NCM116-RLE - OR
 Refers to events during the entire
PERIOPERATIVE NURSING - Sir EF
CONDITIONS REQUIRING SURGERY
 Obstruction - impairment to the flow
of vital fluid
 Perforation - rupture of an organ
 Erosion - wearing off of tissue
 Tumor - abnormal new growth
 Foreign body
PURPOSES OF SURGERY
 Diagnostic - to establish diagnosis
(Biopsy)
 Exploratory - to estimate extent of
disease or confirm diagnosis
(Exploratory Laparotomy)
 Palliative - to relieve distressing signs
& symptoms; not cure (Colostomy)
 Curative - to remove or repair
 Ablative: to remove a diseased organ
(Appendectomy)
 Reconstructive: to restore (partially or
completely) a damage organ or tissue
to its normal appearance & function
(Rhinoplasty, Perineoraphy)
 Constructive: repair of congenital
defect (Hypospadia)
TYPES OF SURGERY
According to risk involved
 Major: high risk, prolonged in OR, large
amount of blood loss, post operative
complications may develop. EXTENSIVE
RESECTION IS PERFORMED, a body
cavity is entered, normal anatomy is
altered, organs are removed
 Minor: little risk, not prolonged, fewer
complications
According to urgency
 Emergency: done without delay
 Imperative: performed ASAP within
24-48 hrs
 Planned or required: scheduled ahead
for patient’s well being
 Elective: not absolutely necessary
 Optional: per request for aesthetic
purposes
PERIOPERATIVE NURSING
surgical period, from preparation for
surgery to recovery from the
temporary effects of surgery &
anesthesia.
3 PHASES
 Preoperative
 Intraoperative
 Postoperative
PREOPERATIVE PHASE
 This phase begins when the decision
for surgical intervention is made &
ends with transfer of the client to the
OR bed
PRE-OP NURSING CARE
 Psychological preparations: fear&
anxiety, patient expectations after
surgery,
 Physiologic: CP clearance, FBS, CBC,
ECG, x-ray
 Physical: NPO. Laxative, enema, rest &
sleep, pre-op checklist, pre-op meds
(sedatives, hypnotics)
 Teaching pre-op exercises: DBE,
coughing ex. Foot & leg ex.
 Informed consent: clients voluntarily
agrees to undergo a particular
procedure or treatment after having
received these information
PREOPERATIVE PHASE
 Description of the procedure or
treatment
 Name & qualifications of Person
performing the procedure or
treatment
 Explanation of the risks involved,
including potential for Damage
disfigurement or death
 That the client has the right to refuse
treatment
NURSING CONSIDERATIONS
 Surgeon explains everything
 Must be written in understandable
language
 Permission is repeated for each
procedure
 Signed at least 24 hours before
elective surgery
 Not be forced into signing
 Patient signs own consent if he/she is
of age (18 years or older) mentally
capable, or is an emancipated minor
(<18 but independent from parents)
 In emergency where client is unable to
sign or there is immediate threat to
life, effort should be made to contact
family & 2 surgeons sign the consent
INTRAOPERATIVE PHASE
 This phase begins when the client is
transferred to the operating room bed
& ends when the client is admitted to
the post anesthesia recovery area
NURSING CARE DURING SURGERY
1. Providing emotional care
2. Skin preparation
3. Assisting with client positioning
4. Maintaining surgical asepsis
5. Preventing client heat lost
6. Assisting surgical wound closure
7. Assessing drainage
8. Transporting the client to the post
anesthesia or ICU
POSTOPERATIVE
 Begins when the admission to the post
anesthesia recovery area & ends with
resolution of the surgical sequelae.
OBJECTIVE OF POST-OP CARE
 Re-establishment of physiologic
equilibrium
 Prevention of pain & complication
PRINCIPLES OF SURFICAL ASEPSIS
 Only sterile items are used within the
sterile field
 Gowns are considered sterile only from
the waist to shoulder level in front and
the sleeves
 Tables are sterile only at table level
 Person who are sterile touch only
sterile items or areas; persons who are
not sterile touch only unsterile items
or areas
 Unsterile persons avoid reaching over
to a sterile field; Sterile persons avoid
leaning over to an unsterile are
 Edges of anything that encloses sterile
contents are considered unsterile
 Sterile field is created as close as
possible to the time of use
 Sterile areas are continuously kept in
view
 Sterile person keep well within the
sterile area
 Sterile person keep contact with sterile
areas to a minimum
 Unsterile person avoid sterile areas
 Destruction of integrity of microbial
barriers results in contamination
 Microorganisms must be kept to an
irreducible minimum
 If in doubt of sterility of anything,
consider it unsterile
ANESTHESIA
 Partial or total loss of sensation of pain
with or without loss of consciousness
EFFECTS OF ANESTHESIA
 Analgesia: lessening or insensibility to
pain
 Hypnosis: artificially induced sleep
 Amnesia: loss of memory
 Muscle relaxation
MAJOR CLASSIFICATION OF ANESTHESIA
General: causes total loss of sensation &
consciousness
 Inhalation: giving gas(cyclopropane) or
liquid(halothane) in volatile form
 Intravenous: pentothal sodium,
ketalar, innovar
 Rectal: used in minor procedures; does
not produce complete consciousness
Regional: reduces all painful sensation in
one region of the body without inducing
unconsciousness
 Topical
 Local infiltration block
 Saddle block: commonly used in
obstetrics
 Nerve block: nerve plexus to
anesthetize part of body
 Epidural block: below level of
diaphragm
 Caudal block: produces anesthesia of
perineum, lower abdomen
 Spinal block: subarachnoid space
 Agents used: lidocaine, procaine
(Novocain)
 Taper: needle body is round and tapers
smoothly to a point
 Cutting: needle body is triangular and
has a sharpened cutting edge inside
 Reverse cutting: cutting edge outside
 Trocar point or tapercut: needle body
is round and tapered, but ends in a
small triangular cutting point

STAGES OF ANESTHESIA

SURGICAL SUTURES AND NEEDLES

2 KINDS
 Absorbable: will break down
harmlessly in the body (10 days- 8wks)
 Non-absorbable: not metabolized by
the body and should be removed after
weeks

NEEDLES
2 KINDS
 Traumatic: with separate suture
thread
 Atraumatic: eyeless needles attached CLASSIFICATION OF SURGICAL
to suture threads INSTRUMENTS
SHAPE  Graspers: forceps, clamps and
 Straight occluders (for blood vessels and other
 Half curved organs)
 ¼ circle  Retractors: used to open spread skin,
 3/8 circle rib, and other tissues
 Mechanical cutters: scalpels, lancets,
drill bits, rasps, trocars
 Dilators: for access of narrow passage
or incision
 Scopes/probes: include fiber optic
endoscopes and tactile probes