PERIOPERATIVE NURSING

Prepared by:
Rachelle M. Ganuelas RN, MAN
DEFINITION OF TERMS
 SURGERY -It is the branch of medicine concerned
with diseases and conditions which require or are
amenable to operative procedures. Surgery is the
work done by a surgeon.
-"Surgery can involve cutting, abrading,
suturing, laser or otherwise physically changing
body tissues and organs."
 SURGEON - A physician who treats disease, injury,
or deformity by operative or manual methods. A
medical doctor specialized in the removal of organs,
masses and tumors and in doing other procedures
using a knife (scalpel)
 STERILE - free from living germs or
microorganisms; aseptic: sterile surgical
instruments.
 ASEPSIS - The state of being free of pathogenic
microorganisms.
- The process of removing pathogenic
microorganisms or protecting against infection by
such organisms.
 SEPSIS - a toxic condition resulting from the spread
of bacteria or their toxic products from a focus of
infection; especially : septicemia
 SEPSIS - is a severe illness caused by overwhelming
infection of the bloodstream by toxin-producing
bacteria.
- is caused by bacterial infection that can
originate anywhere in the body.
 DISINFECTANT - any chemical agent used chiefly on
inanimate objects to destroy or inhibit the growth
of harmful organisms.
 ANTISEPTICS - is a substance that prevents or arrests
the growth or action of microorganisms either by
inhibiting their activity or by destroying them. The
term is used especially for preparations applied
topically to living tissue
 STERILIZATION
-the destruction of all living microorganisms, as
pathogenic bacteria, vegetative forms, and spores.
 BACTERIOSTATIC -Capable of inhibiting the
growth or reproduction of bacteria.
- An agent, such as a chemical or biological
material, that inhibits bacterial growth.
 BACTERICIDAL - Capable of killing bacteria.
 BACTERIOCIDES - is a substance that kills bacteria
.Bactericides are either disinfectants, antiseptics or
antibiotics.
PREFIXES & SUFFIXES
 Prefixes & Suffixes can explain the type of procedure the
client will undergo:
 PREFIXES
 Supra – above ; beyond
 Ortho – joint
 Chole – bile or gall
 Cysto – bladder
 Encephalo- brain
 Entero – intestine
 Hystero – uterus
 Mast – breast
 Meningo – membrane; meninges
 Myo – muscle
 Nephro – kidney
 Neuro – nerve
 Oophor - ovary
 Pneumo – lungs
 Pyelo – kidney pelvis
 Salphingo – fallopian tube
 Thoraco – chest
 Viscero – organ esp. abdomen
 SUFFIXES
 Oma – tumor ; swelling
 Ectomy – removal of an organ or gland
 Rhapy – suturing or stitching of a part or
an organ
 Scopy – looking into
 Ostomy – making an opening or a stoma
 Otomy – cutting into
 Plasty – to repair or restore
 Cele – tumor ; hernia ; swelling
 Itis – inflammation of
 PHASES OF O.R. NURSING :
I. PREOPERATIVE PHASE
 The rendering of nursing care to the surgical
client as soon as he is admitted & the decision to
undergo surgery is made.
 It ends on the time the client is transferred to the
O.R.
 NURSING ACTIVITIES :
 Assessment of the client (baseline evaluation of the pt. before
the day of surgery-interview)
 Identification of potential/actual health problems.
 PREADMISSION TESTING- ensure necessary tests have
been performed
 Pre-op teaching involving client & support persons.
 Day of surgery :
 pt. teaching reviewed
 informed consent confirmed
 pt.’s identity & surgical site verified
 IVF started.
PREPARATION FOR SURGERY
 Psychological Support :
a) Assess client’s fears, anxieties, support systems &
patterns of coping.
b) Establish trusting relationship with client &
significant others.
c) Explain routine procedures, encourage
verbalization of fears & allow client to ask
questions.
d) Demonstrate confidence in surgeon & staff.
e) Provide for spiritual care if appropriate.
PREOPERATIVE TEACHING
 Frequently done on an outpatient basis.
 Assess client’s level of understanding of surgical
procedure & its implications.
 Answer questions, clarify & reinforce explanations
given by the surgeon.
 Explain routine pre- & post-op procedures & any
special equipment to be used.
 PREOPERATIVE TEACHING
 Preoperative experience
 Preoperative medication
 Breathing exercises, coughing, incentive spirometer
 Leg exercises
 Position changes and movement
 Pain management
 Reducing anxiety and fear, support of coping
 Special considerations related to outpatient surgery
Preoperative Nursing Interventions
 PHYSICAL PREPARATIONS:
 Patient safety is a primary concern.
 Obtain history of past medical conditions, surgical
procedures, dietary restrictions & medications.
 Perform baseline head-to-toe assessment, including
VS, height & weight.
 Ensure that diagnostic procedures pertinent to
surgery are performed as ordered:
1. CBC
2. Electrolytes
3. PT/PTT (Prothrombin Time;Partial
thromboplastin time)
4. Urinalysis
5. ECG
6. Blood typing & crossmatch
 NPO- to prevent aspiration
 Bowel prep and skin prep
- cleansing enema or laxative before surgery to
allow satisfactory visualization of the surgical site.
- goal of pre-op skin prep is to decrease bacteria
without injuring the skin.
 Immediate preoperative preparation
 Complete checklist and chart
 Hospital gown, voiding, removal of dentures, jewelry,
contacts, etc.
 Preoperative medication
 Transporting the pt. to the Presurgical area about 30
to 60 minutes before anesthetics is to be given.
 Attend to family needs
 LEGAL PREPARATION:
 Surgeon obtains operative permit (informed consent)
1. Surgical procedures, alternatives , possible
complications & disfigurements or removal of body
parts are explained.
2. It is part of the nurse’s role as client advocate to
confirm that the client understands information
given.
 INFORMED CONSENT is necessary in the ff.
Circumstances:
 Invasive procedures, such as surgical incisions,
biopsy, cystoscopy or paracentesis.
 Procedures requiring sedation or anesthesia
 A non-surgical procedure, such as arteriography
 Procedures involving radiation
 Adult client (over 18 y/o) signs own permit unless
unconcious or mentally incompetent.
1. If unable to sign, relative (spouse or next of kin)
or guardian will sign.
2. In an emergency, permission via telephone or
telegram is acceptable; have a 2nd listener on
phone when telephone permission is given
3. Consents are not needed for emergency care if all
4 of the ff. criteria are met:
a. There is an immediate threat to life.
b. Experts agree that it is an emergency.
c. Client is unable to consent.
d. A legally authorized person cannot be reached.
 Minors (under 18 y/o) must have consent signed by
an adult (i.e. Parent or legal guardian)
 Emancipated minor (married or independently
earning his or her own living)may sign his/ her own
consent.
 Witness to informed consent may be a nurse,
another M.D., clerk or any other authorized person.
 The nurse witnessing informed consent, specifies
whether witnessing explanation of surgery or just
signature of the client.
PREOPERATIVE MEDICATIONS
 PURPOSES:
1. To relieve fear & anxiety.
2. To reduce dose needed for induction &
maintenance of anesthesia.
3. To prevent reflex bradycardia that happens
during induction of anesthesia.
4. To minimize oral secretions.
II. INTRAOPERATIVE PHASE
 Giving nursing care to client undergoing surgery.
 It starts from the time the pt. was admitted to the
O.R. , during operation until it ends & transferred
to the PACU.
 NURSING ACTIVITIES:
 Activities providing for pt’s safety.
 Maintenance of aseptic environment.
 Ensuring proper function of equipments.
 Providing surgeons with specific instruments & supplies for
surgical field.
 Completing documentation.
 Positioning pts.
 Acting as scrub/circulating nurse.
Members of the Surgical Team
 Patient
 Anesthesiologist
or anesthetist
 Surgeon
 Nurses (Scrub &
Circulating)
 Surgical
technologists
SCRUB TEAM @ WORK
 PATIENT – the most important member of the surgical
team. May feel relaxed & prepared, or fearful & highly
stressed.
- is also subject to several risks.
 OPERATING SURGEON – pre-op dx & care.
- performance of operation.
- post-op mgt & care
- assumes all responsibility for all medical acts of
judgement & mgt.
 SURGEON & ASSISTANTS – scrub & perform the
surgery.
 REGISTERED NURSE 1ST ASST. – practices under the
direct supervision of the surgeon. (handling tissue,
suturing, maintaining hemostasis)
 ANESTHESIOLOGIST /
 NURSE ANESTHETIST – administers the anesthetic
agent & monitors the pt’s physical status throughout
the surgery.
 SCRUB NURSE – provides sterile instruments &
supplies to the surgeon during the procedure.
- performs surgical hand scrub.
 CIRCULATING NURSE – coordinates the care of the pt.
in the O.R.
- care provided includes assisting with pt. positioning ,
skin prep, managing surgical specimens &
documenting intraoperative events.
 SCRUB NURSE
CIRCULATING
NURSE
Prevention of Infection
 The surgical environment – stark appearance &
cool temperature. Located central to all supporting
services.
 Unrestricted zone – where street clothes are allowed.
 Semirestricted zone- where attire consists of scrub
clothes & caps.
 Restricted zone- where scrub clothes, shoe covers,
caps & masks are worn.
THE OPERATING ROOM
SURGICAL ASEPTIC TECHNIQUE
 BEFORE AN OPERATION, it is necessary to sterilize
and keep sterile all instruments, materials, and
supplies that come in contact with the surgical site.
Every item handled by the surgeon and the
surgeon's assistants must be sterile. The patient's
skin and the hands of the members of the surgical
team must be thoroughly scrubbed, prepared, and
kept as aseptic as possible.
 DURING THE OPERATION, the surgeon, surgeon's
assistants, and the scrub nurses must wear sterile gowns
and gloves and must not touch anything that is not
sterile.
 Maintaining sterile technique is a cooperative
responsibility of the entire surgical team.
 Each member must develop a surgical conscience, a
willingness to supervise and be supervised by others
regarding the adherence to standards.
BASIC PRINCIPLES OF SURGICAL
ASEPSIS
 All personnel assigned to the operating room must
practice good personal hygiene. This includes daily
bathing and clothing change.
 Those personnel having colds, sore throats, open
sores, and/or other infections should not be
permitted in the operating room.
 Operating room attire (which includes scrub suits,
gowns, head coverings, and face masks) should not be
worn outside the operating room suite. If such occurs,
change all attire before re-entering the clean area. (The
operating room and adjacent supporting areas are
classified as "clean areas.")
 All members of the surgical team having direct contact
with the surgical site must perform the surgical hand
scrub before the operation.
 All materials and instruments used in contact with the
site must be sterile.
 · The gowns worn by surgeons and scrub corpsmen are
considered sterile from shoulder to waist (in the front
only), including the gown sleeves.
 · If sterile surgical gloves are torn, punctured, or have
touched an unsterile surface or item, they are
considered contaminated.
 The safest, most practical method of sterilization for
most articles is steam under pressure.
 · Label all prepared, packaged, and sterilized items
with an expiration date.
 · Use articles packaged and sterilized in cotton muslin
wrappers within 28 calendar days.
 Use articles sterilized in cotton muslin wrappers and
sealed in plastic within 180 calendar days
 Unsterile articles must not come in contact with
sterile articles.
 Make sure the patient's skin is as clean as possible
before a surgical procedure.
 Take every precaution to prevent contamination of
sterile areas or supplies by airborne organisms.
HANDLING STERILE ARTICLES
 When you are changing a dressing, removing
sutures, or preparing the patient for a surgical
procedure, it will be necessary to establish a sterile
field from which to work. The field should be
established on a stable, clean, flat, dry surface.
 An article is either sterile or unsterile; there is no
in-between. If there is doubt about the sterility of
an item, consider it unsterile
 Any time the sterility of a field has been
compromised, replace the contaminated field and
setup.
 Do not open sterile articles until they are ready for
use.
 Do not leave sterile articles unattended once they
are opened and placed on a sterile field.
 Do not return sterile articles to a container once they
have been removed from the container.
 Never reach over a sterile field.
 When pouring sterile solutions into sterile containers
or basins, do not touch the sterile container with the
solution bottle. Once opened and first poured, use
bottles of liquid entirely. If any liquid is left in the
bottle, discard it.
 Never use an outdated article. Unwrap it, inspect it,
and, if reusable, rewrap it in a new wrapper for
sterilization.
Intraoperative Complications
 Nausea and vomiting
 Anaphylaxis
 Hypoxia and respiratory complications
 Hypothermia
 Malignant hyperthermia
 Disseminated intravascular coagulation (DIC)
Potential Adverse Effects of
Surgery and Anesthesia
 Allergic reactions and drug toxicity or reactions
 Cardiac dysrhythmias
 CNS changes and oversedation or undersedation
 Trauma: laryngeal, oral, nerve, and skin, including burns
 Hypotension
 Thrombosis
Nursing Goals for the Patient in the
Intraoperative Period
 Reducing anxiety
 Preventing positioning injuries
 Maintaining patient safety
 Maintaining the patient's dignity
 Avoiding complications
Protecting the Patient from Injury
 Patient identification
 Correct informed consent
 Verification of records of health history and exam
 Results of diagnostic tests
 Allergies (include latex allergy)
 Monitoring and modifying the physical environment
 Safety measures such as grounding of equipment, restraints,
and not leaving a sedated patient
 Verification and accessibility of blood
III. POSTOPERATIVE PHASE
 Begins with the admission of the client to PACU &
ends with discharge of client from hospital or
facility providing continuity of care.
Post-Anesthesia Care Unit
 The PACU environment
 Beds and other equipment
Nursing Management in the PACU
 Provide care for the patient until he/she has recovered from
the effects of anesthesia.
 Patient has resumption of motor and sensory function, is
oriented, has stable VS, and shows no evidence of
hemorrhage or other complications of surgery.
 Frequent skilled assessment of the patient is vital
Responsibilities of the PACU Nurse
 Review pertinent information and baseline assessment upon
admission to the unit.
 Assessments include airway and respirations, cardiovascular
function, surgical site, function of the central nervous
system; also assess IVs and all tubes and equipment.
 Reassess VS and patient status every 15 minutes or more
frequently as needed.
 Provide report and transfer the patient to another unit or
discharge the patient to home.
Outpatient Surgery/Direct
Discharge
 Discharge planning and discharge assessment

 Provide written and verbal instructions regarding

follow-up care, complications, wound care, activity,
medications, and diet.

 Give prescriptions and phone numbers. Discuss actions to

take if complications occur.
Outpatient Surgery/Direct
Discharge
 Give instructions to the patient and a responsible adult who
will accompany the patient.

 Patients are not to drive home or be discharged to home

alone. Sedation and anesthesia may cloud memory and
judgment and affect ability.