2. OBJECTIVESOBJECTIVES
At the end of the presentation the participants willAt the end of the presentation the participants will
be able to:be able to:
1.1. Recognize the different phase of perioperativeRecognize the different phase of perioperative
nursing care.nursing care.
2.2. Identify the goal of care in each phasesIdentify the goal of care in each phases
3.3. Identify the different nursing role andIdentify the different nursing role and
responsibility.responsibility.
4.4. Effectively apply it in actual nursing practice forEffectively apply it in actual nursing practice for
care and safety of the patientcare and safety of the patient
22
4. IntroductionIntroduction
PERIOPERATIVE NURSING is thePERIOPERATIVE NURSING is the
nursing care rendered to the totalnursing care rendered to the total
surgical experience of the patientsurgical experience of the patient
33PhasesPhases
11..Preoperative phasePreoperative phase
22..Intra operative phaseIntra operative phase
33..Post operative phasePost operative phase
44
6. Pre operative CarePre operative Care
Care rendered to the patientCare rendered to the patient
from the time the decision isfrom the time the decision is
made for surgicalmade for surgical
intervention to the time theintervention to the time the
patient is transfer to thepatient is transfer to the
operating roomoperating room..
66
7. GOAL OF CAREGOAL OF CARE
To prepare the patientTo prepare the patient
physically, psychologicallyphysically, psychologically
spiritually and legallyspiritually and legally..
77
8. PHYSICAL PREPARATIONPHYSICAL PREPARATION
1. Develop nursing history1. Develop nursing history
2. Physical assessment ( P.E, V/S, Lab.2. Physical assessment ( P.E, V/S, Lab.
Examination)Examination)
3. Assessment for risk factors3. Assessment for risk factors
4. Preparation of the operative site4. Preparation of the operative site
Skin preparation:Skin preparation:
a. scrubbing or taking a batha. scrubbing or taking a bath
b. shaving or hair removalb. shaving or hair removal
Gastro intestinal tract preparation:Gastro intestinal tract preparation:
a. NPO ( Nothing per Orem )a. NPO ( Nothing per Orem )
b. Bowel clearanceb. Bowel clearance
Genitourinary tract preparation-Genitourinary tract preparation-
5. Some patients may benefit from a sleeping5. Some patients may benefit from a sleeping 88
9. Psychological and spiritualPsychological and spiritual
preparationpreparation
Patients are often fearful or anxious about havingPatients are often fearful or anxious about having
surgery.surgery.
1.1. It is often helpful for the patient to express theirIt is often helpful for the patient to express their
concernsconcerns
2.2. Family needs to be included in psychologicalFamily needs to be included in psychological
preoperative carepreoperative care
3.3. Pastoral care or religious affair assistancePastoral care or religious affair assistance
Children may be especially fearful.Children may be especially fearful.
1.1. They should be allowed to have a parent with themThey should be allowed to have a parent with them
as much as possibleas much as possible
2.2. Encouraged to bring a favorite toy or blanket to theEncouraged to bring a favorite toy or blanket to the
hospital on the day of surgery.hospital on the day of surgery. 99
10. Legal preparationLegal preparation
Informed consent or operative permit - is theInformed consent or operative permit - is the
process of informing the patient about theprocess of informing the patient about the
surgical procedure and its benefits thesurgical procedure and its benefits the
risk, and possible complication therisk, and possible complication the
anesthesia, and other treatment optionanesthesia, and other treatment option..
1010
11. Purpose of informed consentPurpose of informed consent
1.1. To ensure that the patient understands theTo ensure that the patient understands the
nature of the treatment.nature of the treatment.
2.2. To indicate that the patient’s decision was madeTo indicate that the patient’s decision was made
without pressure.without pressure.
3.3. To protect the patient against unauthorizedTo protect the patient against unauthorized
procedure.procedure.
4.4. To ensure that the procedure is performed onTo ensure that the procedure is performed on
the correct body part.the correct body part.
5.5. To protect the surgeon and hospital against legalTo protect the surgeon and hospital against legal
action by a patient who claims that anaction by a patient who claims that an
authorized procedure was performed.authorized procedure was performed. 1111
12. Obtaining a consentObtaining a consent
1.1. Adult patient with sounds mind sign consentAdult patient with sounds mind sign consent
2.2. Patient should be properly informed.Patient should be properly informed. Signature isSignature is
obtained with the patient’s complete understanding.obtained with the patient’s complete understanding.
3.3. The surgeon is responsible for obtaining the consent.The surgeon is responsible for obtaining the consent.
4.4. Older client and minors , mentally ill, need a legalOlder client and minors , mentally ill, need a legal
guardian to sign the consent form.guardian to sign the consent form.
5.5. The nurse may witness the clients signing of the consentThe nurse may witness the clients signing of the consent
6.6. If patient is unable to write, thumb mark is acceptable ifIf patient is unable to write, thumb mark is acceptable if
there is a witness to his mark.there is a witness to his mark.
7.7. Emancipated minors.Emancipated minors.
1212
13. Validity of a consentValidity of a consent
1.1. Written permission is required by lawWritten permission is required by law
2.2. Adult mentally healthy are competent to sign there consentAdult mentally healthy are competent to sign there consent
3.3. Minors – (18 and below) parents or legal guardian signedMinors – (18 and below) parents or legal guardian signed
4.4. Mentally ill- parents or legal guardian, appointed by the courtMentally ill- parents or legal guardian, appointed by the court
5.5. Emergency- ( if patient is unconscious or no legal guardian,Emergency- ( if patient is unconscious or no legal guardian,
the medical practitioner is expected to act in the patient's bestthe medical practitioner is expected to act in the patient's best
interests until family can be found.interests until family can be found.
6.6. A witness to the patient’s signature is required.A witness to the patient’s signature is required.
7.7. If the patient is unable to write a thumb mark is acceptable ifIf the patient is unable to write a thumb mark is acceptable if
there is a witness to his mark.there is a witness to his mark.
““Validity may vary depend on the jurisdiction”Validity may vary depend on the jurisdiction”
1313
14. Some recent cases:
In April 2011 an ophthalmologist in Portland,
operated on the wrong eye of a 4-year-old boy.
In December 2010, Beth Israel Deaconess
Medical Center in Boston reported that
neurosurgeons had performed three wrong-site
spinal surgeries in a two-month period.
And after five wrong-site operations in less than
three years, state officials in 2009 ordered that
video cameras be installed in the operating
rooms of Rhode Island Hospital in Providence,
which was fined $150,000.
15. THE WASHINGTON POST
The Pain of Wrong Site Surgery
By Sandra G. Boodman, June 20, 2011
Based on state data, Joint Commission
officials estimate that wrong-site surgery
occurs 40 times a week in U.S. hospitals
and clinics. Last 2010, 93 cases were
reported to the accrediting organization,
compared with 49 in 2004.
16. Patient educationPatient education
1.1. A vital component of the surgical experience.A vital component of the surgical experience.
2.2. Designed to help the patient understand theDesigned to help the patient understand the
surgical experience to minimize anxiety andsurgical experience to minimize anxiety and
promote full recovery from surgery andpromote full recovery from surgery and
anaesthesia.anaesthesia.
3.3. Preoperative patient education maybe offeredPreoperative patient education maybe offered
through conversation, discussion, audiovisualthrough conversation, discussion, audiovisual
aids or videos & demonstrations.aids or videos & demonstrations.
1616
17. Post-operative exercisesPost-operative exercises
Incentive spirometry (10-12 times per hour)Incentive spirometry (10-12 times per hour)
Coughing – promotes removal of chest secretionsCoughing – promotes removal of chest secretions
Deep breathing- decrease or lessen the painDeep breathing- decrease or lessen the pain
Turning – stimulates circulation and relievesTurning – stimulates circulation and relieves
pressure areaspressure areas
Foot and leg exercise – improves circulation andFoot and leg exercise – improves circulation and
muscle tonemuscle tone
*SHOULD be taught to patient prior to Operation **SHOULD be taught to patient prior to Operation *
1717
18. Pre-operative medicationPre-operative medication
To aid in the administration of anTo aid in the administration of an
anesthetic,anesthetic,
minimize respiratory tract secretionsminimize respiratory tract secretions
and changes in heart rateand changes in heart rate
to relax the patient and reduce anxietyto relax the patient and reduce anxiety
1818
19. Types of PreoperativeTypes of Preoperative
medicationmedication
1.1. Opiates – such as morphine and demerolOpiates – such as morphine and demerol
2.2. Anticholinergic – such as atrophineAnticholinergic – such as atrophine
3.3. Barbiturates/Tranquilizers – pentobarbitalBarbiturates/Tranquilizers – pentobarbital
4.4. Prophylactic antibiotics – to be effectiveProphylactic antibiotics – to be effective
when bacterial contamination is expectedwhen bacterial contamination is expected..
1919
20. Admitting the patient toAdmitting the patient to
surgerysurgery::
1.1. Final Checklist/ PreoperativeFinal Checklist/ Preoperative
checklistchecklist
2.2. Identification and verificationIdentification and verification
3.3. Review of patient recordReview of patient record
4.4. Consent formConsent form
5.5. Patient preparednessPatient preparedness
6.6. Transporting the patient to the ORTransporting the patient to the OR
2020
21. Intra-operative careIntra-operative care
The intra-operative phase extend from theThe intra-operative phase extend from the
time the client is admitted to the operatingtime the client is admitted to the operating
room, to the time of anesthesiaroom, to the time of anesthesia
administration, performance of the surgicaladministration, performance of the surgical
procedure and until the client isprocedure and until the client is
transported to the recovery room ortransported to the recovery room or
postanethesia care unit (PACUpostanethesia care unit (PACU(.(.
2121
22. Surgical TeamSurgical Team
Scrub team orScrub team or
sterile teamsterile team
1.1. SurgeonSurgeon
2.2. AssistantAssistant
surgeonsurgeon
3.3. Scrub nurseScrub nurse
Non sterile noneNon sterile none
scrub teamscrub team
1.1. AnesthesiologiAnesthesiologi
st andst and
technicianstechnicians
2.2. CirculatingCirculating
nursenurse 2222
23. Throughout the surgical experienceThroughout the surgical experience
the nurse functions as the patient’sthe nurse functions as the patient’s
advocateadvocate
Goals of care:Goals of care:
1.1. Safe administration of anesthesia, right patient,Safe administration of anesthesia, right patient,
right procedure, correct siteright procedure, correct site
2.2. HomeostasisHomeostasis
3.3. Promote the principle of asepsisPromote the principle of asepsis
4.4. HemostasisHemostasis
2323
24. Anesthesia classificationAnesthesia classification::
A.A. General anesthesia-General anesthesia- is the loss of allis the loss of all
sensation and consciousness.sensation and consciousness.
B.B. Regional / Local Anesthesia-Regional / Local Anesthesia- TheThe
client loss sensation in an area of theclient loss sensation in an area of the
body but remains conscious.body but remains conscious. ::
2424
25. Anesthesia ClassificationAnesthesia Classification
General anesthesiaGeneral anesthesia
administered by :administered by :
1.1. Intravenous infusionIntravenous infusion
2.2. Inhalation of gasesInhalation of gases
through a mask orthrough a mask or
3.3. through an endo-through an endo-
tracheal tubetracheal tube
inserted into theinserted into the
trachea.trachea.
Regional / LocalRegional / Local
anesthesiaanesthesia
1.1. TopicalTopical
2.2. Local/infiltrationLocal/infiltration
3.3. Nerve blockNerve block
4.4. Intravenous blockIntravenous block
5.5. SpinalSpinal
6.6. EpiduralEpidural
2525
26. 44Stages of anesthesiaStages of anesthesia
1.1. Stage I begins with the induction of anesthesia andStage I begins with the induction of anesthesia and
ends with the patient's loss of consciousness.ends with the patient's loss of consciousness.
2.2. Stage II, or REM stage,. From Loss ofStage II, or REM stage,. From Loss of
consciousness to loss of lid reflex.consciousness to loss of lid reflex.
3.3. Stage III, or surgical anesthesia, Loss of lid reflex toStage III, or surgical anesthesia, Loss of lid reflex to
loss of most reflexloss of most reflex
4.4. Stage IV, or medullary stage, or overdose- it isStage IV, or medullary stage, or overdose- it is
marked by hypotension or circulatory failure.marked by hypotension or circulatory failure.
Note: Being aware of the different stages will help us toNote: Being aware of the different stages will help us to
better predict the course of event and actbetter predict the course of event and act
accordingly in emergency situation.accordingly in emergency situation. 2626
28. Principle of Aseptic techniquePrinciple of Aseptic technique
1. All items used within the sterile field must1. All items used within the sterile field must
be sterile.be sterile.
2. A sterile barrier that has been permeated2. A sterile barrier that has been permeated
must be considered contaminated.must be considered contaminated.
3. The edges of a sterile wrapper or container3. The edges of a sterile wrapper or container
are considered unsterile once the package isare considered unsterile once the package is
opened.opened.
4. Gowns are considered sterile from chest to4. Gowns are considered sterile from chest to
the level of the sterile field, and the sleevesthe level of the sterile field, and the sleeves
to 2inches above the elbows.to 2inches above the elbows.
2828
29. Cont. principlesCont. principles
5. Tables are sterile at table level only.‡5. Tables are sterile at table level only.‡
6. Sterile persons and items touch only6. Sterile persons and items touch only
sterile areas; unsterile persons andsterile areas; unsterile persons and
items touch only unsterile areas.‡items touch only unsterile areas.‡
7.Movement around the sterile field must7.Movement around the sterile field must
not contaminate the field.not contaminate the field.
8. ‡All items and areas of doubtful8. ‡All items and areas of doubtful
sterility are considered contaminated.sterility are considered contaminated.
2929
31. ReferencesReferences
Lippincott Manual of nursing Practice 8Lippincott Manual of nursing Practice 8thth
EditionEdition
MSD Gen Surgery F02AMSD Gen Surgery F02A
American Nurses Association. Role of registeredAmerican Nurses Association. Role of registered
nurse in the management of patient receivingnurse in the management of patient receiving
conscious sedation for short term therapeutic,conscious sedation for short term therapeutic,
diagnostic or surgical procedure.diagnostic or surgical procedure.
Association of Perioperative Registered Nurses (2004)Association of Perioperative Registered Nurses (2004)
AORN standards and recommended practices forAORN standards and recommended practices for
perioperative nursing.perioperative nursing.
http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Chttp://www.surgeryencyclopedia.com/Pa-St/Preoperative-C
http://nursingcrib.com/http://nursingcrib.com/
