Perioperative Nursing

Peg Trueman RN MSN Ed.D. CNE

 Meet the Patient

 The experience
of surgery is a
routine event for
everyone
involved EXCEPT
for the patient!
Nursing Management
after Surgery
Postoperative Phase:
Plan of Care
 System Assessments

 Respiratory
 Cardiovascular
 Fluid Status
 Nutrition
 Elimination
 Activity
 Wound Healing
 Respiratory

 Pulmonary
assessment data

 TCDB
• C/I: CHI, eye sx
 O2 therapy
 IPPB
The real reason dinosaurs
 I.S. became extinct.
 Cardiovascular

“Okay, Williams, we’ll vote…

 Cardiac how many here say the
assessment heart has four
data chambers?”

 Leg exercises
 Avoiding venous
statsis
 ICD/hose
 Fluid Status

 Hydration status
data
 Drainage amts
 vital signs
 daily weights!

 IV therapy
 Blood therapy
 Nutrition

 NPO status
 Progression of
diet
 check bowel
sounds

 Feedings “The Nurse says a trip-o’-loomin’

cow-filler is feeding Grandma.
 TPN It has three loops--one for breakfast,
one for lunch, and one for dinner!”
 Elimination

 Urinary output
• retention?!!
• Dehydration
• Catheter is the
last resort!
 Bowel activity
• bowel sounds
• flatus
 Ambulation!!!!
 Activity

 OOB ASAP!!
• Usually within 24
hrs

 Psychological
impact

 Needs
encouragement!
 Physiology of Wound
Healing
 Inflammatory Stage
• “insult”
 Proliferative Stage
• reinforcemen/framework
 Maturation Stage
• “settling in”
 Wound Healing:
First Intention
 Scar formation is minimal
 Properly closed
 Heal with little tissue reaction
 Wound Healing:
Second Intention
 Wound is left open to granulate
 Resultant in scar formation
 “Healing by granulation”
 Wound Healing:
Third Intention
 Two opposing granulation surfaces
are brought together
 Scar is deeper and wider
 “Delayed closure”
 Factors Affecting
Wound Healing
 Age  Oxygen deficit
 Hemorrhage  Drainage
 Hypovolemia  Medications
 Local Factors  Systemic
 Nutritional Disorders
Deficits  Wound Stressors
 Wound Care

“Just a friendly suggestion…next time you do a dressing

change, don’t say, OH MY GOD, WILL YOU LOOK AT THAT !”
 Post-op Pain Control

 What is pain?
 Factors affecting pain
 Administration
• Preventative Approach
• PRN vs ATC
• Routes of Administration
• Intramuscular
• Intravenous
• PCA pump/Epidural lines
 Post-op Pain Control

 Common Pain Medication

• Demerol
• Morphine
• Dilaudid
• Stadol
• NSAIDs

 Side Effects of Pain medication*

 Managing Potential
Complications
 Shock/Hemorrhage
 Deep Vein Thrombosis (DVT)
 Pulmonary Embolism
 Respiratory Complications
 Urinary Retention
 Intestinal Obstruction
 Wound Complications
 Surgery Specific Care

 Postoperative Uniquities and

“worries”
 Remember Mr. P?

 Case Study
Review
Perioperative Nursing