Perioperatove nursing for nursing students 1 year as per INC

2. PERIOPERATIVE
NURSING
PRESENTED BY ;
P.RAMYA
B.SC NURSING – VII
SEM
CON- PIMS
SUBMITTED TO;
MRS. ANNE JENNEFER
ASST. PROFESSOR
DEPT OF CHN
CON -PIMS

3. INTRODUCTION
Perioperative nursing care is given before
(preoperative), during (intraoperative), and
after (postoperative) surgery. It takes place in
hospitals surgical centers attached to
hospitals , freestanding surgical centers or
health care providers offices . Perioperative
nursing is a fast paced , changing and
challenging field.

4. DEFINITION
Perioperative nursing refers to the role of the
nurse during the preoperative , intraoperative
and postoperative phases of a client’s surgical
experience the concept of perioperative
nursing stresses the importance of providing
continuity of care .

5. PHASES OF PERIOPERATIVE NURSING
PRE OPERATIVE –
• Begins – when the decision is made to
undergo surgical intervention.
• End– when the patient is transferred to the
operating table.

6. INTRAOPERATIVE PHASE –
• Begins – transfer of the patient to the
operating table
• End - time the patient is admitted to the
recovery phase

7. POSTOPERATIVE –
Begins – admission of the patient to the
recovery area which includes post anesthesia
care or ICU
End – when the surgeon discontinues follow up
care.

8. CLASSIFICATION OF SURGICAL
PROCEDURE
Surgery can be defined as the art and science of
treating diseases , injuries and deformities by
operation and instrumentation.
• BASED ON SERIOUSNESS
1. Major – involves extensive reconstruction or
alteration in body parts ; poses great risk to
well being.
Ex- coronary artery bypass , colon resection .

9. 2. Minor – involves minimal alteration in body
parts ; often designed to correct deformities;
involves minimal risks compared with major
procedures.
Ex- cataract extraction , tooth extraction

10. • BASED ON URENCY
1. Elective – performed on basis of patient’s
choice ; is not essential and is nit always
necessary for health .
Ex – bunionectomy , hernia repair , breast
reconstruction.

11. 2. Urgent – necessary for patient’s health ;
often prevents additional problems from
developing; not necessarily emergency .
ex – excision of cancerous tumor , removal of
gallbladder for stones .

12. 3.Emergency –must be done immediately to
save life or preserve function of body part
Ex- repair of perforated appendix or traumatic
amputation .

13. BASED ON PURPOSE
1. Diagnostic – surgical exploration that allows
health care providers to confirms diagnosis;
often involves removal of tissue for futher
diagnostic testing .
Ex – explorating laparotomy ( incision into
peritoneal cavity to inspect abdominal organs)

14. 2. ABLATIVE – excision or removal of diseased
body part.
Ex- amputation , removal of appendix.
3. PALLATIVE – relieves or reduces intensity of
disease symptoms , does not produce care.
Ex- colostomy , debridement of necrotic tissue.

15. 4. Reconstructive / restorative – restores
function or apperance to traumatized or
malfunctioning tissues.
Ex- internal fixation of fractures , scar revision.

16. 5. Procurement for transplant – removal of
organs and /or tissues from a person
pronounced brain dead for transplantation
into another person .
Ex- kidney , heart or liver transplant.

17. 6. Constructive- restores function lost or
reduced as result of congenital anomalies
Ex- repair of cleft palate , closure of atrial septal
defect in heart.
7. Cosmetic- performed to improve personal
appearance.
Ex- Blepharoplasty for eyelid deformities ,
rhinoplasty to reshape nose.

18. PREOPEARTIVE NURSING
THE PREPARATION OF THE PATIENT BEFORE
SURGERY
PSYCHOLOGICAL PREPARATION
The patient may tensed about his surgery
because of ignorance, feet etc , the nurse
should give psychological support to the
patient.

19. DISCUSS WITH THE PATIENT TO GIVE FEEL
INFORMATION ABOUT THE SURGERY SUCH
AS:
• Type of surgery
• Consequences of surgery
• The problems to be faced
• Expected duration of hospitalization.

20. Cont….
• Expected time of resuming duty
• Cost of surgery
• Treatment done before surgery and if
purpose.
• Necessary arrangement to be made about the
family , financial matters ,work hospitalization
etc.

21. ERADICATE FEAR OF OPERATION FROM THE
PATIENT
• Allows the patient to ask questions and clear
all the doubts
• Introduced to the patient some one who had
similar surgeries and successfully recovered
from the symptoms
• Explain what happens during anesthesia

22. Cont……
• Explain how to get rid of pain after surgery
• Till the patient when he can meals
• Answer all the questions asked by the patient
in a language he can understand.
• Let the patient see the persons , places and
equipments involved in this operation.
• Always short the procedures with an
examples.

23. Cont….
• For many patients their admission to the
hospital is a experience in their times; in such
situations,
The nurse should make them feel at home by
eradicating their fear.

24. MEET THE SPIRITUAL NEEDS OF THE PATIENT
The patient may what to see someone who is
near to him , allow him for that or if he wants
to go religious places allows him to go.

25. CHECK THE INFORMED CONSENT
• The nurse should check for an informed
consent from Patient /guardian for each
operation.
• Never compel them to give their consent
• They should understand the language used in
the consent form
• Explain the complications that may occur in
the period of anesthesia.

26. PRE OPRTATIVE TEACHING
• We should teach the patient to increase his
health by giving advice like
Stop smoking
Maintain personal hygiene
Deep breathing exercises and coughing
exercises
Active and passive exercises

27.  SURGICAL PREPARATION OF SKIN
• Help to reduce the number of micro
organisms present on the skin
• Reduces the possibility of wound infection
• Shave the area and clean the area with spirit
swab

29. PREPARATION OF THE PATIENT …
ON THE EVENING BEFORE SURGERY
• Remove all the jewelery and hand over them
to relative .
• Remove lipstick and nail polish
• Shave the area to be operated
• After shaving ask the patient to have a
through bath and dress in clean cloths
• Readdressed to prevent anxiety

30.  ON THE DAY OF SURGERY
• Help the patient to go the toilet and mouth
care
• Remove hair pins, clips ,ornaments , false
teeth ,etc
• Comb and tie the hair with ribbon
• Remind about the fasting
• Check the order for bowel elimination

31. Cont…..
• Introduce the nasogastric tube, urinary
catheter if ordered
• Stop all the medication unless specifically
ordered by the physicians.

32. SENDING THE PATIENT TO OPERATING ROOM
• Administer the premedication's to the patient
one hour before surgery
• Ask the patient to void just before sending to
the operation table
• Check the vital signs
• Check the patient details

33. Cont…..
• Transfer the patient on to a patient trolley and
cover him with clean sheets
• Never leave the patient alone on trolley
• Always send the patient charts with all reports
• Always send the patient with an attended up
to the operation theater.

34. INTRAOPERATIVE NURSING
NURSING CARE DURING SURGERY
• Assisting the patient with positioning (as
require and for type of surgery)
• Maintain safety
• Maintain surgical asepsis

35. Cont…..
• Assisting with the surgeons to perform surgery
by proving proper equipments(scrub and
circulatory nurse)
• Assist in draping
• Transferring patient to recovery room.

39. POSTOPERATIVE NURSING
• Final phase of the surgical experiences
• DIVIDED INTO TWO PHASES
Immediate post anesthesia period
Post operative period

40. IMMEDIATE POSTOPERATIVE PHASE
• First few hours after surgery
• When the client is recovering from the effects
of anesthesia
• Assess airway patency and support as needed
• Assess the presence of hoarseness, cramp,
strider , wheezes ,etc.
• Applies humidified oxygen via nasal cannula or
face mask

41. Cont…..
• Records vital signs
• Observe the client IV infusions, dressing ,
drains and special equipments.
• Assess the level of consciousness , muscle
strength.
• Remain at the client bedside
• Continuing close observation.

42. cont…..
• POSTANESTHETIC ASSESSMENT PARAMETER
• Airway
• Vital signs
• Level of consciousness
• Patient position
• Tissue oxygenation
• Dressing
• Suture lines and tubes .

43. PREPARATION OF POSTANESTHETIC BED
• After sending the patient to operating room
prepare a bed to receive the patient
undergone surgery.
• There should be adequate number of people
to transfer
• Receive the patient without disturbing the
devices attached to the patient
• Ask the theater for about any complications

44. Cont….
that occur during the surgery
• Before the theater staff check the vital signs
• Check the operation site for bleeding ,
discharge , etc
• Keep the patient well covered to prevent
draught.
• Never leave the patient alone to prevent
injury from fall

45. Cont……
• Observe the patient for swallowing reflexes
• Observe the functions of all devices
• Check the doctors order for other instruction
and treatment .

46. POSTOPERATIVE PERIOD
• Close and diligent observation by the nurse is
important to defect complication in the early
stages
• On the first day the patient need close
observation
Vital signs
Intake and output charts
Urine output

47. Cont…….
Bowel movements
Signs of hypovolemia
Any breathing difficulty
Pain over calf muscles

48. DIET OF THE PATIENT
• All patient , except patients who had
abdominal surgery may start the normal diet.
• Patient who had abdominal surgeries , can
have the clear fluids on the day after the
surgery
• Gradually , it can change into normal diet.

49. POSTOPERATIVE HEALTH TEACHING
• Maintain of personal hygiene
• Diet that is allowed for the patient , any
control on the diet
• Ambulation , activities that are permitted as
well as restricted.
• Drugs to be taken , and its side effects
• Date on which the patient may resume duty
• Next appointment and further treatment

50. conclusion

51. summary

52. refereance

53. assingenment

54. thankyou