PERIOPERATIVE

NURSING
Course Outline

 INTRODUCTION
 PREOPERATIVE PHASE
 INTRAOPERATIVE PHASE  Physical Preparation
 POST-OPERATIVE PHASE o Nutrition & Fluids
o Elimination
o Hygiene
INTRODUCTION
o Medications
Nursing care rendered to the total surgical experience of the  Sedatives/tranquilizers
patient.  Narcotic Analgesics
 Anticholinergics
 Histamine-receptor
THREE PHASES OF PERIOPERATIVE NURSING
 Neuroleptanalgesics
I. PREOPERATIVE PHASE o Rest & Sleep
- From decision to have surgery to o Valuables
transferring to the operating table. o Prostheses
II. INTRAOPERATIVE PHASE o Special orders
- From transferring to the operating table to o Skin preparation
PACU admission.
III. POSTOPERATIVE PHASE
POST-OPERATIVE INSTRUCTIONS
- From PACU administration to healing
completion.  Food
 Bowel movements
PREOPERATIVE PHASE  Sexual activity
 Wound care
 Lifting
INFORMED CONSENT  Pain
 Required prior surgical procedure.  Bathing
 Surgeon is responsible for obtaining an informed  Activities
consent
o Nature & reason of surgery PREOPERATIVE CHECKLIST
o All available options and risks
o Risks of surgical procedure and potential
outcomes
o Name and qualifications of surgeon
o Right to refuse or withdraw consent
 It is only possible when the pt understands the info,
can speak, conscious, mentally competent, and not
sedated.
 Should not be given to minor or pediatric patient

PROCEDURES REQUIRING PERMIT

 Scalpel, scissors, suture, hemostats, or
electrocoagulation involvement. NURSING DIAGNOSIS
 Entrance into body cavity.  Risk for Aspiration
 Radiologic procedure  Ineffective Protection
 General anesthesia, local infiltration, and regional  Impaired Skin Integrity
block.  Risk for Perioperative Positioning Injury
 Risk for Imbalanced Body Temperature
PREOPERATIVE TEACHIN G  Ineffective Peripheral Tissue Perfusion
 Information regarding what will happen to the client,
INTRAOPERATIVE PHASE
when and what the client will experience, such as
expected sensations and discomforts.
 Psychosocial support to reduce anxiety. STERILE TECHNIQUE
 Roles of the client and support people throughout.
 Skills training  An object is sterile only when it is free of all
o Moving microorganisms.
o Leg Exercises  Sterile field
o Deep breathing and coughing  A microorganism-free area.

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  Conscientiousness, alertness, and honesty are
essential qualities in maintaining surgical asepsis.
 When a sterile object becomes unsterile, it does not
necessarily change in appearance.
 Do not set up a sterile field ahead of time for future
use.

POST-OPERATIVE PHASE

ASSESSMENT
 Level of consciousness
 Vital Signs
PRINCIPLES & PRACTICES OF SURGICAL ASEPSIS  Skin color
 Comfort
 All objects used in a sterile field must be sterile  Fluid Balance
 All articles are sterilized by dry or moist heat,  Dressing and bedclothes
chemicals or radiation before use.  Drains and tubes
 Always check a package containing a sterile object
for intactness, dryness, and expiration date. Any
package that appears already open, torn, punctured
or wet is considered as unsterile.
NURSING CONSIDERATIO NS
 Always check chemical indicators of sterilization
before using a package □ Pain management
 All objects become unsterile when touched by
□ Positioning
unsterile objects
 Handle sterile objects only with sterile gloved hands □ Deep-breathing and coughing exercises
and/or sterile forceps. □ Leg exercises
 Discard or resterilize objects that are expose or had □ Moving and ambulation
contact with unsterile objects.
□ Hydration
 Sterile objects that are out of vision or below the
waist or table level considered as unsterile. □ Diet
 Once left unattended, a sterile field considered as □ Urinary elimination
unsterile. □ Suction
 Nurses do not turn their backs on sterile field.
 Only the front part of a sterile gown, from shoulder
to waist (or table height, whichever is higher) and NURSING DIAGNOSIS
the cuff of the sleeves to 2 inches above the elbows  Acute Pain
considered as sterile.  Risk for Infection
 Sterile objects can become unsterile by prolonged  Risk for Injury
exposure to airborne  Risk for Deficient Fluid Volume
 microorganisms  Ineffective Airway Clearance
 Keep doors closed and minimize traffic in the OR or  Ineffective Breathing Pattern
any sterile field.  Delayed Surgical Recovery
 Keep areas in which sterile procedures carried out as  Disturbed Body Image
clean as possible.
 Keep hair clean and short or enclose in a net.
 Wear surgical caps in the OR, DR, burn units, etc.
 Refrain from sneezing or coughing over a sterile
field.
 Sterile objects can become unsterile by prolonged
exposure to airborne microorganisms
 Nurses with mild URTI refrain from carrying out
sterile procedures or wear masks.
 Minimize talking when walking over a sterile field.
 Refrain from reaching over a sterile field and moving
an unsterile object over a sterile field.
 Fluids flow in the direction of gravity.
 Unless gloves worn, always hold wet forceps with
the tips below the handles.
 During surgical hand wash, hold the hands higher
than the elbows to prevent contaminants from the
forearms from reaching the hands.
 Moisture that passes through a sterile object draws
microorganisms from unsterile surfaces above or
below to the sterile surface by capillary action.
 The edges of a sterile field considered as unsterile.
 A 2.5cm (1 in) margin at each edge of an opened
drape considered as unsterile.
 The skin cannot sterilized and is unsterile.

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