NCM116-RLE - OR PERIOPERATIVE NURSING
Refers to events during the entire
PERIOPERATIVE NURSING - Sir EF surgical period, from preparation for
surgery to recovery from the
CONDITIONS REQUIRING SURGERY temporary effects of surgery &
Obstruction - impairment to the flow anesthesia.
of vital fluid
Perforation - rupture of an organ 3 PHASES
Erosion - wearing off of tissue Preoperative
Tumor - abnormal new growth Intraoperative
Foreign body Postoperative
PURPOSES OF SURGERY PREOPERATIVE PHASE
Diagnostic - to establish diagnosis This phase begins when the decision
(Biopsy) for surgical intervention is made &
Exploratory - to estimate extent of ends with transfer of the client to the
disease or confirm diagnosis OR bed
(Exploratory Laparotomy)
Palliative - to relieve distressing signs PRE-OP NURSING CARE
& symptoms; not cure (Colostomy) Psychological preparations: fear&
Curative - to remove or repair anxiety, patient expectations after
Ablative: to remove a diseased organ surgery,
(Appendectomy) Physiologic: CP clearance, FBS, CBC,
Reconstructive: to restore (partially or ECG, x-ray
completely) a damage organ or tissue Physical: NPO. Laxative, enema, rest &
to its normal appearance & function sleep, pre-op checklist, pre-op meds
(Rhinoplasty, Perineoraphy) (sedatives, hypnotics)
Constructive: repair of congenital Teaching pre-op exercises: DBE,
defect (Hypospadia) coughing ex. Foot & leg ex.
Informed consent: clients voluntarily
TYPES OF SURGERY agrees to undergo a particular
According to risk involved procedure or treatment after having
Major: high risk, prolonged in OR, large received these information
amount of blood loss, post operative
complications may develop. EXTENSIVE PREOPERATIVE PHASE
RESECTION IS PERFORMED, a body Description of the procedure or
cavity is entered, normal anatomy is treatment
altered, organs are removed Name & qualifications of Person
Minor: little risk, not prolonged, fewer performing the procedure or
complications treatment
Explanation of the risks involved,
According to urgency including potential for Damage
Emergency: done without delay disfigurement or death
Imperative: performed ASAP within That the client has the right to refuse
24-48 hrs treatment
Planned or required: scheduled ahead
for patient’s well being NURSING CONSIDERATIONS
Elective: not absolutely necessary Surgeon explains everything
Optional: per request for aesthetic Must be written in understandable
purposes language
Permission is repeated for each not sterile touch only unsterile items
procedure or areas
Signed at least 24 hours before Unsterile persons avoid reaching over
elective surgery to a sterile field; Sterile persons avoid
Not be forced into signing leaning over to an unsterile are
Patient signs own consent if he/she is Edges of anything that encloses sterile
of age (18 years or older) mentally contents are considered unsterile
capable, or is an emancipated minor Sterile field is created as close as
(<18 but independent from parents) possible to the time of use
In emergency where client is unable to Sterile areas are continuously kept in
sign or there is immediate threat to view
life, effort should be made to contact Sterile person keep well within the
family & 2 surgeons sign the consent sterile area
Sterile person keep contact with sterile
INTRAOPERATIVE PHASE areas to a minimum
This phase begins when the client is Unsterile person avoid sterile areas
transferred to the operating room bed Destruction of integrity of microbial
& ends when the client is admitted to barriers results in contamination
the post anesthesia recovery area Microorganisms must be kept to an
irreducible minimum
NURSING CARE DURING SURGERY If in doubt of sterility of anything,
1. Providing emotional care consider it unsterile
2. Skin preparation
3. Assisting with client positioning ANESTHESIA
4. Maintaining surgical asepsis Partial or total loss of sensation of pain
5. Preventing client heat lost with or without loss of consciousness
6. Assisting surgical wound closure
7. Assessing drainage EFFECTS OF ANESTHESIA
8. Transporting the client to the post Analgesia: lessening or insensibility to
anesthesia or ICU pain
Hypnosis: artificially induced sleep
POSTOPERATIVE Amnesia: loss of memory
Begins when the admission to the post Muscle relaxation
anesthesia recovery area & ends with
resolution of the surgical sequelae. MAJOR CLASSIFICATION OF ANESTHESIA
General: causes total loss of sensation &
OBJECTIVE OF POST-OP CARE consciousness
Re-establishment of physiologic Inhalation: giving gas(cyclopropane) or
equilibrium liquid(halothane) in volatile form
Prevention of pain & complication Intravenous: pentothal sodium,
ketalar, innovar
PRINCIPLES OF SURFICAL ASEPSIS Rectal: used in minor procedures; does
Only sterile items are used within the not produce complete consciousness
sterile field
Gowns are considered sterile only from Regional: reduces all painful sensation in
the waist to shoulder level in front and one region of the body without inducing
the sleeves unconsciousness
Tables are sterile only at table level Topical
Person who are sterile touch only Local infiltration block
sterile items or areas; persons who are Saddle block: commonly used in
obstetrics
Nerve block: nerve plexus to Taper: needle body is round and tapers
anesthetize part of body smoothly to a point
Epidural block: below level of Cutting: needle body is triangular and
diaphragm has a sharpened cutting edge inside
Caudal block: produces anesthesia of Reverse cutting: cutting edge outside
perineum, lower abdomen Trocar point or tapercut: needle body
Spinal block: subarachnoid space is round and tapered, but ends in a
Agents used: lidocaine, procaine small triangular cutting point
(Novocain)
STAGES OF ANESTHESIA
SURGICAL SUTURES AND NEEDLES
2 KINDS
Absorbable: will break down
harmlessly in the body (10 days- 8wks)
Non-absorbable: not metabolized by
the body and should be removed after
weeks
NEEDLES
2 KINDS
Traumatic: with separate suture
thread
Atraumatic: eyeless needles attached CLASSIFICATION OF SURGICAL
to suture threads INSTRUMENTS
SHAPE Graspers: forceps, clamps and
Straight occluders (for blood vessels and other
Half curved organs)
¼ circle Retractors: used to open spread skin,
3/8 circle rib, and other tissues
Mechanical cutters: scalpels, lancets,
drill bits, rasps, trocars
Dilators: for access of narrow passage
or incision
Scopes/probes: include fiber optic
endoscopes and tactile probes