INTRA-OPERATORIO

Intraoperative care begins at the moment your child

enters the operating room and concludes when the surgery ends and the child
enter the recovery room. For most of the
Time, at this stage, your child will be asleep. Knowing what it is like
anesthesia process, what the operating room is like and who will be there
Operating room with your son can help you overcome some things.
fears. In the directory that appears below you will find
additional information about intraoperative care, regarding which
We provide you with a brief description.

Nurse attention during the intraoperative period

Know the surgical space and its environment.

Describe the figures and functions of nursing in the operating room.

Describe the roles and functions of operating room personnel.

Know the different types of anesthesia, advantages and disadvantages.

Identify the risk factors arising from the surgery and of the
anesthesia.

Nursing care for the family

PRE-OPERATIVE

The surgical act arises from the performance and evaluation of a history.
correctly prepared clinic.
Anamnesis, physical examination, and complementary practices.
Pre-existing pathology, usual medication, surgeries
previous

Physical examination: Semiology of the affected area, blood pressure,

pulse, auscultation

cardíaca, adenopatías, examen ginecológico, tacto rectal, examen

mammary, varicose veins, lung auscultation, skin and mucous membrane color,
alterations in eyes, nose, ears, throat, temporomandibular joint
maxilla, etc.
The assessment of the medical history allows for the classification of patients.
in the following categories according to the scale.

Assume the following steps:

• Diagnosis of the causal disease.

• Assessment of surgical and anesthetic risk.
• Preoperative preparation.

Currently, anesthetists use a series of scales to

determine the surgical risk of the patient.

The preoperative phase includes conducting a thorough interview.

with the patient, from whom we collected their personal history and
relatives, the current medication, when was the last intake, it
a physical examination by systems, tests
complementary (analytical, chest X-ray, ECG), and exams
special complements according to situations.

The elderly patient must be well hydrated before surgery.

You should drink at least two liters of water a day, and if we cannot
To ensure this intake, we must schedule therapy. This is how it is prevented.
the renal failure that we sometimes find in the perioperative period.

In front of a patient undergoing an emergency surgical procedure

we must try to get the best before the surgery
possible conditions, including hydration, infection prophylaxis
and prophylaxis of thromboembolism.

Due to the multiple expenses that healthcare faces today,

it is attempted that the postoperative period is carried out in a manner
ambulatory, as well as the pre-anesthesia consultation, in which it
assess the surgical risk.

PREOPERATIVE CARE

NURSING CARE DURING THE PREOPERATIVE PERIOD

The preoperative period encompasses the time frame.

since the patient is informed that their health issue has
to be surgically treated, he accepts this treatment and a
date for the surgical intervention until the patient is
transferred to the surgical area.

OBJECTIVES OF THE EVALUATION

The main objective is to collect data in order to identify the

risk factors and plan care to maintain safety
of the patient throughout the entire surgical experience. The objectives
of this valuation are:

Determine the psychological and emotional state to reinforce the

strategies for overcoming and achieving optimal conditions for
face the intervention and prevent possible complications
postoperative.

Determine the related and unrelated physiological factors

with the surgical procedure that can increase the risk
operational.

Identify the prescribed medications, the over-the-counter drugs

medical and the natural products that the patient takes and that can
change the outcome of the surgery or anesthesia.

Establish the baseline data for comparison during the period

preoperative and postoperative.

Identify the cultural or ethnic factors that may affect the

surgical experience.

Determine if the patient has received the surgical information

suitable for the surgeon to make an informed decision about the
surgery.
Nursing Assessment

The nursing professional collects data in the preoperative period.

for:

Obtain basic health data of the patient: physiological state before

of the surgery.

Determine the patient's expectations regarding the surgery and the

anesthesia.

To know the knowledge that the patient has of the facts that are
they are going to produce. Provide and clarify information about the
facts that are going to occur.

Assessment of emotional state and psychological preparation of the

surgery.

PARAMETERS TO OBSERVE AND EVALUATE

cardiovascular system
respiratory system
nervous system
urinary and fecal elimination system
hepatic system
skin and integument system
musculoskeletal system
nutritive system
-comfort. Pain assessment

SPECIFIC TEACHING PROGRAM FOR THE PREOPERATIVE PATIENT

About diaphragmatic breaths

Teach him to cough.
Postural changes every 2 hours.
Teach him to get out of bed
Exercises for the lower limbs

FINAL PREOPERATIVE PREPARATION. PROBLEM PREVENTION

Check that the identification band is secure and it is

legible.

-Remove hairpins and wigs: protect the hair with a hat.

Remove the jewelry.

Remove the nail polish.

Remove any prosthesis.

Do not forget the antithrombotic measures to prevent embolisms.

Make sure the patient urinates before the pre-anesthesia.

EVALUATION OF NURSING RECORDS: BEFORE THE PATIENT

GO TO THE OPERATING ROOM IS VERIFIED:

Well-done and verified skin preparation.

vital signs recorded
Premedication given and recorded.
Other medications given.
Weight and height recorded.
Consent for the intervention signed.
Complete medical history with preoperative tests.

TRANSFER TO THE OPERATING ROOM PATIENT: NURSING MUST INFORM THE

PATIENT'S FAMILY ABOUT:

Where to wait until the patient returns to the room.

Where is a café or similar place?
Time intervals for the planned surgery.
Place to receive information after the intervention.
What to prepare when the patient returns from the operating room.

POST - OPERATIVE
Care period that starts when the patient finishes the
surgery aims to complement the needs
psychological and physical conditions immediately after the surgery.

The awakening from anesthesia is often accompanied by sensations.

painful, depending on the type of intervention, so the periods
Postoperative procedures require special care.

The surgical therapist can be divided into three stages: preparation

preoperative, the intervention itself and the postoperative treatment,
which can be subdivided into immediate postoperative and
mediato. The term preoperative preparation refers to the arrangement of
operating room where the intervention will take place as well as the preparation
of the patient who is going to undergo surgery. The level of mental health of the
patient influences the success of the intervention and in the evolution
favorable postoperative period.

The fact of a surgical intervention represents for the patient

a physical aggression, with its consequent pain, and the lack of knowledge
the cause and the meaning of that pain creates anguish and
unease. It must be, therefore, and as far as possible,
duly informed of the type of operation, of the precautions of
success and the possible risks it entails and must be provided with a
preanesthesia medication that relaxes you and reduces your anxiety.

The immediate postoperative period begins once completed the

intervention: covers the next six hours, although it may
sometimes extending up to 36 hours. The patient is taken to the
post-surgical recovery room, where the specialized team
monitor your vital signs (consciousness, respiratory rate,
blood pressure and pulse) continuously.

The immediate postoperative period - is equivalent to the time that passes

since the patient has been taken to the room or hall (24 or 48
hours after the operation) until the day he is discharged.
During this period, vital signs are monitored more closely.
spaced out and intestinal transit must be restored and restarted
normal diet by oral route. Likewise, control is essential.
frequent of the temperature and of the surgical wound

POSTOPERATIVE CARE

General nursing actions postoperatively in the unit

surgical hospitalization
This period begins when the patient has recovered from the
anesthesia and stabilized in his postoperative state is transferred to the
hospitalization unit.

As soon as it has been placed on the unit bed, the

The nursing professional will conduct a quick assessment of
patient's situation regarding:
Record vital signs every half hour during the
first hours.
Evaluate the permeability of the airways and the need for
aspiration.
Evaluate the general respiratory state: depth, rhythm and
characteristics.
Observe the condition of the skin in terms of temperature and color.
Evaluate the surgical dressing and the drains if there are any.
Assess blood losses if there are any.
Conduct a neurological assessment every 15 minutes, to
check the sensory and motor responses and the level of
consciousness.
Control all catheters, dressings, and bandages.
Control the loss of fluids through any of the routes
exit, dressings, drains, and probes.
Control the diuresis at least every half hour.
Assess the need to catheterize the patient if the bladder is
relaxed and if not urinating within 6-8 hours after surgery.
evaluate and alleviate the presence of pain, nausea, and vomiting.
control the effects of the administered medication.
Place the patient in a comfortable position that facilitates the
ventilation.
Keep the family informed.
Evaluation of the surgeon's postoperative guidelines and the
anesthetist. After carrying out the complete initial assessment
of the patient and meet the most immediate needs, the
the nursing professional will authorize the visit of family members for
to explain to them:
How is the patient doing?
If the vital signs are stable.
Objectives and observation of the different drainage systems.
Intravenous routes of the solutions.
Numbness of the patient.
Notify the professional immediately of any changes.
nursing.

POSTOPERATIVE PROBLEMS AND DISCOMFORTS REQUIRING CARE

NURSING

The patient presents a series of discomforts and problems of various kinds.

entity, which can be relieved by medical treatment and the
appropriate nursing care. These can be a cause of
complications if not treated in time.

PAIN
Identify the location.
Informing about the pain in the throat.
To inform you of possible discomfort and joint pain.
Interpret in depth their respiratory function before and after the
administration of analgesics.
Analyzing the persistence of acute pain for several days can
to be indicative of surgical infection.

HYPOTHERMIA
60% of patients experience having a temperature
central inferior to normal limits. A generalized hypothermia
it occurs when the patient has a temperature below 35ºC
during the postoperative period with a slight increase for 24-48 hours.
Immediately start the heating measures, active and
passive measures to prevent the onset of chills and tremors.

HYPERTHERMIA
Hours after the surgery, you may experience slight
temperature rise, which can last for 24-48 hours.
Start taking temperature every 4-6 hours.

Nausea and vomiting

Frequent problem in the postoperative period. Caused by the
inadequate gastric emptying.
It can be caused by intense pain, abdominal distension,
fear, medications, eating and drinking before having resumed the
peristalsis, initiation of the nausea reflex, etc.
Tilt the patient's head to one side.
Place him/her in a lateral position.
Eliminate oral intake.
Indicate that she should hold the incision area with her crossed hands.
to relieve his pain.
Help him/her to maintain oral hygiene regularly.
Restart the oral diet once the vomiting has
missing.

URINARY RETENTION
- Frequent problem in the postoperative period. If there is retention of
the 8-10 hours after, the bladder will be palpated to see if
there is bladder distension and pain.
It can be caused by: effect of anesthesia, analgesic and
narcotic.
- Activities: help the patient to force diuresis through
irrigate the perineal area with warm water, let the tap water run, or
well, a little massage in the area. If these techniques do not work
the result will require probing the patient.

HIPPO
It is the result of intermittent spasms of the diaphragm, and it
manifests with a characteristic noise. It usually appears after surgery
abdominal.
The measures to relieve it are: hold your breath while you
drink sips of water, breathe the expelled air into a bag
of paper and digital pressure on the ocular globes during several
minutes.

POSTOPERATIVE COMPLICATIONS AND NURSING CARE

1. RESPIRATORY SYSTEM
Atelectasis: nursing will frequently aspirate secretions,
perform breathing exercises to induce coughing, make changes
postural every 2 hours, encourage walking and increase the
liquid intake.

- Pneumonia: nursing will administer antibiotics, physiotherapy

respiratory, postural drainage, deep breathing exercises and coughing,
sputum culture, etc.

2. CIRCULATORY SYSTEM
- Hypovolemic shock: nursing will replenish fluids to correct the
hypovolemia, will administer fluids, will monitor vital signs,
bladder catheters for monitoring diuresis and blood analysis, etc.
Thrombophlebitis: nursing will immobilize both actively and
passively the lower limbs will promote ambulation
precoz, it will avoid incorrect pressures or postures, will apply the
anticoagulant treatment, etc.

NURSING CARE AT HOSPITAL DISCHARGE Discharge usually occurs

during the 3rd to 5th day depending on:
Type of surgical intervention.
Conditions of physical and mental health.
Social-family conditions.
The nursing professional will plan their actions for discharge.
Regarding: an education program that includes: educating him to
that I carried out their self-care and with it their independence. There are aspects
common ones for which information will need to be provided and
teaching
care of the surgical wound.
Activity and exercise that the patient must perform.
Diet and dietary restrictions.
Urinary and fecal elimination.
POSSIBLE COMPLICATIONS THAT
CAN BE SUBMITTED IN THE LONG TERM
The teaching will be conducted verbally and practically, but it must be
reinforced with written documentation that will be provided to you before the
high.