Perioperative Nursing

By: Mr. Mark Anthony P. Placido, BSN, RN, RM, MAN

Phases of Perioperative Nursing

Pre-operative Phase
Extends from the time the client is admitted in the surgical unit, to the time he/she is prepared physically, psychosocially, spiritually and legally for the surgical procedure, until he/she is transported into the operating room.

Phases of Perioperative Nursing

Intra-operative Phase
Extends from the time the client is admitted to the operating room, to the time of administration of anesthesia, surgical procedure is done, until he/she is transported to the recovery room or post-anesthesia care unit (PACU).

Phases of Perioperative Nursing

Post-operative Phase
Extends from the time the client is admitted to the recovery room, to the time he/she is transported back into the surgical unit, discharged from the hospital, until the follow up care.

Sterile Aseptic Technique

A method by which contamination with microorganisms is prevented.

Is needed at all times in an operating room. Is the primary responsibility of everyone on a case or in the operating room during a case.

Asepsis
Freedom from infection. Absence of microorganisms that can cause disease.

It prevents contamination of surgical wounds either thru scrubbing, use of antimicrobial agents and scrubs suit.

Sources of Contamination
Members of the operating team. Patient All articles used in the wound and on the sterile set up. Dust in the air. Other personnel or visitors in the operating room.

Activities to reduce or eliminate bacteria:

Covering the mouth and nose. Clean operating room clothes and shoes, not worn outside operating room. Meticulous housekeeping practices. Proper methods of sterilization of all items used. Strict aseptic techniques in all details. Minimum of activity in the room and of movement in and out of it.

Surgical Conscience

Is the foundation upon which the growth and development of an operating room nurse is built.

Principles of Sterile Technique

All articles in an operation have been sterilized previously.

Persons who are sterile touch only sterile techniques; persons who are unsterile touch only the unsterile articles. If in doubt about the sterility of anything, consider it not sterile.

Principles of Sterile Technique

Unsterile persons avoid reaching over a sterile field; sterile persons avoid leaning over a sterile area. Tables are sterile only at table level.
Gowns are considered sterile only from waist to shoulder level in front and the sleeves.

Principles of Sterile Technique

The edge of anything that encloses sterile contents is not considered sterile.

Sterile persons keep well within the sterile area. Unsterile persons keep away from sterile areas.

Principles of Sterile Technique

Sterile persons keep contact with sterile areas to minimum. Moisture may cause contamination. When microorganisms cannot be eliminated from a field, they must be kept to an irreducible minimum.

Surgical Scrubbing
Is the removal of as many microorganisms as possible from the hands and arms by mechanical washing and chemical disinfection before taking part in a surgical procedure.

Purpose of Surgical Scrubbing

To prevent the possibility of contamination of the operative wound by microorganisms on the hands and arms.

Types of Scrubbing
1. Counted Brush Stroke Method This method dictates a specified number of strokes for each surface of the fingers, hands, and arms. It ensures complete and thorough coverage of all areas no matter how rapid the scrubbing is. 30 strokes for left and right fingernails. 20 strokes for all the skin surface.

Types of Scrubbing
2. Anatomical Timed Method It allows scrubbing each surface of the fingers, hands, and arms for a specified time using a prescribed anatomic pattern. It starts from 4 surfaces of each fingers; beginning with the thumb and moving from 1 finger to the next, down the outer edge of the 5th finger, over the dorsal surface of the hand, palmar surface of the hand or vice versa, from the small finger to thumb over the wrist and up the arm, ending 2 inches above the elbow.

Kinds of Scrubbing
1. Complete Scrubbing It usually takes 5 10 minutes. This scrubbing is done when: a. In the morning before the 1st gowning and gloving. b. Following a clean case if gloves have had a hole. c. Following a clean case if hands have been contaminated in any other way. d. Following a contaminated case before starting the next case like in ruptured appendicitis.

Kinds of Scrubbing
Sequence of this scrubbing for maximum of 10 minutes: a. Left hand for 1 minute. b. Left arm for 1 minute. c. Left elbow area for minute. d. Rinse brush. e. Right hand for 1 minute. f. Right arm for 1 minute. g. Right elbow area for minute. h. Rinse hands, arms, and brush well. i. Repeat the step from the start. j. Turn off water. k. Drop the brush into the sink. l. Proceed to the operating room.

Kinds of Scrubbing
2. Short Scrubbing It usually takes 3 5 minutes. This Scrubbing is done when: a. Following a clean case if the hands and arms have not been contaminated. b. To remove microorganisms that have emerged from the pores and multiplied while the gloves is worn. Sequence of this scrubbing for maximum of 5 minutes: a. Left hand for minute. b. Left arm for minute.

Kinds of Scrubbing
c. d. e. f. g. h. i. j. k. l. Left elbow area for minute. Rinse brush. Right hand for minute. Right arm for minute. Right elbow area for minute. Rinse hands, arms, and brush well. Repeat the step from the start. Turn off water. Drop the brush into the sink. Proceed to operating room.

Gowning
This is immediately done after surgical scrubbing and drying.

Purpose of Gowning
To permit the wearer to come within the sterile field and carry out sterile technique during an operative procedure. To protect the wearer from contact to the hazardous bodily fluids as medium of contamination.

Gloving
This is immediately done after gowning.

Purpose of Gloving
To complete the sterile dress, in order that the wearer may handle sterile equipments/instruments. To protect the hands of the scrub nurse from harsh antiseptics used in and near the operative field.

Types of Gloving

1. Closed Method 2. Open Method

Types of Surgery
1. According to Time Requirement 2. According to Purpose 3. According to Extent

According to Time Requirement

Optional Surgery
A type of surgery which is done at the preference of the patient. Surgery is not needed. Example: Liposuction Cosmetic surgery

According to Time Requirement

Elective Surgery
A type of surgery which is done at the convenience of patient as failure to have surgery is not catastrophic. Example: Excision of Superficial Cyst

According to Time Requirement

Planned/Required Surgery
A type of surgery which is done within a few weeks as surgery is important. Example: Cataract Extraction

According to Time Requirement

Urgent/Imperative Surgery
A type of surgery which is done within 24 to 48 hours. Example: Cancer Surgery

According to Time Requirement

Emergency Surgery
A type of surgery which is done immediately without delay in order to maintain life, remove damage and prevent complications. Example: Intestinal Obstruction

According to Purpose
Diagnostic Surgery
A type of surgery which is done to confirm a diagnosis. Examples: Excision and Biopsy Fractional Curettage

According to Purpose
Exploratory Surgery
A type of surgery which is done to estimate the extent of the disease and to confirm a diagnosis as well. Example: Exploratory Laparotomy

According to Purpose
Curative Surgery
a. Ablative Surgery
A type of curative surgery which is done to remove a diseased organ. Example: Hysterectomy

b. Constructive Surgery
A type of curative surgery which is done to repair a congenital defects. Example: Chieloplasty

According to Purpose
c. Reconstructive Surgery A type of curative surgery which is done to restore a damaged organ. Example: Episiorrhapy

According to Purpose
Palliative Surgery
A type of surgery which is done to relieves symptom but does not cure the disease. Example: Rhizotomy and Chordotomy (for pain relief) Myringotomy (for Otitis Media)

According to Extent
Major Surgery
An extensive surgery that involves serious risk and complications as it involves major organ.

Minor Surgery
- A type of surgery that involves minimal complications and minimal blood loss.

Commonly Used PreOperative Medications

Tranquilizer
It decreases anxiety and apprehension. It may cause confusion, clumsiness, dizziness as adverse reaction. Example: Diazepam (Valium)

Commonly Used PreOperative Medications

Sedatives
Promethazine (Phenargan)
It decreases anxiety and has an antiemetic effect. It may cause hypotension during and after surgery as adverse effect.

Commonly Used PreOperative Medications

Sedatives
Secobarbital Sodium (Seconal)
It decreases anxiety and promote sedation. It may cause disorientation as adverse effect.

Commonly Used PreOperative Medications

Analgesics
It is used to relieve pain primarily. It also decreases the anxiety level of the patient. It also promote sedation. It may cause Respiratory Depression as adverse effect. Examples: Morphine Sulfate Meperidine HCl (Demerol)

Commonly Used PreOperative Medications

Anticholinergics
It control secretions. It may cause excessive dryness of the mouth and tachycardia as adverse effect. Example: Atrophine Sulfate

Commonly Used PreOperative Medications

Histamine (H2) Receptor Antagonist
It inhibits gastric acid production. It may cause mild dizziness and diarrhea. Examples: Cimetidine (Tagamet) Ranitidine (Zantac)

Types of Anesthesia
General Anesthesia
It produces total loss of consciousness and sensation. It may also produced amnesia. Examples: Intravenous (Thiopental Sodium) Inhalation (Halothane and Isoflurane) Rectal (Methohexital Sodium)

Types of Anesthesia
Regional Anesthesia
It reduces all painful sensations in one region without inducing unconsciousness. Example: Topical, Field Block, Nerve Block, Local Infiltration, IV Regional, Spinal and Epidural Block

Stages of Anesthesia
Analgesia Stage
Loss of consciousness Client maybe drowsy or dizzy. May experience hallucinations.
Close the operating room doors. Keep the environment quiet. Stand by to assist client.

Stages of Anesthesia
Delirium/Excitement Stage
Loss of eyelid reflexes. Increase automatic activity. Irregular breathing.
Remain quietly by patients side. Assist patient if needed.

Stages of Anesthesia
Surgical Anesthesia Stage
Depressed vital functions. Client unconscious Muscles relaxed
Begin preparation. Client is under good control.

Stages of Anesthesia
Medullary Paralysis/Danger
Death/Disability Client may not be breathing. May not have heart beat.
Assist in resuscitation.

Pain
Any unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

Types of Pain
Acute Pain
Short duration (less than 6 months). Has identifiable, immediate onset and fast pain. Limited and predictable duration (selflimiting). Reversible or controllable. Elicits sympathetic symptoms (tachycardia, diaphoresis, guarding behavior, and tachypnea).

Types of Pain
Chronic Pain
Long term (usually more than 6 months). Continual, persistent and recurrent. Has identifiable cause; has qualities of slow pain. More difficult to treat. Has sympathetic adaptation but nurses should depend on clients report not on the sympathetic symptoms.