NCM of Clients in Need of

Surgery (Ms. Myrvi Vergara)

I. PERIOPERATIVE NURSING

SURGERY
-branch of medicine concerned
with diseases and trauma
requiring operative procedures.

PERIOPERATIVE
Encompasses the three phases of
the surgical experience: pre-
operative, intraoperative, and
post operative

PERIOPERATIVE NURSING
- activities that occur in any
or all of the three phases

PREOPERATIVE
- period of time from when the
decision for surgical
intervention is made to when the
patient is transferred to the
OR table.

INTRAOPERATIVE
- period of time from when the
patient is transferred to the
operating table to when he or
she is admitted to the PACU.

POSTOPERATIVE
- period of time that begins
with the admission of the
patient to PACU and ends after a
follow-up evaluation in the
clinical setting or home.

Word elements that make up a

surgical term or phrase:

 Word root
- meaning of the word
- describes a body part of
function
- usually Greek & Latin origin
 Prefix
 Suffix

 Combining Vowel
– connects the word root with a
suffix (usually the letter “o”) TYPES OF PATHOLOGIC
PROCESSES REQUIRING SURGICAL
INTERVENTION

 Obstruction
 Perforation
 Erosion
 Tumors

Classification of Surgical
Procedures

 PURPOSE
 SERIOUSNESS
 URGENCY

II. INTRAOPERATIVE PHASE
Types of Anesthesia:
General - total loss of
consciousness and sensation
(also produces amnesia)
 Intravenous - Thiopental Na
 Inhalation - Halothane;
Isoflurane
Regional - reduces all painful
sensations in one region without
inducing unconsciousness
 Topical
 Local infiltration
 Nerve Block
 Spinal
 Epidural
Stages of General Anesthesia
The Surgical Team
STERILE TEAM
 Surgeon
 First Assist
 Registered Nurse First
Assistant (RNFA)
 SCRUB Nurse (RN,
LPN,Surgical Technician)
NON STERILE TEAM
 Anesthesiologist
 Certified Registered Nurse
Anesthetist (CRNA)
 Circulating Nurse
Roles:
SURGEON
- The Head of the Surgical Team
- A Physician specially trained
and qualified to perform the
surgical procedure.
First Assist
- May be a resident, intern,
physician’s assistant, or a
perioperative nurse
- Assist in retracting,
hemostasis, suturing, etc.
Registered Nurse First Assistant
- expanded role of perioperative
nursing.
- under the direct supervision
of the surgeon.
- Responsibilities: handling
tissue, providing exposure at
the operative field, suturing
and maintaining hemostasis.
Scrub Nurse
RN, LPN, Surgical Technician
-Selects instruments, equipment,
supplies appropriate for the
surgery.
- Prepares the sterile field and
sets-up sterile tables.
- Assist with applying surgical
drapes.
- Maintain sterility of the
sterile field.
- Anticipates the surgeons needs
- Surgical counts instruments,
sponges & sharps.
- Clean & prepare instruments
for sterilization.
Anesthesiologist
-is a physician specifically
trained in the art and science
of anesthesiology.
CRNA
- is a qualified health care
professional who administers
anesthetics.
- Administers anesthesia under
the direct supervision of the
anesthesiologist .
- Assesses the patient before
surgery
- Selects and administers
anesthesia
- Intubates the patient if
necessary
- Manages any technical problems
related to the administration of
anesthetic agent
- Supervises the patient
condition throughout the
surgical procedure
- Monitors BP, pulse,
respirations, ECG, blood O2
saturation level.
Circulating Nurse
- Completes a preoperative
assessment
- Establish and implement the
intraoperative plan of care,
evaluate the care, and provide
for the continuity of care
postoperatively.
- Assists the anesthesia care
provider with endotracheal
intubation
- Performing on going patient
assessment.
- Monitors sterile technique of
all members of the team and a
safe OR environment
- Assist the surgeon and scrub
nurse by operating non sterile
equipment, providing additional
instrument and supplies.
- Maintain accurate and complete
documentation.
- Tracking sponge, needle, and
instrument counts.
- Preparing and disposing of
specimens.
The Surgical Environment
Surgical Zones:
 Unrestricted
Street clothes allowed
 Semi restricted
scrub suits, caps
 Restricted zone
scrub suits, caps, shoe covers,
masks
Health Hazards
- Exposure to blood and body
fluids
- Hazards associated with laser
beams
- Exposure to latex and adhesive
substances
- Exposure to radiation and
toxic agents
- Unintentional leaving of an
object
Intraoperative Nursing
Management
ASSESSMENT
 Presurgical care unit (PSCU)
* surgical holding area outside
OR
- Confirmation of client’s
identity
- Assessment of physical &
emotional status
 Anesthesiologist/ CRNA
- continuous assessment to
prevent, detect and initiate
prompt interventions for adverse
surgical responses
NURSING DIAGNOSES
- Risk for aspiration
- Ineffective protection
- Impaired skin integrity
- Risk for perioperative
positioning injury
- Risk for imbalance body
temperature
- Ineffective peripheral tissue
perfusion
- Risk for deficient fluid
volume
PLANNING/ INTRAOPERATIVE GOALS
- To reduce anxiety
- To prevent infection
- To prevent intraoperative
positioning injury
- To protect from injury
- Maintain patient’s dignity
- Monitor and manage
complications
SAFETY & HOMEOSTASIS
IMPLEMENTATION (The Surgical
Experience)
 Circulating nurse
- Coordinates activities and
manages client care by
continuous assessment of
client’s safety; monitors
aseptic technique; environment
 Scrub person & RNFA
- Assist surgeon
I. To Reduce Anxiety
Pedisposing Factors:
 Fear of the unknown
 Fear of death
 Fear of anesthesia
 Fear of disfigurement
 Financial difficulties
- Introduce self
- Address the patent by name
- Verify details
- Encourage and answer questions
- Pay attention to physical
comfort
II. To Prevent Infection
Surgical Site Infection (SSI)
- A surgical incision creates an
opportunity for microorganisms
to enter the body and for
infection to result.
Sources: endogenous; exogenous
(personnel, environment,
equipment)
Control: Adherence to aseptic
practices
Surgical Asepsis
Aseptic technique - refers to
the practices by which
contamination with microorganism
in the surgical environment is
prevented
SURGICAL CONSCIENCE - inner
commitment to adhere to aseptic
practices:
- Surgical attire
- Gowning & Gloving
- Scrubbing
- Skin Preparation
- Sterilization of instruments &
equipments
- Creation & maintenance of a
sterile field
- Control of the environment
sources of infection
III. To Prevent Intraoperative
Positioning Injury
Benefits of Proper Positioning
 Optimal access (surgical
site, IV line, monitoring
devices)
 Protection of the client from
harm
Complications:
 MS Pain, joint dislocation,
peripheral nerve damage, skin
breakdown, cardiovascular &
respiratory compromise

SURGICAL POSITIONS
Dorsal Recumbent / Supine
– most common
- Abdominal surgeries ;anterior
approach, head, neck,
extremities
Trendelenburg
-lower abdomen, pelvis
Reverse Trendelenburg
- head and neck
Lithothomy
- perineum, pelvic organs,
genitalia
Sims’ or Lateral Decubitus
- thorax, kidney,
retroperitoneal space, hip
Jackknife or Kraske’s
- proctologic, rectal surgeries
Prone
- spine, back, rectum,
extremities
Sitting (Semi-sitting; Semi-
Fowler’s)
- cranial procedures
IV. To Protect Patient From
Injury
 Verify information, check the
chart for completeness
- Informed consent with
patient’s signature
- Complete records for history &
PE
- Results of diagnostic studies
Allergies
 “TIME OUT”
- prevent wrong site injury
 Safe transferring practices
- If possible, let the patient
do as much of the transfer
- Check chart for precautions
(joint disease)
- Watch for signs of orthostatic
hypotension
 Reduce potential for foreign
body retention
- Surgical Count - refers to the
accounting of sponges, sharps &
instruments during surgery
- Performed & documented prior
to beginning, during, before
closure of cavity/ incision
- Incorrect count - Inform
surgeon & team members to assist
in locating missing item
 Prevent injury related to use
of electrosurgery
- Burn, Shock
- inadvertent contact of an
active electrode
- grounding pad positioning
LEGAL & ETHICAL ASPECTS
1. Borrowed Servant Rule -
surgeon was considered the
captain of the ship and was
liable for the negligent acts of
the servants (before).But courts
now recognize that the surgeon
does not have complete control
over the acts of the
perioperative team at all times.
2. Doctrine of Respondeat
Superior - a subordinate acts
according to his/ her superior’s
direction therefore, the
hospital is liable for the
negligent actions of the nurse.
3. Doctrine of Res Ipsa Loquitor
- “the thing speaks for itself”.
The courts allow the patient’s
injury to stand as inference of
negligence.
4. Assault and Battery -
unlawful threat to harm another
physically; carrying out of
bodily harm (touching without
consent)
* Periop nurse ensures that
informed consent has been
obtained, documented, and placed
in the health record/ hospital
policy
5. Invasion of Privacy - the
patient has the right to expect
that all communications and
records pertaining to
individualized care will be
treated as confidential and will
not be misused.
Confidentiality agreement

6. Abandonment - leaving the

patient when patient’s condition
is contingent on the presence of
the caregiver

V. To Maintain Patient’s
Dignity
Nurse as patient advocate
- Maintain patient’s physical &
emotional comfort
- Provide physical privacy
- Treat patient as a person
- Maintain confidentiality

VI. To Monitor and Manage

Complications
- Being alert to and reporting
changes
- Assist in managing
complications
- Maintain sepsis

EVALUATION
- The intraoperative nurse uses
the goals developed during
planning stage
- Data collected to evaluate
- Achieved; Reformulate plan