Perioperative Care

Definition
Perioperative care , is a care that clients •
receive before , during and after the surgery
Preoperation , intraoperation and •
postoperation
 Preoperative Period
Starts when the clients or families in an
emergency learn that surgery is necessary and
ends when the clients are transported to the
operating room
This period can be short or long this depend on
the Types of surgery (page 615)
Reasons for surgery (page 615)
 Inpatient Surgery
Is a term used for procedures performed on a
client who is admitted to the hospital
expected to remain at least overnight and
need nursing care for more than one day after
surgery
Inpatient Client undergo lab studies and seen by
anesthesiologist
 Outpatient Surgery
Also called ambulatory surgery or same day
surgery in which the client does not remains
:in hospital , the client is discharged when
Client is awake and alert-1
V/S stable 3-Pain & nausea controlled-2
Oral fluids are retained 5-Voided-4
Clients received discharge instructions-6
 Laser Surgery
Is another form for outpatient surgery the •
advantages of laser surgery page 616
Description of General and Regional •
anesthesia (see table page 616)
 Informed Consent

The physician is responsible for providing •

information that meet the criteria for
informed consent which is a permission a
client gives after explanation of the risks ,
benefits and alternative
:Consent form concerned illegally in case of •
Confused or unconscious client-1
Mentally ,3-Alcoholic , or taking narcotics-2
In case of emergency it is legally to obtain the •
consent by telephone
Preoperative Blood Donation : Autologous •
transfusion which is self-donated blood
recipient of Blood , types and cross-match & •
 Immediate Preoperative Care

Nursing assessment ; depends on the-1 •

urgency of the surgery , inpatient or same day
:so assessment include
Taking history & performing physical •
assessment
Assess if the client understand the surgical •
procedures
If the client knows about postoperative •
 Expectations and recovery •
Consider the cultural beliefs of the patient •
such as the privacy , family participation
On admission the nurse review the diet and •
fluids restrictions
Bowel & skin preparation •
Withhold or administration of medications •
The nurse identifies client’s potential risk for •
 Complications •
The risk factors that increase the risk for •
:complications are
MalnutritionDehydrationAge •
Smoking Obesity •
Cardiopulmonary disease •
Drug & Alcohol abuse •
Bleeding Tendencies •
 Low HB •
Pregnancy •
Preoperative Teaching :The following are-2 •
examples of information to include in
:preoperative teaching
Medication & Pain control •
Explanation & Description of the post •
anesthesia recovery room and post surgical area
Preoperative Teaching concerning
A-Taking Deep Breath , the benefits are •
Prevent atelectasis which is lung collapse •
Pneumonia which is lung infection because •
both can lead to hypoxemia
Technique : inhale deeply using the abdominal •
muscles holding the breath for several seconds
and exhale slowly pursing the lips may extend the
period of exhalation, incentive spirometry
B-Coughing : use to clean the secretion from •
the lung (technique page 620)
Coughing is painful so sometimes we •
administer pain medication30 before
coughing exercise , we place pillow on the
incisional area
 C-Leg Exercise : promote circulation and •
reduce the risk for thrombus , also the use of
antiembolism stocking help to prevent
thrombus
 Physical Preparation-3
A-Skin Preparation : removing hair because •
the hair is reservoir for microorganisms , so
reducing bacteria help to prevent
postoperative infections
B-Elimination : for some operations the nurse •
may insert indwelling catheter particularly of
the lower abdomen , Enemas or laxative may
ordered to clean the lower bowel , the
.enemas usually given evening before op
 C-Food & Fluid : usually fasting from food and •
water day before after midnight , the nurse
should educate the client to maintain good
nutrition and hydration before surgery
D-Valuable : better to leave at home or with •
the family or with the health care agency , the
client sign and the nurse writes the items , for
the wedding band either the client remove or
apply gauze around the finger , eyeglasses and
 Contact lenses are removed •
E-Surgical Attire : the client wear a gown and •
surgical cap , sometime the client wear
antiembolism stockings , makeup and nail
polish should removed to facilitate assessing
the oxygenation
F-Dentures & Prosthesis removed , but some •
anesthetic allow the denture in place if it is
well fit
 preoperative medications-4
See in the book page 622 •
Psychological preparation :-5 •
preparing the client emotionally and
spiritually
Preoperative checklist : is a form-6 •
that identifies the status of essential
presurgical activities and is completed before
surgery ( see page 623)
 Intraoperative Period
The intraoprative period is time during which •
the client undergo surgery takes place in
operating suite , where anesthesia is
administered and procedure is performed ,
: the steps
Receiving Room : is a room in operating dept. •
the client are observed until the room and
surgical team are ready , some cases in this
.room the client receive med
 Operating room: the nurse and physician •
place the client drape him/her , so the care
and safety of the client are on the hands of
.the expert nurse and physician
Anesthesia ; discuss before •
Surgical waiting area : is a room where the •
family await information about the patient , in
some hospitals drinks provide to the family and
usually the Dr. discuss about pt. in his private room
 Postoperative Period
Postoperative period begins after the •
operative procedure is completed and the
client is transported to an area to recover
from anesthesia and ends when the client is
discharged
Postanesthesia care unit (PACU) or recovery •
room is an area in a surgical dept. where the
client is closely monitor and the nurse ensure
.that the pt. is recover from anesthesia
 Nursing care
Postoperative care :Nursing care after surgery •
: divided into
A-Immediate Postoperative Care first 24 hours •
after surgery , during this time the nurse
reports any complications and once the client
is stable the nurse prepares room for client’s
return and the nurse continue to do
assessment in order to prevent any
:complications , there are in this type
 Initial postoperative assessment : the •
circulating nurse and the anesthesiogist report
the pertinent information , and once the pt.
transfer to recovery room , the PACU nurse ,
major responsibilities to ensure pt. airway,
circulation , assess and management in case of
shock , good positioning , the drains , tubes ,
IV in place , to detects evidence of
complication (see points page 626)
 Preparing the room: (Explain about the •
position and arrangement of the bed)
Monitoring for complications: (See table page •
627)
;B-Continuing postoperative care : such as •
Food & Oral Fluids ; usually after 6 hours or •
when the client awake and free from nausea
and vomiting , then we start liquid diet to soft
Venous circulation ; ambulate client as soon as •
possible after surgery with assistance , apply
antiembolism stockings , leg exercise , elevate
leg with ambulation , to prevent thrombi
encourage the client also to drink fluids , avoid
long period of sitting do not cross the leg
; Wound management •
Discharge instructions ; directions for managing self- •
care and medical follow-up (see page 627)