monitoring equipment
 The nurse helps in relieving the pain by instructing the patient regarding proper positioning.
 The nurse helps in improving the respiratory status by instructing the patient regarding deep
breathing exercises.
 The nurse also provides skin care like cleaning the incision part and providing clean dressing
following a strict aseptic technique
 The nurse instructs the patient about the medications that are prescribed by the physician
 Discussing recommended follow-up management with the physician and the surgeon

1.5. Expected Outcomes of the Surgical Treatment Performed

Most clients are discharged on the day of surgery or the day after. As the days and weeks go by
after the surgery, there would be a verbalization of a decrease in pain from the patient he could do
splinting properly and adhere to medication therapy for pain. Another expected outcome is that the
patient demonstrates appropriate respiratory function as evidenced by the achievement of a full
respiratory excursion and coughs effectively.
The patient’s incision should also be free from the presence of foul-smelling discharge or pus
around the incision. Absence of fever or inflammation is indicative of the absence of infection. The
patient should also know and demonstrate proper wound cleaning or wound care as well as the
correct management of drainage tube if applicable. A report of a return in appetite, no vomiting,
bleeding should come from the patient together with normal and stable vital signs.
Since there would be the elimination of the signs and symptoms such as pain, there would be a
better quality of life for the patient which could increase productivity and minimize hospital or clinic
visits, upon discharge clients may be given information regarding:
Discomfort
1. After surgery, headache pain is managed with narcotic medication. Because narcotic pain pills are
addictive, they are used for a limited period (2 to 4 weeks). Their regular use may also cause
constipation, so drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of
Magnesia) may be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g.,
Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin,
Nuprin; naproxen sodium, Aleve).
2. A medicine (anticonvulsant) may be prescribed temporarily to prevent seizures. Common
anticonvulsants include Dilantin (phenytoin), Tegretol (carbamazepine), and Neurontin (gabapentin).
Some patients develop side effects (e.g., drowsiness, balance problems, rashes) caused by these
anticonvulsants; in these cases, blood samples are taken to monitor the drug levels and manage the side
effects.
Restrictions
1. Do not drive after surgery until discussed with your surgeon and avoid sitting for long periods of time.
2. Do not lift anything heavier than 5 pounds (e.g., 2-liter bottle of soda), including children.
3. Housework and yardwork are not permitted until the first follow-up office visit. This includes
gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
4. Do not drink alcoholic beverages.
Activity
5. Gradually return to your normal activities. Fatigue is common.
6. An early exercise program to gently stretch the neck and back may be advised.
7. Walking is encouraged; start with short walks and gradually increase the distance. Wait to participate
in other forms of exercise until discussed with your surgeon.
Bathing/Incision Care
8. You may shower and shampoo 3 to 4 days after surgery unless otherwise directed by your surgeon.
9. Sutures or staples, which remain in place when you go home, will need to be removed 7 to 14 days
after surgery. Ask your surgeon or call the office to find out when.