PERIOPERATIVE NURSING

MANAGEMENT
• NURS 311(FUNDAMENTALS OF NURSING)

• BY

• YUNUSA AHMAD
 OUTLINE
• Introduction
• Definition
• Classification of surgery
• Pre-operative nursing care
• Intra-operative nursing care and introduction to
anaesthesia
• Post operative nursing care
• Conclusion
 PREOPERATIVE PREPARATION AND
POSTOPERATIVE CARE
INTRODUCTION
• Patient education is a vital component of surgical
experiences. Pre-operative patient education may be
offered through conversation
• The Nurse assesses the patient knowledge and use
this information in developing a plan for full peri-
operative care
 Perioperative care
• The client meets many health care personal including
surgeons, nurse, anesthesiologist, therapist all play a
role in the client care and recovery.
• The nurse must effectively communication with the
client and family because the nurse client relationship
is the foundation of care.
 Perioperative care
• The nurse assesses the client physical, emotional
and spiritual well being and cultural heritage,
recognizes the degree of surgical risk, coordinates
diagnostic test, identifies nursing diagnosis and
nursing interventions and establishes outcome in
collaboration with the client and with family.
 Definition
• Peri-operative nursing is a term used to describe the
nursing functions in the total surgical experience of
the patient, pre operative, intra operative, and post
operative (Lipincott Manual of Nursing Practice 6th
edition)
 Classification of surgery
The type of surgical procedure are classified
according to the following bases

a. Seriousness/Risks

b. Urgency

c. Purpose
 Classification of surgery
a. SERIOUSNESS: Major and minor
i. Major surgery Involves expensive reconstruction or alternation
in body parts . Poses great risk to well-being. E.g. Laparotomy
ii. Minor surgery Involves minimal alteration in body parts often
designed to correct deformities. It involves minimal risk
compared with major procedure. e.g. Cataract extraction,
facial plastic surgery, tooth extraction
 Classification of surgery cont
b. BASED ON URGENCY:
i. Elective
ii. Urgent
iii. Emergency
i. ELECTIVE:- It is performed on basis of Clients choice. It is
not essential and may not be necessary for health . e.g.-
facial plastic surgery , breast reconstruction(e. g Tranverse
abdominus myocutenious plaf (TAMCP)
 Classification of surgery cont
ii. URGENT: Is necessary for client health, may prevent additional
problem from developing (e.g. tissue destruction or impaired organ
function e.g.:- excision of cancerous famour, removal of gall
bladder for stone
iii. EMERGENCY:- Must be done immediately for save life or
preserve function of body part. e.g. Repair of perforated appendix,
Repair of traumatic amputation, Control of internal hemorrhaging.
 Classification of surgery cont
c. Purpose:
i. Diagnostic :- Is surgical exploration that allows
physician to confirm diagnosis. May involve removal
of tissue for further diagnostic testing e.g. Breast
mass biopsy
ii. Cosmetic :- Perform to improve personal
appearances e.g. Rhinoplasty to reshape noses
Classification of surgery cont

i. Constructive:- Restore function lost or reduced as

result congenital abnormalities e.g. Repair of cleft
palate , closure of arterial septal defect in heart
ii. Palliative:- Relieves or reduces intensity of
symptoms. e.g. colostomy, debridement of
necrotic tissue
Pre-operative care

• Pre-operative means before surgery

 ASSESSMENT
The aim of assessment of surgical client is to establish the
clients normal pre- operative function to assist the nurse in
prevention and recognizing possible post operative
complications.
• Medical history: Nutrition, past history, allergies, habits,
family history, age, obesity, fluid and electrolyte imbalance
and pregnancy
• Physical examination: general assessment/head to toe
examination, VS
• Diagnostic screening: blood investigation, radiological
investigation, ECG
 CONSENT
• Informed consent: Surgery cannot be legally or ethically
performed until client understands the need for a procedure,
the steps, risk, expected outcomes and alternative treatment.
• It is surgeons responsibility to explain the procedure and
obtain the informed content.
• After the consent form has been completed the nurse ensure
that the form is placed in the client record.
• Implied consent may be given if the patient is unconscious or
in case of children
 PRE-OPERATIVE CARE
• Pre –operative teaching The client education is an
important aspect of the client surgical experiences. The
nurse should provide client with information about
sensation typically experienced after surgery.
• Deep breathing:. The nurse then demonstrates how to
take a deep slow breath and now exhale slowly.
 PHYSICAL PREPARATION
• Maintenances of normal fluid and electrolyte
• A client will take nothing by mouth (Nil Per Os) 8-12 hours
• Promotional of rest and comfort
• Skin preparation is done
• Urinary catheter may be passed
• Intravenous line is set
 Psychological preparations
• Anxiety about the impending surgery can easily
interfere with ability to relax or sleep.
• The nurse should attempts to make the client
environment quite and comfortable.
 PREPARATION ON THE DAY OF SURGERY
• The nurse completes a number of routine procedures before
releasing the client for surgery
• Hygiene:- basic hygiene measure provide additional comfort
before surgery e.g. bath, provide clean hospital gown
• Removal of prostheses: the client must remorse all presence.
Including denture artificial limb hearing aids or contact lens
Cont
• Safeguarding valuables :- If client has any
valuables the nurse should give them to family
members of secure them for safekeeping
• Preparing the bowel and bladder :- The client may
required an enema or catheter the morning of
surgery to ensure that the colon is empty.
 Cont
• Vital signs:- The nurse measures final pre operative vital
signs. If pre operative vital signs are abnormal surgery may
need to be postponed
• Documentation: Before the client goes to surgery the nurse
choice the contents of the medical record, laboratory reports
and consent from check list
• Administering preoperative medication: Typically the
physician orders operative medication to be administered
 INTRA OPERATIVE SURGICAL PHASE
• The nurse conducts a focused pre operative assessment to
verify client is ready for surgery and plan.
• ACUTE CARE :-Physical preparation : After safely securing
the client on the operating room table, the nurse applies
monitoring devices to the client before surgery.
• Client for general and regional anesthesia undergo
continues ECG monitoring during surgery. Pulse oximetry
will be used to monitor oxygen saturation
 INTRODUCTION OF ANESTHESIA
• Client undergoing surgical procedure benefits from one of four
types of anesthesia, general, regional, local or conscious
sedation
• General anesthesia: It results in an immobile client who does
not recall the surgical procedure.
• The client amnesia acts as a protective measure from the
unpleasant feeling of the procedure.
• General anesthesia involves major surgical procedures
 Introduction to anaesthesia cont
• Regional anesthesia: Regional anesthesia resulting
of sensation in an area of the body
• The method of induction influences the potion of sensory
path way that are anesthetized
• No loss of sensation of consciousness
• Administration technique includes nerve block and spinal
or epidural
 Introduction to anaesthesia cont
• Local anesthesia
• Local anesthesia involves loss of sensation at desired
site E.g. (growth on skin or cornea of the eye
• Conscious sedation
• A systemic intravenous drug may be added to
infusion to maintain patient on continuous sedation
 POST OPERATIVE CARE
The nurse thoroughly documents the assessment
including
• Vital signs,
• Level consciousness
• Condition of dressing and drain,
• Comfort level
• All fluids status and Urinary output measurement
• Diseases are prone to developing complication such as
atelectasis or pneumonia
 Post-operative care cont
• Circulation: The client is at risk for cardio-vascular
complication resulting of actual or potential blood loss
from surgical site.
• Side effect of anesthesia, electrolyte imbalance and
depression of normal circulatory regulating mechanism
• Carefully assessment of heart rate and rhythm
 Post-operative care cont
• A common early circulatory problem is haemorrhage.
• Blood loss may occur externally through a drain or
incision or internally.
• Either type of haemorrhage resulting a fall in blood
pressure elevate heart and respiratory rate leading to
cool or pale skin and restlessness
 Post-operative care cont
• The nurse maintains IV fluid infusion

• The need to monitor vital signs every 15 minutes

• Oxygen may be administered if need be.

• Medications are administered.

 Post-operative care cont
• Temperature control: Temperature regulation is
important in the post operative period.
• Warmed blanket is used post operatively

• Maintain neurological function

• Orientation to environment is important in maintaining

the clients mental status
 Post-operative care cont
Maintain fluids and electrolyte balance :- An important
nursing responsibility is to maintain patency of IV
infusion in the post operative period
• Promoting wound healing

• Achieving rest, sleep and comfort

Conclusion

• Adequate preparation of patient for surgery is key

to success of the surgery
• Thank you.