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Perioperative Nursing

O Presented by: Mary Cade T.

Operating Room
Surgical Environment
Unrestricted Area
- provides an entrance and exit
from the surgical suite for personnel,
equipment and patient.
- street clothes are permitted in
this area, and the area provides
access to communication with
personnel within the suite and with
personnel and patients outside the
Semirestricted Area
- provides access to the procedure
rooms and peripheral support areas
within the surgical site.
- personnel entering this area
must be in proper operating room
Restricted Area
- includes the procedure room
where surgery is performed and
adjacent substerile areas where the
scrub sinks and autoclaved are
- personnel working in this area
must be in proper operating room
Peri operative Nursing
OUsed to describe the
nursing care provided in the
total surgical experience of
the patient.
Peri operative Care

1. Pre operative Phase
OExtends from the time the
client is admitted to the
surgical unit to the time
he/she is prepared for the
surgical procedure until he
is transported into the
operating room.
2. Intra operative Phase
OExtends from the time the
client is admitted to the
OR , to the time of
administration of anesthesia
, surgical procedure is done,
until he/she is transported
to the RR/PACU
3. Post Operative Phase
OExtends from the time the
client is admitted to the
recovery room, to the time
he is transported back into
the surgical unit, discharged
from the hospital, until the
follow up care
Classification of Surgery
O 1. Major - surgical interventions which
involves major or multiple organs and
poses greater risk.

O 2. Minor - intervention which does not

involve a major organ and possess
lesser risk.
4 Major Types of Pathologic Process
Requiring Surgical Intervention

O Obstruction impairment to the

flow of vital fluids (blood,urine,
CSF, bile)
O Perforation rupture of an organ
O Erosion wearing off of a
surface or membrane
O Tumors abnormal new growths
Classification of Surgical Procedure

According to Purpose:
Diagnostic to establish the
presence of a disease condition
(e.g biopsy)

Exploratory to determine the

extent of disease condition (e.g
Curative to treat the disease
Ablative removal of an organ
Constructive repair of
congeniality defective organ
Reconstructive repair of damage
Palliative to relieve distressing
sign and symptoms not necessarily
to cure the disease
Types of Surgery
Classification Indication of Examples
Emergent requires Without delay -severe bleeding
immediate attention, -gunshot/stabwounds
life threatening -fractured skull
Urgent/Imperative Within 24 30 hours - Kidney urethral
patient requires stones
prompt attention
Required patient Plan within a few - Cataract
needs to have weeks or months - Thyroid
surgery within a few
Elective patient Failure to have Repair of scar
should have surgery surgery not Vaginal repair
(scheduled) catastrophic
Optional patients Personal preference - Cosmetic surgery
Informed Consent
O process of informing the patient
about the surgical procedure and
obtaining consent.

O legal requirement
Purposes of Informed Consent
O a. to ensure that the patient understands
the nature of the treatment, including
potential complications

O b. to indicate that the patient decision was

made without pressure

O c. To protect the client against

unauthorized procedure
O To protect the surgeon, health
care team and the hospital
against legal action by a client
who claims that an
unauthorized procedure was
Surgical risk factors
ONutritional status
OGeneral health
OMental status
According to Degree of Risk
O Major Surgery
- High Risk / Greater risk for
- Extensive
- Prolonged
- large amount of blood loss
- vital organ maybe handled or
Preoperative Phase
Preoperative Phase
Assessing and correcting
physiologic and psychologic
problem that may increase
surgical risk
Pre op assessment
O Physical status
O Physical examination
O Nutritional fluid status
O Respiratory status
O Cardiovascular status
O Hepatic and renal status
O Endocrine status
Peri operative phase
Nursing Assessment
O Patients history
O past surgical history
O Allergies
O Smoking and alcohol habits
O Emotional health
O Significant others support
O Pt and significant others understanding
to surgery
O Immune status
O Premedication history
O Diagnostic screening
and hydration
O nutrition

- npo 6- 12 hrs prior to

OCatheter insertion
OBowel preparation ( use of
enema or laxatives)
O Rest and sleep
O hygiene
O bath
O remove of cosmetics and nail polish
O remove all hairpins & clips
O remove dentures
O provide an OR gown
O Medications
Discontinue medications that are advised to
be discontinued
Administer preoperative medications

Special orders:
Ngt insertion
Skin preparation
Take care of patients belongings and remove
Preoperative Teaching
Incentive Spirometry
- Encouraged to use incentive
spirometer about 10 12 times per hour
- Deep inhalations expand alveoli, which
prevents atelectasis and other pulmonary
Diaphragmatic Breathing
- Refers to a flattening of the
diaphragm during inspiration, with
resultant enlargement of upper
abdomen as air rushes in. During
expiration, abdominal muscles
- in a semi-fowlers position, with
your hands loose fist, allow to rest
lightly on front of lower ribs
- breathe out gently and fully as the
ribs sink and inward toward midline
- then take a deep breathe through
the nose and mouth, letting the
abdomen rise as the lungs fill with air.
- hold breathe for a count of 5
- exhale and let out all the air
through the nose and mouth ( repeat
exercise 15 times with a short rest after
each group of 5)
-promotes removal of chest secretions
- interlace his fingers and place hands
over the proposed incision site
- lean forward slightly while sitting in
-breathe using diaphragm
- inhale fully with the mouth slightly
-let out 3-4 sharps hacks
-with mouth open, take in a deep
breath and quickly give 1-2 strong
- changing positions from back to
side lying (vice versa) stimulates
circulation, encourages deeper
breathing and relieve pressure areas
- help the patient to move onto his
side if assistance is needed
- place the upper most leg in a more
flexed position than that of the lower
leg and place a pillow comfortably
between the legs
- done every 2 hours
Foot and Leg Exercise
- Moving the legs improves
circulation and muscle tone
- Have the patient lie supine,
instruct the patient to bend a knee
and raise the foot hold it a few
seconds and lower it to the bed
- Repeat above about 5 times
with one leg and then with the
other. Repeat the set 5 times every
3-5 hours
- Then have the patient lie on
one side and exercise the legs by
pretending to pedal a bicycle

- For foot exercise, trace a

complete circle with the great toe
Turning to the side

- turn on your side with the

uppermost leg flexed most and
supported on a pillow

-Grasp the side rails as an aid to

maneuver to the side
Intra operative Phase
Transporting the
patient to Operating
OProper patient identification
OAdhere the principle of
maintaining the comfort and
safety of the client
Otransferring the patient from to
Intraoperative Phase
safe administration of
Communication in
Operating Room??

Surgical Team
Compose of..
O Primary responsible for the pre
operative medical history and
physical assessment
O Performance of the operative
O The primary decision maker
regarding surgical technique to use
during procedure
O May assist with positioning and
prepping the patient or may
delegate this task to other members
OAssistant Surgeon

O May be a resident, intern,

physicians assistant or a
perioperative nurse
O Assist with retracting, hemostasis,
suturing and any other tasks
requested by the surgeon to
facilitate speed while maintaning
quality during the procedure
O Anaesthesiologist
- selects the anesthesia, administers it,
intubates the client if necessary, manages
technical problems related to the
administration of anesthetic agents, and
supervises the clients condition
throughout the surgical procedure
- a pysicians who specializes in the
administration and monitoring of
anesthesia while maintaining the over all
well being of the patient
O Scrub Nurse
- maybe either a nurse or a surgical
- reviews anatomy, physiology and
the surgical procedures
- assist with the preparation of the
- scrubs, gowns and gloves self and
other members of the surgical team
- prepared the instrument table and organizes
sterile equipment for functional use

- assists with the draping procedure

- passess instruments to the surgeon and

assistants by anticipating their need
- counts sponges, needles and instruments
- monitor practices of aseptic technique in self
and others
- keeps track of irrigation used for calculation
of blood loss
O Circulating Nurse

- responsible and accountable for all

activities occurring during a surgical
procedure including the management of
personnel equipment, supplies and the
environment during surgical procedure

- patient advocate, teacher, research

consumer, leader and role model
- responsible for monitoring the
patient during the local
procedures if a second
perioperative nurses is not
- ensure all equipment is
working properly
- guarantees sterility of
instruments and supplies
- assist with positioning
- monitor the room and team
members for breaks in the sterile
- handles specimen
- coordinates activities with
other departments such as
radiology and pathology
- documents care provided
Principles of Surgical Asepsis
sterile object remains sterile only when
touched by another sterile object
only sterile objects may be placed on a
sterile field

a sterile object or field out of range of vision

or an object held below a persons waist is

when a sterile surface comes in contact with

a wet contaminated surface, the sterile
object or field becomes contaminated
fluids flows in direction of gravity
the edges of the sterile field or container
are considered to be contaminated ( 1 inch)
Postoperative Phase
Transport of patient to
from OR to Recovery
Post operative Phase
> maintain adequate body system
> restore homeostasis
> alleviate pain and discomfort
> prevent post op complication
> ensure adequate discharge
planning and teaching
Post operative Phase
O Initial Nursing Assessment
O Verify patients identity, operative
procedure and the surgeon who
performed the procedure
O Check patients vital signs (monitor until
O Monitor intake and output closely
O Monitor O2 status
O Monitor fluid volume (IV solutions as
O Maintain safety ( keep side rails up)
O Give medications as ordered
O Avoid exposure
O Avoid rough handling
O Avoid hurried movement and rapid
changes in position