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Perioperative Nursing Care

Perianesthesia and
Perioperative Nursing
is the field of nursing that addresses the nursing
roles associated with the three phases of
surgical experiences : pre operative
postoperative and intraoperative

Preoperative Nursing Care:
• begins when the decision to proceed with
surgical intervention is made and end with the
transfer of patient to the operation table

Examples of nursing activities in the preoperative
phase include :
Pre admission testing
• Initial preoperative assessment
• Initiate teaching appropriate to patients needs
• Involve family in interview
• Verify completion of preoperative testing

Admission to surgical unite or center
• Complete the preoperative assessment
• Assess for risk of complications
• Report upnormal findings
• Verify that informed consent obtained
• Answers family questions
• Develop a plan of care

Others also in the holding area prior to the surgery

• Review patient chart

• Identify patient
• Verify surgical site
• Establish intravenous line eg canula
• Administer prescribed medications
• Provide support

Intraoperative Nursing Care

• Begins when patient is transferred to onto the operation

table and ends with admission to the post anesthesia care

Main nursing activities include

• Maintain safety
• Maintain aseptic environment
• Transfer patient to operation room or table
• Position the patient in correct alignment
• Ensure that instruments count are correct
• Complete documentation

Physiologic monitoring
• Calculate fluid loss or gain
• Distinguish normal and abnormal data
• Report changes in vital sign

Physiologic support
• Provide emotional support

Postoperative Nursing Care

• Begins when patient is admitted to the post anesthesia care

unite and end with follow up evaluation in home or clinical

Activities include

• Maintain airway
• Monitor vital sign
• Assess the effect of anesthetic agents
• Assess complications assess pain
• Promote recovery and initiate teaching
• Initiate discharge plan

Surgical classification ( according to

• Emergent : immediately with no delay eg sever


• Urgent: patient needs prompt attention must be done

within 24 hrs eg gall bladder infection and kidney stone
• Required : patient must have surgery within few weeks
or months eg cataract, Thyroid disorder
• Elective : failure to have surgery has some impact on
patient life but not very dangerous eg repair of scare
and simple hernia
• Optional : personal preference eg cosmetics
Preparation for Surgery

Informed Consent
• process for getting permission before conducting a healthcare
intervention on a person. A health care provider may ask a patient

Which procedures need informed consent ?

• Invasive procedure such as need anesthesia

• Non surgical procedure that carry considerable risk such as
• Procedures that involve radiation

Criteria for valid informed consent
• Voluntary
• Must be written
• Patient must be competent and able to comprehend
• In case of incompetent patient family member or law
representatives may give consent
• Should contain explanation of procedure
• Instruction that patient can withdraw consent
• Explanation that all patients questions would be
answered and if there is any significant notes such as
change in customary procedure

Assessment of health factor that affect patient
• Nutritional and fluid status
• Drug and alcohol abuse
• Respiratory status
• Cardiovascular status
• Hepatic and renal function
• Endocrine function
• Immune function
• Previous medication use
• Psychosocial factors
• Spiritual and cultural beliefs
Special situations
• Ambulatory surgery : patient discharge the
same day of surgery

• Obese patient

• Emergency surgery

Preoperative nursing intervention
• Preoperative teaching
• Deep breathing coughing exercise
• Teach patient how to promote mobility and active body
movement by frequent position
• Leg exercise
• Getting out of bed

• Pain management
• Coping strategies

• Reduce anxiety and fear

• Maintain patient safety
• Manage fluid status
• Prepare the bowel
• Prepare the skin

Immediate preoperative nursing interventions
• Administer pre anesthetic medications
• Maintain preoperative records
• Transport patient to the operation room