4. PERIOPERATIVE NURSING
Perioperative nursing includes activities
performed by the registered nurse during
pre operative, intra operative and post
operative phases of the patient’s surgical
experiences.
Period of the time that constitute the
surgical experience, include the
preoperative, intra-operative,
postoperative phases.
6. Operation room nurse: Operation room (OR)
nurse are referred to as peri operative nurse to
meet accurately reflect their specialized duties.
Scrub nurse: Selecting and passing instruments
and supplies used for the operation to maintain a
safe, comfortable environment.
Postoperative period: The postoperative period
begins after the transfer to the PACU( Peri-
Anesthetic Care Unit) and terminates with the
resolution of the surgical sequelae. It is quite
common for this period to end outside of the
care of the surgical team
7. Preoperative phase: This phase begins when
the decision for surgical intervention is made
and ends when the patient is transferred from
the operating room.
Intra operative phase: This phase begins
when the patient is admitted or transferred to
the surgery department and ends when he or
she is admitted to the recovery area.
8. Ectomy: A suffix denoting removal or excision of a
structure, e.g. hysterectomy (removal of the uterus).
Orrhaphy: A plastic or repair operation; e.g.,
perineorrhaphy (repair of the perineum.The plasty is
also used, to describe a plastic operation where the
aim is to rebuild and restore tissue destroyed by
injury or disease.
Oscopy: Inspection of the interior of an organ or
passage by means of special instruments, usually
carrying a light, e.g., cystoscopy (examination of the
bladder by means of acystoscope).
9. Ostomy: Constructing an artificial opening
into an organ, e.g., gastrostomy (makes an
opening from the stomach on to the surface
of the abdomen).
Ectomy: Incision or dividing a structure, e.g.,
laparotomy (incision and opening
theabdomen), tenotomy (dividing a tendon).
11. 1) Pre-operative phase: This is the phase of the
patient’s surgical experience which begins when
the decision is made to undergo surgical
intervention.
This phase ends when the patient is transferred
to the operating table
12. 2) Intra-operative phase: this phase begins with
transfer of the patient to the operating table and
extends to the time the patient is admitted to
the recovery area.
3) Post operative phase: this phase begins with
admission of the patient to the recovery area
which includes post anesthesia care unit or an
intensive care unit.
This phase ends when the surgeon discontinues
follow-up care
13. 1. PREOPERATIVE PHASE
Preoperative phase is the period between the decision
to do the surgery & the client being shifted to the
operation table.
During this phase the nurse gathers data by doing
assessment and plan components of nursing process
The nurse identifies the patient’s physiologic,
psychologic and spiritual needs and finds existing or
potential problems
14. PURPOSES
Preoperative nursing is based on the nursing care
is the care given to the patient before surgery.
The preoperative period for different type
surgery is different e. g, for emergency surgery
preoperative period is very short. For planned
surgery time for surgery is fixed with the mutual
consent of the surgeon and the patient.
Preoperative care of the patient surgeon makes
with diagnosis end decides that an operation is
necessary for the patient.
15. NURSING RESPONSIBILITY IN PRE-
OPERATIVE PHASE
Assessment of the patients
Identify health problem.
Plan for care according to individual health
needs.
HealthTeaching: client & supportive people.
Preparation of client for surgery.
16. PREPARATION OF PATIENT FOR
SURGERY
1. Psychological preparation:
Give information about surgery:
Type of surgery
Problem to be faced
Sequence of surgery
Duration of hospitalization
Cost of surgery
Purpose of investigation / treatment done before
surgery
Necessary arrangement about financial
matters,works,hospitalization.
17. 2. Eradicate fear of operation from
the patient.
Ask question & clear doubts
Introduction to other patients who had
similar surgery
Explain about anesthesia
Answers all question in their language
The patient see the person,place,equipment
involved in operation
Start procedure with explanation.
18. 3)Meet the spiritual needs of the patients
Help the patient to meet the ministers of his
religion.
4)Obtain informed consent
Take sign of patients or relatives
Explain complication
19. 5)Build up the general health of patients &
Correction of disease process for speedy
recovery
Assist doctor to carry out physical examination
Take whole history
Carry out investigation
Arrange for blood donors
Diet to be adjusted to correct under
weightoverweight
Fluid administered if dehydrated
20. 6)Preoperative teaching
Stop smoking
Maintain personal hygiene
Deep breathing & coughing exercise
Exercise of limbs
Control of visitors to prevent infection.
21. 7)Surgical preparation of the skin:
Check type of operation &area &prepared
Check cleanliness of the skin lesions
Wash hands
Shave skin
22. 8)Preparation of patients on the evening
before surgery:
Remove jewellery & hand over to relatives
Get order from doctor
Give medication as per order
Shave the part of operation
Paint area of operation
Enema is ordered
Light diet & fasting after midnight is advised to
prevent vomitting & aspiration(6-8hrs prior to
surgery)
Diazepam for good sleep
Remove fear & anxiety
23. 9)Preparation of patients on day of
surgery:
Help patients to go toilet & for mouth wash
Remove jewellery
Comb hair and tie
Fasting before surgery
Bowel preparation
Clean operation site
Paint area of operation
Cover operation site with sterile towel
Introduce naso gastric tube, catheter etc.
24. 10)Sending patients to Operating Room
Administer pre medication before 1hr of
surgery
Check vital signs
Change O.T dress
Bind identity band on hand
Ask to patients to void just before surgery
Transfer to O.T
Never leave patient alone
Sent patients with reports& charts.
25. 2. INTRA OPERATIVE PHASE
Is the period from the time the client is shifted to
operating table & later admitted to the post
anesthesia care unit or recovery room.
Intraoperative nurses are responsible for the safety
and well-being of the patient, the cordination of
operating room personnel and activities of
circulating nurse and scrub nurse
26. Groups of personnel
involved in the care
during Intra-
Operative Phase
1)Anesthesia team
2)Surgical team
3)O.T room nurses
27. The basic design principles which are common to all
operating rooms must fulfill the following criteria:
1.The design must always be simple and easy to keep it clean
2.Wall and floor surfaces should be smooth and made of
nonporous materials
3. In order to prevent cross – contamination, there should be
separate rooms for clean or sterile instruments and soiled
ones.
4.There should be sufficient space to ensure the safe
transportation of patients and staff.
5.The layout of the department should be convenient for the
supervisor to control the incoming and outgoing traffics.
6.The recovery room should be near the operating room, so
that patients can be transported safely and quickly
following surgery.
30. A. Unrestricted Area
Street cloths are permitted.
It serves as an outside-to-inside access area.
B. Semi restricted Area
Limited to properly attired (dressed) personnel
Body and head coverings are required
This area includes peripheral support areas and
access corridors to the operating rooms.
The patient may be transferred to a clean inside
stretcher on entry to this area
The patient’s hair must be covered
31. C. Restricted Area
Masks are required to supplement surgical attire
Sterile procedures are carried out in this area
The area includes the operating rooms, scrub sink
areas and sub sterile rooms or clean core area(s)
where unwrapped supplies are sterilized.
32. Operating Room Team
• a. Surgeon
• b. Assistants to the surgeon
• c. Scrub nurse
Sterile team
• a. Anesthesia provider
• b. Circulator/ Runner nurse
• c. Others, such as students, cleaners.
Unsterile team
33. ROLE OF SCRUB NURSE BEFORETHE
OPERATION:
Collect the equipment & linen
Gowning & gloving
Draping trolley
Collect suture material ,needles ,blades ,mops ,gauze
cotton .
Check patients identity with O.T list
Ensuring safe positioning of patients.
34. ROLE OF SCRUB NURSE DURING OPERATION
Skin preparation agents & swabs
Assisting in draping
Positioning table
Arranging diathermy & suction
Passing instruments ,suture ,swabs to doctor
Count extra instruments
Maintain discipline& minimum disturbance
35. ROLE OF SCRUB NURSE AT THE END OF
OPERATION
Confirming instruments
Collect dressing materials from circulator
Removing draps
Disposing the blades, needles
Clean perioperative area
Cover patient with clean sheets
Returning instruments for washing &
Sterilization
Completing entries in the operation registers.
36. ROLE OF CIRCULATORY NURSE BEFORE
OPERATION
Who helps the scrubbed nurse & available through
procedure
Check O.T clean
Equipment are working condition or not
Check light, suction and other machine
Ensuring the temperature & humidity controls are
correctly set
Collect necessary stocks
Prepare sterile gown & gloves
Assists with counts & records.
37. ROLE OF CIRCULATORY NURSE DURING
OPERATION
Being available in O.T
Connect machine
Disposing of used swabs or other materials
Ensuring doors close
Anticipating the requirements of the team
Preparing wound dressings
38. ROLE OF CIRCULATORY NURSE AFTER
OPERATION
Handing dressing to scrub assistant
Help in removal of drapes
Help in shift patient
Ensuring clean the theater & prepared for
next patient
Removing instruments trolley
39. Post operative period begins as soon as the
operation is completed. It is described as the
period of 1-4 hours after surgery.
The Post-Anesthesia Care Unit (PACU), also
called the post anesthesia recovery room, is
located adjacent to the operating rooms.
40. PHASES OF POSTANESTHESIA CARE
Post-Anaesthesia care is divided into two phases.
Phase I PACU:
Used during the immediate recovery phase,
Intensive nursing care is provided.
Phase II PACU:
Is reserved for patients who require less frequent
observation and less nursing care.
The patient is prepared for discharge.
May also be referred to as step-down, sit-up, or
progressive care units.
Patients may remain in a phase II PACU unit for as
long as 4 to 6 hours, depending on the type of
surgery and any pre-existing conditions of the
patient.
41. 1) Preparation of post anesthetic bed &
reception of the patient:
Prepare bed without disturbing functioning of
the devices
Receive patients on bed without complication
Ask about operation to theatre staff nurse
Check vital signs
Compare records
Check operation sites
Never leave patient alone
Give treatments as per dr.order.
42. 2)Care of patients who is under the
effects of anesthesia
Close observation until patient recover
Noisy breathing indicate airway obstruction so
do suction
Give suitable position to prevent vomits &
aspiration
Cyanosed then administer oxygen
Put side rails
While awakening from anesthesia orient patient
Ask for drinking water
Informed successfully completion of surgery
43. 3)Observation of patient in post operative
period
Need close observation to find out complication
2 hrly check vital sign ,intake output, bowel
movements ,pain ,breathing difficulty ,
operation sites.
44. 4)Care of wounds
Promote intake of foods high in protein and vitamin C.
Prevent infection that delays healing.
Change soiled wet dressings immediately.
Use strict aseptic technique when changing dressings.
Cover moist dressings with a dry sterile cover.
Surgical wounds because they are aseptically created,
generally heal well and quickly. Dressings over closed
wounds are usually removed by 3rd or 4th day.
45. 5)Health teaching:
Maintain personal hygiene
Diet: normal diet, clear fluids, soft diet etc.
Medication
Next visit
Ambulation activities
Prevention of complication
48. Sr
no
parameters assessment
1 Airway Patency, presence/ adequacy of artificial
airway
2 Vital sign Respiratory rate: depth, character, heart rate
(pulse, pulse oximeter or cardiac monitor)
blood pressure (cuff or arterial line)
3 Pressure
reading
Pulmonary artery wedge pressure, central
venous pressure (CVP) , intracranial pressure
4 Level of
consciousne
ss
Ability to follow commands, sensation and
ability to move extremities following
regional anaesthesia
5 Patient
position
Position to facilitate breathing , to prevent
pressure on body parts or invasive lines and
to promote comfort
49. Sr
no
parameters Assessment
6 Tissue
oxygenatio
n
Skin : color, temperature, moisture. Nail
beds: color , capillary refill. Lips / oral
mucosa: color pulse oximetry. peripheral
pulse: presence strength
7 Dressing/
suture line
Dressing: dry or minimal drainage, suture
line(if visible) color approx. of wound edge.
8 Fluid lines/
tube
IV fluids : rare, amounts in
bottle/bag/infusion site other lines (e.g. CVP
line, arterial line); patency, connection,
character and amount of drainage. Ryle’s
tube drainage tube, urine output, quality
and color . Note and record fluids coming
out of dressing.