TOPRANK NURSING

PERIOPERATIVE NURSING

PATRICK MIGEL MERCADO,RN

 PREOPERATIVE When the decision to have surgery is
made and ends when the client is
PHASE transferred to the operating table

PERIOPERATIVE
NURSING
When the client is transferred to the
used to describe the INTRAOPERATIVE operating table and ends when the client
nursing care provided in
the total surgical PHASE is admitted in the PACU
experience of the
patient.

POSTOPERATIVE When the client is admitted to the PACU

and ends when the healing is complete
PHASE
 TYPES OF SURGERY
ACCORDING TO:

PURPOSE DEGREE OF DEGREE OF

URGENCY RISK
q Diagnostic
q Exploratory q Emergency
q Re-constructive q Major
q Urgent q Minor
q Constructive q Required
q Transplant q Elective
q Curative q Optional
q Palliative
 TYPES OF SURGERY
ACCORDING TO PURPOSE
DIAGNOSTIC – Confirms and establishes diagnosis
Examples:
• Biopsy
• Exploratory laparotomy
 TYPES OF SURGERY
ACCORDING TO PURPOSE
PALLIATIVE – Relieves or reduces pain or symptom of a
disease; it does not cure
Examples:
• Colostomy
• Debridement of necrotic tissue
 TYPES OF SURGERY
ACCORDING TO PURPOSE
EXPLORATORY – To determine the extent of the disease
condition such as exploratory laparotomy
Examples:
• Exploratory laparotomy
• Pelvic laparotomy
 TYPES OF SURGERY
ACCORDING TO PURPOSE
RECONSTRUCTIVE – To restore function to TRAUMATIZED
or malfunctioning tissue and to improve self-concept
Examples:
• Skin graft
• Plastic Revision
• Scar revision
 TYPES OF SURGERY
ACCORDING TO PURPOSE
CONSTRUCTIVE – to restore function in congenital
anomalies
Examples:
• Cheiloplasty
• Palatoplasty
• Closure of Atrial Septal Defect
 TYPES OF SURGERY
ACCORDING TO PURPOSE
TRANSPLANT – to replace organs or structures that are
disease or malfunctioning
Examples:
• Kidney Transplant
• Corneal Transplant
• Liver Transplant
 TYPES OF SURGERY
ACCORDING TO PURPOSE
CURATIVE/ABLATIVE – to treat the disease condition
Examples:
• Gastrectomy
• Thyroidectomy
• Appendectomy
 TYPES OF SURGERY
ACCORDING TO URGENCY
PATIENT REQUIRES IMMEDIATE ACTION EMERGENCY
PATIENT REQUIRES A PROMPT ATTENTION URGENT
PATIENT NEEDS TO HAVE THE SURGERY REQUIRED
PATIENT SHOULD HAVE THE SURGERY ELECTIVE
DECISION RESTS WITH THE PATIENT OPTIONAL
 TYPES OF SURGERY
ACCORDING TO URGENCY
EMERGENCY– REQUIRES IMMEDIATE ATTENTION
q May be life threatening
q Performed immediately to preserve life
 TYPES OF SURGERY
ACCORDING TO URGENCY
EMERGENCY
Examples:
• Intestinal Obstruction
• Repair of trauma
• Fracture of Skull
• Extensive burns
• Internal Hemorrhage
• Fracture
• Ulcer
 TYPES OF SURGERY
ACCORDING TO URGENCY
URGENT – PATIENT REQUIRES PROMPT SURGERY
q Indications: done within 24-48 hours
Examples:
• Removal of the gall bladder
• Amputation
• Colon Resection
 TYPES OF SURGERY
ACCORDING TO URGENCY
REQUIRED – PATIENTS NEEDS TO HAVE SURGERY
q Indications: plans within a few weeks or months
Examples:
• Prostatic Hyperplasia
• Thyroid disorders
 TYPES OF SURGERY
ACCORDING TO URGENCY
ELECTIVE – PATIENTS SHOULD HAVE SURGERY
q Indications: failure to have surgery not catastrophic
Examples:
• Tonsillectomy
• Hernia Repair
• Cataract Extraction
 TYPES OF SURGERY
ACCORDING TO URGENCY
OPTIONAL – DECISION REST WITH CLIENT
q Indications: Personal preference
Examples:
• Cosmetic Surgery
 TYPES OF SURGERY
ACCORDING TO RISK
MAJOR SURGERY MINOR SURGERY
q High risk q Involves little risk
q Complicated q Produces few complications
q Prolonged q Day surgery
q Large blood loss q Ambulatory surgery centers
q More possible complication

q Eg: Open heart surgery, removal

of kidney; organ transplant
SUPRA ABOVE; BEYOND CYSTO BLADDER

ORTHO JOINT ENCEPHALO BRAIN

CHOLE BILE OR GALL ENTERO INTESTINE

HYSTERO UTERUS MYO MUSCLES

MAST BREAST NEPHRO KIDNEY

MENINGO MEMBRANE/MENINGES NEURO NERVE

OOPHOR OVARY THORACO CHEST

PNEUMO VISCERO ORGAN ESPECIALLY IN

LUNGS THE ABDOMEN

SALPHINGO FALLOPIAN TUBE

-OMA TUMOR/SWELLING -SCOPY LOOKING INTO

-ECTOMY REMOVAL OF AN -OSTOMY MAKING AN OPENING

ORGAN OR GLAND OR STOMA

-RHAPY SUTURING OR STITCHING -OTOMY CUTTING INTO

-PLASTY TO REPAIR OR RESTORE -CELE TUMOR; SWELLING;
HERNIA

-ITIS inflammation
“Extends from the time the client is admitted in the surgical unit, to the time
he/she is prepared physically, psychosocially, spiritually and legally for the
surgical procedure, until he is transported into the operating room” – Josie
Udan

PRE-OPERATIVE PHASE
 PREOPERATIVE PERIOD
Refers to the time interval that begins when the decision for surgical intervention is
made until the client is transported to the OR

GOAL:
FOCUS: The patient to be in
Preparation of the the best possible
patient physical and emotion
condition for surgery
 PREOPERATIVE PERIOD
INFORMED CONSENT
Prior to any surgical procedure, informed consent is required from the client or
legal guardian.

Informed consent implies that the client has been informed and involved in
decisions affecting his or her health.

THE HEALTHCARE PROVIDER WHO WILL DO THE PROCEDURE SHOULD

OBTAIN THE CONSENT.
 PREOPERATIVE PERIOD
INFORMED CONSENT
Before obtaining the informed consent, the surgeon/HCP should provide
the following information the client.

q The nature of and the reason for the surgery

q All available options and the risks associated with each option
q The risks of the surgical procedure and its potential outcomes
q Name and qualifications of the surgeon performing the procedure
q The right to refuse consent or later withdraw the consent
 PREOPERATIVE PERIOD
INFORMED CONSENT
ROLE OF THE NURSE
q Witness the client’s signature on the consent
q Discusses and reviews advanced directive document
q Ensures that the patient signed the document
voluntarily
q Ensures that the patient is competent to sign the
document
 PREOPERATIVE PERIOD
INFORMED CONSENT

R RADIATION

I INVASIVE PROCEDURES

A ANESTHESIA WITH SEDATION

 PREOPERATIVE PERIOD
INFORMED CONSENT
WHO CAN GIVE CONSENT? WHO CANNOT GIVE CONSENT?
1. At least 18 years old 1. Minors
2. Conscious, Coherent and Mentally 2. Unconscious
Competent 3. Mentally Ill person
3. Voluntarily
4. Emancipated Minors**
 PREOPERATIVE PERIOD
INFORMED CONSENT
CONSENTS ARE NOT
WHAT IF I CANNOT GIVE AN NEEDED FOR EMERGENCY
INFORMED CONSENT? CARE IF ALL 4 ARE MET:
1. Spouse 1. There is an immediate threat to life
2. Son or daughter 2. Experts agree that it is an
3. Either parents emergency
4. Brother or sister of legal age 3. Client is unable to consent
5. Guardian/Next of Kin 4. A legally authorized person cannot
be reached
PREOPERATIVE PERIOD
ASSESSMENT
PHYSICAL ASSESSMENT

DIAGNOSTICS

PSYCHOLOGICAL ASSESSMENT

OTHERS
 PREOPERATIVE PERIOD
PHYSICAL ASSESSMENT
HEIGHT AND
CARDIOVASCULAR GASTROINTESTINAL
WEIGHT

VITAL SIGNS PULMONARY NEUROLOGIC

MENTAL STATUS ENDOCRINE AND

RENAL INTEGUMENTARY
EXAMINATION
 PREOPERATIVE PERIOD
DIAGNOSTICS
AST, ALT, LDH,
CBC URINALYSIS
BILIRRUBIN

SERUM AND COAGULATION

FBS
ELECTROLYTES STUDIES

CREATININE AND
CHEST XRAY ECG
BUN
 PREOPERATIVE PERIOD
DIAGNOSTICS
CT SCAN ABG

MRI PREGNANCY TEST

OTHER RADIOLOGIC
PET SCAN
STUDIES
 PREOPERATIVE PERIOD
PSYCHOLOGICAL ASSESSMENT
CONCERN ON THREAT OF
FEAR OF THE UNKNOWN
PERMANENT INCAPACITY

FEAR OF DEATH SPIRITUAL BELIEFS

CULTRUAL VALUES AND

FEAR OF ANESTHESIA
BELIEFS
LOSS OF WORK, TIME, JOB AND
SUPPORT
FEAR OF PAIN
 PREOPERATIVE PERIOD
OTHER ASSESSMENT
USE OF MEDICATIONS
• Over-the-counter medications that may affect the effect of
the anesthesia
• Herbal medications
PRESENCE OF TRAUMA
• Internal Hemorrhage
• Further need for surgical managment
PREOPERATIVE PERIOD
OTHER ASSESSMENT
CONTRAPTIONS
• Porta Cath, subclavian line
• AVF, AVG
• Stents, Metal implants,
Pacemakers
 PREOPERATIVE PERIOD
OTHER ASSESSMENT
PREVIOUS SURGERIES
• Effect of anesthesia to the patient
• Removed organs
• To identify other contraptions of the patient
• To identify the precautions that should be done to the
patient

SOCIAL RESOURCES
 PREOPERATIVE PERIOD
OTHER ASSESSMENT
SMOKING HISTORY
• Urged to stop 4 to 8 weeks before the surgery to significantly
reduce pulmonary and would healing complications
• Should be withheld at least 24 hours prior the surgery
• Smoking cessation
 PREOPERATIVE PERIOD
OTHER ASSESSMENT
ALLERGIES
• Food Allergies
• Allergies to medication such as Ibuprofen
• Skin Testing
• Latex Allergies
 PREOPERATIVE PERIOD
SKIN TESTING
Goal: To provide a medication that the client requires for allergy testing and TB
screening.
Assessment:
qMeasure the area of redness
and induration in millimeters at
the largest diameter and
document findings.
qSwelling
qRashes
PREOPERATIVE PERIOD
SKIN TESTING
 PREOPERATIVE PERIOD
MEDICAL CONDITIONS THAT HAS HIGH RISK FOR SURGERY

q Bleeding Disorders -- Thrombocytopenia or hemophilia

q Diabetes mellitus
q Chronic pain
q Heart Disease – Myocardial infarction, dysrhythmia, heart
failure or peripheral vascular disease
q Obstructive Sleep Apnea
q Upper Respiratory Tract Infection
 PREOPERATIVE PERIOD
MEDICAL CONDITIONS THAT HAS HIGH RISK FOR SURGERY

q Liver Disease
q Fever
q Chronic respiratory disease -- emphysema, bronchitis,
asthma or COVID
q Immunological disorders – leukemia, HIV, AIDS, bone
marrow suppression or use of chemotherapy
q Renal Disease
 PREOPERATIVE PERIOD
MEDICATIONS THAT CAN INCREASED RISK FOR SURGERY

q Antibiotics – potentiate action of anesthesia

q Anticholinergics –- tachycardia, confusion, hypomotility
q Anticoagulants, Antiplatelets, Thrombolytics
q Anticonvulsants
q Antidepressants – Higher BP
q Antidysrhythmic – impairs cardiac contractility
q Antihypertensives
 PREOPERATIVE PERIOD
MEDICATIONS THAT CAN INCREASED RISK FOR SURGERY

q Corticosteroids
q Diuretics
q Herbal Substances
q Insulin
 PREOPERATIVE PERIOD
DIAGNOSIS
Deficient Knowledge related to lack of education about the perioperative
process

Anxiety related to effects of surgery on ability to function in usual roles

Grieving related to perceived loss of body part associated with planned surgery

Ineffective Coping related to lack of clear outcomes of surgery

 PREOPERATIVE PERIOD
PLANNING/IMPLEMENTATION

DIAGNOSTICS SPIROMETRY DIET

PAIN
MEDICATIONS PSYCHOSOCIAL
MANAGEMENT
PREOPERATIVE
TEACHING
EXERCISES ELIMINATION OTHERS

EMBOLIC
SKIN PREPARATION
STOCKINGS
 PREOPERATIVE TEACHING
DIAGNOSTICS

AST, ALT, LDH,

CBC URINALYSIS
BILIRRUBIN

SERUM AND COAGULATION

FBS
ELECTROLYTES STUDIES

CREATININE AND
CHEST XRAY ECG
BUN
PREOPERATIVE TEACHING
DIAGNOSTICS

CT SCAN ABG

MRI PREGNANCY TEST

OTHER RADIOLOGIC
PET SCAN
STUDIES
 PREOPERATIVE TEACHING
PREOPERATIVE MEDICATIONS
q Sedatives and Tranquilizers – Lorazepam (Ativan)
q Narcotic Analgesics – Morphine
q Anticholinergics – Atropine
q Antiemetic – Ondansetron and Metoclopramide
q Histamine-receptor antihistamines -- Ranitidine
q Analgesics – Paracetamol
 PREOPERATIVE TEACHING
PREOPERATIVE MEDICATIONS
NURSING CONSIDERATIONS:
q Ensure side rails are always up
q Place the call bell next to the client
q Ensure that client has companion at all times
q Verify the patient prior to giving preanesthetic
medications
q Instruct the client not get out of bed and to use call
light if needed assistance
 PREOPERATIVE TEACHING
EXERCISES
DEEP BREATHING LEG EXERCISES EARLY
AND COUGHING AMBULATION
q To enhance lung q To promote
expansion and venous return, q To promote venous
mobilize secretions return
thereby
q To enhance lung
thereby preventing preventing expansion and
atelectasis. thrombophlebitis mobilize secretions
and thrombus q To stimulate GI
formation motility
q To urinary secretion
INCENTIVE SPIROMETRY
1. Instruct the client to assume
sitting or upright position
2. Instruct the client to place the
mouth tightly around the
mouthpiece
3. Instruct client to inhale slowly to
raise & maintain the flow rate
indicator between 600-900
4. Instruct client to hold the breath
for 5 seconds and then to
exhale through pursed lips
5. Instruct client to repeat this
process 10 times every hour
 DEEP BREATHING EXERCISES
1. Sitting position gives the best
lung expansion for coughing and
deep-breathing exercises.
2. Instruct to breathe deeply 3 times,
inhaling through The nostrils and
exhaling slowly through pursed
lips.
3. Instruct the client that the third
breath should be held for
3seconds; then the client should
cough deeply 3 times.
4. The client should perform this
exercise every 1 to 2 hours.
 SPLINTING INCISION
1.If the surgical incision is
abdominal or thoracic,
instruct the client to place
a pillow, or 1 hand with
the other hand on top,
over the incisional area.
2.During deep breathing
and coughing, the client
presses
 LEG AND FOOT EXERCISES
GASTROCNEMIUS (CALF) PUMPING: Instruct the client to move both
ankles by pointing the toes up and then down.
 LEG AND FOOT EXERCISES
QUADRICEPS (THIGH) SETTING: Instruct the client to press the back
of the knees against the bed and then to relax the knees; this contracts
and relaxes the thigh and calf muscles to prevent thrombus formation.
 LEG AND FOOT EXERCISES
FOOT CIRCLES: Instruct the client to rotate each foot in a circle.
 LEG AND FOOT EXERCISES
HIP AND KNEE MOVEMENTS: Instruct the client to flex the knee and
thigh and to straighten the leg, holding the position for 5 seconds
before lowering (not performed if the client is having abdominal
surgery or if the client has a back problem).
 PREOPERATIVE TEACHING
SKIN PREPARATION
q Clean the surgical sites with a mild antiseptic or antibacterial
soap
q Clients are asked to bath or shower the evening or morning
of surgery to reduce risk of wound infection.
q TRIMMING/CLIPPING of the hair may be done in the
operative area
 PREOPERATIVE TEACHING
ELIMINATION
q Enema, Laxatives or both can be given depending to the
physician’s orders.
q Enemas before surgery are NO LONGER routine but
cleansing enema may be order if bowel surgery is planned.
q Upon the Administration of Enema, the client should position
in left lateral position
PREOPERATIVE TEACHING
ELIMINATION

This position facilitates the flow of

solution by gravity into the sigmoid
and descending colon, which are
on the left side. Having the right leg
acutely flexed provides for
adequate exposure of the anus.
 PREOPERATIVE TEACHING
ELIMINATION
LAXATIVES
q Lactulose (Duphalac, Lilac)
q Bisacodyl (Dulcolax, Correctal)
q Senna (Senakot)
q Mineral Oil
q Castor Oil
 PREOPERATIVE TEACHING
ELIMINATION
TYPES OF ENEMAS
q Cleansing Enema – to remove feces
 PREOPERATIVE TEACHING
ELIMINATION
TYPES OF ENEMAS
q Carminative Enema – to expel flatus
q Oil Retention Enema – to soften the feces and to lubricate
the rectum and anal canal, thus facilitating passage of the
feces.
q Return-Flow Enema – to expel flatus
q Fleet Enema – Uses a salt called sodium phosphate to
keep water in the intestines
PREOPERATIVE TEACHING
ANTI-EMBOLIC STOCKINGS
PREOPERATIVE TEACHING
ANTI-EMBOLIC STOCKINGS
PURPOSE
q To facilitate venous
return from the lower
extremities
q To prevent venous stasis
and DVT
q To reduce peripheral
edema
 X
PREOPERATIVE TEACHING
DIET
NPO after Midnight Consumption of clear liquids up to 2 hours
before elective surgery

Consumption of breast milk 4 hours before

ALWAYS REVIEW THE surgery
SURGEON’S
PRESCRIPTIONS
A light breakfast 6 hours before the
REGARDING THE NPO
procedure
STATUS DURING THE
SURGERY.
A heavier meal 8 hours before surgery
 PREOPERATIVE TEACHING
PSYCHOSOCIAL PREPARATION

q Inform the client about what to expect postoperatively

q Level of anxiety
q Answer any questions or concerns that the client may have
regarding surgery
q Psychosocial support
 PREOPERATIVE TEACHING
OTHERS
q Anesthesia
q Postoperative restrictions
q Jewelries, makeup, dentures, hairpins, nail polish, glasses
and prosthesis
q No Smoking for 24 hours and smoking cessation
 PREOPERATIVE TEACHING
OTHERS
q CONTRAPTIONS
Examples:
q Nasogastric tubes
q Indwelling catheters
q Epidural catheters
q Wound drains
q A-line
q Intravenous lines
q Subclavian or Intrajugular line
q O2 Support
PREOPERATIVE TEACHING
OTHER CONTRAPTIONS
PREOPERATIVE TEACHING
OTHER CONTRAPTIONS
PREOPERATIVE TEACHING
OTHER CONTRAPTIONS
 “Extends from the time the client is admitted to the operating room, to the
time of administration of anesthesia, surgical procedure is done, until he/she
is transported to the recovery room/post anesthesia care unit” – Josie Udan

INTRAOPERATIVE PHASE
 INTRAOPERATIVE PERIOD

ASEPSIS

HOMEOSTASIS
GOAL

SAFE ADMNISTRATION OF ANESTHESIA

HEMOSTASIS
 INTRAOPERATIVE PERIOD
TYPES OF ANESTHESIA
GENERAL ANESTHESIA LOCAL ANESTHESIA
q Loss of sensation and consciousness q Temporary interruption of the
q Protective reflexes such as cough & gag transmission of nerve impulses to and
q Analgesia à Amnesia à from a specific area or region of the
Unconsciousness à Loss of reflexes body
and muscle tone
q Chief disadvantage: Respiration and
cardiac depression
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q Loss of Consciousness
q Amnesia
q Anesthesia
q Analgesia
q Skeletal Muscle Relaxation
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q Inhalational Anesthetics
q IV Barbiturates
q IV and IM nonbarbiturates
q Conscious sedation
q Neuromuscular blocking agents
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q Inhalational Anesthetics
q Halothane
q Nitrous Oxide

q IV Barbiturates
q Affects cerebral tissue
q Methohexital (Brevital)
q Thiopental (Pentothal)
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q IV and IM nonbarbiturates – PRODUCES

CATALEPTIC STATE AND AMNESIA

q Midazolam
q Combination product: Fentanyl and Droperidol
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q Conscious sedation
q Depress consciousness but maintains airway and
ventilation
q Midazolam
q Ketamine
q Fentanyl
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA

q Neuromuscular blocking agents

q Pancuronium (Pavulon)
q Succinylcholine (Anectine)
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA NURSING CARE

q Assess for allergies and medical problems that could

alter a response to anesthetic agents
q Oxygen and emergency resuscitative equipment
available
q Maintain calm environment during induction of
anesthesia
q Use safety precautions with flammable agents
 INTRAOPERATIVE PERIOD
GENERAL ANESTHESIA NURSING CARE

q Provide for safety because of decreased sensory

awareness and reflexes
q Maintain side-lying position to prevent aspiration after
general anesthesia
q Restrict oral intake after general anesthesia until ability to
swallow has returned
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
TOPICAL ANESTHESIA
q Usually applied to skin and mucous membranes
q Open skin surfaces, wounds and burns
Examples:
• Lidocaine
• Benzocaine
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
LOCAL ANESTHESIA
q Infiltration
q Injected to a specific area and is used for the minor
surgical procedure such as suturing a small wound or
performing biopsy
Examples:
• Lidocaine
• Tetracaine
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
NERVE BLOCK
q Injected the nerve or small nerve group that supplies
small area of the body
Examples:
• Brachial Plexus – arms
• Facial Nerve
• Pudendal block
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
NERVE BLOCK
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
SPINAL ANESTHESIA
q Also known as SUBARACHNOID BLOCK
q Requires lumbar puncture through on of the
interspaces between lumbar disk and the sacrum
q Injected to subarachnoid space surrounding the spinal
cord
 INTRAOPERATIVE PERIOD
LOCAL ANESTHESIA
EPIDURAL ANESTHESIA
q Anesthetic agent in the epidural space that surrounds
the dura mater of the spinal cord
q Advantage: Absence of headache
q Disadvantage: greater technical challenge of introducing
the anesthetic agents into the epidural rather that
subarachnoid space
4.) MEDULLARY/STAGE OF
DANGER
Respiratory or Cardiac depression or arrest
INTRAOPERATIVE
3.) SURGICAL
Extends from the loss of lid reflex to the loss of most
PERIOD
reflexes. Surgical procedure is started. STAGES OF
2.) EXCITEMENT/DELIRIUM ANESTHESIA
Extends from the time of loss of consciousness by
the time of loss of lid reflex. It may be characterized
by shouting, struggling of the client

1.) ONSET/INDUCTION
Extends from administration of anesthesia to
the time of loss of consciousness
 INTRAOPERATIVE PERIOD
STAGES OF ANESTHESIA

STAGE 1 (BEGINNING/ONSET/INDUCTION)
q Feeling of detachment
q Drowsy/Dizziness
q Hallucination occurs
q Close OR Doors
q Ringing, roaring or buzzing in the ears
 INTRAOPERATIVE PERIOD
STAGES OF ANESTHESIA

STAGE 2 (EXCITEMENT/DELIRIUM)
q Pupils are dilated
q Pulse rate are rapid
q Increased autonomic activity
q May have irregular respiration
q Because of uncontrolled movement of the patient,
restraints are necessary
 INTRAOPERATIVE PERIOD
STAGES OF ANESTHESIA

STAGE 3 (SURGICAL ANESTHESIA)

q Patient is unconscious and lies quietly
q Pupils are small but reactive to light
q Respirations are regular, the pulse rate is normal
q Skin is pink or slightly flushed
 INTRAOPERATIVE PERIOD
STAGES OF ANESTHESIA

STAGE 4 (MEDULLARY DEPRESSION/DANGER)

q Too much anesthesia had been administered
q Shallow respiration, weak and thready pulse
q Widely dilated pupils
q Death may occur
q If this stage develops, discontinue anesthesia and
initiate respiratory and circulatory support
INTRAOPERATIVE PERIOD
 INTRAOPERATIVE PERIOD
NURSING DIAGNOSIS

Risk for Aspiration Risk for Injury

Ineffective Protection Risk for Imbalanced Body Temperature

Impaired Skin Integrity Ineffective Peripheral Tissue Perfusion

Risk for Deficient Fluid Volume

 INTRAOPERATIVE PERIOD
POSITIONING

q Straps maintains positions on the operating table, and

body prominences are frequently padded

q The position should consider normal join range of motion

and good body alignment, thereby avoiding strain or
injury to muscles, bones and ligaments
INTRAOPERATIVE PERIOD
POSITIONING
 DORSAL RECUMBENT LITHOTOMY
qHernia Repair qVaginal repairs
qMastectomy qD&C
qBowel Resection qRectal Surgery
qAbdominal-perineal resection
 PRONE SUPINE
qSpinal Surgeries q Cranial Surgery
qLaminectomy q Thoracic Surgery
q Surgeries including peritoneal
body cavities
INTRAOPERATIVE PERIOD
Operating Surgeon

Surgical Assistant

Anesthesiologist

Circulating Nurse

Scrub Nurse
 INTRAOPERATIVE PERIOD
SURGEON ANESTHESIOLOGIST

q Performs the procedure q Assesses the patient before the

q Heads the surgical team and is surgery
specially trained and qualified q Supervises the patient’s condition
q Has the ultimate responsibility for throughout the surgical procedure
performing the surgery in an q Monitors the VS, ECG, Blood
effective and safe manner oxygen saturation and body
temperature
 INTRAOPERATIVE PERIOD
CIRCULATING OR SCRUB?

Coordinates all personnel in the OR CIRCULATING

Monitors responsible cost
compliance associated with CIRCULATING
operating room procedures
Ensure all equipment is working
CIRCULATING
properly
Assisting with positioning CIRCULATING
Handling specimens CIRCULATING
 INTRAOPERATIVE PERIOD
CIRCULATING OR SCRUB?

Assisting anesthesia personnel CIRCULATING

Guaranteeing sterility of instruments CIRCULATING
and supplies
Maintains sterility during surgery SCRUB
Performing surgical skin preparation CIRCULATING
Handles supplies & instruments SCRUB
during surgery
Performs aftercare SCRUB
 INTRAOPERATIVE PERIOD
CIRCULATING OR SCRUB?

Gathering of equipment & supplies SCRUB

Prepares all supplies and
SCRUB
instruments using sterile technique
Maintains sterility during surgery SCRUB
Keep accurate count of sponges, SCRUB
sharps and instruments during the
surgery
Documenting care provided CIRCULATING
 INTRAOPERATIVE PERIOD
CIRCULATING OR SCRUB?

Monitors the room and team CIRCULATING

members for breaks in sterile
technique
Coordinating activities with other CIRCULATING
departments
Minimizing conversation and traffic SCRUB
within the OR suite
 INTRAOPERATIVE PERIOD

UNRESTRICTED ZONE SEMI-RESTRICTED RESTRICTED ZONE

ZONE
q Can wear street clothes q Scrub attire (Scrub clothes q Scrub clothes, shoe cover
q Patient reception area and and caps) is required caps and masks are worn
holding area q May include areas where q Operating theater and
q Area in the operating room surgical instruments are sterile core area
that interfaces with other processed
department
 SURGICAL ASEPTIC TECHNIQUE
All materials in contact with surgical wound or used within the
STERILE FIELD MUST BE STERILE

STERILE OBJECT TO STERILE AREA ONLY

Contact with UNSTERILE OBJECTS AT ANY POINT RENDERS A

STERILE AREA CONTAMINATED

Gowns of the surgical team are considered sterile in FRONT

FROM THE CHEST TO THE LEVEL OF THE STERILE FIELD
SURGICAL ASEPTIC TECHNIQUE
 SURGICAL ASEPTIC TECHNIQUE
The sleeves are also considered sterile from 2 inches above the
elbow to the stockinette of the cuff
 SURGICAL ASEPTIC TECHNIQUE
Sterile drapes are used to create a sterile field.

Only the top surface of a draped table is considered sterile.

 SURGICAL ASEPTIC TECHNIQUE
After a sterile package is opened, the EDGES ARE CONSIDERED
UNSTERILE.
The movements of the surgical team are from STERILE TO
STERILE AREAS ONLY.
Sterile areas MUST BE KEPT IN VIEW DURING MOVEMENT
around the area
Whenever a sterile barrier is breached, the area must be
considered contaminated.
SURGICAL ASEPTIC TECHNIQUE
 SURGICAL ASEPTIC TECHNIQUE

A tear or puncture of the drape permitting access to an unsterile

surface underneath renders the area unsterile

ITEMS OF DOUBTFUL STERILITY ARE CONSIDERED

UNSTERILE.
SURGICAL ASEPTIC TECHNIQUE
SURGICAL ASEPTIC TECHNIQUE
SURGICAL ASEPTIC TECHNIQUE
SURGICAL ASEPTIC TECHNIQUE
“Extends from the time the client is admitted to the recovery room, to the time
he is transported back into the surgical unit, discharged from the hospital,
until the follow-up care.” – Josie Udan

POSTOPERATIVE PHASE
 POSTOPERATIVE PERIOD
Maintain adequate body Ensure discharge planning
systems function and teaching

Restore homeostasis
GOAL
Prevent postop
complications
Alleviate pain and
discomfort
 POSTOPERATIVE PERIOD
ASSESSMENT

O2 Sats & Ventilation Skin Color

Cardio Status Fluid Status

LOC Postoperative site

AIRWAY
Cough & Gag Reflex Drains

POSITION? Ability to extremities Pain and Safety

 POSTOPERATIVE PERIOD
ASSESSMENT

AIRWAY
q Assess for the breath sounds
q Wheezing, stridor or Crowing
q Crackles or rhonchi
q Monitor for the secretions
q Avoid positioning the client in supine position
q Always ensure lateral position
 POSTOPERATIVE PERIOD
ASSESSMENT

OXYGEN SATURATION AND VENTILATION

q Observe for the chest movement for symmetry
q Oxygen support
q Hook to continuous pulse oximeter
q DBE
q WOF respiratory distress, atelectasis or respiratory
complications
q Low Fowler’s
 POSTOPERATIVE PERIOD
ASSESSMENT

CARDIAC STATUS
q Skin color, pulses and capillary refill
q Absence of edema, numbness or tingling
q Hypertension and Hypotension
q Cardiac Dysrhythmias
 POSTOPERATIVE PERIOD
ASSESSMENT

CARDIAC STATUS
q Encourage the use of anti-embolic stockings,
sequential compression device
• To promote venous return
• Strengthen muscle tone
• Prevent pooling of blood in the extremities
 POSTOPERATIVE PERIOD
ASSESSMENT

LEVEL OF CONSCIOUSNESS
q Make a frequent periodic attempts to awaken the client
until the client awakens
 POSTOPERATIVE PERIOD
ASSESSMENT

COUGH AND GAG REFLEX

ABILITY TO MOVE EXTREMITIES
q One of the discharge criteria
 POSTOPERATIVE PERIOD
ASSESSMENT

FLUID STATUS
q IV Fluid Administration
q Record Intake and Output
q Monitor for signs of fluid and electrolyte imbalance
 POSTOPERATIVE PERIOD

GENERAL ANESTHESIA
Side lying and Fowler’s

POSITION
SPINAL/EPIDURAL ANESTHESIA
Flat on bed
 POSTOPERATIVE PERIOD
ASSESSMENT

POSTOPERATIVE SITE AND DRAINS

q Assess for the surgical site, drains and wound dressing
q Record Intake and Output
q Monitor for signs of fluid and electrolyte imbalance
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
 POSTOPERATIVE PERIOD
CONTRAPTIONS

q Clear or straw colored

SEROUS q Occurs as a normal part of the healing
process

q Pink colored due to the presence of a

small amount of blood cells mixed with
SEROSANGUINEOUS serous drainage
q Occurs as a normal part of the healing
process
 POSTOPERATIVE PERIOD
CONTRAPTIONS

q Yellow, gray or green drainage due to

PURULENT infection in the wound

q Red drainage from trauma to blood

vessel
SANGUINEOUS q May occur with wound cleansing or
other other trauma to wound bed
q Abnormal in wounds
 POSTOPERATIVE PERIOD
CONTRAPTIONS

q Frank blood from a leaking blood vessel

q May require emergency treatment to
HEMORRHAGE control bleeding
q Hemorrhage is an abnormal wound
exudate
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
POSTOPERATIVE PERIOD
CONTRAPTIONS
 POSTOPERATIVE PERIOD
DIAGNOSIS
Acute Pain Ineffective Airway Clearance

Risk for Infection Ineffective Breathing Pattern

Risk for Injury Delayed Surgical Recovery

Risk for Deficient Fluid Volume Disturbed Body Image

 POSTOPERATIVE PERIOD
PLANNING AND IMPLEMENTATION

“POSTOPERATIVE CARE PLANNING AND DISCHARGE

PLANNING BEGIN IN THE PREOPERATIVE PHASE WHEN
PREOPERATIVE TEACHING IS IMPLEMENTED”
 POSTOPERATIVE PERIOD
CRITERIA IN DISCHARGING TO PACU
ACTIVITY à able to obey commands such as deep breathing exercises

RESPIRATION à easy and noiseless breathing

CIRCULATION à BP is within +/- 20 mmHg preop level

CONSCIOUSNESS à responsive

COLORà Pinkish skin and mucus membrane

 POSTOPERATIVE PERIOD
CRITERIA IN DISCHARGING TO PACU
POSTOPERATIVE PERIOD
Pain Management Hydration

Positioning Urine and GI FXN

IS, DBE & Coughing Diet

Leg Exercises Drains/Suction

Early Ambulation Wound Care

 POSTOPERATIVE PERIOD
DIET

q Nausea and Vomiting

q Maintain the PATENCY OF THE NGT for the drainage
q WOF for abdominal distention
q WOF for flatus and return of bowel sounds
q Maintain NPO status until the gag reflex and peristalsis
 POSTOPERATIVE PERIOD
EARLY AMBULATION

q Early ambulation has a SIGNIFICANT EFFECT on the

recovery and the prevention of complications
q Atelectasis
q Hypostatic pneumonia
q GI Discomfort
q Circulatory problems
q Blood stasis
q Thromboembolism
 POSTOPERATIVE PERIOD
EARLY AMBULATION

q Help the patient move gradually from lying position to the

sitting position by the raising the head of the bed and
encourage the patient to splint the incisions when
applicable.
q Position the patient completely upright (sitting) and
turned so that both legs are hanging over the edge of the
bed.
q Help the patient stand beside the bed.
q Bed exercises are also encouraged to improve circulation.
 An unpleasant sensory and
emotional experience associated
with, or resembling that
associated with, actual or
potential tissue damage,
5TH VITAL SIGN

ALWAYS SUBJECTIVE
qPain is always a PERSONAL EXPERIENCE that is influenced
to varying degrees by biological, psychological, and social
factors.
qPain and nociception are different phenomena. Pain cannot
be inferred solely from activity in sensory neurons.
qTHROUGH THEIR LIFE EXPERIENCES, individuals learn the
concept of pain.
qA person’s report of an EXPERIENCE AS PAIN SHOULD BE
RESPECTED.

qIt may have adverse effects on function and social and

psychological well-being.

qVERBAL DESCRIPTION IS ONLY ONE OF SEVERAL

BEHAVIORS TO EXPRESS PAIN; inability to communicate
does not negate the possibility that a human or a nonhuman
animal experiences pain.
FACTORS AFFECTING THE PAIN EXPERIENCE

Ethnic and Cultural Values Previous pain experience

Developmental Stage Meaning of pain

Environment and support

people
 TYPES OF PAIN: LOCATION

REFERRED PAIN --> pain that appears/arise in different areas of the body

VISCERAL PAIN--> pain arising from organs or hollow viscera/ perceived in a

remote area
 TYPES OF PAIN: DURATION

ACUTE PAIN --> last only through the expected recovery period

CHRONIC PAIN --> also known as persistent pain; lasting 6 months

 TYPES OF PAIN: ETIOLOGY
NOCICEPTIVE PAIN--> experienced when an intact, properly functioning nervous
system sends signals that tissues are damaged, requiring attention and proper care

SOMATIC PAIN à originates in the skin, muscles, bone or connective tissue.

NEUROPATHIC PAINà associated with damager or malfunctioning nerves due to

illness, injury or undetermined reasons.
 TYPES OF PAIN: ETIOLOGY

INTRACTABLE PAIN--> pain not relieved by conventional treatment

PHANTOM PAIN à pain experienced in missing body part

RADIATING PAINà pain experienced at source and extending to other areas

PAIN THRESHOLD is the least amount of stimuli that is needed for
a person to label a sensation as pain.

PAIN TOLERANCE is the maximum amount of painful stimuli that

a person is willing to withstand or to endure
PHYSICAL DEPENDENCE is an expected physical response when
a client who is on long-term opioid therapy has the opioid
significantly reduced or withdrawn.

ADDICTION is a chronic, relapsing, treatable disease influenced

by genetic, psychosocial, and environmental factors
 ASSESSMENT
P What are the factors that precipitated the pain? What are you doing?

Q Crashing? Burning? Throbbing? Tingling?

R Where is the pain? Does it radiate?

S Pain scale

T How long? Intermittent?

 0 NO PAIN
1
2 MILD PAIN
3
4
5 MODERATE PAIN
6
7
8 SEVERE PAIN
9
10
 IMPLEMENTATION
Acknowledging and Reducing misconceptions
accepting client’s pain about pain

Assisting support people Reducing Fear and Anxiety

Preventing pain
PATIENT CONTROLLED ANALGESIA

It allows patient to control the administration of their own medication within

predetermined safety limits.

LOCKED OUT
BASAL RATE BOLUS DOSE
TIME

A PCA pump is electronically controlled by a timing device.

PATIENT CONTROLLED ANALGESIA
Even if the patient pushes the button multiple times in a rapid succession, no
additional doses are released.

ALWAYS WATCH OUT FOR RESPIRATORY DEPRESSION!!!

 WHO ANALGESIC LADDER
The three main principles of WHO Analgesic Ladder – BY THE CLOCK, BY THE
MOUTH AND BY THE LADDER

BY THE CLOCK BY THE MOUTH BY THE LADDER

q Drugs should be given q The oral route is the q Non-opoiods

“by the clock” or preferred route for q Mild opoiods
”around the clock: ease of use. q Strong opoiods
rather than PRN. q IM is not
recommended.
q Least invasive as much
as possible.
First step. Mild pain: non-opioid analgesics
such as nonsteroidal anti-inflammatory drugs
(NSAIDs) or acetaminophen with or without
adjuvants
Second step. Moderate pain: weak opioids
(hydrocodone, codeine, tramadol) with or
without non-opioid analgesics, and with or
without adjuvants
Third step. Severe and persistent pain: potent opioids
(morphine, methadone, fentanyl, oxycodone,
buprenorphine, tapentadol, hydromorphone,
oxymorphone) with or without non-opioid analgesics,
and with or without adjuvants
 MILD MODERATE SEVERE
• Paracetamol • Hydrocodone • Fentanyl
• Aspirin • Codeine • Hydromorphone
• Ibuprofen • Tramadol • Oxycodone
• Indomethacin • Morphine
• Naproxen • Oxymorphine
• Ketorolac • Methadone
• Celecoxib
 WOUND CARE
SEQUENTIAL SIGNS OF HEALING Appearance
1. ABSENCE OF BLEEDING Size
and the appearance of a clot
binding the wound edges Drainage
2. INFLAMMATION AT ASSESSMENT
WOUND edges for 1 to 3
days Swelling
3. Reduction in inflammation
Pain
when the CLOT DIMINISHES
4. SCAR FORMATION
Drains/Tubes
5. DIMINISHED SCAR over a
period of months or years
 POSTOPERATIVE COMPLICATIONS
ATELECTASIS PNEUMONIA

CAUSE Accumulated secretions Infection, aspiration

or failure of client to and immobility
DBE and ambulate

ONSET 1-2 days after Sx 3-5 days after Sx

Dyspnea and increased respiratory rate, Crackles, Elevated

SIGNS AND SX
body temperature, productive cough and chest pain
POSTOPERATIVE COMPLICATIONS
 POSTOPERATIVE COMPLICATIONS
ATELECTASIS
q A COLLAPSED OR AIRLESS STATE of the lung that
may result of the airway obstruction
q CAUSED BY:
q Accumulated secretions
q Failure to do Deep Breathing Exercise
q Failure to Ambulate
 POSTOPERATIVE COMPLICATIONS
PNEUMONIA
q An INFLAMMATION OF THE ALVEOLI caused by
infectious process
q CAUSED BY:
q Infection
q Aspiration
q Immobility
 POSTOPERATIVE COMPLICATIONS
PNEUMONIA AND ATELECTASIS NURSING
INTERVENTIONS
q Assess lung sounds
q Reposition the client every 2 hours
q Encourage the client to do DBE, cough and use of
incentive spirometry as prescribed
q Provide chest physiotherapy and postural drainage
q Encourage fluid intake and early ambulation
 POSTOPERATIVE COMPLICATIONS
PNEUMONIA AND ATELECTASIS NURSING
INTERVENTIONS
q Use suction to clear secretions if the client is unable to
cough
 POSTOPERATIVE COMPLICATIONS
HYPOXEMIA
q An INADEQUATE CONCENTRATION OF OXYGEN in
the arterial blood
q Can be due to shallow breathing from the effects of
the anesthesia and medications
 POSTOPERATIVE COMPLICATIONS
HYPOXEMIA
q Signs and Symptoms
q Restlessness
q Dyspnea
q Diaphoresis
q Tachycardia
q Cyanosis
q Low pulse oximetry
reading
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTIONS FOR HYPOXEMIA
q Monitor for lung sounds and pulse oximetry
q WOF for signs of progression of hypoxemia
q Administer oxygen as ordered
q DBE and Coughing
q Use of IS
q Turning and early ambulation
q Notify the MD
 POSTOPERATIVE COMPLICATIONS
PULMONARY EMBOLISM
q An EMBOLUS BLOCKING the pulmonary artery and
disrupting blood flow to 1 or more lobes of the lungs.
q Signs and symptoms:
q Sudden dyspnea
q Sudden sharp chest pain
q Cyanosis
q Tachycardia
q Hypotensive
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTION FOR PULMONARY EMBOLISM
q Notify the surgeon
q Monitor vital signs
q Administer oxygen and medications as prescribed
 POSTOPERATIVE COMPLICATIONS
WOUND INFECTION
INTERVENTIONS:
ONSET: 3 to 6 days
q Administer antibiotics
CAUSES OR RISK q Monitor VS
Assessment: q Assess wound drainage
FACTORS:
q Fever and chills q Maintain asepsis, change
q Poor aseptic technique
q Contaminated wound q Warm, tender, dressing & perform from
prior Sx painful & inflamed wound irrigation
q Diabetes Mellitus site q Monitor for signs infection:
q Immunocompromised q Edematous site Redness, Erythema.
q Elevated WBC Ecchymosis, Drainage and
Approximation
 POSTOPERATIVE COMPLICATIONS
HEMORRHAGE
Loss of large amount of blood externally and internally in a short
period of time
Capillary: Slow and oozing
MANIFESTATIONS
qRestlessness
Venous: Dark in color and qWeak and rapid pulse
bubble out
qHypotension
Arterial: Spurts and is bright qTachypnea
in color qCool, clammy skin
qReduced urine output
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTION FOR HEMORRHAGE
q Pressure to the site of the bleeding
q Administer O2 as needed
q Ligation of bleeders
q BT and IV fluids
q Vitamin K and Hemostan
q Notify the MD
 POSTOPERATIVE COMPLICATIONS
SHOCK
q Loss of circulatory fluid volume which is usually caused
by hemorrhage.
q Signs and symptoms:
q Restlessness
q Weak and rapid pulse
q Hypotension, tachypnea
q Cool, clammy skin
q Reduced UO
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTION FOR SHOCK
q If shock develops, elevate legs
q Administer the oxygen as prescribed
q Determine and treat the cause of shock
q Monitor level of consciousness
q Monitor vital signs for increased pulse or decreased
blood pressure
q Notify the surgeon
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTION FOR SHOCK
q Monitor for intake and output
q Administer IV Fluids, blood and colloid substances
WOUND DEHISCENCE

Is the separation of the wound edges

at the suture line; it is usually occurs 6
to 8 days after surgery

WOUND EVISCERATION

Is the protrusion of the internal organs

through an incision; it is usually occurs
6 to 8 days after surgery
 WOUND DEHISCENCE WOUND EVISCERATION

qINCREASED IN DRAINAGE qDischarge of serosanguineous

qOpened wound edges fluid from a previously dry wound
qAppearance of underlying tissuesqThe APPEARANCE OF LOOPS
through the wound OF BOWEL OR OTHER
ABDOMINAL CONTENTS
THROUGH THE WOUND
qClient reports of feeling of
popping sensation after coughing
or turning.
EVISCERATION IS MOST COMMON AMONG OBESE CLIENTS WHO HAVE
HAD ABDOMINAL SURGERY!!!
 EVISCERATION IN A WOUND
1. Call for help; ask that the surgeon be notified and that needed supplies
be brought to the client’s room
2. Place the client in a low Fowler’s position with the knees bent
3. Cover the wound with a sterile normal saline dressing and keep the
dressing moist
4. Take vital signs and monitor the client closely for signs of shock
5. Prepare the client for surgery as necessary
6. Document the occurrence, actions taken and the client’s response.
 POSTOPERATIVE COMPLICATIONS
URINARY RETENTION
q Is an involuntary accumulation of urine in the bladder
as a result of loss of muscle tone
q Appears 6 to 8 hours after the surgery
 POSTOPERATIVE COMPLICATIONS
URINARY RETENTION
q Signs and symptoms
q Inability to void
q Distended bladder
q Lower abdominal pain
q Restlessness and diaphoresis
q Hypertension
q On percussion, bladder sounds like a drum
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTIONS FOR URINARY RETENTION
q Monitor for due to void 6-8 hours
q Assist the client in voiding
q Encourage fluid intake
q Encourage ambulation
q Apply alternating warm and cold compress
q Catheterize the patient if she cannot void after 6-8 hours
 POSTOPERATIVE COMPLICATIONS
CONSTIPATION
q Abnormal infrequent passage of stool
q Failure to pass stool within 48 hours
q Signs and symptoms:
q Absence of bowel movements
q Abdominal distention
q Anorexia, headache and nausea
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTIONS CONSTIPATION
q Encourage fluid intake up to 3000ml/day
q Encourage ambulation
q Encourage consumption of high fiber foods
q Administer stool softeners and laxative
 POSTOPERATIVE COMPLICATIONS
PARALYTIC ILEUS
q Failure of appropriate forward movement of bowel
contents
q May occur as a result of anesthetic medication or
manipulation of bowel during surgery
q Signs and symptoms:
q Vomiting
q Abdominal distention
q No BS, BM nor flatus
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTIONS CONSTIPATION
q Maintain on NPO status
q Maintain patency of the NGT.
q Encourage ambulation
q Administer IV Fluids
q Administer medications as prescribed to
increase GI motility and secretions
 POSTOPERATIVE COMPLICATIONS
FEMORAL PHLEBITIS/DEEP THROMBOPHLEBITIS
q Inflammation of the vein, often accompanied by clot
formation
q Veins in the legs are the most affect
q Causes:
q Injury: damage to the vein
q Hemorrhage
q Prolonged immobility
q Obesity/Debilitation
 POSTOPERATIVE COMPLICATIONS
FEMORAL PHLEBITIS/DEEP THROMBOPHLEBITIS
q Signs and symptoms:
q Pain
q Redness
q Swelling
q Heat/Warmth
q Veins feel hard and cordlike and is tender to
touch
 POSTOPERATIVE COMPLICATIONS
NURSING INTERVENTIONS FOR THROMBOPHLEBITIS
q Hydration
q Encourage leg exercises and ambulation
q Elevate the affected leg with pillow support
q Avoid massage on the calf of the leg
q Anticoagulant, Anti-embolic stockings
THANK YOUUU!!! <3