Perioperative Nursing

By Fuad A.

11/24/2023 by Fuad A. 1
 Learning outcomes
• At the end of this lecture, the student must be able to:
• Differentiate the phases of perioperative care.
• Define the types and categories of surgery.
Identify the preoperative assessments.
•
Develop a preoperative teaching plan.
•
Identify surgical risk factors.
• Describe the preoperative preparation.
• Discuss assessments needed in immediate and later postoperative
• period.
• Identify the postoperative complications.

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• Surgery is invasive medical procedure used to diagnosis, treat,
or cure illness, injury, or deformity.

• The nurse assumes an active role in caring for the client

before, during and after surgery.

• Surgery is a unique experience of a planned physical alteration

encompassing three phases:
• Preoperative
• Intraoperative
• Postoperative
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 Purposes of surgical procedures
• Diagnostic
• Palliative
• Constructive
• Transplant

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• Surgical procedures are commonly grouped according to:

• Degree of urgency:
▪ Emergency surgery.
▪ Elective surgery.

• Degree of risk: (is affected by the client’s age, general

health, nutritional status…….)
▪ Major surgery.
▪ Minor surgery.

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Age: Very young and older clients are greater surgical risk than
adults.
Nutrition: a malnourished client is prone to poor tolerance of
anesthesia, infection, poor wound healing and the potential for
multiple organ failure after surgery
Obesity: contribute to postoperative complications such as
pneumonia and wound infections and wound separation.
Medical Problems: Acute and chronic respiratory problems,
Hypertension, Liver dysfunction, Renal failure and Diabetes.
General Health: surgery is least risky when the client’s general
health is good.
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 What is meant by
perioperative?

Perioperative is a term used to

describe the entire span of surgery,
including what occurs before,
during, and after the actual
operation.

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 Preoperative: begins with the decision to perform
surgery and continues until the client has reached the
Operating area.

Intraoperative: begins when the client is transferred

to the operating table and ends when the client is admitted
to the(PACU)

Postoperative: begins with admission to the recovery area and

continues until the client receives a follow up at home, or is
discharged to a rehab unit.( Ends when healing is complete)
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Focuses on
• Obtaining informed consent for surgery .

• Identifying
client risk factors and needs prior to and
during surgery.

• Physical and psychological preparation of the client.

• Educatingthe client and family about the surgery,

expected outcomes, and the recovery process.

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• Prior to any surgical procedure, informed consent is
required from the client or legal guardian.

• Information on the surgical procedure is provided

by the physician, such as the risks, benefits, and
alternatives.

• A signed form, witnessed by a nurse is evidence that

consent has been obtained.
• Each nurse must be familiar with hospital policies
and laws regarding surgical consent forms.
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Competence:
The person giving consent must be mentally and physically
competence and legally an adult .
Comprehension:
The person giving consent must thoroughly understand the
procedure, it's risks, benefits and alternative procedure.
Voluntaries:
The consent must be given voluntarily (not forced or manipulated).
Disclosure:
The person giving consent must have the opportunity to have all.
Questions answered satisfactory.
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 I. Review preoperative laboratory and
diagnostic studies

II. Review the client’s health history

and preparation for surgery

III. Assess physical needs

IV. Assess psychological needs

V. Assess cultural needs

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 Complete blood count.
Fasting blood glucose
Blood grouping and cross match.
Serum electrolytes (Na+, K+, Ca+, HCO3+)
Urinalysis.
Chest X-rays.
Electrocardiogram.
Other tests related to procedure or client’s medical condition,
such as: Prothrombin time, partial thromboplastin time, blood
urea nitrogen, creatinine, and other radiographic studies.
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• History of present illness, present medication and reason for
surgery
• Past medical history
• Medical conditions (acute and chronic)
• Previous hospitalization and surgeries
• History of any past problem with anesthesia
• Allergies: to medications, topical agents used to prepare the
skin for surgery
• Substance use: alcohol, tobacco Review of system
•

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• Ability to communicate
• Vital signs
• Level of consciousness
• Weight and height Skin integrity
• Ability to
• Move/ambulate Level of exercise Prostheses
• Circulatory status
•
•
•
•
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• Emotional state
• Level of understanding of surgical procedure, preoperative
and postoperative instruction
• Coping strategies
• Support system
• Roles and responsibilities

• Stress response: fear & anxiety , disturbance in body image.

Assess cultural needs:

• Language-need for interpreter

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Knowledge deficit related to:
lack of education about the prioperative process.
lack of exposure to the specific perioperative experience.
Anxiety related to:
Effects of surgery on body function.
Outcome of exploratory surgery for malignancy.
Risk of death.
Change in health status and /or body image.
Disturbed sleep pattern related to:
Hospital routines.
Psychological stress.
Ineffective coping related to:
Lack of clear outcomes of surgery.
Unresolved past negative experience with surgery.
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 Careful preoperative teaching can reduce fear and anxiety of the
clients.

Timing teaching:
● Most useful when started the week before admission and
reinforced before surgery and the client is less anxious.
● Information in a preoperative teaching plan varies with the type
of surgery and the length of the hospitalization.

Content teaching :
Surgical Procedure Preoperative routines
Intraoperative routines Postoperative routine
Pain relief

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• Preoperative medication- when they are given and their effects.
• Post operative pain control.
• Explanation and description of the post anesthesia recovery room
or post surgical area.
• Discussion of the frequency of assessing vital signs and use of
monitoring equipment.
• Explanation and demonstration deep breathing and coughing
exercises, how to support the incision for breathing exercises and
moving, position changes, and feet and leg exercises.
Information about intravenous (IV) fluids and other lines and
• tubes such as nasogastric tubes.

by Fuad A. 20
Deep breathing is a form of controlled ventilation that opens and
fills small air passages in the lungs to prevent atelectasis and
pneumonia.

Coughing exercise is a natural method of clearing secretions

from the airways.

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 Leg exercises help promote circulation and reduce the risk of
forming a thrombus in the veins.
Antiembolism stockings help prevent thrombi by compressing
superficial veins and capillaries redirecting blood to larger and
deeper veins, where it flows more effectively toward the heart.

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 Physical Preparation.
• Food and fluids
• Elimination
• Hygiene , clothing/ grooming : - no polish, gown only,
no pins, no clips
• Medication
• Care of valuables
• Prostheses
• NGT; Foley catheter, IV; drains, etc.
• Testing
• Skin preparation

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 Managing nutrition and fluids.
• The major: fasting period of 8 - 12hours is recommended for a
meal that includes fried or fatty foods or meat.
Preparing the bowel for surgery.
• Enema is not commonly ordered, unless the patient is
undergoing abdomen or pelvic surgery.
Preparing the skin.
• The goal of preoperative skin preparation is to decrease bacteria
without injuring the skin.

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Pre-op. medications:
• The anesthesiologist may order routinely taken medications to be
held the day of surgery.
• The preoperative medications are given to the client prior to going to
the operating room.
Purpose of Pre-op. medications:
• Reduce anxiety and ease anesthetic induction.
• Decrease oral and pulmonary secretions and prevent
laryngospasm.
• Decrease side effects of anesthesia.

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Final Preparation for surgery:
ü All personal belongings are identified and secured.
ü Jewelry is usually removed.
ü Dentures are removed, labeled and placed in a
denture cup.
ü Verbally confirm the surgical procedures and the
surgical site.
ü This verification process is documented in the medical record on
the preoperative checklist.

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• Intraoperative phase:
Transferred to OR-ends with the transfer to the recovery area.

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• Surgeon
• Surgical assistant
• Anesthesiologist
• Scrub Nurse
• Circulating Nurse
• Certified surgical
technologist

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Scrub nurse: preparation of supplies and equipment on the sterile
field.
• Maintenance of patient’s safety and integrity,
• Provision of appropriate sterile instrumentation,
• Assist the surgeon by controlling bleeding, handling and cutting tissue
sutures during the procedure.
• Responsible for accounting for all sponges, needles, and instruments at
the close of surgery

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 Circulating Nurse:
• Responsible for creating a safe environment
• Managing the activities outside the sterile field.
• Documenting intraoperative nursing.
• Ensuring surgical specimens are identified and place in the right media.
• Arranges sterile and non sterile supplies
• Positions client on operating room table.
• Prepares operating room with necessary equipment & supplies.
• Accompanies client to the recovery room

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 It has three phases:

• Immediate postoperative phase:is usually provided in a

postanesthesia room (recovery room).

• Ongoing postoperative phase: (follow up phase) In the patent’s

room.

• Discharge postoperative phase: Continuing care after discharge.

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• Maintain a patent airway.
• Positioning.
• Assessing the patient.
• Maintaining cardiovascular stability
• Relieving pain and anxiety
• Assessing and managing the surgical site
• Assessing and managing gastrointestinal function
• Assessing and managing voluntary voiding
• Encourage activity

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 Maintaining a patent airway:
• • The nurse applies oxygen, and assesses respiratory rate
and depth, oxygen saturation.
• • The semiconscious patient should be positioned on the side, with
the face slightly down..
• In lateral or semi-prone position the head is hyperextended,
which allows the free entry of air in and out of the lungs

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• Assessing the patient for:
• Adequacy of airway and oxygen saturation
• Adequacy of ventilation and Cardiovascular status
• Level of consciousness and manage pain
• Presence of protective reflexes
• Activity, ability to move extremities
• Skin color and fluid status
• Condition of operative site
• Patency and amount of drainage from catheters, tubes, and
drains
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• Risk for altered respiratory function related to immobility,
effects of anesthesia, analgesics and pain.
• Pain related to surgical incision and manipulation of body
structures.
• Altered Comfort (nausea and vomiting) related to effects of
anesthesia or side effects of narcotics.
• Risk for Infection related to break in skin integrity (surgical
incision, wound drainage devices).
• Activity Intolerance related to decreased mobility and weakness
secondary to anesthesia and surgery.

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 Cardiovascular complications:
• Hemorrhage, Hypovolemic shock:, Deep vein thrombosis

• (DVT).
Respiratory complications:
• Pulmonary embolism, Pneumonia and Atelectasis:
•
Gastrointestinal complications:
• • Abdominal distention and Intestinal obstruction.:
• Urinary tract complications:
Urinary Retention and Urinary tract Infection
Perceptual complication: Pain

.
•
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Wound complications:
Wound infection {sepsis}
Wound dehiscence:
Is an opening of the wound edges.
Wound Evisceration
Is characterized by the protrusion of loop of bowel through the
incision.

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When caring for post-surgical patient,
think of the “4 W’s”
1. Wind: prevent respiratory
complications
2. Wound: prevent infection
3. Water: monitor I & O
4. Walk: prevent thrombophlebitis

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 Thanks

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