Surgical Nursing - PPTX PDF 1

Perioperative Nursing
PERIOPERATIVE NURSING
- nursing care provided in

the total surgical
experience of the patient
a. Preoperative
b. Intraoperative
c. Postoperative
PREOPERATIVE PHASE
Extends from the time the client

decided to have surgery, to the time
he/she is prepared for operation until
he is transported to the operating
room.
INTRAOPERATIVE PHASE
Extends from the time the patient is

admitted at OR, to induction of anesthesia,
surgical procedure is done, until he/she is
transported to the RR/PACU.
POSTOPERATIVE PHASE
Extends from the time the patient is

admitted to RR, to the time he/she is
transported back to surgical unit/
private room, discharged from hospital,
until the follow up care.
SURGERY
-use of instruments during an operation to treat injuries,
diseases, and deformities.
− branch of medicine concerned
with diseases and trauma
requiring operative
procedures.
Perioperative Nursing 3
INpatient OUTpatient
Settings
4 Major Types of Pathologic Process
requiring Surgical Intervention (OPET)
1. Obstruction – impairment to the flow of vital

fluids (blood, urine, CSF, bile)
2. Perforation – rupture of an organ
3. Erosion, wearing off of a surface or
membrane.
4. Tumors – abnormal new growth
Classifications of Surgical
Procedure:
PURPOSE URGENCY
Diagnostic Emergent
Exploratory DEGREE of RISK Urgent
Curative Major Required
Palliative Minor Elective
Cosmetic Optional
According to URGENCY:
Classification Indication for Surgery Examples
Emergent – patient requires - severe bleeding
immediate attention, life
threatening condition. - gunshot/ stab wounds
Without delay
- Fractured skull
Urgent / Imperative – patient Within 24 to 30 hours - kidney / ureteral stones
requires prompt attention.
Required – patient Plan within a few weeks - cataract

or months
needs to have surgery. - thyroid d/o
Elective – patient should have Failure to have surgery - repair of scar
surgery. not catastrophic
- vaginal repair
Optional – patient’s decision. Personal preference - cosmetic surgery
According to PURPOSE:
Diagnostic:
to establish the presence of a dse
condition. (e.g) biopsy
Exploratory:
to determine the extent of dse
condition. (Ex. Lap)
Curative:
to treat the dse condition.
Ablative – removal of organ. “ectomy”
Constructive- repair of congenitally
defective organs. “plasty”,
“oorhaphy”, “pexy”
Reconstructive – repair of damage
organ Perioperative Nursing 13
Palliative:
to relieve distressing s/sx and
not necessarily cure the
disease.
Cosmetic:
performed primarily to alter or
enhance personal appearance.
According to DEGREE of RISK:
MAJOR:
High risk; extensive; prolonged;
large amount of blood loss, vital
organ maybe handled or removed.
Minor:
Less risk; not prolonged; few
complication.
DRILL: Categorize the following acc.to surgery urgency, purpose
of surgery and to the degree of risk.
Pathology/Procedure Urgency Purpose Degree of Risk
Pap Smear Optional Diagnostic Minor
Skin Grafting for Urgent Curative Major
extensive burn
Cholecystectomy Urgent Curative Major
Osteoplasty Required Curative Minor
Gunshot/ Stab wound Emergent Curative Major
Severe bleeding Emergent Curative Major
Scar repair Elective Cosmetic Minor
Fractured skull Emergent Curative Major
Thyroidectomy Required Curative Major
Cataract extraction Required Curative Minor
Ambulatory Surgery/ Same-day Surgery /
Outpatient Surgery
Advantages:
• Reduces length of hospital stay and cuts costs
• Reduces stress for the patient
• Less incidence of hospital acquired infection
• Less time lost from work by the patient; minimal
disruptions on the patient’s activities and family
life.
Disadvantages:
• Less time to assess the patient and perform
preoperative teaching.
• Less time to establish rapport
• Less opportunity to assess for late
postoperative complication.
Ambulatory Surgeries
• Tooth extraction
• Circumcision
• Vasectomy
• Cyst removal
• Tubal ligation
Surgical Risks
Surgical
Risk:
AGE
Nsg. Considerations:
1. Anticipate lesser dosage of meds.
2. Anticipate problem from c.dses.
3. Diet:
4. SAFETY!
Surgical
Risk:
NUTRITIONAL Status
1. Weigh the aeg before surgery.
2. Diet:
3. Encourage wt. reduction.
4. Instruct aeg. about proper wound
splinting.
5. Drugs should be dosed accordingly!
6. Recommend repair of dental caries
and proper mouth hygiene.
Surgical
Risk:
FLUID and ELECTROLYTE IMBALANCE
1. Correct any imbalances.
2. MIO
Surgical
Risk:
Chronic COMORBID diseases
1. Avoid fluid overload.
2. Assess v/s.
3. Encourage position changes.
4. Monitor blood glucose.
Surgical
Risk:
ALCOHOLISM
1. Anticipate acute withdrawal
symptoms.
Surgical
Risk:
SMOKING
1. Encourage vitamin intake.
Surgical
Risk:
Concurrent or prior PHARMACOTHERAPY
1. Obtain medication history.
2. Stop ALL medications!
PREOPERATIVE
PHASE
PREOPERATIVE
PHASE
GOALS:
▪ Assessing and correcting physiologic and
psychological problems that might increase
surgical risk.
▪ Giving the person and SOs complete learning/

teaching guidelines regarding surgery.
PREOPERATIVE
PHASE
GOALS:
▪ Instructing and demonstrating exercises that will
benefit the person during postop period.
▪ Planning for discharge and any projected

changes in lifestyle due to surgery.
PREOPERATIVE
PHASE
Routine Pre.op Screening Tests
CBC X matching Serum Electrolytes
ALT, AST S.albumin, total CHON
BUN, Crea U/A ECG
C-XR PT, PTT FBS
DRILL
45/M with Rectal CA. Plan: Abdomino-
perineal surgery. Timing of hair removal?
a. Night before surgery

b. 3 hours before surgery
c. Early a.m on the day of the surgery
d. At the operating threatre
PREOPERATIVE
PHASE
Informed Consent
-permission obtained from a patient to perform a specific test or
procedure.
Purposes:
1. To ensure that the client understands the nature
of the treatment.
2. Indicate that the client’s decision was made without
pressure.
PREOPERATIVE
PHASE
Purposes:
3. To protect the client against unauthorized procedure.
4. To protect the surgeon and hospital against legal

actions by a client who claims that unauthorized procedure
was performed.
PREOPERATIVE
PHASE
Under what
circumstances?
1. Any surgical procedures where scalpels,

scissors, sutures, hemostats of
electrocoagulation may be used.
2. Entrance into body cavities.
3. Radiologic procedures, i.e with contrast
media.
4. General anesthesia, local infiltration and
regional block.
1
PREOPERATIVE
ESSENTIAL ELEMENTS
• The diagnosis and explanation of the condition.

• A fair explanation of the procedure to be done and
used and the consequences.
• A description of alternative treatment or procedure.
• A description of the benefits to be expected
• The prognosis, if the recommended care procedure
is refused
REQUISITES for VALIDITY
✓ Written permission is best and legally accepted. Signature is obtained with

the client’s complete understanding of what to occur.
• adult sign their own operative permit
• obtained before sedation
✓ For minors, parents or someone standing in their behalf, gives the consent.
Note: for a married emancipated minor parental consent is not needed
anymore, spouse is accepted
✓ For mentally ill and unconscious patient, consent must be taken from the
parents or legal guardian
✓If the patient is unable to write, an “X” is accepted if there is a
witness to his mark
• Secured without pressure and threat
• A witness is desirable – nurse, physician or authorized persons.
• When an emergency situation exists, no consent is necessary

because inaction at such time may cause greater injury.
(permission via telephone/cellphone is accepted but must be
signed within 24hrs.)
PREOPERATIVE Teachings:
PREOPERATIVE
Preoperative Teaching: PHASE
INCENTIVE SPIROMETRY
Encouraged to use incentive
spirometerabout 10 to 12 times
per hour.
ﾘ Deep inhalations expand alveoli,

whichprevents atelectasis and other
pulmonary complication.
ﾘ There is less pain with

inspiratoryconcentration than
with expiratory concentration.
PREOPERATIVE
DIAPHRAGMATIC BREATHING
Procedure:
1. Position in Semi-Fowler’s.
2. Breathe out gently and fully.
3. Take a deep breath through nose and
mouth.
4. Hold breath.
5. Exhale through your nose and mouth.
PREOPERATIVE
COUGHING EXERCISES
Procedure:
1. Interlace fingers and place
hands over the proposed incision
site. (SPLINTING)
2. Lean forward slightly while sitting
in bed.
3. Breath with mouth slightly open.
4. Let out 3-4 sharp hacks.
5. Take in deep breath with mouth open
and quickly give 1-2 strong coughs.
PREOPERATIVE
TURNING
Procedure:
1. Place the uppermost leg in a
more flexed position than lower leg.
2. Place a pillow in between the legs.
3. Make sure that the patient is turned
from one side to back and v.v

every 2 hours.
PREOPERATIVE
FOOT AND LEG EXERCISES

Procedure:
1. Ask the patient to lie
supine.
2. Instruct the patient to
bend a knee and raise
a foot.
3. Repeat 5 times with
one leg and the other
every 3-5 hours.
PREOPERATIVE
PHASE
PREOPERATIVE Preparations:
4
BEFORE SURGERY
✓ Correct any dietary deficiencies
✓ Reduce an obese person’s weight
✓ Correct fluid and electrolyte imbalances
✓ Restore adequate blood volume with BT
✓ Treat chronic diseases
✓ Halt or treat any infectious process
✓ Treat an alcoholic person with vit.
supplementation,
✓ IVF or fluids if dehydrated
PREOPERATIVE
PHASE
Preparing the Patient the Evening Before Surgery
❖ Skin Preparation:
- FULL Bath
- Hair removal: within 1-2 mm of skin, use electric clipper.
❖ GIT Preparation:
- NPO
- Cleansing enema
Liquid and Food Minimum Fasting
Intake Period (Hrs.)
Clear Liquids 2
Breast Milk 4
Nonhuman Milk 6
Light Meal 6
Regular/Heavy 8
Meal
PREOPERATIVE Perioperative Nursing 42

PHASE
PREOPERATIVE
PHASE
Preparing the Patient the Evening Before Surgery
❖ Preparing for Anesthesia:

- Avoid alcohol and cigarette smoking.
❖ Promoting Rest and Sleep:

- Adm.sedatives as ordered.
Preparing the Patient the Day Before Surgery
- Awaken 1 hour before

preop meds.
- Remove hairpins, braid
long hair, cover hair
with cap
- Remove hearing aid,
contact lenses
- Check for special
orders
- Have client void before
preop meds.
PREOPERATIVE
PHASE
PREOPERATIVE MEDICATIONS
❖ Tranquilizers and Sedatives

diazepam
midazolam
lorazepam
diphendydramine
PREOPERATIVE
PHASE
❖ Analgesics
nalbuphine
fentanyl
meperidine
Morphine SO4
PREOPERATIVE
PHASE
❖ Anticholinergics
AtSO4
PREOPERATIVE
PHASE
❖ Antiemetics
odansetron
metoclopramide
promethazine Hcl
scopolamine
PREOPERATIVE
PHASE
❖ H2 antagonists and Proton pump inhibitors

cimetidine
ranitidine
famotidine
omeprazole
PREOPERATIVE
PHASE
❖ Antibiotics
amoxicillin
cefazolin
ampicillin
Let me help you
review the
colours of IV
cannula...
Operative Site Identification
INTRAOPERATIVE
PHASE
INTRAOPERATIVE
PHASE
GOALS:
▪ Homeostasis
▪ Asepsis
▪ Safe administration of anesthesia
▪ Hemostasis
5
INTRAOPERATIVE
PHASE
SURGEON
✓Preoperative medical Hx and P.A

✓Performs operative procedure
✓Primary decision maker
✓May assist with positioning and
prepping the patient or may
delegate.
INTRAOPERATIVE
PHASE
ASST.SURGEON
✓Assists with retracting, hemostasis,

suturing and other tasks requested by
the surgeon.
INTRAOPERATIVE
PHASE
ANESTHESIOLOGIST
✓Selects and administers the

anesthesia.
✓Intubates the patient as necessary.
✓Manages technical problems r/t
anesthesia.
SCRUB NURSE
✓Reviews the surgical
procedure.
✓Assists with room prep.
✓Scrubs, gowns and gloves self and
other members of the team.
✓Prepares instrument table and
organizes sterile equipment.
✓Assists with the draping procedure .
INTRAOPERATIVE
PHASE Perioperative Nursing 67
SCRUB NURSE
✓Passes anticipated/requested
instruments to the surgeon and
assistant.
✓Counts sponges, needles and
instruments.
✓Monitors the consistency of aseptic
practices.
✓Keeps track of irrigations used for
calculations of blood loss.
INTRAOPERATIVE
PHASE Perioperative Nursing 68
CIRCULATING NURSE
✓Manages personnel equipment,
supplies and the environment.
✓Ensures all equipment are working
properly.
✓Guarantees sterility of equipment and
supplies.
✓Assists with positioning.
INTRAOPERATIVE
PHASE
CIRCULATING NURSE
✓Handles specimen.
✓Coordinator, patient advocate, teacher,
research consumer, leader and role
model.
✓Documents care provided.
✓Monitor the room and team members
for break in the sterile technique.
INTRAOPERATIVE
PHASE
Aseptic Techniques
Sequence in Removing Soiled Gowns & Gloves at the End of
the Procedure
INTRAOPERATIVE
PHASE
Position During Surgery
Procedures: Dorsal Recumbent

❖ Hernia repair
❖ Bowel resection
❖ Bartholins Cyts Removal
INTRAOPERATIVE
PHASE
Procedures:
❖ Abdominal surgery S upine
❖ Chest/Breast surgery
❖ Neck surgery
❖ Ear surgery
❖ Abdomino-thoracic surgery
❖ Lower extremity procedures
INTRAOPERATIVE
PHASE
Procedures: Trendelenburg
❖ Lower abdomen surgery
❖ Pelvic Surgery
INTRAOPERATIVE
PHASE
Procedures: Lithotomy
❖ Perineal Repair
❖ Vaginal Repair
❖D&C
INTRAOPERATIVE
PHASE
Procedures: Prone
❖ Laminectomy
❖Surgery of the posterior surface
of the body
❖ Surgery involving buttocks
❖ Spinal Surgery
INTRAOPERATIVE
PHASE
Procedures: Lateral
❖ Hemithorax
❖ Kidney surgery
❖ Hip surgery
INTRAOPERATIVE
PHASE
Procedures: Jack Knife

❖ Rectal procedures
INTRAOPERATIVE
PHASE
Procedures:
Reverse Trendelenburg
❖ Thyroidectomy
❖ Upper abd’l surgery
❖ Head and Neck surgery
❖ Facial surgery
Positions During INTRAOPERATIVE
PHASE
Surgery
Procedures:
Procedure:
❖ NGT Insertion
❖ Rectal Procedures
❖ Bronchoscopy
❖ Thoracentesis
❖ Otorhinologic
procedures
ANESTHESIA
-produces muscle relaxation, block transmission of pain
nerve impulses and suppress reflexes.
- decreases temporarily the memory retrieval and recall.
INTRAOPERATIVE
PHASE
TYPES OF ANESTHESIA
GENERAL
- covers the entire body
REGIONAL
- covers a specific area of
the body
INTRAOPERATIVE
PHASE
General Anesthesia
• reversible state consisting of complete loss of
consciousness and sensation.
• protective reflexes such as cough and gag are
lost.
• Produces amnesia and hypnosis.
• Can be administered through IV or inhalation.
INTRAOPERATIVE
PHASE
Intravenous Anesthesia: Inhalation Anesthesia:

- prepares the client for smooth - comprises of volatile liquids or
transition to surgical anesthesia. gas and oxygen.
- effects are extremely rapid; requires
artificial airway
Ex.
Ex. nitrous oxide
thiopental Na (Pentothal Na) halothane (Fluothane)
methohexical Na (Brevital) enfluorane (Ethrane)
fentanyl (Sublimaze)
isoflurane (Forane)
diazepam (Valium)
midazolam (Versed)
STAGES (DEPTH OF ANESTHESIA) GENERAL ANESTHESIA
• Stage: ANALGESIA
• Time: Adm. of anesthesia (loss of pain sensation) to loss of consciousness
• Response: drowsy, dizzy, decreased pain sensation, hearing is exaggerated
I • Nsg. Action/s: avoid unnecessary external stimuli, safety measures
• Stage: EXCITEMENT
• Time: Loss of consciousness to loss of lid reflex, Combative response
• Response: loss of lid reflex, inc.muscle tone, dilated pupils, inc. RR and PR
II • Nsg. Action/s: avoid auditory and physical stimuli, protect extremities, suctioning
• Stage: SURGICAL
• Time: Loss of lid reflex to loss of muscle reflexes
• Response: Normal/ near normal vitals
III • Nsg. Action/s: Assist with intubation, operative position, skin prep
• Stage: MEDULLARY DEPRESSION

• Time: depressed vitals, CNS depression
• Response: cardiac/resp. arrest
IV • Nsg. Action/s: prepare to do CPR
GENERAL
ANESTHESIA
INTRAOPERATIVE
PHASE
Complications and Discomforts of Anesthesia:

Aspiration
Hypoventilation
Oral trauma
Malignant hyperthermia
HTN
Cardiac Dysrhythmias
Hypothermia/ Hyperthermia
N/V
Headache
Urinary retention
INTRAOPERATIVE
PHASE
Regional Anesthesia
• achieved by injecting local anesthetics in close
proximity to appropriate nerves.
• reduce all painful sensation in one region of

the body without inducing unconsciousness.
REGIONAL ANESTHESIA
Topical Anesthesia:
- applied directly to the skin and mucous membrane, open
skin surfaces, wounds and burns.
Ex: lidocaine ointment/ spray, benzocaine, EMLA
REGIONAL ANESTHESIA
Spinal Anesthesia:
- lumbar puncture.
- procaine, tetracaine, lidocaine
and bupivacaine
Epidural Anesthesia:
- achieved by injecting local
anesthetic into epidural space.
- chloroprocaine, lidocaine
and bupivacaine
REGIONAL ANESTHESIA
Peripheral Nerve Block

− Anesthetic is injected around a nerve that blocks
sensation at a small area of the body
− Chloroprocaine, lidocaine, bupivacaine
Intravenous Block
- arm, wrist and hand procedure
- involves IV injection of a local
agent and the use of an
occlusion tourniquet.
REGIONAL ANESTHESIA
Caudal Anesthesia:
- anesthetic is injected into
caudal/sacral canal.
Field Block Anesthesia:

- the area proximal to a planned
incision can be injected and
infiltrated with local anesthetic
agent.
INTRAOPERATIVE
PHASE
Surgical Skin Preparation:
- an aseptic procedure that is used to

reduce the resident and transient flora
naturally present on the skin surface.
- accomplished by application of anti-

microbial agents.
INTRAOPERATIVE
PHASE
Abdominal Prepping
Chest and Beast Prepping

INTRAOPERATIVE
PHASE
Lower Leg Prepping
Lower Extremity Prepping

INTRAOPERATIVE
PHASE
Upper arm prepping
Lower arm prepping

INTRAOPERATIVE
PHASE
Rectoperineal/Vaginal Skin Prep.
INTRAOPERATIVE
PHASE
Surgical Incisions
Butterfly Limbal
INTRAOPERATIVE
PHASE
Surgical Incisions
Halstead Subcostal
INTRAOPERATIVE
PHASE
Surgical Incisions
P fannenstiel Lumbotomy
Surgical Incisions
INTRAOPERATIVE
PHASE
Wound Closure
Commonmethods of suturing:
Everting Suture Inverting Suture
Retention Suture Traction Suture
Everting Suture
Inverting Suture

Inverting Suture
Commonmethods of
Retention Suture suturing:

Commonmethods of
Traction Suture suturing:

SUTURE CLASSIFICATION
Absorbable
Behavior in tissue:
Non-absorbable
Monofilament
Structure:
Multifilament

INTRAOPERATIVE
PHASE
SURGICAL NEEDLES
Traumatic Needle Atraumatic Needle
- needles with holes or eyes - comprise an eyeless needle

which are supplied to the attached to a specific length of
hospital separate from their suture thread.
suture thread.
- this type of suture rips the
tissue to a certain extent.

INTRAOPERATIVE
PHASE

SURGICALNEEDLES
Point and Body Shape:
Tapercut/Cutting
- small triangular cutting point and flat
body (cross section)
- fascia, ligaments, tendon, uterus, skin, oral
cavity and etc.
Taperpoint
- taper point and round or quadrangular
body (cross section)
- intestines, muscles, nerves, liver, kidneys,
peritoneum, blood vessels, valves.
SURGICALNEEDLES
Point and Body Shape:
Blunt point
- blunt point and flat body (cross section)
- bowels, kidney, spleen, liver.
Triangular
- triangular point and flat or quadrangular

body (cross section).
- skin, sternum, fascia, ligaments, tendons.

Basic SurgicalInstruments
11
Cutting and Dissecting:
Mayo Scissor
Suture Scissor
Metzenbaum
Cutting and Dissecting:
Bandage Scissor Blade holder

Grasping and Holding:
Russian Tse Forcep
Adson Tse Forcep

DeBakey Tse Forcep

Allis
Backhaws towel clip
Tenaculum

Babcock
Randall Stone Forcep Kocher

Foester
Retracting and Exposing:
US Army Navy
Senn
Richardson
Vein Retractor
Deaver
Malleable

Green Goiter
Volkmann Rake
Weitlaner

Skin Hooks
Langenback
Vaginal Speculum
Clamping and Occluding:
Straight & Curved

Mosquito Mixter Kelly
DRILL
A female client, 23 y.o was admitted for
the first time at NDH. She was
diagnosed to have ruptured appendicitis.
She was scheduled to have emergency
Ex-Lap under G.A. Preop instructions
include all but one:
a. Deep breathing & coughing
b. Explaining the procedure
c. Turning to side
d. Foot and leg exercises
DRILL
During induction of anesthesia, what is
your nursing priority action?
a. Secure informed consent
b. Close OR door and keep voice to
minimum
c. Ensure safety
d. Anticipate for CPR.
DRILL
Compared to patients with simple
appendicitis, patients with ruptured
appendicitis have more tubes like NGT
and foley catheter and require closer
monitoring….
Why?

POSTOPERATIVE
PHASE

POSTOPERATIVE
PHASE
GOALS:
▪ Maintain adequate body system functions.
▪ Restore homeostasis.
▪ Alleviate pain and discomfort.
▪ Prevent postop complication
▪ Ensure adequate discharge planning and teaching.
13
ADMITTING PATIENT TO PACU
• Transferring of the patient from the OR

to the PACU is the responsibility of the
anesthesiologist.
• During transport the anesthesiologist
remains at the head part of the patient
and a surgical team member remains at
the opposite side.
• Transporting the patient involves the
special consideration of the incision site,
potential vascular changes and exposure.
POSTOPERATIVE
Initial Nursing Assessment: PHASE
▪ Verify patient’s identity, operative procedure and the surgeon

who performed the procedure.
▪ Position
▪ Evaluate vital sings: respiratory status, circulatory
status, pulses, temp., O2 sat.,

▪ Pain
▪ Determine vital reflexes, LOC and response to stimuli.
▪ Skin integrity
▪ Condition of the wound
▪ IV lines
▪ Evaluate drainage patency.
▪ Ensure safety!
POSTOPERATIVE
PHASE
Immediate Stage
- period of 1 to 4 hours after surgery.
Intermediate Stage
- period of 4 to 24 hours after surgery.
Extended Stage
- period of 1 to 4 days after surgery.

POSTOPERATIVE
IMMEDIATE STAGE
PHASE
Nursing Interventions:
▪ Monitor v/s.
▪ Monitor airway patency and adequate ventilation.
▪ Encourage coughing & deep breathing q1-2h.
▪ MIO
▪ Watch out for s/sx of shock
▪ Assess for Homan’s sign
▪ Proper positioning
▪ Monitor for return of gag reflex/ bowel sounds.
▪ Provide comfort measures to relieve pain.
13
POSTOPERATIVE
INTERMEDIATE STAGE
PHASE
▪ Monitor v/s.
▪ Before ambulation, instruct the client to
sit at the edge of the bed with the feet
supported.
▪ Avoid wound infection.
▪ Maintain NPO status until gag reflex and
peristalsis return.
▪ MIO
13
POSTOPERATIVE
EXTENDED STAGE
PHASE
▪ Monitor for signs of infection.
▪ Encourage ROM exercises.
▪ Continue to encourage ambulation.
▪ Encourage food rich in CHON and vit.C.
13
DISCHARGING PATIENT FROM PACU
• Stable V/S
• Orientation to person, place, events and
time
• Uncompromised pulmonary fxn
• Adequate O2 saturation
• UO at least 30ml/hr
• N and V absent or under control
• Minimal pain
POSTOPERATIVE
Wounddressing: PHASE

Suture removal
•Scalp: 7 to 10 days
•Face: 3 to 5 days
•Chest or trunk: 10 to 14 days
•Arms: 7 to 10 days
•Legs: 10 to 14 days
•Hands or feet: 10 to 14 days
•Palms of hands or soles of feet: 14 to 21 days
POSTOPERATIVE
Drains: PHASE

COMMON POSTOPERATIVE
COMPLICATIONS

PNEUMONIA ATELECTASIS
collapse of the alveoli.
• inflammation of the alveoli.
• etio: mucous plug
• etio: infection, immobility, aspiration
• S/Sx:
• S/Sx:
✓ Dyspnea
✓ Fever
✓ Tachycardia
Dull/absent lung
Hemoptysis ✓ Dec. O2 Saturation sounds
✓ Cyanosis

POSTOPERATIVE
PHASE
Nursing Interventions: Pneumonia/ Atelectasis
1. Assess lung and breath sounds.

2. Reposition the client.
3. Promote lung expansion and airway patency.
4. Encourage fluid intake.
5. Encourage early ambulation.

Cardiovascular
HEMORRHAGE
• loss of large amount of blood externally or internally in a short
period of time.
• etio: disruption of sutures, insecure ligation of vessels
• S/Sx:
✓ cold, moist, pale skin
✓ tachycardia & tachypnea
✓ HTN
✓ Restlessness Bruising/swelling around incision

POSTOPERATIVE
PHASE
Nursing Interventions: Hemorrhage
1. Provide pressure to the dressing.

2. Notify physician immediately!
3. Adm. O2 a.d
4. Adm. IV and blood products a.d
5. Prepare client for surgical procedure as
necessary.

Cardiovascular
THROMBOPHLEBITIS
• inflammation of the vein usually of the legs and associated with a
blood clot.
• etio: immobility, increased blood coagulability
• S/Sx:
✓ elevated temperature pallor
on the affected extremity
✓ vein feels hard
✓ Vein is swollen, red and hard to vein
Homan’s sign
POSTOPERATIVE
PHASE
Nursing Interventions: Thrombophlebitis
1. Elevate the extremity without pressure on the

popliteal area.
3. Encourage the use of antiembolism stockings a.p
4. Encourage leg exercises.
5. Hydrate adequately.
6. Initiate anticoagulant therapy a.p
7. AVOID massaging the affected calf!!!

Urinary
URINARY RETENTION
• inability to empty the bladder with excessive urine accumulation.
• etio: anesthesia, bladder sphincter spasm
• S/Sx:
inability to void
Distended bladder
Restlessness
Suprapubic pain
HPN
POSTOPERATIVE
PHASE
Nursing Interventions: Urinary retention
1. Hot and cold compress?

2. MIO
3. Encourage ambulation.
4. Assist in voiding.

Gastrointestinal
PARALYTIC ILEUS
• Lack of bowel peristalsis
• etio: anesthesia, immobility
• S/Sx:
N/V
abdominal distention
abdominal pain
(-) bowel sounds
POSTOPERATIVE
PHASE
Nursing Interventions: Paralytic Ileus
1. Monitor bowel sounds.


Wound
WoundInfection
• Inflammation and infection of incision or drain site.
• etio: poor aseptic technique
• S/Sx:
fever and chills
pus or foul discharge on wound site
s/sx of infection

POSTOPERATIVE
PHASE
Nursing Interventions: Wound Infection
1. Keep wound clean and dry.

2. Surgical aseptic technique when changing
dressing.
3. Administer antibiotic a.p.

DEHISCENCE EVISCERATION
• separation of the suture lines. • extrusion of internal organs/tses.

Obesity/ malnutrition
Excessive strain on suture line
• S/Sx: • S/Sx:
Opened wound increased wound drainage (+) protrusion of

edges abdominal contents

POSTOPERATIVE
PHASE

POSTOPERATIVE
PHASE
Nursing Interventions: Dehiscence & Evisceration
1. Cover the wound with a sterile NS dressing.

2. Semi-Fowler’s position with knees bent.
3. Notify the physician.
4. Administer antiemetics a.p
5. Encourage diet: High CHON, vit. C
6. Splinting when coughing/ abdominal binders.
DRILL
The RN is preparing to insert a Foley catheter
into a patient. It would be most important for
the RN to take which of the ff .actions?
a. Place all supplies closed to the edge of

the table.
b. Keep the field holding the supplies in
front of the nurse.
c. Set up a field below the nurse’s waist
level.
d. Add clean supplies to the field.
DRILL
A nurse instructs a preoperative client in the
proper use of incentive spirometer.
Postoperative assessment of the effectiveness
of its use is determined by absence of?
a. Coughing
b. Shallow breaths
c. Wheezing in one lung field
d. Unilateral chest expansion

yeng
If I could present to you all the ANSWERS, I will. But I
LEARNED along the way that the best thing I can do is to
make sure that you won’t STOP THINKING and that you
KEEP SEARCHING what’s best for you.
yeng

Surgical Nursing - PPTX PDF 1

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Perioperative Nursing

- nursing care provided in

Extends from the time the client

Extends from the time the patient is

Extends from the time the patient is

1. Obstruction – impairment to the flow of vital

Required – patient Plan within a few weeks - cataract

2. Anticipate problem from c.dses.

3. Encourage position changes.

4. Monitor blood glucose.

2. Stop ALL medications!

▪ Giving the person and SOs complete learning/

▪ Planning for discharge and any projected

Routine Pre.op Screening Tests

CBC X matching Serum Electrolytes

ALT, AST S.albumin, total CHON

BUN, Crea U/A ECG

C-XR PT, PTT FBS

a. Night before surgery

4. To protect the surgeon and hospital against legal

1. Any surgical procedures where scalpels,

• The diagnosis and explanation of the condition.

✓ Written permission is best and legally accepted. Signature is obtained with

• When an emergency situation exists, no consent is necessary

ﾘ Deep inhalations expand alveoli,

ﾘ There is less pain with

from one side to back and v.v

FOOT AND LEG EXERCISES

Preparing the Patient the Evening Before Surgery

PREOPERATIVE Perioperative Nursing 42

Preparing the Patient the Evening Before Surgery

❖ Preparing for Anesthesia:

❖ Promoting Rest and Sleep:

- Awaken 1 hour before

❖ Tranquilizers and Sedatives

❖ H2 antagonists and Proton pump inhibitors

▪ Safe administration of anesthesia

✓Preoperative medical Hx and P.A

✓Assists with retracting, hemostasis,

✓Selects and administers the

Position During Surgery

Procedures: Dorsal Recumbent

Position During Surgery

Position During Surgery

Position During Surgery

Position During Surgery

Position During Surgery

Position During Surgery

Procedures: Jack Knife

Position During Surgery

- decreases temporarily the memory retrieval and recall.

Intravenous Anesthesia: Inhalation Anesthesia:

• Stage: MEDULLARY DEPRESSION

Complications and Discomforts of Anesthesia:

• reduce all painful sensation in one region of

Peripheral Nerve Block

Field Block Anesthesia:

Surgical Skin Preparation:

- an aseptic procedure that is used to

- accomplished by application of anti-

Chest and Beast Prepping

Lower Leg Prepping

Lower Extremity Prepping