Chapter 27 Perioperative Care

Introduction to Operative Care Perioperative care is care that clients receive before, during, and after surgery Nurses assume general responsibilities when caring for clients during the preoperative, intraoperative, and postoperative periods of perioperative care

Preoperative Period Starts when client, or his family in an emergency situation, learn that surgery is necessary (the physician decided that operation is required) Ends when client is transported to the operating room

Types of Surgery According to Urgency

Preoperative Period (cont’d) Inpatient surgery Term used for procedures performed on a client who is admitted to the hospital, expected to remain at least overnight, and needs nursing care for more than 1 day after surgery Clients who have inpatient surgery undergo prior laboratory and diagnostic tests

Preoperative Period (cont’d) Outpatient surgery Term used for operative procedures performed on clients who return home the same day

Preoperative Period (cont’d) Outpatient surgery (cont’d) Clients remain in the outpatient surgical suite for a brief time and get discharged by midafternoon or early evening when: The client is awake and alert Vital signs are stable Oral fluids are retained

Preoperative Period (cont’d) Informed consent Permission for a procedure that a client gives after an explanation of the risks, benefits, and alternatives

Surgical Consent Form

Preoperative Period (cont’d) Immediate preoperative care 1. Nursing assessment (Hx, physical assessment, understandig) Surgical risk factors Age Low Hgb & RBCs Cardiopulmonary disease Malnutrition Chronic Dz Dehydration

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Preoperative teaching Deep breathing (Atelectasis & pneumonia) Coughing Leg exercises (thrombus) Postoperative pain management

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Physical preparation Skin preparation Elimination (catheter, urinate, enema, laxatives_ Food and fluid restrictions (clear fluid 2, light breakfast 6, heavy meal8)

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Physical preparation (cont’d) Care of valuables Surgical attire; remove makeup Disposition of dentures and prostheses

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Preoperative medications Psychosocial preparation Preoperative checklist

Preoperative Checklist

Postoperative Period Immediate postoperative care (1st 24 Hrs) Initial postoperative assessments (PACU): LOC VS Effectiveness of respiration Condition of wound & dressing Drains IV solutions Pain Catheter

Continuing Postop care Preparing the room Monitoring for complications: Airway obs., Shock, Hypoxemia,…. Continuing postoperative care Food and oral fluid intake (When???????)

Postoperative Period (cont’d) Continuing postoperative care (cont’d) Promoting venous circulation ?????, Leg exercises, Antiembolism socks,leg elevation, fluid. Wound management (Reinforcement) Elimination

Pneumatic Compression Device

Postoperative Period (cont’d) Continuing postoperative care (cont’d) Discharge instructions How to care for the incision site Signs of complications to report Which foods to consume or avoid When and where to return for a medical appointment

Nursing Implications Applicable nursing diagnoses Deficient knowledge, fear, acute pain Risk for ineffective therapeutic regimen management, infection, impaired gas exchange, deficient fluid volume Ineffective breathing pattern, airway clearance Impaired skin integrity, disturbed body image