1. Perioperative nursing Care
Adult health nursing
351
Lecturer Name
year

2. Outline Preoperative nursing care Intra operative nursing care
Postoperative nursing care

3. Preoperative Preparation
1. Preparing the person the evening before surgery
Bathing or scrubbing a local skin area with an antiseptic
The surgeon will usually specify the site for a local skin scrub if indicated
Restricting food and fluid: nothing per mouth (NPO) after midnight

4. Preoperative Preparation
1. Preparing the person the evening before surgery
Perform enema for GIT surgeries only
Promote rest and sleep through:
A well ventilated room
Comfortable, clean bed
Back rub
Warm fluid
Sleeping medication as doctor order

5. Preoperative Preparation
2. Preparing the person on the day of surgery
Make sure the patient has had no solid food for at least 6 hours and no water for at least 2 hours before surgery.
Make sure the chart contains all necessary information, such as signed surgical consent, diagnostic test results, health history, and physical examination.

6. Preoperative Preparation
2. Preparing the person on the day of surgery
Tell the patient to remove jewelry , makeup, hairpins and nail polish.
Perform mouth care.
Ask the patient void
Put on a surgical cap and gown.

7. Preoperative Preparation
2. Preparing the person on the day of surgery
Instruct patient to remove dentures or partial plates, contact lenses, glasses, or prostheses (such as an artificial eye). You may remove his hearing aid. However, if the patient wishes to keep his hearing aid in place, inform operating room and PACU staff of this decision

8. Preoperative Preparation
2. Preparing the person on the day of surgery
Take and record vital signs.
Make sure the informed consent form is signed by the patient or a responsible family member
The site of surgery should be marked with a permanent marker by the surgeon.

9. Preoperative Preparation
2. Preparing the person on the day of surgery
Check for and carry out special orders (administering enema, NGT insertion, IV line)
Check the identification band
Administer preoperative medication as ordered.

10. Perioperative Medication
Types:-
Opiates- Morphine
Anticholinergics: Atropine (reduce resp. Tract secretions and prevent sever reflex of slowing of heart)
Opiates- Morphine, Demerol
Anticholinergics-Atropine, Robinul, scopolamine, - reduce resp. Tract secretions and prevent sever reflex of slowing of heart
Barbiturates-tranquilizers - Pentobarbital (Nembutal) and other hypnotic - night before ensure rest
Prophylactic antibiotics- just before or during surgery - bacterial contamination is expected; given before skin incision; lover GI - bowel surgery colon’s microflora.

11. Perioperative Medication
Types:-
Prophylactic antibiotics: just before or during surgery
Purpose:- Facilitate effective anesthetics, minimize respiratory tract secretions and relax, reduce anxiety.
Opiates- Morphine, Demerol
Anticholinergics-Atropine, Robinul, scopolamine, - reduce resp. Tract secretions and prevent sever reflex of slowing of heart
Barbiturates-tranquilizers - Pentobarbital (Nembutal) and other hypnotic - night before ensure rest
Prophylactic antibiotics- just before or during surgery - bacterial contamination is expected; given before skin incision; lover GI - bowel surgery colon’s microflora.

12. Common nursing diagnosis in preoperative phase
Knowledge deficit
Anxiety related to surgical operation
Disturbed sleep pattern related to unfamiliar environment and outcome of surgery

13. Nursing diagnosis
1. Anxiety related to results of surgery and postoperative pain.
Goal: the patient will decrease level of anxiety
Nursing intervention:-
Activities that decreasing anxiety are deep breathing, relaxation exercises, music therapy, massage and animal-assisted therapy.
Administer medication to relieve anxiety as doctor orders

14. Nursing diagnosis Nursing intervention:-
Explain the surgical procedures for patient
Allow the patient to ask questions
Reassessment

15. Nursing diagnosis
2. Knowledge deficit related to the preoperative procedure
Goal: the patient will explain the preoperative procedure
Nursing intervention:-
Explain the surgical procedures for patient
Explain the preparation of operation for patient

16. Nursing diagnosis Nursing intervention:-
Instruct the patient about type of anesthesia is planned, such as general, regional, or balanced
Teach patient measure to decrease postoperative pain
Teach patient postoperative care, including diet, mobility, leg and deep breathing exercises, Range of motion exercises and treatments.

18. Intraoperative care
Intraoperative: includes the entire duration of the surgical procedure, until transfer of the client to the recovery area.

19. Intraoperative Anesthesia
It is an artificially induced state of partial or total loss of sensation, occurring with or without consciousness.
There are three types of anesthesia:
General
Regional
local

20. Intraoperative Anesthesia
General anesthesia
Blocks awareness centers in the brain
• Produces unconsciousness, body relaxation, and loss of sensation
• Is administered by inhalation or I.V. infusion

21. Intraoperative Anesthesia
2. Regional anesthesia
Inhibits excitatory processes in nerve endings or fibers
Provides analgesia over a specific body area
Doesn’t produce unconsciousness
Is administered by spinal or epidural

22. Intraoperative Anesthesia
3. Local anesthesia
Blocks transmutation of nerve impulses at the site of action, analgesia over limited tissue area and doesn’t produce unconsciousness
Is administered by topical

23. Intraoperative Staff Surgeon, surgical assistant Anesthesiologist
Holding Area Nurse
Circulating Nurse
Scrub Nurse/Surgical Technologist (ORT’s)
Specialist Nurse
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

24. Role of nurse in operating room
Operating room responsibilities are divided between the scrub nurse and the circulating nurse
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

25. Role of nurse in operating room
Scrub nurse
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

26. Role of nurse in operating room
Scrub nurse
Perform surgical hand scrub, wear sterile gloves, gown, and mask before the operation
Sets up the sterile table, prepares and counts sutures and special equipment
Provides help to the surgeon and his assistants throughout the operation.
Assists in draping and skin preparation
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

27. Role of nurse in operating room
Circulating nurse
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

28. Role of nurse in operating room
Circulating nurse
Nosocomial, surgical team, not break sterile field.
Anesthesians – monitor level of consciousness, sensation, movement, cardiopulmonary function, vs, IV, I&O, possible blood components

30. Postoperative nursing care
Postoperative: begins with admission to the recovery area and continues until the client receives a follow up evaluation at home, or is discharged to a rehabilitation unit.

31. Postoperative phases Immediate ( post-anaesthetic ) phase (1)
Intermediate ( hospital stay ) phase (2): starts with complete recovery from anesthesia and lasts for the rest of the hospital stay.
Recovery ( after discharge to full recovery )

32. Aim of phases 1 & 2 Homeostasis Treatment of pain
Prevention & early detection of complications

33. Postoperative Nursing Care
1. Immediate postoperative care “recovery room”
- In this stage the patient is assessed every 10 to 15 minutes initially
level of consciousness; orientation, sensation, ability to follow command, pupillary response and ability to move extremity following regional anesthesia
Respiratory Status - patent airway and ability to deep breath and cough

34. IMMEDIATE POST-OPERATIVE PERIOD

35. Postoperative Nursing Care
Immediate postoperative care
a. Assess patient for the following items:
Cardiovascular: regular, strong heart rate and stable BP ; peripheral pulses
Position of patient
Safety: need for side rails, draining tubes unobstructed
Assess patient’s pain
Wound condition: including dressings and drains

36. Postoperative Nursing Care
Immediate postoperative care
Presence of IV lines
Drainage system such as nasogastric, chest, urinary)
Ability to void Urinary output > 30 ml/hr
Fluid balance, including IV fluids, output from catheters and drains

37. Postoperative Nursing Care
B) Respiratory Care according to patient condition:
O2 mask.
Ventilator.
Tracheal suction.
Chest physiotherapy.
C) Position in bed and mobilization:
Turning in bed usually every 30 min. until full mobilization.
Special position required sometimes.
DVT prevention mechanically through leg and calf muscle exercise.

38. Postoperative Nursing Care
D) Diet:
NPO until return the bowel movement then:
Liquids, Soft diet and finally Normal or special diet.
E) Administration of I.V. fluids according to Daily requirements.
F) Administration of Medication such as Antibiotics, analgesic or sedatives.

39. The Intermediate Post-Operative period (phase 2)

40. Postoperative Nursing Care
- The following are the criteria for patient discharge from recovery room:
Demonstrate quiet respirations
Be awake or easily aroused to answer simple questions
Have stable vital signs with a patent airway and spontaneous respirations
Have a gag reflex
Feel minimal pain

41. Postoperative Nursing Care Assessment
Ongoing Assessment
Respiratory function
General condition
Vital signs
Cardiovascular function
Fluid input and urine output and fluid balance chart
Pain level and characteristics
Bowel and urinary elimination
Surgical site and wound drainage systems
Intravenous sites for patency and infusions for correct rate and solution

42. Postoperative Nursing Care Assessment
Monitor vital signs including Blood pressure, Respiration, Pulse rate , O2 saturation and Temperature :
15mins for first hour
30mins for next 2hours
Hourly for next 2
Then if stable 4 hourly While monitoring these vital signs it is also important to observe (look, feel, listen)

43. Postoperative Nursing Care
Nursing Diagnosis
Risk for altered respiratory function related to immobility, effects of anesthesia, analgesics and pain.
Pain related to surgical incision and manipulation of body structures.
Nausea and vomiting related to effects of anesthesia or side effects of narcotics.

44. Postoperative Nursing Care
Nursing Diagnosis
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.

45. 1. Pulmonary care
Encourage changing position at least every 2 to3 hours for bed patient
Encourage deep breathing and coughing exercises every hour while he’s awake
Encourage worm fluid

46. 1. Pulmonary care
Encourage patient to use incentive spirometer for person at high risk for pulmonary complications
Monitor breath sounds until patient is ambulatory

47. 2. Care of the wound
Dressing can be removed 3-4 days after operation or according to hospital policy.
Wet dressing should be removed earlier and changed.
Symptoms and signs of infection should be looked
Good nutrition.

48. 3. Management of drains
The drains are used to drain fluids accumulating after surgery, blood or pus.
Should be removed as long as no function.
Should come out throw separate incision to minimize risk of wound infection.
Inspection of drain’s contents and its amount.

49. 4. Maintain nutrition
NPO until peristalsis returns, it is usually takes about 24hs.
Gradual return of oral feeding from liquids to normal diet.
Teach patients to select foods high in protein and vitamin C to enhance wound healing
Improve patient immunity through nutration

50. 5. Control pain
Teach pain relieving measures such as relaxation techniques and position changes
Splinting the incision may help the patient reduce pain when he coughs or moves especially following chest or abdominal surgery

51. 5. Control pain
Instruct the patient to use the bed’s side rails for support when he moves and turns. He should move slowly and smoothly, without sudden jerks.
Position patient in comfortable position
Administer analgesic as ordered

52. 6. Promote activity Encourage leg exercises for the bed patient
Encourage patient to carry out activity of daily life
Encourage progressive ambulation as soon as permitted
Avoidance of heavy lifting, pushing or pulling for at least 6 weeks after major surgery

53. 7. Maintain elimination
Encourage fluids and maximal activity within prescribed limits to prevent constipation
Use measures to encourage defecation if patient has not has a bowel movement 2 to 3 days after peristalsis returns

54. Thanks