AN INTRODUCTION TO PERIOPERATIVE

CARE (PRE, INTRA & POST)

NCM-N112A LECTURE/WEEK2-5
Classifying Surgery:
Surgery is a medical procedure that invades
(enters) the body, usually by cutting or puncturing the
skin or by inserting instruments into the body.
• Minimally invasive surgery:
- surgical procedures that use specialized
instruments inserted into the body either
through natural orifices or through small

• Robotics Robot-assisted technology:

- this type of surgery aims to achieve a more
precise and less invasive surgical procedure.
- staff assisting in this type of surgery are trained
and should be knowledgeable in the
instrument and in manipulating the device.
- is increasingly part of the intraoperative
environment for cardiac, colorectal, general,
gynecologic, head and neck, thoracic, and
urologic surgeries (Finkelstein, Rabino,
Mashiach, et al., 2014).

• Traditional

The Perioperative phase covers period of time that

constitutes the surgical experience.
It consists of three phases:
➢ Preoperative phase:
- period of time from when the decision for
surgical intervention is made to when the
patient is transferred to the operating room.
➢ Intraoperative phase:
- period of time that begins with transfer of the
patient to the operating room area and
continues until the patient is admitted to the
post anesthesia care unit.
➢ Postoperative phase:
- period of time that begins with the admission
of the patient to the post anesthesia care unit
and ends after follow-up evaluation in the
clinical setting or home.
LEARN YOUR SURGICAL TERMS:
-TOMY = the surgeon cut something
-ECTOMY = the surgeon cut something out
-OSTOMY = the surgeon made an opening
-PLASTY = the surgeon changed the shape of
something
-PEXY = the surgeon moved the argan to the
right place
-RRAPHY = the surgeon sewed something up
-DESIS = the surgeon made two things stick
together
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
The surgical risks: The old, the young and the
sick
• Surgery in itself is stressful enough.
• Risk of Infection; deformity; temporary
• failure to relieve symptoms or correct a
complication; and permanent
• death is uncommon but potential outcome
❖ The following entries written below are
factors that increase:
• The risk for surgery:
• General Risks
• Age
• Obesity
• Fluid and electrolyte imbalances
• Co morbidity
• Concurrent or prior pharmacotherapy
The surgical risks: The old
• exposed to more risk as they have less
physiologic reserve or the ability of an
organ to return to normal after a
disturbance
• age-related cardiovascular and pulmonary
changes
• The aging heart and blood vessels have
decreased the ability to respond to stress
• Impaired ability to increase metabolic rate
and impaired thermoregulatory
mechanisms increase susceptibility to
hypothermia.
• Bone loss (25% in women, 12% in men)
necessitates careful manipulation and
positioning during surgery.
• Reduced ability to adjust rapidly to
emotional and physical stress influences
surgical outcomes and requires meticulous
observation of vital functions
• Age-related changes in kidney and liver
function may delay the elimination of
anesthetic and analgesic agents,
increasing the risk for adverse reactions.
❖ The Therapeutic Approach:
• Consider using lesser doses for
therapeutic effect.
• Anticipate problems from chronic medical
conditions such as DM, HTN, Anemia,
Obesity etc.
• When possible, cater to the set patterns
in older patients such as sleeping and
eating
• Make sure devices for thermoregulation
are available intra operatively and in post
operative settings
• Decrease anxiety preoperatively,
intraoperatively and postoperatively
Older adults are given small doses of anesthetic
agents since medications tend to stay longer in
their system and are more potent.
Clients above 40 years old require CP clearance**
The surgical risks: The Young
• Children undergoing surgeries are
especially challenging. Starting from the
preoperative preparations, the
instruments and equipment’s, medication
dosing down to the anatomy.
• At risk for complications arising from
anesthesia
• Prone to hypothermia
• Hard to draw and establish IV line
• Hard to elicit cooperation
❖ The Therapeutic Approach:
• Talk to young clients according to
their level of perception
• Encourage emotional comfort:
security blanket, favorite toy or
parents
• Pedia clearance needed for pediatric
clients
• For close observation intra op and
post op as they are prone to post op
hypothermia
• implement measures to prevent
hypothermia (bairhugger, lamp or
extra blanket)
• Once in PACU, parents may be
allowed in some cases, refer to
hospital protocol and doctor's
preference
• Prepare for body restraints if needed
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
Pediatric Clients usually require a clearance from
their pediatric doctor before being granted a GO
signal to proceed with the surgical intervention
especially if procedure requires use of anaesthetic
agents.
The surgical risks: The Sick: OBESE
- Obesity is defined as a body mass index of
greater than 30 kg/m2 (Centers for Disease
Control and Prevention [CDC], 2015).
• Increases difficulty involved in technical
aspects in performing surgery
• Chances wound dehiscence is greater
• Increases potential for post operative
pneumonia and other pulmonary
complications because they tend to
hypoventilate and less likely ambulate early
• Increased demands on the heart, leading to
cardiovascular compromise
• Has altered response to many drugs and
anaesthetic agents
❖ The Therapeutic Approach:
• Anticipate postoperative obesity-related
complication especially respiratory
complication
• Adequately splint abdominal incision
when moving or coughing
NEVER attempt to move an impaired client
without assistance or proper body
mechanics, this promotes the safety of
both the patient and the nurse.
The surgical risks: The Sick
PATIENTS WITH FLUID & ELECTROLYTE
IMBALANCE
• Dehydration and electrolyte imbalance can
have an adverse effect in terms of general
anaesthesia and the anticipated volume
losses associated with surgery, causing
shock and cardiac dysrhythmias.
❖ The Therapeutic Approach:
• Assess fluid and electrolyte status
• Correct or maintain fluid electrolyte status
as ordered by the attending physician
• Monitor client's intake and output, be
particular about the expected drainage
amount and report any abnormalities
• May contribute to hypoventilation,
leading to pneumonia and possible
atelectasis. Thus, these conditions
should be treated preoperatively to
reduce such risks.
These conditions are very critical
especially when using General Anesthesia
as this may cause patients oxygen level to
desaturate.
These conditions are usually treated
before case is pushed through.
The surgical risks: The Sick: Patients with
Comorbidities DIABETES MELLITUS
• Hyperglycemia is potentiated by increased
catecholamines and glucocorticoids due to
surgical
• stress
• Hypoglycemia due to NPO
• Poor wound healing
• At risk for development of infection
❖ The Therapeutic Approach:
• 181 Obesity-related complication
especially respiratory complication
• Adequately splint abdominal incision
when moving or coughing
The surgical risks: The Sick:
PREVIOUS SURGERY AND ANESTHESIA
• This factor affects the patient's readiness for
surgery. Previous experiences, especially
with complications, may increase anxiety
about the scheduled surgery.
❖ The Therapeutic Approach:
❖ Ask about the patient's experience with
anesthesia and all allergies.
❖ These data provide information about
tolerance of and possible fears about the use
of anesthesia.
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5

The family medical history and problems TAKE NOTE:

with anesthetics may indicate possible
reactions to anesthesia, such as malignant Anticoagulant vs Antiplatelet
hyperthermia - Anticoagulant delay or prevent formation of
blood clots by interrupting the clotting 'factors
while antiplatelets prevent platelet aggregation
The surgical risks: The Sick: and impair clot formation.
PATIENTS WITH CONCURRENT AND PRIOR
MEDICATION
• Hazards exists when medications are Other factors that affect surgery:
given concomitantly with others,
including herbal medications. This posts
dangers with drug-drug interaction and
certain medications are contraindicated
to patients undergoing surgery.

❖ The Therapeutic Approach:

• Notify healthcare provider and
anaesthesiologist if patient is taking
any of the following medications:
• Certain antibiotics may interrupt
nerve transmission when combined
with a curariform muscle relaxant,
causing respiratory paralysis and
apnea.
• Phenothiazines MAOIS (monoamine
oxidase inhibitors) and St. John's
wort, an herbal product, increase
hypotensive effects of anesthesia
• Diuretics, particularly thiazides can
cause electrolyte imbalance and THE PREOPERATIVE PHASE:
respiratory depression during
anaesthesia Preoperative phase
• Steroids inhibit wound healing
• Anticoagulants,warfarin and - period of time from when the decision for
heparin,or medications (syntheticand surgical intervention is made to when the
herbal) may affect coagulation such patient is transferred to the operating room.
as aspirin, gingko biloba, NSAIDS Legal Aspect of surgery: INFORMED CONSENT
and clopidogrel (plavix) may cause
unexpected bleeding. • Informed consent is the patient's autonomous
decision about whether to undergo a surgical
procedure (Brunner and Suddarth, 2017)
• Surgical procedure and anaesthesia consent
is explained by the doctor, is signed by the
client, and is witnessed by the nurse
• Must be voluntary signed by the patient
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
• Should be in legal age 3. Secure airway and IV access
• If below age consent is signed by the parents patency.
of the patient
• Validity for consent for surgical procedure ➢ Anxiolytics: Diazepam, Tramadol*,
depends on the institutional policy, but is Nalbuphine*
usually 24 hours
o NURSING RESPONSIBILITIES:
Consent is a legal mandate, but it also helps the 1. Ensure Patient is Vitally Stable;
patient to prepare psychologically, because it helps 2. Patient Safety;
to ensure that the patient understands the surgery 3. Secure airway and IV access
to be performed (Rothrock, 2014). patency.
An informed consent should be in writing and
➢ GI Prophylaxis: Omeprazole, Ranitidine,
should contain the following:
Metoclopramide
1. Explanation of procedure and its risks
2. Description of benefits and alternatives; o NURSING RESPONSIBILITIES:
3. An offer to answer questions about 1. Ensure proper administration;
procedure; 2. Ensure safety (dizziness).
4. Instructions that the patient may withdraw
consent; ➢ DVT Prophylaxis: Low Molecular Weight
Heparin (Enoxaparin) Antiembolic (TED)
If the patient is non-English speaking, it is Stocking
necessary to provide consent (written and ➢ DVT Prophylaxis:*
verbal) in a language that is understandable to o NURSING RESPONSIBILITIES:
the client. 1. Monitor coagulation profile
5. A statement informing the patient if the (aPTT,CT/BT);
2. Check: on hold or continued
protocol differs from customary procedure.
administration
(SAMPLE SURGICAL CONSENT)
3. Place compression/antiembolic
stockings as ordered
POSSIBLE NURSING DIAGNOSES
1. Anxiety related to upcoming surgical Medications that may cause bleeding are
procedure usually discontinued 1 week before
2. Risk of latex allergy response due to scheduled OR or as prescribed by the
possible exposure to latex in OR doctor.
environment
3. Risk for perioperative positioning injury Common Diagnostic Procedures
related to positioning in the OR; • Urinalysis
4. Risk for infection; and • Blood type and screen (for infectious
5. Risk for compromised human dignity diseases)
related to general anesthesia or sedation. • Complete blood count or hemoglobin level
and hematocrit
PREOPERATIVE MEDICATIONS • Clotting studies (prothrombin time [PT],
international normalized ratio [INR],
➢ Pain Medications: Nubain, Tramadol, activated partial thromboplastin time
Ketorolac, Paracetamol [aPTT], platelet count)
• Electrolyte levels
o NURSING RESPONSIBILITIES: • Serum creatinine and blood urea nitrogen
1. Ensure Patient is Vitally Stable; levels
2. Patient Safety;
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
• Depending on a female patient's age and
the nature of the surgery, a pregnancy test
may be required
• Radiologic studies ( esp for orthopaedic
surgery)
• ECG (anesthesia protocol for young
population and older adults, patients with
cardiac disease)
- Skin prep is also done in the OR using
providone lodine Solution, Chlorhexidine, or
70% Alcohol.
- 7.5 % povidone iodine is used on the outer
surfaces of the skin (1st layer);
- 10% povidone iodine is used for inner
structures such as in peritoneal cavity
washing. (2nd layer)

Other Preparations Anesthesia

➢ ✔ NPO 8-10 hours
- Anesthesia is a state of narcosis (severe
o NURSING RESPONSIBILITIES:
central nervous system depression produced
1. Ensure NPO;
by pharmacologic agents), analgesia,
2. Monitor for signs of hypoglycemia**
relaxation, and reflex loss.
3. Ensure IVF is running.
• Anesthetic agents - are substances, such
➢ ✔ VENEMA as a chemical or gas, used to induce
o Indications: anesthesia
1. Evacuate Bowel for Surgery
2. Endoscopy The main types of anesthesia are:
o NURSING RESPONSIBILITIES:
• General anesthesia (inhalation, IV),
1. Secure Doctors order;
• Regional anesthesia (epidural, spinal, and
2. Privacy
local conduction blocks)
3. Empty bladder
• Moderate sedation (monitored anesthesia
4. Clear Return.
care [MAC])
• Local anesthesia.
➢ ✔IV FLUIDS
o NURSING RESPONSIBILITIES:
1. Ensure Patency;
2. Use large-bore IV Catheter General Anesthesia
3. Place on the unaffected side.
- Patients under general anesthesia are not
arousable, not even to painful stimuli.
- They lose the ability to maintain ventilatory
function and require assistance in maintaining
THE INTRAOPERATIVE PHASE: a patent airway. Cardiovascular function may
be impaired as well.
The Intraoperative Phase
- period of time that begins with transfer of the
patient to the operating room area and
continues until the patient is admitted to the
post anaesthesia care unit.
Preparing the Skin
- The goal of preoperative skin preparation is to
decrease bacteria without injuring the skin.
- hair on the operative site should be shaved or
clipped.
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5

❖ Advantage:
• This method provides safe and controlled
anesthetic delivery, especially for older and
high-risk patients.
❖ Disadvantage:
• This method is risky as it suppresses
respiratory function. Serious complications
may occur such as:
• Anesthetic overdose
• Intubation complication
• Unrecognized hypoventilation
Because of risks involved in GA, a surgeon
must be present in case there is failure in
intubation in case tracheotomy is needed.

Common Drugs used during induction of GA:

➢ IV Medications
• Propofol (Lipuro/ IV Pro) "milk of amnesia
• Muscle relaxant (Rocuronium/
succinylcholine)
• Opioid analgesics (nalbuphine/morphine)
• Fentanyl
• Ketamine

➢ INHALANTS
• Sevoflurane
• Less potent compared to Isoflurane,
Costly, less side effects
• Isoflurane
• Potent, incidence of complication is high
• Nitrous Oxide
• Less potent than Sevoflurane and
Isoflurane
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
➢ NURSING RESPONSIBILITY:
READY EMERGENCY MEDICATIONS READY
MACHINES (SUCTION, ANESTHESIA MACHINE)
REVERSAL MEDS/ANTIDOTE KEEP PATIENT
MONITORED AT ALL TIMES
The Sellick maneuver is an effective means of
preventing passive aspiration of gastric content
Regional Anesthesia
- In this method, an anesthetic agent is injected
around nerves so that the region supplied by
these nerves is anesthetized. The effect
depends on the type of nerve involved.
Spinal anesthesia
- Injection through the dura mater into the
subarachnoid space surrounding the spinal
cord usually between L4 and L5
• Produces anesthesia of the lower
extremities, perineum, and lower abdomen
• Produces after-effect: spinal headache (CSF
leakage, Hydration status)
Epidural anestesia
- Achieved by injecting a local anesthetic agent
into the epidural space that surrounds the dura
mater of the spinal cord.
- Doses are much higher because the epidural
anesthetic agent does not make direct contact
with the spinal cord or nerve roots
❖ Advantage:
• Absence of headache, longer anesthesia
effect
❖ Disadvantage:
• Greater technical challenge of introducing
the anesthetic agent into the epidural space
rather than the subarachnoid space.
Local Conduction Blocks
- The anesthetic is injected near a specific nerve
or bundle of nerves to block sensations of pain
from a specific area of the body. Nerve blocks
usually last longer than local anesthesia.
Brachial plexus block
- which produces anesthesia of the arm
Paravertebral anesthesia
- which produces anesthesia of the nerves
supplying the chest, abdominal wall, and
extremities
Transsacral (caudal) block
- which produces anesthesia of the perineum
and, occasionally, the lower abdomen
▪ Meds Commonly Used:
1. Bupivacaine (Sencorcaine) Heavy 5%
2. Bupivacaine (Sencorcaine) Isobaric
3. Morphine
4. Atropine
**Morphine Precaution**
Post Op clients on spinal and epidural
anesthesia is usually positioned flat on
bed for 2 hours to prevent spinal leak
Local Anesthesia
- Injection of a solution containing the anesthetic
agent into the tissues at the planned incision
site
- Local anesthesia is sometimes incorporated
with Epinephrine.
Epinephrine constricts blood vessels, which
prevents rapid absorption of the anesthetic agent
and thus prolongs its local action and prevents
seizures
❖ Advantages:
• It is simple, and economical;
• Equipment needed is minimal;
• Postoperative recovery is brief; and
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
•
Undesirable effects of general anesthesia are
avoided.
❖ Disadvantage:
• Short Acting

Monitored Anesthesia Care (MAC)

- (Conscious sedation) involves the use of
sedation to depress the level of consciousness
without altering the patient's ability to maintain
a patent airway and to respond to physical
stimuli and verbal commands.
• Light Sedation
• Moderate Sedation
Moderate sedation is given by an
anesthesiologist or certified registered nurse
anesthetist (CRNA)
• Deeper sedation, provider must be ready to
convert to GA in case of respiratory and
anesthesia fail
➢ Potential Adverse Effects of Surgery and
Anesthesia:
1. Allergic Reaction;
2. Anesthesia Awareness;
3. Cardiac Dysrhythmia from electrolyte
imbalance or adverse effects of anesthetic
Agents;
4. Myocardial depression, bradycardia, and
circulatory collapse;
5. CNS agitation or disorientation, especially in
older
6. Oversedation or undersedation;
7. Hypoxemia and hypercarbia due to
hypoventilation and inadequate respiratory
support;
8. Laryngeal trauma, oral trauma, and broken
teeth;
9. Hypothermia due to cool temperatures,
exposure of body cavities, and secondary to
use of anesthetic agents;
10. Hypotension due to blood loss or adverse
effects of anesthesia
A skilled nurse must always anticipate and prepare
needed equipment in case anesthesia fails and
must be ready to assist incase anesthesia is
converted to GA.
The Operating Room
- The surgical suite is located out of the
mainstream of the hospital and near the PACU
and support services (e.g., blood bank,
pathology, CSSD and laboratory
departments).
- Traffic flow is patterned to reduce
contamination from outside the suite. Within
the suite, clean and contaminated areas are
separate.
Unrestricted Zone / Clean Area- interfaces
other areas: Holding area, reception area and
locker room/changing room
Semi restricted Area/ Sub-sterile area- area in
the operating room where scrub attire is
required: Nurses Station, hallway, ante room
Restricted Area/ Sterile Area-area in the OR
where scrub attire, OR cap, mask is required:
OR Theatre, scrub area
The Surgical Team
1. Surgeon- a physician who is responsible for the
surgical procedure and any surgical judgments
about the patient.
2. Surgical Assistant- might be another surgeon
or a nurse, who, under the direction of the
surgeon may hold retractors, suction the wound
(to improve viewing of the operative site), cut
tissue, suture, and dress wounds
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
3. Anaesthetist-specializes in giving anesthetic
agents to induce and maintain anesthesia and
delivers other drugs to support the patient during
surgery.
4. Anaesthesia practitioner/ Nurse
Anaesthetist- an advanced practice registered
nurse with additional education and credentials
who delivers anesthetic agents under the
supervision of an anesthesiologist, surgeon,
dentist, or podiatrist
HIGHLIGHT ON MALIGNANT HYPERTHERMIA
5. Scrub Nurse-registered nurse, licensed
practical nurse, or surgical technologist who
scrubs and dons’ sterile surgical attire, prepares
instruments and supplies, and hands
instruments to the surgeon during the
procedure.
❖ Manifestations:
6. Circulating Nurse/ Circulator-manages the
OR and protects the patient's safety and health
by monitoring the activities of the surgical team,
checking the OR conditions, and continually
assessing the patient for signs of injury and
implementing appropriate interventions.
7. Post Anesthesia Care Unit (PACU Nurse) - a
registered nurse that provides care until the
patient has recovered from the effects of
anesthesia (e.g., until resumption of motor and
sensory functions), is oriented, has stable vital
signs, and shows no evidence of hemorrhage or
other complications (Helvig, Minick, & Patrick,
➢ Sympathetic nervous stimulation also leads to
2014; Noble & Pasero, 2014; Penprase &
Johnson, 2015).
The Health Hazards in OR
1. Retained instrument, sponges or needles in
patient's body. wound infection abscess
formation, and fistulas may develop between
organs (Rothrock, 2014).
2. Inhalation of toxins; electric cautery units
general anesthesia exhaust fumes.
3. Exposure to blood and other body fluids;
double-gloving is routine in trauma and other
types of surgery where sharp bone fragments
are present. rubber boots, a waterproof apron,
and sleeve protectors. Goggles, or a
wraparound face shield
- Malignant hyperthermia is a rare inherited
muscle disorder that is chemically induced by
anesthetic agents (Rothrock, 2014).
- It usually manifests about 10 to 20 minutes
after induction of anesthesia, it can also occur
during the first 24 hours after surgery.
• The initial symptoms of malignant
hyperthermia are often cardiovascular,
respiratory, and abnormal musculoskeletal
activity.
• Tachycardia (heart rate greater than 150 bpm)
may be an early sign.
• Hypercapnia, an increase in carbon dioxide
(CO2), may be an early respiratory sign.
• Generalized muscle rigidity is one of the
earliest signs.
• Late sign: Elavated Body temperature
(increases 1°C to 2°C every 5 minutes) that
can exceed 42°C
ventricular dysrhythmia, hypotension, decreased
cardiac output, oliguria, and, later, cardiac arrest.
With the abnormal transport of calcium, rigidity or
tetanus-like movements occur, often in the jaw.
Medical Management:
1. Postpone surgery if possible
2. Change anesthetic agents
3. Ensure proper support intraoperatively
Nursing Role:
1. Identify patients at risk,
2. Recognize the signs and symptoms,
3. Have the appropriate medication and
equipment available.
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
Hypopharyngeal Obstruction / Aspiration:
THE POSTOPERATIVE PHASE: ❖ Assessment:
1. Choking
2. Noisy irregular respiration
POST OPERATIVE PHASE 3. Decreased 02 saturation
4. Cyanosis
- period of time that begins with the admission 5. Properly check if patient is ventilating
of the patient to the PACU and ends after ❖ Diagnosis:
follow-up evaluation in the clinical setting or 1. Ineffective Airway Clearance
home. ❖ Plan:
1. Establish and maintain Patent Airway
The postanesthesia care unit (PACU) 2. Prevent complications related to airway
• Recovery Room Monitoring obstruction
• Access to skilled personnel, equipment and ❖ Intervention(Hypopharyngeal
medications Obstruction):
1. Head Tilt/ Jaw Thrust Maneuver
❖ Phases in PACU: 2. Administer 02 as ordered
• In phase I PACU, used during the immediate 3. Place Oral Airway
recovery phase, intensive nursing care is 4. Inform Anesthesiologist
provided.
• In the phase II PACU, the patient is prepared Hypotension and Shock:
for self-care or an extended care setting. - Hypotension can result from blood loss,
• In phase III PACU, the patient is prepared for hypoventilation, position changes, pooling of
discharge. blood in the extremities, or side effects of
- Step down medications and anesthetics.
- Prepared for discharge **> 500 ml Blood loss (Rapid)**
- Transition from clinical area to home care
setting ❖ Assessment:
• pallor; cool, moist skin; rapid breathing;
** care provided until the patient has recovered
cyanosis of the lips, gums, and tongue;
from the effects of anesthesia
rapid, weak, thready pulse; narrowing
GOALS: pulse pressure; low blood pressure;
and concentrated urine.
• Stabilization ❖ Diagnosis:
• Pain Management 1. Decreased Cardiac Output.
2. Deficient Fluid Volume.
❖ CORNERSTONE IN PACU: 3. Ineffective Tissue Perfusion
1. Airway; ❖ Plan:
2. Respiratory Function; 1. Prevention and Correction of
3. Cardiovascular function; Symptoms
4. Skin color; ❖ Intervention:
5. LOC; and 1. Replace Fluid Volume (LR, NSS,
6. Ability to obey commands Colloids, Blood components)
2. Oxygen support (facemask, nasal
Maintaining a Patent Airway cannula, ventilation)
- maintain ventilation and prevent 3. Close Monitoring of Vital Signs, Urine
hypoxemia and hypercapnia. Output, LOC
- depth, rate, rhythm, ease of respiration, 4. Position properly if not contraindicated.
oxygen saturation, and breath sounds
AN INTRODUCTION TO PERIOPERATIVE
CARE (PRE, INTRA & POST)
NCM-N112A LECTURE/WEEK2-5
➢ EVALUATION TOOL:
1. Modified Aldrette Score
Hemorrhage 2. Post op Handover Checklist
- can present insidiously or emergently at
any time in the immediate postoperative
period or up to several days after surgery
o COMMON POST OPERATIVE MEDICATIONS:
❖ Assessment:
1. hypotension; • Pain Management: Nalbuphine,
2. rapid, Ketorolac, tramadol,
3. thready pulse; • Paracetamol, diclofenac, Morphine
4. disorientation; • Hyperthermia: Paracetamol IV
5. restlessness; oliguria; • Nausea/ Vomiting: Metoclopramide
6. and cold, pale skin. • Allergic Reaction: Promethazine,
❖ Initial findings: Diphenhydramine
1. Change in mood and LOC • Antibiotic of choice
2. Labored Breathing • Continuous IVF
3. Hyperthermia
4. Possible Tinnitus

❖ Intervention:
1. Determine the Cause
2. Control the bleeding (apply pressure
dressing/ elevate to heart level.
3. Correct Vital Signs

Hypertension
- sympathetic nervous system stimulation
from pain, hypoxia, or bladder distension

Dysrhythmia
- associated with electrolyte imbalance,
altered respiratory function, pain,
hypothermia, stress, and anesthetic
agents. Both hypertension and
dysrhythmias are managed by treating the
underlying causes.
**Relieving Pain and Anxiety**
**Control Nausea and Vomiting**