PERI-OPERATIVE NURSING

PRACTICE

Margielyn Onor Reyes, RN,

RM,MAN
Professor

May 30, 2020 1

 HISTORY OF SURGERY
• The first surgical procedures were
performed in the Neolithic Age (about
10,000 to 6000 B.C.

May 30, 2020 2

• Egypt, carvings dating to 2500 B.C.
describe surgical circumcision

• Operations such as castration (the removal

of a male’s testicles); Lithotomy (the
removal of stones from the bladder); and
amputation (the surgical removal of a limb
or other body part) are also believed to have
been performed by the Egyptians.

May 30, 2020 3

• Ancient Egyptian medical texts have been
found that provide instructions for many
surgical procedures including repairing a
broken bone and mending a serious
wound
• In ancient India, the Hindus surgically
treated bone fractures and removed
bladder stones, tumors, and infected
tonsils

May 30, 2020 4

• They are also credited with having
developed plastic surgery as early as 2000
B.C. in response to the punishment of
cutting off a person’s nose or ears for
certain criminal offenses
• Using skin flaps from the forehead, Hindu
surgeons shaped new noses and ears for
the punished criminals

May 30, 2020 5

• In the 4th century B.C., the Greek
physician Hippocrates published
descriptions of various surgical
procedures, such as the treatment of
fractures and skull injuries, with
directions for the proper placement of
the surgeon’s hands during these
operations.

May 30, 2020 6

 HISTORIC HEADLINES
• First Successful Heart Transplant
–This Los Angeles Times article reports on a
medical breakthrough: the first successful
human heart transplant. Dr. Christiaan
Barnard led the South African medical team
that performed the operation. His name is
spelled differently here than in other
reports.

May 30, 2020 7

• During most of the Middle Ages (5th
century to 14th century A.D., the practice
of surgery declined. It was viewed as
inferior to medicine, and its practice was
left to barbers who traveled from town to
town cutting hair, removing tumors, pulling
teeth, stitching wounds, and bloodletting,
the practice of draining blood from the
body, then thought to cure illness.

May 30, 2020 8

• The red-and-white striped pole that
today identifies barbershops derived its
design from this practice. The red stripes
symbolize blood and the white stripes
signify bandages.

May 30, 2020 9

In 1316 the French surgeon Guy de Chauliac
published Chirurgia magna (Great Surgery).

• This massive text describes how to

remove growths, repair hernias
(protrusion of an organ through
surrounding structures), and treat
fractures using slings and weights

May 30, 2020 10

 During the 16th, 17th, and 18th centuries,
many discoveries in surgical practice took
place.
• Much credit belongs to the French surgeon
Ambroise Paré, often called the father of
modern surgery.
• Paré successfully employed the method of
ligating, or tying off, arteries to control bleeding,
thus eliminating the old method of cauterizing,
or searing, the bleeding part with a red-hot iron
or boiling oil.

May 30, 2020 11

• William Harvey-discovered the process of
blood circulation
• Marcello Malpighi- Italian anatomist,
identified the existence of tiny blood vessels
called capillaries that carry blood from the
major blood vessels to the cells of the body.
• John Hunter-, a British anatomist and
surgeon, stressed the close relationship
between medicine and surgery and
performed many experimental operations
that advanced the practice of surgery.

May 30, 2020 12

• Most surgery, however, continued to be
restricted to less critical areas of the
body or to operations that did not
penetrate the skin too deeply. Surgeons
rarely opened the abdomen, chest, or
skull because of the pain it caused the
patient and the risk of infection.

May 30, 2020 13

• This changed in 1846 when anesthesia was
used as a way to mask pain during surgery
by American dentist William Morton.
• Although Morton is often credited with the
discovery of surgical anesthesia, American
surgeon Crawford W. Long used anesthesia
in 1842 during the removal of tumors but
did not publish his results until 1849.

May 30, 2020 14

• In 1865 the British surgeon Joseph
Lister applied Pasteur’s work to
surgery, developing antiseptic (germ-
killing) techniques including the use
of a carbolic acid spray to kill germs
in the operating room before
surgery.

May 30, 2020 15

• Austrian Ignaz Semmelweiss and American
Oliver Wendell Holmes,
- determined that bacteria are also carried
on the hands and clothing and transferred
from patient to patient as a physician attends
one after another.
- These physicians pioneered techniques such
as washing hands and changing into clean
clothing before surgery that prevent wounds
from being contaminated during surgery.

May 30, 2020 16

• In the late 1800s, having solved the
problems of pain and infection, surgeons
began performing new types of surgery
including procedures on the abdomen,
brain, and spinal cord.
• At the turn of the 20th century,
improved diagnostic abilities and
methods of treatment helped surgery
become even more effective.

May 30, 2020 17

• German physicist Wilhelm Conrad Roentgen
invented X rays in 1895 to “photograph” the
inside of the body he changed the way surgery
was performed.
• The discovery of the blood groups A, B, and O by
Austrian pathologist Karl Landsteiner enabled
surgeons to give patients transfusions of their
own blood type to ensure survival during
surgery. The need for a readily available supply
of blood for transfusions led to the creation of
blood banks in 1937.

May 30, 2020 18

• The introduction of antibiotics in the
1940s further minimized the risk of
postoperative infection.
• The development of the heart-lung
machine in 1953 by American surgeon
John H. Gibbon allowed surgeons to
more easily and successfully perform
surgery on these organs.

May 30, 2020 19

• The operating microscope, developed in
the 1950s, provided surgeons with a way
to perform delicate operations on minute
body structures like the inner ear and the
eye, and more recently, enabled surgeons
to reattach the tiny blood vessels from
severed limbs to the body (see
Microsurgery).

May 30, 2020 20

• The first kidney transplants were
performed in the 1950s, and
• The first heart transplant, in 1967,
was performed by South African
physician Christiaan Barnard

May 30, 2020 21

 Peri -operative Nursing
• Use to describe the nursing functions
in the total surgical experience of the
patient.
• Practice- refers to the expected
behavior patterns and technical
activities the nurse performs during
the 3 phases of surgical experiences
May 30, 2020 22
 3 Phases of surgical experiences:

• Intra-operative
• Pre-operative
• Post-operative

May 30, 2020 23

 CHARACTERISTICS OF PERI-
OPERATIVE NURSE
• Possess a depth and breadth of knowledge
that allows for the coordination of care of
the surgical patient.
• Prioritize interventions based on a
comprehensive and scientific body of
knowledge and variations in patient
responses.

May 30, 2020 24

• Using critical thinking skills in:
a. Applying Nursing Process
b. Acting as a patient advocate
c. Exercising judgment in a
professionally accountable manner to
achieve the best possible patient
outcomes.

May 30, 2020 25

 • Designs, coordinates and deliver care to
meet the identified physiologic,
psychologic, socio-cultural, and
spiritual needs of patient whose
protective are compromised because of
invasive procedures.
• Nursing activities address the needs and
responses of patients and their families
or significant others.

May 30, 2020 26

• Flexible and diverse to practice in
technologically complex
environment
• Make decisions about patient’s
problems, needs and health
status.

May 30, 2020 27

 PHASES:
• I PRE-OPERATIVE PHASE
– From the decision is made for surgical
intervention to the transfer of patient to the
OR.
– The nurse performs the assessment and
planning of nursing process.
– Assess the patient to identify potential
health problems
– Determine the nursing diagnosis and
prioritize nursing intervention.
May 30, 2020 28
• II INTRA-OPERATIVE PHASE
–From the time the patient is received
from OR until he is admitted to the
recovery room
–Implementation of nursing process is
performed
–The nurse carries out the plan of care
with:
May 30, 2020 29
 Skills
Safety
Efficiency
Effectiveness

May 30, 2020 30

 POST-OPERATIVE PHASE
• From the time of admission to the recovery
room to follow-up home or clinic evaluation.
–Post-anesthesia care unit (PACU)
–ICU
• Evaluation is completed during this phase
• Appraise the quality of nursing care needed
during the pre-op and intra-op phase of care.
• Effectiveness of nursing care is also evaluated

May 30, 2020 31

Pre-operative Intra-operative Post-operative

Decision OR Admitted to RR

↓ ↓ ↓
Preparation Induction of anesthesia surgical unit

↓ ↓ ↓
(Holistic & legal) surgical procedure discharge

↓ ↓ ↓
OR Recovery Room Follow-up care

May 30, 2020 32

 TYPES OF SURGERY
A. According to Purpose
1. Diagnostic Surgery- makes it
possible to verify a suspected
diagnosis.
• Example: BIOPSY
»confirm the diagnosis by
histologic and cytologic
analysis, the study of cells.
May 30, 2020 33
 Types of Biopsy
(Pre Operative)
a. Bone Marrow Biopsy- a small skin incision or
percutaneous puncture, a trocar puncture needle is
placed into bone usually the sternum or iliac crest to
aspirate bone marrow.
b. Aspiration Biopsy- fluid is aspirated thru’ the
needle placed in a lesion such as abscess or in joint
and body cavity.
c. Excision Biopsy- tissue is cut from the body,
removed thru’ an incision.
E.g. Breast- guided by ultrasonography
May 30, 2020 34
d. Percutaneous Needle Biopsy- tissue is
obtained from an internal organ or solid
mass by means of hollow needle.
d.1. Dorsey Cannula- to remove a
sample of brain tissue for biopsy.
d.2. Franklin-Silverman- obtaining
biopsy specimens of thyroid,
liver, kidney, prostate and
other.
d.3. Bernardino- Sones- needle is
inserted thru’ chest wall to
obtain biopsy of the lungs.
May 30, 2020 35
 (INTRA-OPERATIVE)

May 30, 2020 36

 a. Cultures- drainage is cultured to enable
the surgeon to effectively prescribe
antibiotics .
b. Frozen Section Biopsy- identifies tissue
whether it is malignant or regional nodes
involved. The surgeon removes a piece of
tissue for an immediate diagnosis.
c. Surgical Specimen/histopathology-
tissue is remove during the surgical
procedure is sent to the pathology
laboratory for verification of diagnosis.
May 30, 2020 37
1. Exploratory Surgery- makes it
possible to estimate the extent of
disease and perhaps to confirm the
diagnosis.
E.g. Exploratory- Laparotomy

May 30, 2020 38

2. Palliative Surgery- relieves symptoms and
improves quality of life but does not cure
the underlying disease.
E.g. Intestinal bypass operation may relieve
symptoms of intestinal obstruction from
inoperable bowel cancer.
Nursing Alert: Cancer basically is a
systemic disease. Therapy is curative if the
disease process can be totally eradicated but
if not possible palliative therapy is used.

May 30, 2020 39

3. Curative - removes or repair damaged,
diseased, or congenitally
malformed organs or tissues.

May 30, 2020 40

 Classifications:
A. Ablative Surgery- involves
removing diseased organs
E.g. Kidney
1. Radical Nephrectomy- removal of
a lobe or entire kidney

May 30, 2020 41

 B. Reconstructive- is the partial or
complete restoration of a damage
organ or tissue to its original
appearance or function.

May 30, 2020 42

C. Constructive Surgery- repairs a
congenitally defective organ,
improving its function and appearance.
e.g. Plastic Surgery of the congenital Cleft
Palate
c.1. Palatoplasty - closure of the soft palate
c.2. Cheiloplasty - closure of cleft lip with
in few days after birth to facilitate
feeding and minimize psychologic
trauma of patient.
May 30, 2020 43
Others:
Orchidopexy - repair of
undescended testes (cryptorchidism)
Anoplasty - repair of the
imperforate anus.

May 30, 2020 44

 According to Urgency

1. Optional surgery- is scheduled

completely at the preference of
the patient. Requested by the
patient for anesthetic purposes.

May 30, 2020 45

E.g. Cosmetic Surgery
a. Rhinoplasty - reshaping of the nose
b. Otoplasty - repair for both external
ears as a result of burn or
traumatic avulsion.
c. Rhytidoplasty - referred to as face
lift. Repair of facial muscles and
skin.
May 30, 2020 46
2. Elective Surgery
- the approximate time for surgery is at
the convenience of the patient, failure
to surgery is not catastrophic. It is
not absolutely necessary; any delay
may not cause adverse effect.
- E.g. Superficial cyst, removal of
warts, and surgery of simple goiter.

May 30, 2020 47

3. Required or Planned
- the condition requires surgery within
a few weeks
E.g. Eye cataract
a. Cataract Extraction- the most
frequently performed of all
surgical procedures

May 30, 2020 48

• a.1. Extracapsular - incision in
cones and sclera/

• a.2. Intracapsular - incision in

region of limbus

May 30, 2020 49

 4. Urgent or Imperative

surgical problem
requires attention
within 24 to 48 hours
E.g. Cancer, PUD,
and renal failure
for hemodialysis

May 30, 2020 50

5. Emergency
• requires immediate
surgical attention without
delay. This is done to
save the function of other
or of an organ.
–E.g. Appendicitis,
ruptured uterus,
retained placental
fragments, meconium
stained babies.

May 30, 2020 51

6. Day or Ambulatory

- out-patient basis
E.g. Circumcision, wound
suturing, and mole removal.

May 30, 2020 52

 According to Magnitude or extent /
Degree of risk

1. Major – extensive, may be prolong,

and may involve significant loss of
blood and greatest risk of
complications

May 30, 2020 53

 CRITERIA:
A. High risk
B. Extensive
C. Prolonged
D. Large amount of blood loss
E. Vital organs may be removed or
manipulated.
F. Greatest risk of complication
May 30, 2020 54
 E.g. Nephrectomy
Radical neck dissection
Explore-lap.

May 30, 2020 55

2. Minor
– is generally not prolonged leads to a
few serious complications, less risk.
E.g. Skin biopsy
Debridement
Dilatation and curettage

May 30, 2020 56

 Pathology Requiring
Surgical Intervention
(conditions)

May 30, 2020 57

Obstruction
 causes impairment to vital flow of
fluid in the body.

E.g. Blood – Thrombus, Embolism

CSF - Tumor
Bile - Tumor, Stone

May 30, 2020 58

Perforation
- rupture of organs
E.g. Appendicitis
Uterine

rupture

May 30, 2020 59

E- rosion - damage of intestinal lining.
E.g. PUD
T- umors - abnormal new growth of
malignant cells
A. Benign
B. Malignant

May 30, 2020 60

 Nursing Activities: Preoperative Phase
• Preadmission testing
1. Initiates initial preop assessment
2. Initiates teaching appropriate to patient’s
needs
3. Involves family in interview
4. Verifies completion of preop testing
5. Verify understanding of surgeon-specific
preop orders (bowel prep, preop shower)
6. Assess pt’s need for postop transportation
and care
May 30, 2020 61
 Nursing Activities: Preoperative Phase
• Admission to Surgical center or unit
1. Develops a plan of care
2. Completes preop assessment
3. Assess for risks for postop complications
4. Reports unexpected findings or any deviations from
normal
5. Verify operative consent has been signed
6. Coordinates teaching with other nursing staff
7. Reinforce previous teaching
8. Explain the phases in perioperative prd. and
expectations
9. Answers pt’s an family’s questions
May 30, 2020 62
 Nursing Activities: Preoperative Phase
• In the holding area
1. Assess pt’s status, baseline pain, and nut’l status
2. Review chart
3. Identifies patient
4. Verifies surgical site and mark site per institution
policy
5. Establish intravenous line
6. Administer medications if prescribed
7. Takes measures to ensure pt’s comfort
8. Provide psychological support
9. Communicates pt’s emotional status to other
appropriate members of the care team
May 30, 2020 63
 Nursing Activities: Intraoperative Phase
• Maintenance of safety
1. Maintain aseptic, controlled environment
2. Effectively manages human resources, equipment,
and supplies for individualized nursing care
3. Transfer pt to OR bed or table
4. Position the pt.
• Functional alignment
• Exposure of surgical site
5. Applies grounding device to pt
6. Ensures that sponge, needle and instrument counts
are correct
7. Completes intraop documentation

May 30, 2020 64

 Nursing Activities: Intraoperative Phase
• Physiologic monitoring
1. Calculates effects on pt of excessive fluid
loss or gain
2. Distinguishes normal from abnormal
cardiopulmonary data
3. Reports changes in pt’s VS
4. Institute measures to promote
normothermia

May 30, 2020 65

 Nursing Activities: Intraoperative Phase
• Psychological support (before induction and
when patient is conscious)
1. Provide emotional support to pt.
2. Stand near or touches pt during procedures
and induction
3. Continue to assess pt’s emot’l status

May 30, 2020 66

 Nursing Activities: Postoperative Phase
• Transfer of patient to Postannesthesia Care
Unit (PACU)
1. Communicates intraop information
• Identifies pt by name
• States type of surgery performed
• Identify type of anesthetic used
• Reports pt’s response o surgical procedure
and anesthesia

May 30, 2020 67

 • Describe intraop factors (insertions of
drains or cath, adm of blood, analgesic
agents, or other meds during surgery;
occurrence of unexpected events)
• Describes physical limitations
• Report pt’s preop LOC
• Communicates necessary equipment needs
• Communicates presence of family and/or
significant others

May 30, 2020 68

 Nursing Activities: Postoperative Phase

• Postoperative Assessment Recovery

Area
1. Determine pt’s immediate response to
surgical interventions
2. Monitor pt’s physiologic status
3. Assess pt’s pain level and administers
appropriate pain relief

May 30, 2020 69

4. Maintain pt’s safety (airway, circulation,
prevention of injury)
5. Adm meds, fluids, and blood component
therapy, if prescribed
6. provides oral fluids if prescribed for
ambulatory surgery pt.
7. Assess pt’s readiness for transfer to in-
hospital unit or for discharged home based
on institutional policy

May 30, 2020 70

 Nursing Activities: Postoperative Phase
• Surgical Unit
1. Continue close monitoring of pt’s physical and
psychological response to surgical intervention
2. Assess pt’s pain level and administers appropriate
pain relief measures
3. Provide teaching to pt during immediate recovery
prd.
4. Assist pt in recovery and preparation for discharge
home
5. Determine pt’s psychological status
6. Assist with discharge planning
May 30, 2020 71
 Nursing Activities: Postoperative Phase
• Home or Clinic
1. Provides follow-up care during office or
clinic visit or by telephone contacts
2. Reinforces previous teaching and answers
pt’s and family questions about surgery and
follow-up care
3. Assess pt’s response to surgery and
anesthesia and their effects on body image
and function
4. Determine family perception of surgery and
its outcome
May 30, 2020 72
 Criteria for valid informed consent:
• Voluntary consent
- freely given without coercion
• Incompetent patient
- not autonomous; cannot give or withhold consent
• Informed subject- should be in writing
– Explanation of procedure and its risks
– Description of benefits and alternatives

May 30, 2020 73

 – An offer to answer question about procedure
– Instructions that the pt may withdraw consent
– A statement informing the pt if the protocol
differs from customary procedure
• Patient able to comprehend
- must be written and delivered in language
understandable to the pt
- Q’s must be answered to facilitate comprehension
if material is confusing

May 30, 2020 74

 Assessment of health Factors that Affect Pt’s
Preoperatively
• Nut’l status
• Drug or alcohol use
• Respiratory status
• Cardiovascular status
• Hepatic and renal function
• Endocrine function
• Immune function
• Previous medication use
• Psychosocial factors
• Spiritual beliefs
May 30, 2020 75
 Preoperative teaching:
• When and what to teach
• Deep-breathing, coughing and incentive
spirometers
• Mobility and active body movement
• Pain management
• Cognitive coping strategies
– Imagery
– Distraction
– Optimistic self-recitation
• Instruction for ambulatory surgical pt’s
May 30, 2020 76
 Preoperative psychosocial interventions:

• Reducing preop anxiety

• Decreasing fear
• Respecting cultural, spiritual and
religious beliefs

May 30, 2020 77

 General Preoperative Nursing Interventions:

• Managing nutrition and fluids- NPO

• Preparing the bowel for surgery
• Preparing for the skin

May 30, 2020 78

Immediate Preoperative Nursing Interventions:

• Change of gown
• Remove hair pins, jewelry, wear caps
• Dentures and plates removed
• Instruct to void; perform cathe. as ordered
• Administer preanesthetic meds
• Maintaining preop record-checklist
• Transporting pt to the presurgical area
• Attending to family needs
May 30, 2020 79
 Preoperative Nursing Diagnosis:
• Anxiety r/t surgical experience and
outcome of surgery
• Fear r/t perceived threat of the surgical
procedures and separation from support
system
• Knowledge deficit of preop procedures
and protocols and postop expectations

May 30, 2020 80

 Intraoperative Nursing Management:

• The surgical team:

–Pt
–Anesthesiologist/ anesthetist
–Surgeon
–Intraop nurses (circulating/scrub)
–Surgical technologist

May 30, 2020 81

 Intraoperative Nursing Management:
• The surgical environment:
– Principles of surgical asepsis
– Environmental controls
– Basic guidelines for maintaining surgical
asepsis

May 30, 2020 82

 Intraoperative Nursing Management:
• Health hazards associated with the surgical
environment:
– Laser risks
– Exposure to blood and body fluids
– latex allergy

May 30, 2020 83

 Intraoperative Nursing Management:
• The surgical experience:
– Sedation and anesthesia
• Minimal
• Moderate
• Deep

May 30, 2020 84

 Intraoperative Nursing Management:
• The surgical experience:
– Anesthesia:
• Stage I- Beginning anesthesia
• Stage II- Excitement
• Stage III-Surgical anesthesia
• Stage IV-Medullary depression

May 30, 2020 85

 Intraoperative Nursing Management:
• Methods of Anesthesia administration:
a. Inhalation
b. Intravenous
c. Regional anesthesia
d. Conduction block or and spinal anesthesia
(epidural anes. etc)
e. Local infiltration anesthesia

May 30, 2020 86

 Intraoperative Nursing Management:
• Potential intra-op Complications
1. Nausea and vomiting
2. Anaphylaxis
3. Hypoxia and other respiratory complications
4. Hypothermia
5. Malignant hyperthermia
6. Disseminated intravascular coagulopathy

May 30, 2020 87

 Intraoperative Nursing Management:

• Nursing Diagnoses:
1. Anxiety r/t expressed concerns due to
surgery or OR environment
2. Risk for perioperative positioning injury
r/t environmental conditions in the OR
3. Risk for injury r/t anesthesia or surgery
4. Disturbed sensory perception r/t
general anesthesia or sedation
May 30, 2020 88
 Postoperative Nursing Management:

• The Postanesthesia Care Unit/ Recovery

Room
– Adjacent to OR
– quiet, clean and free from
unnecessary equipment
– Soundproof, soft pleasing color
– Well ventilated

May 30, 2020 89

 Postoperative Nursing Management:

• Phases of Postanesthesia care:

1. Phase I PACU- during the immediate
recovery phase, intensive care is
provided
2. Phase II PACU- require less frequent
observation and less nursing care

May 30, 2020 90

 Postoperative Nursing Management:
• Admitting the Pt to PACU, the nurse review
the ff:
– Medical dx and type of surgery performed
– Pertinent medical history and allergies
– Pt’s age and general condition, airway
patency, VS
– Anaesthetics and meds used during the
procedure (opioids, analgesic agents,
muscle relaxant, antibiotics)
May 30, 2020 91
 Postoperative Nursing Management:
• Admitting the Pt to PACU, the nurse review
the ff:
– Any problem that occurred in the OR that
might influence post op care (extensive
hem., shock, cardiac arrest)
– Pathology encountered (if malignancy is an
issue, know whether pt or family informed)
– Fluid administered, estimated blood loss
and replacement fluids
May 30, 2020 92
 Postoperative Nursing Management:

• Admitting the Pt to PACU, the nurse

review the ff:
– Any tubing, drains, cathe., or other
supportive aids
– Specific info about which surgeon,
anesthesiologist, or anesthetist wishes
to be notified (BP, Heart rate below or
above a specified level)
May 30, 2020 93
 Postoperative Nursing Management:
• Nursing management in the PACU:
1. Assessing pt’s:
• Bld. O2 saturation level
• Pulse rate
• Rate, Depth and nature of respiration
• LOC
• Ability to respond to commands (GCS)
• VS

May 30, 2020 94

 Postoperative Nursing Management:
• Nursing management in the PACU:
1. Assessing pt’s:
• Pt’s general status
• Patency of airway
• Respi function (1st)
• Assessment of cardiovascular fxn (to be
followed)
• Condition of surgical site
• Fxn of CNS
• Pertinent med / history of pt
May 30, 2020 95
 Postoperative Nursing Management:

2. Maintaining patent airway

3. Maintaining cardiovascular stability
a. Hypotension and shock
b. Hemmorhage
c. Hypertension and dysrhythmias
4. Relieving pain and anxiety
5. Controlling nausea and vomiting
May 30, 2020 96
 Postoperative Nursing Management:
• Determining Readiness for Discharge from PACU:
– Stable VS
– Orientation to person, place, events, and time
– Uncompromised pulmonary fxn
– Pulse Oximetry readings indicating adequate
blood O2 SATURATION
– Urine output at least 30ml/h
– N/V absent or under control
– Minima pin
May 30, 2020 97
 Postoperative Nursing Management:

• Promoting Home and Community-Based

Care:
– Teaching pt’s self-care
– Continuing care

May 30, 2020 98

 Postoperative Nursing Management:
• Receiving the Patient in Clinical Unit
– Prepare equipment:
• IV pole,
• drainage receptacle, emesis basis,
• tissue, disposable pads,
• blankets, postop charting forms

May 30, 2020 99

 Postoperative Nursing Management:

– Receive reports:
• Demographic data, med’l dx, proced.
Performed, comorbid conditions,
allergies, unexpected intraop events,
est. bld loss, type and amt. fluids
received, meds adm for pain, whether
pt has voided,, info that pt/family
received about pt condition

May 30, 2020 100

 Postoperative Nursing Management:

• Receiving the Patient in Clinical Unit

– Review postop orders
– Admits pt to the units
– Performs initial assessment
– Attends o pt’s immediate needs

May 30, 2020 101

 Postoperative Nursing Management:

• Standard Post-op N/I:

1. Assess breathing and adm
supplemental O2, if prescribed
2. Monitor v/s and note skin warmth,
moisture and color
3. Assess surgical site and wound
drainage system

May 30, 2020 102

 Postoperative Nursing Management:
4. Assess LOC, orientation and ability to move
extremities
5. Connect all drainage tubes to gravity or
suction as indicated and monitor closed
drainage systems
6. Assess pain level, char., (location, quality),
and timing, type, and route of adm of last
pain meds
7. Adm analgesics prescribed and it
effectiveness
May 30, 2020 103
 Postoperative Nursing Management:
8. Position pt to enhance comfort, safety and lung
expansion
9. Assess IV sites for patency and infusion rate and
solution
10. Assess urine out put in closed drainage sys., pt’s
urge to void and bladder distention
11. Reinforce need to begin deep-breathing and leg
exercises
12. Place call light, emesis basin, ice chips, (if allowed),
and bedpan or urinal with in reach
13. Provide info to pt and family
May 30, 2020 104
 Postoperative Nursing Management:

• Nursing Diagnoses:
1. Risk for ineffective airway clearance r/t
depress Respi fxn, pain and bed rest
2. Acute pain r/t surgical incision
3. Dec. cardiac output r/t shock or hem.
4. Activity intolerance r/t generalized
weakness 2nd to surgery

May 30, 2020 105

 Postoperative Nursing Management:

5. Impaired skin integrity r/t sur. Incision and

drains
6. Risk for imbalanced body temp r/t surg
environment and anesthetic agents
7. Risk for imbalanced nut, LBR r/t dec intake
nd inc need for nutrients 2nd to surgery
8. Risk for constipation r/t effects of meds,
surgery,, dietary change and immobility

May 30, 2020 106

 Postoperative Nursing Management:
9. Risk for urinary retention r/t anesthetic
agents
10. Risk for injury r/t surgical procedure or
anesthetic agents
11. Anxiety r/t surgical procedure
12. Risk for ineffective mgt of therapeutic
regimen r/t insufficient knowledge about
wound care, meds, dietary restrictions,
activity recommendations, follow-up care or
s/s of complications
May 30, 2020 107
 Postoperative Nursing Management:

• Dehiscence- disruption of surgical

incision or wound
• Evisceration- protrusion of wound
contents

May 30, 2020 108

 END

May 30, 2020 109