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ÞLkICÞLkA1IVL

ÞerloperaLlve nurslng descrlbes Lhe wlde varleLy of nurslng funcLlons assoclaLed wlLh Lhe paLlenL's surglcal
managemenLŦ lL has Lhree phases of Lhe surglcal experlence namelyť
1Ŧ ÞreoperaLlve phaseŦ 1hls phase beglns when Lhe declslon for surglcal lnLervenLlon ls made and ends when Lhe
paLlenL ls Lransferred from Lhe operaLlng roomŦ
2Ŧ lnLraoperaLlve phaseŦ 1hls phase beglns when Lhe paLlenL ls admlLLed or Lransferred Lo Lhe surgery deparLmenL
and ends when he or she ls admlLLed Lo Lhe recovery areaŦ
3Ŧ ÞosLoperaLlve phaseŦ 1hls phase beglns wlLh Lhe admlsslon of Lhe paLlenL Lo Lhe recovery area and ends wlLh a
followŴup evaluaLlon ln Lhe cllnlcal seLLlng or aL homeŦ
ÞLkICÞLkA1IVL ÞnASL
Þreoperat|ve Þhase of the Surg|ca| Lxper|ence
1he paLlenL who consenLs Lo have surgeryţ parLlcularly surgery LhaL requlres a general anesLheLlcţ renders hlmself
dependenL on Lhe knowledgeţ sklllţ and lnLegrlLy of Lhe healLh care LeamŦ ln accepLlng Lhls LrusLţ Lhe healLh care
Leam members have an obllgaLlon Lo make Lhe paLlenL's welfare Lhelr flrsL conslderaLlon durlng Lhe surglcal
experlenceŦ
1he scope of acLlvlLles durlng Lhe preoperaLlve phase lncludes Lhe esLabllshmenL of Lhe paLlenL's basellne
assessmenL ln Lhe cllnlcal seLLlng or aL homeţ carrylng ouL preoperaLlve lnLervlew and preparlng Lhe paLlenL for Lhe
anesLheLlc Lo be glven and Lhe surgeryŦ
Goa|s dur|ng the Þreoperat|ve Þhase
AlLhough Lhe physlclan ls responslble for explalnlng Lhe surglcal procedure Lo Lhe paLlenLţ Lhe paLlenL may ask Lhe
nurse quesLlons abouL Lhe surgeryŦ 1here may be speclflc learnlng needs abouL Lhe surgery LhaL Lhe paLlenL and
supporL persons should knowŦ A nurslng care plan and a Leachlng plan should be carrled ouLŦ uurlng Lhls phaseţ
emphasls ls placed onť
Assesslng and correcLlng physlologlcal and psychologlcal problems LhaL may lncrease surglcal rlskŦ
lvlng Lhe paLlenL and slgnlflcanL oLhers compleLe learnlng and Leachlng guldellnes regardlng Lhe surgeryŦ
lnsLrucLlng and demonsLraLlng exerclses LhaL wlll beneflL Lhe paLlenL posLoperaLlvelyŦ
Þlannlng for dlscharge and any pro[ecLed changes ln llfesLyle due Lo Lhe surgeryŦ
Þhys|o|og|c Assessment dur|ng the Þreoperat|ve Þhase
8efore any LreaLmenL ls lnlLlaLedţ a healLh hlsLory ls obLalned and a physlcal examlnaLlon ls performed durlng
whlch vlLal slgns are noLed and a daLa base ls esLabllsh for fuLure comparlsonsŦ
ulagnosLlc LesLs may be carrled ouL durlng Lhe preoperaLlve phase such asť
8lood analyses such as compleLe blood counLţ sedlmenLaLlon raLeţ cŴreacLlve proLelnţ serum proLeln
elecLrophoresls wlLh lmmunoflxaLlonţ calclumţ alkallne phosphaLaseţ and chemlsLry proflle
OŴray sLudles
,l and C1 scans (wlLh or wlLhouL myelography)
lecLrodlagnosLlc sLudles
8one scan
ndoscoples
1lssue blopsles
Lool sLudles
Drlne sLudles
lgnlflcanL physlcal flndlngs are also noLed Lo furLher descrlbe Lhe paLlenL's overall healLh condlLlonŦ When Lhe
paLlenL has been deLermlned Lo be an approprlaLe candldaLe for surgeryţ and has elecLed Lo proceed wlLh surglcal
lnLervenLlonţ Lhe preŴoperaLlve assessmenL phase beglnsŦ 1he purpose of preŴoperaLlve evaluaLlon ls Lo reduce Lhe
morbldlLy of surgeryţ lncrease quallLy of lnLraŴoperaLlve careţ reduce cosLs assoclaLed wlLh surgeryţ and reLurn Lhe
paLlenL Lo opLlmal funcLlonlng as soon as posslbleŦ
1he followlng are Lhe physlologlc assessmenLs necessary durlng Lhe preoperaLlve phaseť
Age
-uLrlLlonal sLaLus and needs Ŷ deLermlned by measurlng Lhe paLlenL's helghL and welghLţ Lrlceps skln foldţ
upper arm clrcumferenceţ serum proLeln levels and nlLrogen balanceŦ CbeslLy greaLly lncreases Lhe rlsk and
severlLy of compllcaLlons assoclaLed wlLh surgeryŦ
luld and lecLrolyLe lmbalance Ŷ uehydraLlonţ hypovolemla and elecLrolyLe lmbalances should be carefully
assessed and documenLedŦ
lnfecLlon
urug and alcohol use Ŷ Lhe acuLely lnLoxlcaLed person ls suscepLlble Lo ln[uryŦ
esplraLory sLaLus Ŷ paLlenLs wlLh preŴexlsLlng pulmonary problems are evaluaLed by means pulmonary
funcLlon sLudles and blood gas analysls Lo noLe Lhe exLenL of resplraLory lnsufflclencyŦ 1he goal for poLenLlal
surglcal paLlenL us Lo have an opLlmum resplraLory funcLlonŦ urgery ls usually conLralndlcaLed for a paLlenL
who has a resplraLory lnfecLlonŦ
Cardlovascular sLaLus Ŷ cardlovascular dlseases lncreases Lhe rlsk of compllcaLlonsŦ uependlng on Lhe severlLy
of sympLomsţ surgery may be deferred unLll medlcal LreaLmenL can be lnsLlLuLed Lo lmprove Lhe paLlenL's
condlLlonŦ
epaLlc and renal funcLlon Ŷ surgery ls conLralndlcaLed ln paLlenLs wlLh acuLe nephrlLlsţ acuLe renal
lnsufflclency wlLh ollgurla or anurlaţ or oLher acuLe renal problemsŦ Any dlsorder of Lhe llver on Lhe oLher handţ
can have an effecL on how an anesLheLlc ls meLabollzedŦ
ndocrlne funcLlon Ŷ dlabeLesţ corLlcosLerold lnLakeţ amounL of lnsulln admlnlsLered
lmmunologlc funcLlon Ŷ exlsLence of allerglesţ prevlous allerglc reacLlonsţ senslLlvlLles Lo cerLaln medlcaLlonsţ
pasL adverse reacLlons Lo cerLaln drugsţ lmmunosuppresslon
Þrevlous medlcaLlon Lherapy Ŷ lL ls essenLlal LhaL Lhe paLlenL's medlcaLlon hlsLory be assessed by Lhe nurse and
anesLheslologlsLŦ 1he followlng are Lhe medlcaLlons LhaL cause parLlcular concern durlng Lhe upcomlng surgeryť
1Ŧ Adrenal corLlcosLerolds Ŷ noL Lo be dlsconLlnued abrupLly before Lhe surgeryŦ Cnce dlsconLlnued suddenlyţ
cardlovascular collapse may resulL for paLlenLs who are Laklng sLerolds for a long LlmeŦ A bolus of sLerold ls
Lhen admlnlsLered lv lmmedlaLely before and afLer surgeryŦ
2Ŧ ulureLlcs Ŷ Lhlazlde dlureLlcs may cause excesslve resplraLory depresslon durlng Lhe anesLhesla admlnlsLraLlonŦ
3Ŧ ÞhenoLhlazlnes Ŷ Lhese medlcaLlons may lncrease Lhe hypoLenslve acLlon of anesLheLlcsŦ
4Ŧ AnLldepressanLs Ŷ ,ACls lncrease Lhe hypoLenslve effecLs of anesLheLlcsŦ
3Ŧ 1ranqulllzers Ŷ medlcaLlons such as barblLuraLesţ dlazepam and chlordlaxepoxlde may cause an lncrease
anxleLyţ Lenslon and even selzures lf wlLhdrawn suddenlyŦ
6Ŧ lnsulln Ŷ when a dlabeLlc person ls undergolng surgeryţ lnLeracLlon beLween anesLheLlcs and lnsulln musL be
conslderedŦ
7Ŧ AnLlbloLlcs Ŷ º,ycln" drugs such as neomyclnţ kanamyclnţ and less frequenLly sLrepLomycln may presenL
problems when comblned wlLh curarlform muscle relaxanLŦ As a resulL nerve Lransmlsslon ls lnLerrupLed and
apnea due Lo resplraLory paralysls developsŦ
Þresence of Lrauma
Þsycho|og|ca| Nurs|ng Assessment dur|ng the Þreoperat|ve Þer|od
ear of Lhe unknown
ear of deaLh
ear of anesLhesla
Concerns abouL loss of workţ Llmeţ [ob and supporL from Lhe famlly
Concerns on LhreaL of permanenL lncapaclLy
plrlLual bellefs
CulLural values and bellefs
ear of paln

Þsycho|og|ca| Nurs|ng Intervent|onsť
1Ŧ xplore Lhe cllenL's fearsţ worrles and concernsŦ
2Ŧ ncourage paLlenL verballzaLlon of feellngsŦ
3Ŧ Þrovlde lnformaLlon LhaL helps Lo allay fears and concerns of Lhe paLlenLŦ
4Ŧ lve empaLheLlc supporLŦ
Informed consent
An lnformed consenL ls necessary Lo be slgned by Lhe paLlenL before Lhe surgeryŦ 1he followlng are Lhe purposes of
an lnformed consenLť
ÞroLecLs Lhe paLlenL agalnsL unsancLloned surgeryŦ
ÞroLecLs Lhe surgeon and hosplLal agalnsL legal acLlon by a cllenL who clalms LhaL an unauLhorlzed procedure
was performedŦ
1o ensure LhaL Lhe cllenL undersLands Lhe naLure of hls or her LreaLmenL lncludlng Lhe posslble compllcaLlons
and dlsflguremenLŦ
1o lndlcaLe LhaL Lhe cllenL's declslon was made wlLhouL force or pressureŦ

criterio for o vo/id lnformed consent
ConsenL volunLarlly glvenŦ valld consenL musL be freely glven wlLhouL coerclonŦ
or lncompeLenL sub[ecLsţ Lhose who are -C1 auLonomous and cannoL glve or wlLhhold consenLţ permlsslon ls
requlred from a responslble famlly member who could elLher be apparenL or a legal guardlanŦ ,lnors (below
18 years of age)ţ unconsclousţ menLally reLardedţ psychologlcally lncapaclLaLed fall under Lhe lncompeLenL
sub[ecLsŦ
1he consenL should be ln wrlLlng and should conLaln Lhe followlngť
1Ŧ Þrocedure explanaLlon and Lhe rlsks lnvolved
2Ŧ uescrlpLlon of beneflLs and alLernaLlves
3Ŧ An offer Lo answer quesLlons abouL Lhe procedure
4Ŧ LaLemenL LhaL emphaslzes LhaL Lhe cllenL may wlLhdraw Lhe consenL
3Ŧ 1he lnformaLlon ln Lhe consenL musL be wrlLLen and be dellvered ln language LhaL a cllenL can comprehendŦ
6Ŧ hould be obLalned before sedaLlonŦ
Intraoperat|ve Þhase
Def|n|t|on
1he lnLraoperaLlve phase exLends from Lhe Llme Lhe cllenL ls admlLLed Lo Lhe operaLlng roomţ Lo Lhe Llme of
anesLhesla admlnlsLraLlonţ performance of Lhe surglcal procedure and unLll Lhe cllenL ls LransporLed Lo Lhe
recovery room or posLaneLhesla care unlL (ÞACD)Ŧ 1hroughouL Lhe surglcal experlence Lhe nurse funcLlons as Lhe
paLlenL's chlef advocaLeŦ 1he nurse's care and concern exLend from Lhe Llme Lhe paLlenL ls prepared for and
lnsLrucLed abouL Lhe forLhcomlng surglcal procedure Lo Lhe lmmedlaLe preoperaLlve perlod and lnLo Lhe operaLlve
phase and recovery from anesLheslaŦ 1he paLlenL needs Lhe securlLy of knowlng LhaL someone ls provldlng
proLecLlon durlng Lhe procedure and whlle he ls anesLheLlzed because surgery ls usually a sLressful experlenceŦ
Goa|s dur|ng the Intraoperat|ve Þhase
1Ŧ ÞromoLe Lhe prlnclple of asepsls asepslsŦ
2Ŧ omeosLasls
3Ŧ afe admlnlsLraLlon of anesLhesla
4Ŧ emosLasls
1he Surg|ca| 1eam
1he lnLraoperaLlve phase beglns when Lhe paLlenL ls recelved ln Lhe surglcal area and lasLs unLll Lhe paLlenL ls
Lransferred Lo Lhe recovery areaŦ AlLhough Lhe surgeon has Lhe mosL lmporLanL role ln Lhls phaseţ Lhere are key
members of Lhe surglcal LeamŦ
1Ŧ Surgeon Ŷ leader of Lhe surglcal LeamŦ e or she ls ulLlmaLely responslble for performlng Lhe surgery effecLlvely
and safelyŤ howeverţ he ls dependenL upon oLher members of Lhe Leam for Lhe paLlenL's emoLlonal well belng
and physlologlc monlLorlngŦ
2Ŧ Anesthes|o|og|st or anesthet|st Ŷ provldes smooLh lnducLlon of Lhe paLlenL's anesLhesla ln order Lo prevenL
palnŦ 1hls member ls also responslble for malnLalnlng saLlsfacLory degrees of relaxaLlon of Lhe paLlenL for Lhe
duraLlon of Lhe surglcal procedureŦ Aslde from LhaLţ Lhe anesLheslologlsL conLlnually monlLors Lhe physlologlc
sLaLus of Lhe paLlenL for Lhe duraLlon of Lhe surglcal procedure and Lhe physlologlc sLaLus of Lhe paLlenL Lo
lnclude oxygen exchangeţ sysLemlc clrculaLlonţ neurologlc sLaLusţ and vlLal slgnsŦ e or she Lhen lnforms and
advlses Lhe surgeon of lmpendlng compllcaLlonsŦ
3Ŧ Scrub Nurse or Ass|stant Ŷ a nurse or surglcal Lechnlclan who prepares Lhe surglcal seLŴupţ malnLalns surglcal
asepsls whlle draplng and handllng lnsLrumenLsţ and asslsLs Lhe surgeon by passlng lnsLrumenLsţ suLuresţ and
suppllesŦ
4Ŧ |rcu|at|ng Nurse Ŷ respond Lo requesL from Lhe surgeonţ anesLheslologlsL or anesLheLlsLţ obLaln suppllesţ
dellver supplles Lo Lhe sLerlle fleldţ and carry ouL Lhe nurslng care planŦ
Intraoperat|ve Nurs|ng Iunct|ons
ClrculaLlng -urse
1he clrculaLlng nurse manages Lhe operaLlng room and proLecLs Lhe safeLy and healLh needs of Lhe paLlenL by
monlLorlng acLlvlLles of members of Lhe surglcal Leam and checklng Lhe condlLlons ln Lhe operaLlng roomŦ
esponslblllLles of a clrculaLlon nurse are Lhe followlngť
1Ŧ Assures cleanllness ln Lhe CŦ
2Ŧ uaranLees Lhe proper room LemperaLureţ humldlLy and llghLlng ln CŦ
3Ŧ ,ake cerLaln LhaL equlpmenLs are safely funcLlonlngŦ
4Ŧ nsure LhaL supplles and maLerlals are avallable for use durlng surglcal proceduresŦ
3Ŧ ,onlLors asepLlc Lechnlque whlle coordlnaLlng Lhe movemenL of relaLed personnelŦ
6Ŧ ,onlLors Lhe paLlenL LhroughouL Lhe operaLlve procedure Lo ensure Lhe person's safeLy and well belngŦ
crub -urse
1Ŧ crubblng for surgeryŦ
2Ŧ eLLlng up sLerlle LablesŦ
3Ŧ Þreparlng suLures and speclal equlpmenLsŦ
4Ŧ AsslsLs Lhe surgeon and asslsLanL durlng Lhe surglcal procedure by anLlclpaLlng Lhe requlred lnsLrumenLsţ
spongesţ dralns and oLher equlpmenLŦ
3Ŧ keeps Lrack of Lhe Llme Lhe paLlenL ls under anesLhesla and Lhe Llme Lhe wound ls openŦ
6Ŧ Checks equlpmenLs and maLerlals such as needlesţ sponges and lnsLrumenLs as Lhe surglcal lnclslon ls closedŦ
|ass|f|cat|on of Þhys|ca| status for Anesthes|a before Surgery
1he anesLheslologlsL should vlslL Lhe paLlenL before Lhe surgery Lo provlde lnformaLlonţ answer quesLlons and allay
fears LhaL may exlsL ln Lhe paLlenL's mlndŦ 1he cholce of anesLheLlc agenL wlll be dlscussed and Lhe paLlenL has an
opporLunlLy Lo dlsclose and Lhe paLlenL has opporLunlLy Lo dlsclose prevlous reacLlons and lnformaLlon abouL any
medlcaLlon currenLly belng Laken LhaL may affecL Lhe cholce of an agenLŦ Aslde from LhaLţ Lhe paLlenL's general
condlLlon musL also be assessed because lL may affecL Lhe managemenL of anesLheslaŦ 1husţ Lhe anesLheslologlsL
assesses Lhe paLlenL's cardlovascular sysLem and lungsŦ lnqulry abouL preexlsLlng pulmonary lnfecLlon sand Lhe
exLenL Lo whlch Lhe paLlenL smokes musL also be deLermlnedŦ
Anesthes|a
AnesLhesla conLrols paln durlng surgery or oLher medlcal proceduresŦ lL lncludes uslng medlclnesţ and someLlmes
close monlLorlngţ Lo keep you comforLableŦ lL can also help conLrol breaLhlngţ blood pressureţ blood flowţ and
hearL raLe and rhyLhmţ when neededŦ AnesLheLlcs are dlvlded lnLo Lwo classesť
1Ŧ 1hose LhaL suspend sensaLlon ln Lhe whole body Ŷ eneral anesLhesla
2Ŧ 1hose LhaL suspend sensaLlon ln cerLaln parLs of Lhe body Ŷ localţ reglonalţ epldural or splnal anesLhesla

enero/ 4nesthesio
1hls Lype of anesLhesla promoLes LoLal loss of consclousness and sensaLlonŦ eneral anesLhesla ls commonly
achleved when Lhe anesLheLlc ls lnhaled or admlnlsLered lnLravenouslyŦ lL affecLs Lhe braln as well as Lhe enLlre
bodyŦ 1ypes of general anesLhesla admlnlsLraLlonť
volaLlle llquld anesLheLlcs Ŷ Lhls Lype of anesLheLlc produces anesLhesla when Lhelr vapors are lnhaledŦ
lncluded ln Lhls group are Lhe followlngť
1Ŧ aloLhane (luoLhane)
2Ŧ ,eLhoxyflurane (ÞenLhrane)
3Ŧ nflurane (Lhrane)
4Ŧ lsoflurane (orane)
as AnesLheLlcs Ŷ anesLheLlcs admlnlsLered by lnhalaLlon and are ALWA? comblned wlLh oxygenŦ lncluded ln
Lhls group are Lhe followlngť
1Ŧ -lLrous Cxlde
2Ŧ Cyclopropane
oco/ 4nesthesio
Local anesLheLlcs can be top|ca|ţ or lsolaLed [usL Lo Lhe surfaceŦ 1hese are usually ln Lhe form of gelsţ creams or
spraysŦ 1hey may be applled Lo Lhe skln before Lhe ln[ecLlon of a local anesLheLlc LhaL works Lo numb Lhe area
more deeplyţ ln order Lo avold Lhe paln of Lhe needle or Lhe drug lLself (penlcllllnţ for exampleţ causes paln upon
ln[ecLlon)Ŧ
eqiono/ onesthesio
eglonal anesLhesla blocks paln Lo a larger parL of Lhe bodyŦ AnesLheLlc ls ln[ecLed around ma[or nerves or Lhe
splnal cordŦ ,edlcaLlons may be admlnlsLered Lo help Lhe paLlenL relax or sleepŦ ,a[or Lypes of reglonal anesLhesla
lncludeť
1Ŧ Þerlpheral nerve blocksŦ A nerve block ls a shoL of anesLheLlc near a speclflc nerve or group of nervesŦ lL blocks
paln ln Lhe parL of Lhe body supplled by Lhe nerveŦ -erve blocks are mosL ofLen used for procedures on Lhe
handsţ armsţ feeLţ legsţ or faceŦ
2Ŧ pldural and splnal anesLheslaŦ 1hls ls a shoL of anesLheLlc near Lhe splnal cord and Lhe nerves LhaL connecL Lo
lLŦ lL blocks paln from an enLlre reglon of Lhe bodyţ such as Lhe bellyţ hlpsţ or legsŦ
WlLh reglonal anesLheslaţ an anesLheLlc agenL ls ln[ecLed around Lhe nerved so LhaL Lhe area supplled by Lhese
nerves ls anesLheLlzedŦ 1he effecL depends on Lhe Lype of nerve lnvolvedŦ 1he paLlenL under a splnal or local
anesLhesla ls awake and aware of hls or her surroundlngsŦ
eglonal anesLhesla carrles more rlsks Lhan local anesLheslaţ such as selzures and hearL aLLacksţ because of Lhe
lncreased lnvolvemenL of Lhe cenLral nervous sysLemŦ omeLlmes reglonal anesLhesla falls Lo provlde enough paln
rellef or paralyslsţ and swlLchlng Lo general anesLhesla ls necessaryŦ
½ino/ 4nesthesio
1hls ls a Lype of conducLlon nerve block LhaL occurs by lnLroduclng a local anesLheLlc lnLo Lhe subarachnold space
aL Lhe lumbar level whlch ls usually beLween L4 and L3Ŧ Lerlle Lechnlque ls used as Lhe splnal puncLure ls made
and medlcaLlon ls ln[ecLed Lhrough Lhe needleŦ 1he spread of Lhe anesLheLlc agenL and Lhe level of anesLhesla
depend onť
1Ŧ Lhe amounL of fluld ln[ecLed
2Ŧ Lhe speed wlLh whlch lL ls ln[ecLed
3Ŧ poslLlonlng of Lhe paLlenL afLer ln[ecLlon
4Ŧ speclflc gravlLy of Lhe agenL
Nurs|ng Assessment after Sp|na| Anesthes|a
1Ŧ ,onlLorlng vlLal slgnsŦ
2Ŧ Cbserve paLlenL and record Lhe Llme when moLlon and sensaLlon of Lhe legs and Lhe Loes reLurnŦ


S|de Lffects of Anesthes|a
1Ŧ ome numbness or reduced feellng ln parL of your body (local anesLhesla)
2Ŧ -ausea and vomlLlngŦ
3Ŧ A mlld drop ln body LemperaLureŦ
now do anesthes|o|og|sts determ|ne the type of anesthes|a to be used?
1he Lype of anesLhesla Lhe anesLheslologlsL chooses depends on many facLorsŦ 1hese lnclude Lhe procedure Lhe
cllenL ls havlng and hls or her currenL healLhŦ
Þos|t|on a Þat|ent on the Cperat|ng 1ab|e
1he nurse should have an ldea whlch paLlenL poslLlon ls requlred for a cerLaln surglcal procedure Lo be performedŦ
1here are loLs of facLors Lo conslder ln poslLlonlng Lhe paLlenL whlch lncludes Lhe followlngť
1Ŧ ÞaLlenL should be ln a comforLable poslLlon as posslble wheLher he or she ls awake or asleepŦ
2Ŧ 1he operaLlve area musL be adequaLely exposedŦ
3Ŧ 1he vascular supply should noL be obsLrucLed by an awkward poslLlon or undue pressure on a parLŦ
4Ŧ 1here should be no lnLerference wlLh Lhe paLlenL's resplraLlon as a resulL of pressure of Lhe arms on Lhe chesL
or consLrlcLlon of Lhe neck or chesL caused by a gownŦ
3Ŧ 1he nerves of Lhe cllenL musL be proLecLed from undue pressureŦ erlous ln[ury or paralysls may resulL from
lmproper poslLlonlng of Lhe armsţ handsţ legs or feeLŦ
6Ŧ houlder braces musL be well padded Lo prevenL lrreparable nerve ln[uryŦ
7Ŧ ÞaLlenL safeLy musL be observed aL all LlmesŦ
8Ŧ ln case of exclLemenLţ Lhe paLlenL needs genLle resLralnL before lnducLlonŦ
keason of Þerform|ng a Surg|ca| Þrocedure
1Ŧ 1o cure an lllness or dlsease by removlng Lhe dlseased Llssue or organsŦ
1Ŧ 1o vlsuallze lnLernal sLrucLures durlng dlagnoslsŦ
2Ŧ 1o obLaln Llssue for examlnaLlonŦ
3Ŧ 1o prevenL dlsease or ln[uryŦ
4Ŧ 1o lmprove appearanceŦ
3Ŧ 1o repalr or remove LraumaLlzed Llssue and sLrucLuresŦ
6Ŧ 1o relleve sympLoms or palnŦ
Nurs|ng kespons|b|||ty dur|ng the Intraoperat|ve Þhase
1Ŧ afeLyŦ ls Lhe lghesL ÞrlorlLy of nursesŦ
1Ŧ lmulLaneous placemenL of feeLŦ 1hls ls Lo prevenL dlslocaLlon of hlpŦ
2Ŧ Always apply knee sLrapŦ
3Ŧ Arms should noL be more Lhan 90¨
4Ŧ Þrepare and apply cauLery padŦ CauLery ls used Lo sLop bleedlngŦ
Þostoperat|ve Þhase
Def|n|t|on
1he postoperat|ve per|od of Lhe surglcal experlence exLends from Lhe Llme Lhe cllenL ls Lransferred Lo Lhe recovery
room or pasLŴanesLhesla care unlL (ÞACD) Lo Lhe momenL he or she ls LransporLed back Lo Lhe surglcal unlLţ
dlscharged from Lhe hosplLal unLll Lhe followŴup careŦ
Goa|s dur|ng the Þostoperat|ve Þer|od
uurlng Lhe posLoperaLlve perlodţ reesLabllshlng Lhe paLlenL's physlologlc balanceţ paln managemenL and
prevenLlon of compllcaLlons should be Lhe focus of Lhe nurslng careŦ 1o do Lhese lL ls cruclal LhaL Lhe nurse perform
careful assessmenL and lmmedlaLe lnLervenLlon ln asslsLlng Lhe paLlenL Lo opLlmal funcLlon qulcklyţ safely and
comforLably as posslbleŦ
1Ŧ ,alnLalnlng adequaLe body sysLem funcLlonsŦ
2Ŧ esLorlng body homeosLaslsŦ
3Ŧ Þaln and dlscomforL allevlaLlonŦ
4Ŧ ÞrevenLlng posLoperaLlve compllcaLlonsŦ
3Ŧ ÞromoLlng adequaLe dlscharge plannlng and healLh LeachlngŦ
Þat|ent are dur|ng Immed|ate Þostoperat|ve Þhaseť 1ransferr|ng the Þat|ent to kk or ÞAD
Þat|ent Assessment
peclal conslderaLlon Lo Lhe paLlenL's lnclslon slLeţ vascular sLaLus and exposure should be lmplemenLed by Lhe
nurse when Lransferrlng Lhe paLlenL from Lhe operaLlng room Lo Lhe posLaneLhesla care unlL (ÞACD) or
posLanesLhesla recovery room (ÞA)Ŧ very Llme Lhe paLlenL ls movedţ Lhe nurse should flrsL conslder Lhe locaLlon
of Lhe surglcal lnclslon Lo prevenL furLher sLraln on Lhe suLuresŦ lf Lhe paLlenL comes ouL of Lhe operaLlng room
wlLh dralnage Lubesţ poslLlon should be ad[usLed ln order Lo prevenL obsLrucLlon on Lhe dralnsŦ
1Ŧ Assess alr exchange sLaLus and noLe paLlenL's skln color
2Ŧ verlfy paLlenL ldenLlLyŦ 1he nurse musL also know Lhe Lype of operaLlve procedure performed and Lhe name of
Lhe surgeon responslble for Lhe operaLlonŦ
3Ŧ -eurologlc sLaLus assessmenLŦ Level of consclousness (LCC) assessmenL and lasgow Coma cale (C) are
helpful ln deLermlnlng Lhe neurologlc sLaLus of Lhe paLlenLŦ
4Ŧ Cardlovascular sLaLus assessmenLŦ 1hls ls done by deLermlnlng Lhe paLlenL's vlLal slgns ln Lhe lmmedlaLe
posLoperaLlve perlod and skln LemperaLureŦ
3Ŧ CperaLlve slLe examlnaLlonŦ uresslngs should be checkedŦ
Þos|t|on|ng
,ovlng a paLlenL from one poslLlon Lo anoLher may resulL Lo serlous arLerlal hypoLenslonŦ 1hls occurs when a
paLlenL ls moved from a llLhoLomy Lo a horlzonLal poslLlonţ from a laLeral Lo a suplne poslLlonţ prone Lo suplne
poslLlon and even when a paLlenL ls Lransferred Lo Lhe sLreLcherŦ enceţ lL ls very lmporLanL LhaL paLlenLs are
moved slowly and carefully durlng Lhe lmmedlaLe posLoperaLlve phaseŦ
Þromot|ng Þat|ent Safety
When Lransferred Lo Lhe sLreLcherţ Lhe paLlenL should be covered wlLh blankeLs and secured wlLh sLraps above Lhe
knees and elbowsŦ 1hese sLraps anchor Lhe blankeLs aL Lhe same Llme resLraln Lhe paLlenL should he or she pass
Lhrough a sLage of exclLemenL whlle recoverlng from anesLheslaŦ 1o proLecL Lhe paLlenL from fallsţ slde ralls should
be ralsedŦ
afeLy checks when Lransferrlng Lhe paLlenL from C Lo ť
Ŷ ecurlng resLralnLs for lŦvŦ flulds and blood LransfuslonŦ
A Ŷ AsslsL Lhe paLlenL Lo a poslLlon approprlaLe for hlm on her based on Lhe locaLlon of lnclslon slLe and presence
of dralnage LubesŦ
Ŷ all precauLlon lmplemenLaLlon by maklng sure Lhe slde ralls are ralsed and resLralnLs are secured wellŦ
Ŷ llmlnaLlng posslble sources of ln[urles and accldenLs when movlng Lhe paLlenL from Lhe C Lo or ÞACDŦ
Nurs|ng are for Þat|ent |n the ÞAD or kk
AIkWA¥ť Ma|nta|n a patent a|rwayŦ
1Ŧ keep oltwoy lo ploce ootll tbe potleot ls folly owoke ooJ ttles to eject ltŦ 1he alrway ls allowed Lo remaln ln
place whlle Lhe cllenL ls unconsclous Lo keep Lhe passage open and prevenLs Lhe Longue from falllng backŦ
When Lhe Longue falls backţ alrway passage obsLrucLlon wlll resulLŦ eLurn of pharyngeal reflexţ noLed when
Lhe paLlenL regalns consclousnessţ may cause Lhe paLlenL Lo gag and vomlL when Lhe alrway ls noL removed
when Lhe paLlenL ls awakeŦ
2Ŧ Ŧ 5octloo sectetloos os oeeJeJŦ
kLA1nINGť Ma|nta|n|ng adequate resp|ratory funct|onŦ
8 Ŷ 8llaLeral lung ausculLaLlon frequenLlyŦ
Ŷ esL and place Lhe paLlenL ln a laLeral poslLlon wlLh Lhe neck exLendedţ lf noL conLralndlcaLedţ and Lhe arm
supporLed wlLh a plllowŦ 1hls poslLlon promoLes chesL expanslon and faclllLaLes breaLhlng and venLllaLlonŦ
Ŷ ncourage Lhe paLlenL Lo Lake deep breaLhsŦ 1hls aeraLes Lhe lung fully and prevenLs hyposLaLlc pneumonlaŦ
A Ŷ Assess and perlodlcally evaluaLe Lhe paLlenL's orlenLaLlon Lo name or commandŦ Cerebral funcLlon alLeraLlon ls
hlghly suggesLlve of lmpalred oxygen dellveryŦ
1 Ŷ 1urn Lhe paLlenL every 1 Lo 2 hours Lo faclllLaLe breaLhlng and venLllaLlonŦ
Ŷ umldlfled oxygen admlnlsLraLlonŦ uurlng exhalaLlonţ heaL and molsLure are normally losLţ Lhus oxygen
humldlflcaLlon ls necessaryŦ Aslde from LhaLţ secreLlon removal ls faclllLaLed when kepL molsL Lhrough Lhe molsLure
of Lhe lnhaled alrŦ Alsoţ dehydraLed paLlenLs have lrrlLaLed resplraLory passages Lhusţ lL ls very lmporLanL make
sure LhaL Lhe lnhaled oxygen ls humldlfledŦ
IkDA1ICNť Assess status of c|rcu|atory systemŦ
1Ŧ CbLaln paLlenL's vlLal slgns as ordered and reporL any abnormallLlesŦ
2Ŧ ,onlLor lnLake and ouLpuL closelyŦ
3Ŧ ecognlze early sympLoms of shock or hemorrhage such as cold exLremlLlesţ decreased urlne ouLpuL Ŷ less Lhan
30 ml/hrţ slow caplllary reflll Ŷ greaLer Lhan 3 secondsţ dropplng blood pressureţ narrowlng pulse pressureţ
Lachycardla Ŷ lncreased hearL raLeŦ
1nLkMCkLGDA1ICNť Assess|ng the pat|ent's thermoregu|atory statusŦ
1Ŧ ourly LemperaLure assessmenL Lo deLecL hypoLhermla or hyperLhermlaŦ
2Ŧ eporL LemperaLure abnormallLles Lo Lhe physlclanŦ
3Ŧ ,onlLor Lhe paLlenL for posLaneLhesla shlverlng or ÞAŦ 1hls ls noLed ln hypoLhermlc paLlenLsţ abouL 30 Lo 43
mlnuLes afLer admlsslon Lo Lhe ÞACDŦ ÞA represenLs a heaLŴgaln mechanlsm and relaLes Lo regalnlng Lhe
Lhermal balanceŦ
4Ŧ Þrovlde a LherapeuLlc envlronmenL wlLh proper LemperaLure and humldlLyŦ Warm blankeLs should be provlded
when Lhe paLlenL ls coldŦ
IDID VCDMLť Ma|nta|n|ng adequate f|u|d vo|umeŦ
1Ŧ Assess and evaluaLe paLlenL's skln color and Lurgorţ menLal sLaLus and body LemperaLureŦ
2Ŧ ,onlLor and recognlze evldence of fluld and elecLrolyLe lmbalances such as nausea and vomlLlng and body
weaknessŦ
3Ŧ ,onlLor lnLake and ouLpuL closelyŦ
4Ŧ ecognlze slgns of fluld lmbalancesŦ ?ÞCvCL,lAť decreased blood pressureţ decreased urlne ouLpuLţ
lncreased pulse raLeţ lncreased resplraLlon raLeţ and decreased cenLral venous pressure (CvÞ)Ŧ ?ÞvCL,lAť
lncreased blood pressure and CvÞţ changes ln lung sounds such as presence of crackles ln Lhe base of boLh
lungs and changes ln hearL sounds such as Lhe presence of 3 gallopŦ
SAIL1¥ť Þromot|ng pat|ent safetyŦ
1Ŧ Avold nerve damage and muscle sLraln by properly supporLlng and paddlng pressure areasŦ
2Ŧ requenL dresslng examlnaLlon for posslble consLrlcLlonŦ
3Ŧ alse Lhe slde ralls Lo prevenL Lhe paLlenL from falllngŦ
4Ŧ ÞroLecL Lhe exLremlLy where lv flulds are lnserLed Lo prevenL posslble needle dlslodgeŦ
3Ŧ ,ake sure LhaL bed wheels are lockedŦ
CMICk1ť Þromot|ng pat|ent comfortŦ
1Ŧ Cbserve and assess behavloral and physlologlc manlfesLaLlons of palnŦ
2Ŧ AdmlnlsLer medlcaLlons for paln and documenL lLs efflcacyŦ
3Ŧ AsslsL Lhe paLlenL Lo a comforLable poslLlonŦ
SkIN IN1LGkI1¥ť M|n|m|z|ng sk|n |mpa|rmentŦ
1Ŧ ecord Lhe amounL and Lype of wound dralnageŦ
2Ŧ egularly lnspecL dresslngs and relnforce Lhem lf necessaryŦ
3Ŧ Þroper wound care as neededŦ
4Ŧ Þerform hand washlng before and afLer conLacL wlLh Lhe paLlenLŦ
3Ŧ 1urn Lhe paLlenL Lo sldes every 1 Lo 2 hoursŦ
6Ŧ ,alnLaln Lhe paLlenL's good body allgnmenLŦ

LVADA1ICN |n ÞAD
ÞaLlenLs ln ÞACD are evaluaLed Lo deLermlne Lhe cllenL's dlscharge from Lhe unlLŦ 1he followlng are Lhe expecLed
ouLcomes ln ÞACDť
1Ŧ ÞaLlenL breaLhlng easllyŦ
2Ŧ Clear lung sounds on ausculLaLlonŦ
3Ŧ Lable vlLal slgnsŦ
4Ŧ Lable body LemperaLure wlLh mlnlmal chllls or shlverlngŦ
3Ŧ -o slgns of fluld volume lmbalance as evldenced by an equal lnLake and ouLpuLŦ
6Ŧ 1olerable or mlnlmlzed palnţ as reporLed by Lhe paLlenLŦ
7Ŧ lnLacL wound edges wlLhouL dralnageŦ
8Ŧ alsed slde rallsŦ
9Ŧ ApproprlaLe paLlenL poslLlonŦ
10Ŧ ,alnLalned quleL and LherapeuLlc envlronmenLŦ
Þat|ent are dur|ng Immed|ate Þostoperat|ve Þhaseť 1ransferr|ng the Þat|ent from kk to the Surg|ca| Dn|t
1o deLermlne Lhe paLlenL's readlness for dlscharge from Lhe ÞACD or cerLaln crlLerla musL be meLŦ 1he
parameLers used for dlscharge from are Lhe followlngť
1Ŧ Dncompromlsed cardlopulmonary sLaLus
2Ŧ Lable vlLal slgns
3Ŧ AdequaLe urlne ouLpuL Ŷ aL leasL 30 ml/ hour
4Ŧ CrlenLaLlon Lo Llmeţ daLe and place
3Ŧ aLlsfacLory response Lo commands
6Ŧ ,lnlmal paln
7Ŧ Absence or conLrolled nausea and vomlLlng
8Ŧ Þulse oxlmeLry readlngs of adequaLe oxygen saLuraLlon
9Ŧ aLlsfacLory response Lo commands
10Ŧ ,ovemenL of exLremlLles afLer reglonal anesLhesla
,osL hosplLals use a scorlng sysLem Lo assess Lhe general condlLlon of paLlenL ln or ÞACDŦ CbservaLlon and
evaluaLlon of Lhe paLlenL's physlcal slgns ls based on a seL of ob[ecLlve crlLerlaŦ 1he evaluaLlon gulde used ls a
modlflcaLlon of Lhe AÞA scorlng sysLem used for newbornsŦ 1hrough Lhlsţ a more ob[ecLlve assessmenL of Lhe
paLlenL's physlcal condlLlon ls guaranLeed whlle recoverlng Lhe or ÞACDŦ 1he perfecL posslble score ln Lhls
modlfled AÞA scorlng sysLem ls 10Ŧ 1o be dlscharge from or ÞACD Lhe paLlenL ls requlred Lo have aL leasL 7 Lo
8 polnLsŦ ÞaLlenLs wlLh score less Lhan 7 musL remaln ln or ÞACD unLll Lhelr condlLlon lmprovesŦ Areas of
assessmenL ln ÞACD or evaluaLlon gulde areť
1Ŧ esplraLlon Ŷ ablllLy Lo breaLhe deeply and coughŦ
2Ŧ ClrculaLlon Ŷ sysLollc arLerlal pressure ƽ80Ʒ of preanesLheLlc level
3Ŧ Consclousness Level Ŷ verbally responds Lo quesLlons or orlenLed Lo locaLlon
4Ŧ Color Ŷ normal skln color and appearanceť plnklsh skln and mucus
3Ŧ ,uscle acLlvlLy Ŷ moves sponLaneously or on command
-urslng care durlng Lhe lnLermedlaLe posLoperaLlve perlodť
AssessmenL
1Ŧ esplraLory sLaLusť alrway paLencyţ depLhţ raLe and characLer of resplraLlonsţ naLure of breaLh sounds
2Ŧ ClrculaLory LaLusť vlLal slgns lncludlng blood pressure and skln condlLlon
3Ŧ -eurologlcť level of responslveness
4Ŧ uralnageť presence of dralnageţ need Lo connecL Lubes Lo a speclflc dralnage sysLemţ presence and condlLlon of
dresslngs
3Ŧ ComforLť Lype of paln and locaLlonţ nausea and vomlLlngţ poslLlon change requlred
6Ŧ Þsychologlcť naLure of paLlenL's quesLlonsţ need for resL and sleepţ dlsLurbance by nolseţ vlslLorsţ avallablllLy of
call bell or call llghL
7Ŧ afeLyť need for slde rallsţ dralnage Lubes unobsLrucLedţ lv fluld properly lnfuslng and lv slLes properly spllnLed
8Ŧ qulpmenLť checked for proper funcLlonlng

oals and lnLervenLlons
Þ Ŷ ÞrevenLlng and/or rellevlng compllcaLlons
C Ŷ CpLlmal resplraLory funcLlon
Ŷ upporLť psychosoclal wellŴbelng
1 Ŷ 1lssue perfuslon and cardlovascular sLaLus malnLenance
C Ŷ Cbservlng and malnLalnlng adequaLe fluld lnLake
Þ Ŷ ÞromoLlng adequaLe nuLrlLlon and ellmlnaLlon
A Ŷ AdequaLe fluld and elecLrolyLe balance
Ŷ enal funcLlon malnLenance
Ŷ ncouraglng acLlvlLy and moblllLy wlLhln llmlLs
1 Ŷ 1horough wound care for adequaLe wound heallng
l Ŷ lnfecLlon ConLrol
v Ŷ vlgllanL Lo manlfesLaLlons of anxleLy and promoLlng ways of rellevlng lL
Ŷ llmlnaLlng envlronmenLal hazards and promoLlng cllenL safeLy

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