N11 Perioperative Care

Perioperative Care and the Perioperative Care and the Nursing ProcessNursing Process

ObjectivesObjectives Review learned concepts related to Review learned concepts related to

Perioperative carePerioperative care Utilize the nursing process during Utilize the nursing process during

perioperative care of an adult individual perioperative care of an adult individual AssessmentAssessment Nursing diagnosisNursing diagnosis PlanningPlanning ImplementationImplementation EvaluationEvaluation

Perioperative PeriodPerioperative Period

Preoperative Intraoperative

Postoperative

Perioperative phasesPerioperative phases Preoperative Preoperative

From decision to have surgery to From decision to have surgery to the OR tablethe OR table

IntraoperativeIntraoperative From the OR table to PACUFrom the OR table to PACU

Post operativePost operative From PACU until client reach full From PACU until client reach full

healinghealing

Types of SurgeryTypes of Surgery

PurposePurpose DiagnosticDiagnostic PalliativePalliative Ablative (removal of a part Ablative (removal of a part

of a tissue)of a tissue) ConstructiveConstructive Transplant Transplant

Types of Surgery Types of Surgery

Degree of urgencyDegree of urgency Emergency Emergency ElectiveElective

Degree of riskDegree of risk Major Major Minor Minor

Factors affecting Degree of Factors affecting Degree of RiskRisk

AgeAge General healthGeneral health Nutritional statusNutritional status MedicationsMedications Mental statusMental status

Pre Operative PhasePre Operative Phase

Preoperative PhasePreoperative Phase Informed Informed ConsentConsent

Surgeons responsibility to acquire Surgeons responsibility to acquire thisthis

Nurse secures if consent is Nurse secures if consent is availableavailable

Following is given before consentFollowing is given before consent Nature and reason for the surgeryNature and reason for the surgery All available options and riskAll available options and risk Risk of surgery and potential outcomeRisk of surgery and potential outcome Surgeons informationSurgeons information Right to refuse consent or later Right to refuse consent or later

withdrawalwithdrawal

Pre opt AssessmentPre opt Assessment

Nursing HistoryNursing History

Nursing HistoryNursing History


Physical AssessmentPhysical Assessment Baseline physical status Baseline physical status

(Body system)(Body system) Vital signsVital signs Level of consciousnessLevel of consciousness


Screening tests and Diagnostic Screening tests and Diagnostic examinationsexaminations

Nursing Diagnosis Nursing Diagnosis

Deficient knowledge Deficient knowledge AnxietyAnxiety Disturbed sleep patternDisturbed sleep pattern Anticipatory grievingAnticipatory grieving Ineffective copingIneffective coping

PlanningPlanning

Major goalMajor goal To ensure client that the client is To ensure client that the client is

mentally and physically prepared mentally and physically prepared for surgeryfor surgery

NOC/NICNOC/NIC

Nursing Diagnosis: Nursing Diagnosis: Knowledge deficit regarding post opt deep breathing exercises r/t lack of exposure as manifested by: Verbalization of not knowing the procedure

well Performed inappropriate deep breathing

technique

NOCNOC NOC 1: Knowledge: Treatment Procedure NOC 1: Knowledge: Treatment Procedure

(1814)(1814) Extent of understanding conveyed about Extent of understanding conveyed about

procedure required as part of a treatment procedure required as part of a treatment regimenregimen

NICNIC Teaching: Preoperative (5610)Teaching: Preoperative (5610)

Assisting of patient to understand the mentally Assisting of patient to understand the mentally prepare for surgery and the postoperative prepare for surgery and the postoperative recovery recovery

Example ActivitiesExample Activities Instruct client on the technique of splinting Instruct client on the technique of splinting

incision during coughing and deep breathingincision during coughing and deep breathing Provide time for the client to ask questions and Provide time for the client to ask questions and

discuss concernsdiscuss concerns Evaluate the clients ability to return demonstrate Evaluate the clients ability to return demonstrate

deep breathing and coughing exercises deep breathing and coughing exercises

ImplementationImplementation

Preoperative Health TeachingPreoperative Health Teaching Four dimensions Four dimensions of preoperative of preoperative

teaching:teaching: Information: what and when (happen and Information: what and when (happen and

experience)experience)Psychosocial supportPsychosocial supportRoles of the client and support systemRoles of the client and support systemSkills trainingSkills training

Preoperative Preoperative Instructions/PreparationInstructions/Preparation

Explain needs for screening Explain needs for screening teststests

Bowel preparationBowel preparation

Skin preparationSkin preparation

Preoperative medsPreoperative meds

Therapies needed (IV, Therapies needed (IV, catheter, NGT, O2)catheter, NGT, O2)

Food and fluid restriction before Food and fluid restriction before surgerysurgery

Time of surgeryTime of surgery

Removing jewelry, make up etcRemoving jewelry, make up etc

Deep breathing, coughing, splinting, Deep breathing, coughing, splinting, leg exerciseleg exercise

Pre opt checklistPre opt checklist

Adequate rest and sleepAdequate rest and sleep

Pre opt MedicationsPre opt Medications

Special ordersSpecial orders

Intra Operative PhaseIntra Operative Phase

Intraoperative CareIntraoperative Care

Types of anesthesiaTypes of anesthesia General AnesthesiaGeneral Anesthesia

Is the loss of consciousness and all Is the loss of consciousness and all sensationsensation

Regional/Local AnesthesiaRegional/Local Anesthesia Is the temporary interruption of the Is the temporary interruption of the

transmission of nerve impulse to and transmission of nerve impulse to and from a specific area of the bodyfrom a specific area of the body

Intra Opt AssessmentIntra Opt Assessment

Nurse confirms the following in the as Nurse confirms the following in the as the client enters the OR:the client enters the OR: Confirms clients identityConfirms clients identity Assess the clients physical and Assess the clients physical and

emotional statusemotional status Verifies info in the pre operative Verifies info in the pre operative

checklistchecklist Evaluates knowledge of the surgeryEvaluates knowledge of the surgery

Response to pre operative medications is Response to pre operative medications is assessedassessed

Assess placement of tubes or any Assess placement of tubes or any contraptions contraptions

Intra Opt AssessmentIntra Opt Assessment

Vital signsVital signs ECG ECG O2 saturationO2 saturation Fluid intake and outputFluid intake and output OthersOthers

Nursing DiagnosisNursing Diagnosis Risk for AspirationRisk for Aspiration Ineffective ProtectionIneffective Protection Impaired skin integrityImpaired skin integrity Risk for Peri operative Position InjuryRisk for Peri operative Position Injury Risk for Imbalanced Body Risk for Imbalanced Body

TemperatureTemperature Ineffective Tissue PerfusionIneffective Tissue Perfusion Risk for Deficit Fluid Volume Risk for Deficit Fluid Volume

PlanningPlanning

Major goalMajor goal To maintain clients safety To maintain clients safety

and homeostasisand homeostasis

Intra Opt Nursing ActivitiesIntra Opt Nursing Activities

Proper Proper positioningpositioning Skin preparationSkin preparation Preparing and maintaining Preparing and maintaining

a a sterile fieldsterile field Open and dispense Open and dispense sterile sterile

suppliessupplies

Provision of Provision of medication and medication and solutions solutions

Aseptic environmentAseptic environment prep and prep and maintain maintain

Manage Manage contraptionscontraptions Perform Perform instrument countsinstrument counts DocumentDocument nx care provided nx care provided

and clients responseand clients response


Types of OR nurse based on Types of OR nurse based on activities/responsibilitiesactivities/responsibilities Scrub nurse: assist the surgeon by Scrub nurse: assist the surgeon by

draping the sterile field and handle draping the sterile field and handle sterile instruments sterile instruments

Circulating nurse: coordinates activities Circulating nurse: coordinates activities and manages client care and manages client care

Concepts to Remember!Concepts to Remember! Prepare and maintain Prepare and maintain

SURGICAL ASEPSISSURGICAL ASEPSIS Instrument countingInstrument counting Proper positioning forProper positioning for

Optimal visualization and Optimal visualization and accessaccess

Optimal access to IV and Optimal access to IV and monitoring devicesmonitoring devices

Protection of client to harmProtection of client to harm

Post Operative PhasePost Operative Phase

Immediate Post Opt Immediate Post Opt AssessmentAssessment

Adequacy of airwayAdequacy of airway O2 SaturationO2 Saturation Adequacy of VentilationAdequacy of Ventilation Cardiovascular statusCardiovascular status Level of consciousnessLevel of consciousness

Presence of protective reflexesPresence of protective reflexes Activity and ability of the extremitiesActivity and ability of the extremities Skin colorSkin color Fluid statusFluid status Condition of the operative siteCondition of the operative site

Patency and characteristic of the Patency and characteristic of the drainagedrainage

Discomfort, nausea, vomitingDiscomfort, nausea, vomiting SafetySafety

Indicators for discharged in Indicators for discharged in PACUPACU

Conscious and orientedConscious and oriented Maintain a clear airwayMaintain a clear airway Manage deep breathing and Manage deep breathing and

coughing coughing Vital signs stableVital signs stable Presence of protective reflexesPresence of protective reflexes

Move all extremitiesMove all extremities Adequate I/OAdequate I/O Normal temperatureNormal temperature Dry and intact dressingDry and intact dressing

Ongoing Post Opt CareOngoing Post Opt Care

AssessmentAssessment Level of consciousnessLevel of consciousness Vital signsVital signs Skin color and temperatureSkin color and temperature ComfortComfort Fluid balance Fluid balance Dressing Dressing Drains and tubesDrains and tubes

Glasgow Coma ScaleGlasgow Coma Scale

15 indicates alert and completely oriented15 indicates alert and completely oriented 7 or less comatose7 or less comatose

Ongoing Post Opt CareOngoing Post Opt Care

Usual Post Opt Rx Orders Usual Post Opt Rx Orders Oral intake permittedOral intake permitted IV solutions and medsIV solutions and meds PositionPosition MedicationsMedications Lab testsLab tests I/OI/O Activities permitted Activities permitted

Nursing DiagnosisNursing Diagnosis

Acute PainAcute Pain Risk for InfectionRisk for Infection Risk for InjuryRisk for Injury Risk for Deficient Fluid Volume Risk for Deficient Fluid Volume Ineffective Airway ClearanceIneffective Airway Clearance

Ineffective Breathing PatternIneffective Breathing Pattern Self Care DeficitSelf Care Deficit Delayed Surgical RecoveryDelayed Surgical Recovery Disturbed Body imageDisturbed Body image

NOC/NICNOC/NIC

Nursing Diagnosis: Ineffective Breathing Nursing Diagnosis: Ineffective Breathing PatternPattern Inspiration and Expiration that does not Inspiration and Expiration that does not

provide adequate ventilationprovide adequate ventilation As manifested by:As manifested by: Compromised RR, rhythm and ease of Compromised RR, rhythm and ease of

breathingbreathing Presence of adventitious breath soundsPresence of adventitious breath sounds

NOCNOC NOC1: Respiratory Status: Ventilation NOC1: Respiratory Status: Ventilation

(0403)(0403)

Movement of air in and out of the lungs Movement of air in and out of the lungs

NICNIC NIC1: Respiratory Monitoring (3350)NIC1: Respiratory Monitoring (3350)

Collection and analysis of patient data to Collection and analysis of patient data to ensure airway patency and adequate gas ensure airway patency and adequate gas exchange exchange

Sample NIC ActivitiesSample NIC Activities Monitor rate, rhythm, depth, and effort of Monitor rate, rhythm, depth, and effort of

expirationsexpirations Auscultate breath sounds, noting areas of Auscultate breath sounds, noting areas of

decreased/absent ventilation and presence decreased/absent ventilation and presence of adventitiuos soundsof adventitiuos sounds

Monitors ability to cough effectivelyMonitors ability to cough effectively


Pain managementPain management Positioning: depending on the type of Positioning: depending on the type of

surgerysurgery Deep breathing and Coughing exerciseDeep breathing and Coughing exercise Leg exerciseLeg exercise Moving and AmbulationMoving and Ambulation

HydrationHydration DietDiet Urinary eliminationUrinary elimination SuctionSuction Wound careWound care

Perioperative Care and the Nursing ProcessObjectivesPerioperative PeriodPerioperative phasesTypes of SurgeryTypes of Surgery Factors affecting Degree of RiskPre Operative PhasePreoperative PhasePre opt AssessmentSlide 11Slide 12Slide 13Nursing Diagnosis PlanningNOC/NICSlide 17Slide 18ImplementationPreoperative Instructions/PreparationSlide 21Slide 22Intra Operative PhaseIntraoperative CareIntra Opt AssessmentSlide 26Slide 27Nursing DiagnosisSlide 29Intra Opt Nursing ActivitiesSlide 31Slide 32Concepts to Remember!Post Operative PhaseImmediate Post Opt AssessmentSlide 36Slide 37Indicators for discharged in PACUSlide 39Ongoing Post Opt CareGlasgow Coma ScaleSlide 42Slide 43Slide 44Slide 45Slide 46Slide 47Slide 48Slide 49Slide 50Slide 51Slide 52

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N11 Perioperative Care