Role of Perioperative Nurse

‫مسؤوليات ممرضة العمليات‬

Prepared by
Mustafa Zohny
Nurse educator
 Learning outcomes
• To differentiate traffic zones inside the theater.
• ‫للتفرقة بين األماكن داخل العمليات‬
• To identify precautions in each area .
• ‫لمعرفة األحتياطات الالزم اتخاذها عند كل منطقة‬
• To enlist patient safety measures inside OR.
• ‫لمعرفة كيفية اتخاذ اجراءات حماية المريض‬
• To identify roles of pre-operative nurse.
• ‫معرفة دور ممرضة األستقبال‬
• To identify roles of intra-operative nurse.
(circulating nurse & scrub nurse) ‫دور كل من‬
To identify roles of post-operative nurse. ‫دور ممرضة‬
‫األفاقة‬
 Introduction
Our target is patient safety & satisfaction

-We are Dealing with patient as a human being, not a disease.

-We have 3 main areas in the theater which are:‫المناطق األساسية بالعمليات‬
(Reception area-Operation rooms-Recovery room)
‫االفاقة – غرف العمليات – منطقة االستقبال‬
-Each area has its characteristics.
-Nurses assigned for each area have a different role.
-Work harmony & efficiency done by team work & effective
communication between the 3 areas.

-Types of assigned nurses are:‫أنواع التمريض‬

(Preoperative nurse/intraoperative nurse/postoperative nurse)
 Unrestricted Areas
‫منطقة غير محظورة‬
-Including entry of patients,
Front desk & reception area.

-street clothes are permitted

in this area, and traffic is not
Limited.
‫يمكن ألى شخص دخولها بأى نوع من‬
‫المالبس مثل المكاتب االدارية‬
 Semi restricted area
‫منطقة شبه محظورة‬
- including the corridors, storage
areas for sterile supplies and
instrument.‫مثل الطرقة و غرف االالت‬

- Surgical attire is required

(scrub suit, overhead,over shoes)
- Patients are dressed in
hospital attire with over head.
‫يجب ارتداء لبس العمليات مع غطاء الرأس‬
‫ يرتدى‬،‫وغطاء الحذاء وحذاء خاص بالعمليات‬
‫المرضى ايضا لبس مخصص لهم‬
 ‫‪Restricted Area‬‬

‫منطقة محظورة‬
‫‪-including operating rooms‬‬
‫مثل غرف العمليات‬
‫‪-Should wear‬‬
‫)‪(full surgical attire‬‬
‫يجب المحافظة على التعقيم بارتداء‬
‫الجاون المعقم و الجوانتى المعقم و‬
‫ارتداء كمامة الوجه (الماسك)‬
 Role of pre-operative nurse
• the relationship between patient & nurse is strong as she
is the most medical staff communicates & deals with the
patient & his problems.
• Going under surgery is unforgettable experience
‫تجربة غير منسية‬for him.
• first impression ‫ االنطباع األول‬will last with him forever.
• some patients has phobia ‫ الخوف المرضى‬from hospitals,
white coats, needles & blood.
• we should understand his psychological status & provide
psychological support.‫الدعم النفسى‬
 1) Patient preparation ‫تجهيز المريض‬
 Introduce yourself to the patient
 Allow/keep somebody with him in the reception,
especially if the patient is female or child.
 In case he cannot speak English or he has language
barrier, you can ask help from another staff talking the
same language, so he can translate for you or you can get
help from language bank.
 Use simple words rather than medical terminology.
 Identify patient by Checking his name & HC number.
 Reassure him. ‫طمنه‬
 Start doing Patient assessment especially skin assessment.
 Check Skin integrity, for any infection or irritation before
surgery.
 Answer for his questions in easy way.
 Respect his traditions.
 Mention any allergy ‫الحساسية مثل الحساسية من دوا معين أو الجوانتى‬
‫البودرة و الالتكس المطاط أو البيتادين‬or previous operations.
 Patient should be NPO 8 hours ‫ ساعات لتجنب االختناق‬8 ‫الصوم لمدة‬
‫أثناء النوم أثناء التخدير‬before the surgery.
 Surgical & anesthesia consent ‫اقرار الموافقة على الجراحة و التخدير‬
should be ready.
 For emergency cases, emergency consent should be signed
& stamped by both surgical & anesthesia consultant or 2
specialists.
 Check the vital signs & last RBS ‫قياس السكر و العالمات الحيوية قبل‬
‫العملية‬. If any abnormal range inform the doctor.
 Advise the patient for Bowel & bladder evacuation ‫دخول‬
‫الحمام‬. Taking bath if it is possible.
 Be sure patient removed all his clothes, watches &
jewelries plus any movable teeth, denture & contact lenses.
Only to wear the OR gown. ‫التخلص من أى شى معدنى بجسم المريض‬
‫مثل الساعات و المجوهرات و الدهب حتى ال يصاب بحرق نتيجة استعمال جهاز‬
‫الدياثيرمى اذ انها موصلة للكهرباء‬
 Mention any implant or device ‫عمليات زرع األعضاء و األجهزة‬
in the patient body.
 Patient ECG, X-Ray & blood results ‫التحاليل و‬
‫الفحوصات‬should be available.
 Endorsement of any device or pump coming with the
patient. E.g.(monitor) ‫أى أجهزة متصلة بالمريض‬
 Any connections IV access, drain, chest tube & urinary
catheter should be secured.‫وصالت المريض مثل الكانيوال‬
 Endorsement of patient medical history or any other
medical problems.
2) Blood Donations ‫وجود دم و بالزما للمريض‬
• PRBCs (blood) to be ready in the blood bank
before the surgery with blood consent.
‫خصوصا بالعمليات الكبرى‬
 3) Medications ‫األدوية‬
The doctor will decide:
 Which medications patient should stop taking.
 Which one he can continue to take it before surgery.(his
medication)
 Endorsement of the Antibiotics ‫ & المضاد الحيوى‬any IV fluids.
 Endorsement of any medication pump coming with the
patient.
 Also IV access & central line.
 4) Payment ‫الدفع‬
all operations especially with implant ‫خصوصا عمليات الزرع مثل‬:
-Total knee replacement
-total hip replacement
-elective spine cases
-big tumor cases with wide excision & reconstruction
 Role of Intra-operative nurse
circulate nurse
*For patients
For pediatric patient
• Make him wear a colored gown.
 Make a balloon from glove for him.
 Reassure his parents.
 Carry him to the room.
 Adjust room temperature & cover the patient.
 Apply bear hugger & warmer.
 Look to his eyes & smile.
 Be with him, don’t leave him alone.
 Secure him by applying safety belt. ‫ربط حزام الطاولة حتى ال‬
‫يقع المريض أثناء نومه‬
 Talk to him about his family, brothers, sisters, friends,
toys, and cartoon he love.
 Secure the patient & put him in comfortable position.
(Use whatever necessary: pillows, gel pads….)
‫اختيار الوضع الجراحى حسب طلب الجراح و حسب العملية‬
 Before induction time:‫قبل وقت التخدير‬
 ‫التحدث مع المريض اللهائه و طمأنته‬
 Reassure him & Be friendly to him by asking about his
favorite food, hobby, TV show, movie, sport, team &
places he love or already visited.
 Try not to open the instrument in front of him.
 Speak to him from while to while during the surgery.
(if it was spinal anesthesia)
 For female patient
Let female nurse (if possible) to assist a female patient
 While making assessment for her in reception
 While transferring to the operation room
 While transferring her from trolley to OR Table
 While placing ECG Leads
 at induction time.
 In case urinary catheter is needed
 In positioning her
 Communicate with her.
 Ask her if he can move herself or need help.
 When transferring her at least 2 staff should be with
her (one for each side).
 Always keep patient privacy.‫المحافظة على خصوصية المريض‬

What are the surgical Position precautions….?

‫األوضاع الجراحية‬
 What to prepare before starting any case?

You should have the basic instruments, devices & drapes like:
 Minor or major basic set. ‫االالت األساسية‬
 Secondary Instruments e.g.(weitlaner & currette).
 Room devices(diathermy, suction, tourniquet). ‫األجهزة‬
 Suitable bed according to the surgery. ‫طاولة العمليات المناسبة‬
 Availability of bed accessories & supporting devices.
(lateral support, pillows, gel pads) ‫وصالت الطاولة‬
 Suitable sterile pack for draping. ‫الفرش المعقم‬
 Suitable supplies for the surgery. ‫الصبليزمثل الشاش و‬
‫المشرط وفوط البطن و الجاونتيات‬
 Enough gowns & single drapes.‫الجاونات‬
 Prep set, basin, light handles, betadine, chlora prep,
saline, hydrogen peroxide. ‫أغطية و يد ضوء‬-‫محلول الملح‬
‫العمليات –ماء األكسجين‬
-Transferring & positioning the patient safely (team work).
‫نقل المريض بطريقة محترفة بمساعدة أعضاء الفريق الجراحى‬
-Sign in/time out & sign out protocol
.‫للتأكيد على معلومات المريض و العملية‬
-Antibiotic at induction should be given.‫المضاد الحيوى‬
-Preparing Patient Skin ‫تجهيز مكان العملية‬
-Documentation on Cerner.‫نظام كتابة على الكمبيوتربدال من الورق‬
-Specimen proper handling.‫العينات‬
-Review surgeons orders.‫تعليمات الجراح‬
-ENDORSE & HAND OVER USING (ISBAR)TOOL.
‫تسليم و تسلم المريض لالفاقة أو لوحدات أخرى‬
 For the scrub nurse

-Instrument: check availability, sterility & to be complete.

‫التأكد من جهوزية االالت‬
-Implant Components: check sizes & amount (complete)
‫التأكد من القياسات االمبالنت فى حاالت الزرع و العظام‬
-Proper supplies according to the operation.
-Cases instrument preparation.
-Room Equipment are available & ready. ‫جهوزية الغرفة‬
-Using the suitable surgical pack. ‫الفرش المعقم المناسب للعملية‬
-Helping in patient draping.
-Maintain sterility (Aseptic techniques)
-Assist the surgeons by
Proper handling of instrument.
Opening the required supplies.
-Counting with the circulate nurse:
-instrument -implants
-gauzes -abdominal lap
-needles -sutures
-neuropatties
 Role of postoperative nurse
PACU NURSE ‫ممرضة االفاقة‬
 Connect the patient to the monitor.‫توصيل المريض بالمونيتور‬
 Check vital signs. ‫قياس العالمات الحيوية‬
 Check patient temperature & Cover the patient with
warm blankets.‫تدفئة المريض‬
 Check the dressing & drain. ‫الكشف عن مكان العملية و الغيار‬
 Check skin integrity. ‫فحص جلد المريض‬
 Monitor conscious level. ‫قياس مستوى وعى المريض‬
 Call x-ray technician if x-ray is needed. ‫عمل االشعة المطلوبة‬
 Reassure the patient & ask him to relax.
 Apply ice if ordered. ‫وضع ثلج فى بعض الحاالت‬
 Diet: Continue I.V fluids & resume patient diet after 4
hours. ‫ ساعات من اجراء العملية‬4 ‫يبدأ المريض فى شرب الماء بعد‬
 Changing patient position every 2 hours/comfortable for
him. ‫تغيير وضعية المريض كل ساعتين‬
 Medications as orders.‫اعطاء االدوية الموصوفة له‬
 Control pain with analgesics (NSAIDs). ‫اعطاءه مسكنات‬
 If not tolerable pain refer to pain management use:

a) PCA (patient controlled analgesia)

b) PCEA (patient controlled epidural analgesia)

 Check motor & sensory function.‫فحص وظائف الحركة و االحساس‬

 Resume patient diet after 4 hours. ‫البداية فى اطعامه‬
 Resume medication as prescribed.
 Monitor for any complications like: ‫مالحظة أى عواقب‬
 Bleeding or oozing through bandage, dressing or drain.
 ‫مثل نزف الجرح أو خروج مواد سائلة منه‬
 Stitches come apart. ‫قطع بالغرز أو انها فكت‬
 Patient feels numbness or his arm or fingers
 ‫احساس المريض بتنميل أو تخدير مفاجىء بأحد أطرافه‬
 When he looks pale.)‫شحوب وجه و جلد المريض(داللة على نزيف داخلى‬
 Leg becomes larger than normal, red, and feels warm.
 ‫ورم بالساق أو احمرارها أو سخونتها بطريقة غير طبيعية‬
 Blood Clot ‫جلطات‬
 tachycardia + high BP. ‫ارتفاع فى ضربات القلب أو الحرارة‬
 Summary
• We have 3 traffic zones in theater.
• Each area has assigned nurse.
• Each nurse has her specific role.
• They are divided to 3 main roles
1)Pre-operative(Reception) Nurse.
2)Intra-operative(Circulate & Scrub) Nurse.
3)Post-operative(PACU) Nurse.
THANK YOU

Any Questions ?