PERI OPERATIVE NURSING CARE

Introduction
This include the nursing management of the patient before and after
any kind of surgery (Elective or Emergency).
The perioperative period is the time lapse surrounding the surgical act.
It is subdivided into three stages:
Preoperative
Operative
Postoperative
 Phases
Preop • Time period between the decision to have surgery and the
erativ beginning of the surgical procedure
e

• time period from when the patient is on the operating table to when
the operation has finished and the wound is closed (if relevant). We
Intrao consider any activity taking place after induction of anaesthesia to be in
perati this phase because this starts in the operating theatre itself
ve

• Phase of the surgical experience extends from the immediate time the client is
transferred to the recovery room or post anesthesia care unit (PACU) to the
Posto moment he or she is transported back to the surgical unit, discharged from the
perati hospital until the follow-up care
ve
 Pre operative phase
 Nurse admit the patient make sure the file is complete:
Diagnosis, the surgeon, date and time of operation and lab request
 Health education to reassure the patient and sign a consent form
 Vital signs
 Lab sample collection, taken to lab, and assure results are available in the file
 Anesthesia review and consent must be signed
 Fasting starting mid night before any surgical procedure
 Remove dental prosthesis and any jewel (Artificial nails)
 Wash the patient (Bathing)
 Insert a good IV line
 Pre medication (Antibiotics)
 Insert urinary catheter
 Nurse transport the patient and handle him/her to the surgical nurse
Post Operative phase
Nurse must know the criteria for shifting patient from
Operating Room to the recovery and the ward
Hemodynamic stability
Clinical evaluation and complete recovery (Fully
awake)
 Maintenance of oxygen saturation
Normothermia
A patient remains in the post operative unit, until the
patients has fully recovered from anesthesia.
Following measures are used to determine the patient
ready for discharge from post operative unit:
Stable vital signs
Orientation to: Person, place, Time
Adequate oxygen saturation level
Urine output at least 30 ml/hour
Minimal pain
Adequate respiratory function
Attention
• The patient should be transported to the ward or recovery by a
member of anesthesia care team that is knowledgeable about the
patients condition
• Upon arrival in the ward or recovery, the patient should be re-
evaluated and verbal report should be provided to the nurse
• The anesthesiologist responsible for the anesthetic remains
responsible for managing and follow up of the patient
• The surgeon must visit the patient in the ward the following day or
any time called and is responsible to discharge
Transport of the patient
Avoid exposure
Avoid rough
handling
Avoid hurried
movement and
rapid changes in
position.
 Recovery length of stay
Will vary, is dependent upon several factors:
Type of surgery
Patients response to surgery and anesthesia
Medical history
Average length of stay is 2 to 3 hours
Longer stays may be necessary to prevent
complications
What to report to the ward nurse
Intra-operative factors:
Procedure
Type of anesthesia
Estimated Blood loss
Urine output
Assessment and report of
current status
Post operative instructions
 Nursing preparation include:

Get ready after the theatre nurse call to inform that

the patient is coming
Preparation of patient bed assure that is a special
(Surgical) bed and monitor if functioning
The theatre nurse/Anesthesist must provide a
thorough report of the patient's status to the
receiving nurse on the unit, as well as the patient's
family.
 Ward Nurse must
Monitor vital signs
Airway patency (Proper positioning of patients’ head,
Clearing airway, Oxygen therapy)
Neurologic status (Eye opening, verbal and psychomotor
responses)
Manage pain (PRN …)
Assess the surgical site if no bleeding
Assessing and maintaining fluid and electrolyte balance
(IV fluid and Urinary catheter), Drainage ..
Skin color
Patient may feel the following up to 24 hours:
Sore throat
Aching muscles
General malaise
Shivering but not uncommon: Apply cotton blanket
 Protect Airway
Proper positioning of patients head
Clearing airway
Oxygen therapy

Pharyngeal obstruction Can occur when the patient

lies on the back as there are chances for tongue to all
back.
Aspiration if the patient vomit and enter the air way
 Maintaining I.V. Stability
Hypovolemic shock can be avoided by timely
administration of IV fluids, blood and blood products
and medication
Replacement of fluids colloids and crystalloids
Monitor intake and output balance
 Assessment of the Surgical Site
Hemorrhage
Is a serious complication of surgery that can results in
death
Can occur in immediate post operatively or up to
several days after surgery
Left untreated cardiac output decreases and blood
pressure and Hb level be fall rapidly.
Post Operative Complications

Nausea and vomiting

Respiratory complications
Failure to regain consciousness
Circulatory complications (DVT)
Fever
Pain
 Health education

According a surgical procedure done:

Expected outcome
Immediate post operative changes
Written instruction like wound care
Activity + dietary recommendation
Medications
Hygiene
Follow up
PERI OPERATIVE NURSING CARE