Perioperative

Nursing
 Perioperative Nursing

It is a term used to describe the nursing care provided in the

total surgical experience of the patient. It consist of three
phases that begin and end at a particular point in the
sequence of events in the surgical experience.

Preoperative Intraoperative Postoperative

phase phase phase
Preoperative Phase
- Begins when the decision to proceed with surgical intervention is
made and ends with the transfer of the patient onto the operating
table.
GOAL: The patient to be in the best possible physical
and emotion for surgery
 Health history is obtained
 Nutritional and fluid status
 Dentition
 Alcohol and drug abuse
 Respiratory and Cardiovascular status
 Previous medication used
 Informed consent
 Informed Consent
● is the patient’s autonomous decision about whether to
undergo a surgical procedure.

● Voluntary and written informed consent from the patient

is necessary before nonemergent surgery can be
performed to protect the patient from unsanctioned
surgery and protect the surgeon from claims of an
unauthorized operation or battery.
 Role of Nurse
• Witness the client’s signature on the consent
• Discusses and reviews advanced directive document
• Ensures that the patient signed the document voluntarily
• Ensures that the patient is competent to sign the document

Who can give consent?

- At least 18 years old
- Conscious, coherent, mentally competent
- Voluntarily
- Emancipated minors
 Patient Teaching: Preoperative Phase

Deep breathing,
Coughing and Reducing Anxiety
Incentive spirometry and decreasing fear

Mobility and active Managing nutrition

body movement and fluids
 Immediate Pre-operative Nursing
• Interventions
Assist the patient in changing hospital gown.
• Cover the head completely with cap
• Inspect the mount, dentures and plates are removed.
• Remove all jewelries/ body piercing.
• If patient objects in removing wedding ring, secure it with tape.
• All valuable articles are given to family members.
• Patient should void first before going to the OR.
• Keep side rails raised.
• The completed chart accompanies the patient to the OR with consent form
attached.
• Transfer the patient to the holding area/ presurgical area suite 30-60 minutes
before anesthetic agent is administered.
Intraoperative Phase

Begins when the patient is

transferred onto the OR table and
ends with admission to the PACU
(Post-Anesthesia Care Unit)
 Surgical Area
To decrease microbes, the surgical area is divided into three zones:

Unrestricted Zone Semi-restricted Zone

Where street clothes are
Area in the operating room
Restricted Zone
allowed; area in the operating Scrub clothes, shoe cover,
where scrub attire (scrub
room that interfaces with caps, and mask are worn;
clothes and caps) is required;
other departments; includes includes operating room and
may include areas where
patient reception area and sterile core area
surgical equipment are
holding area
processed.
 Surgical Positions
SUPINE POSITION
Used for procedures if
anterior surface such as
abdominal, abdominothoracic
and some lower extremity
procedures.
PRONE POSITION LITHOTOMY
Used for all procedures with
Used for perineal, vaginal,
dorsal or posterior approach
urologic, and rectal
procedures
 Surgical Positions

LATERAL POSITION JACK-KNIFE POSITION

Used for most abdominal Used for renal surgery Used rectal procedures
surgery except for (hemorrhoidectomy)
gallbladder or pelvic
surgeries
SURGICAL TEAM
 STERILE MEMBERS
Surgeon
- “in-charge” of the surgical team
- the person who performs the operation and directs
the activities of other members of the surgical team

Scrub Nurse
- Sets up sterile tables
- Prepares sutures, ligatures, special equipment
- Assists the surgeon and the surgical assistants
during the procedure by anticipating the
instruments and supplies that will be required
- Count the instruments with the circulating nurse
 NON-STERILE MEMBERS
Circulating Nurse
- Verifies consent
- Coordinates the team
- Monitors aseptic practices to avoid breaks in
technique while coordinating the movement of
related personnel
Anesthesiologist
- A physician who specializes in administering
drugs to the patient
- Monitor’s patient response to anesthesia
Surgical Aseptic Technique
- All materials in contact with surgical wound or used within the sterile
field must be sterile
- Sterile surfaces or articles may touch other sterile surfaces or articles
remain sterile
- Contact with unsterile objects at any point renders as sterile area
contaminated
- Gowns of the surgical team are considered sterile in front from the
chest to the level of the sterile field
- The sleeves are also considered sterile from 2 inches above the elbow
to the stockinette of the cuff
- Sterile drapes are used to create a sterile field
- Only the top surface of a draped table is considered sterile
- After a sterile package is opened, the edges are considered unsterile
- The movements of the surgical team are from sterile to sterile areas
only
- Whenever a sterile barrier is breached, the area must be considered
contaminated.
 Health Hazard Associated with Surgical
Environment
LASER RISK
- warning signs must be clearly posted to alert personnel
- Safety precautions are implemented

EXPOSURE TO BLOOD & BODY FLUIDS

- Routine scrub suit, gloves, mask, gown
- double gloving in trauma and other types of surgery
where sharp bone fragments are present
- googles/ wraparound face shield are worn to protect
against splashing when the surgical wound is irrigated
or when bone drilling is performed.
POSTOPERATIVE
PHASE
Begins with admission of
the patient to the PACU
and ends with follow-up
evaluation in the clinical
setting or home
 Monitor vital signs of the patient
 Assess breath sounds
 Monitor secretions
 Assess skin color and capillary refill
 Record intake and output
 Postoperative position
- General Anesthesia: Side lying and Fowler’s
- Spinal/ Epidural: Flat on bed
 Assess for surgical site, drains and wound dressing
- Serous: clear or straw colored; normal part of
healing process
- Serosanguineous: pink colored to presence of
small amount of blood; normal of healing process
 - Purulent: yellow, gray or green drainage due to
infection in the wound
- Sanguineous: red drainage; abnormal in wounds

 monitor for nausea and vomiting

 WOF for abdominal distention
 WOF for flatus and return of bowel sounds
 Maintain NPO status until gag reflex and peristalsis
 Encourage early ambulation
 Monitor patient for complications