PERIOPERATIVE NURSING

Lecturer: Mr. Renato D. Lacanilao, RN,MAN

 Learning Objectives
At the end of this lecture the learner should be
able to:
1. Describe the different perioperative phases
and its purpose.
2. Define the different surgical terms in
perioperative nursing.
3. Identify the roles of a nursing in different
phases in nursing.
4. Discuss the physiologic changes that
happens in the patient undergoing surgery.
5. Describe the principle of asepsis and their
application to nursing practice
 Surgery
 A branch of
medicine dealing
with manual &
operative
procedures for
correction of
deformities and
defects, repair of
injuries and
diagnosis and cure
of certain diseases.
 History of Surgery
 Hippocrates was the father of
surgery (uses wine or boiled water
for wound irrigation as early as 450
BC)
 Galen a Greek physician boiled his
instrument before use
 1846 – the discovery of anesthesia
by American dentist William Morton.
 1847 – Ignaz Semmelweis showed
the importance of handwashing
 1867 – Joseph Lister a British surgeon applied
Pasteur’s work to surgery, developing
antiseptic (germ killing) techniques
 1800 – pain & infection were solved &
surgeon began performing new types of
surgery including procedures on the
abdomen, brain & spinal cord.
 1890s – introduction of the principles of
aseptic technique
 Ambroise Pare (a French surgeon, often called
as the father of Modern surgery)
 He employed the ligations of bleeders
 1890s – brought improvements in
diagnostic tools, including the
discovery of x-rays & advancement
in instrumentation
 1940 – introduction of antibiotics
 20th century – improved diagnostic
abilities & method of treatment
helped surgery become more
effective.
New Technology in Surgery that advance the field
of surgery (Ultrasound, Cryosurgery, Laser
Surgery, Endoscopy, Transplantation , etc.)
Endoscopy
 Perioperative Period
 The time beginning with the decision
to undergo surgery and ending with
the termination of required nursing
intervention and evaluation of care
rendered.
 Perioperative Nursing Practice
 Nursing activities performed by the
professional nurse during the three
phases of surgical intervention;
preoperative (before surgery),
intraoperative (during surgery), and
postoperative (after surgery).
 Each phase refers to a particular
time during the surgical experience,
and each requires wide range of
specific nursing behavior and
functions.
 Perioperative nursing has one
continuous goal: to provide a
standard of excellence in the care of
the client before, during and after
surgery.
 It is a client oriented ; therefore, the
nursing activities must be geared to
meet the client’s psychosocial needs
as well as immediate physical needs
 3 Phases/Periods of the
Perioperative Nursing
1. Preoperative Phase

2. Intraoperative Phase

3. Postoperative Phase
 Preoperative Phase
 a time during the surgical experience
that begins with the client’s decision
to have surgery and ends with the
transfer of the client to the operating
table
Scope of Preoperative activities
 Includes:
 Preoperative assessment of the
client’s physical, psychologic & social
states
 Planning of nursing care to prepare
the patient for surgery
 Implementation of nursing
interventions
 Intraoperative Phase
 A time during the surgical experience
that begins when the client is
transferred to the operating room
table and ends when client is
admitted to the PACU
Scope of Intraoperative activities
 Providing emotional support during
induction of anesthesia & throughout
the procedure
 Establishing & maintaining functional
positioning
 Maintaining asepsis
 Protecting patient from electrical
hazards
 Assisting in fluid balance
 Insuring accurate sponge &
instrument counts
 Assisting the surgeon
 Communicating with the patient’s
family & other health care team
members
 Postoperative Phase
 Is the time during surgical
experience that begins with the end
of the surgical procedure and lasts
until the client is discharged not just
from the hospital but from the
medical care of the surgeon.
Scope of Postoperative activities
 Ongoing assessment of changes in
the patient with appropriate
planning, implementation &
evaluation
 Monitor airway patency
 v/s & n/v status
 Assess & maintain f/e balance
 Managing pain & surgical site
 Providing thorough summary report
of the patient status
 DIVISION OF SURGERY
 General Surgery
 Pediatric Surgery
 Colon and Rectal
Surgery
 Neurological Surgery
 Gynecology
 Ophthalmic Surgery
 Orthopedic Surgery
 Otolaryngology
 Plastic Surgery
 Thoracic Surgery
 Vascular Surgery
 Urology
 Common Indications of Surgical Procedures
 Diagnostics - Biopsy tissue sample
 Repair - closing of hernia
 Removal - foreign body
 Reconstruction - creation of new breast
 Palliation - relief of obstruction
 Aesthetics - facelift
 Harvest - autologous skin graft
 Procurement - donor organ
 Transplant - placement of donor organ
 Bypass/Shunt - vascular rerouting
 Drainage/Evacuation - Incision of abscess
 Stabilization - repair of fracture
 Parturition - caesarian section
 Termination - abortion of a pregnancy
 Staging - checking of cancer progression
 Extraction - removal of tooth
 Exploration - invasive examination
 Diversion - creation of a stoma for
urine/stool
 Major Types of Pathologic Process

 Obstruction
 Perforation
 Erosion
 Tumors
 Effects of Surgery
 Penetration of Bacterial barrier
 Penetration of vascular system
 Removal of tissues/organs
 Initiation of stress response
 Precipitation of anxieties and
depression
 Lifestyle may change
 Common Surgical Suffixes
 ectomy – removal of an organ or gland
 ostomy – making an opening or stoma
 otomy – cutting into
 plasty/pexy – formation of plastic repair
or restore
 rrhaphy – repair, suturing or stitching of
a part
 scopy – looking into
 itis - inflammation
 Classification of Surgery

According to Degree of Risk/Magnitude

 Minor
 Major
According to Extent
 Minimally invasive surgery
 Open
 Simple
 Radical
According to Purpose
Diagnostic
Exploratory
Curative
 Ablative
 Constructive
 Restorative/Reconstructive

Palliative
Cosmetic
According to Urgency
Emergency
Imperative/Urgent
Planned/Required
Elective
Optional