Perioperative Nursing Process

Ns. Heri Kristianto. SKep., MKepPart II

Standard AORN

1. Collect patient health data2. Analyzes the assessment data in

determining diagnoses3. Identifies expected outcomes unique

to the patient4. Develops a plan of care5. Implements the interventions6. Evaluates the patient’s progress

Assesment

Nursing Diagnosis

PlanningImplementation

Evaluation

Preoperative Intraoperative Postoperative

1. Assessment PreoperativeFocus assessment:• The patient’s understanding of events• Any acute & chronic conditions

experienced by the patient• The patient’s previous surgical experiences• The patient nutritional• Fluid and electrolyte• Emotional status

Physical Examination……….cont 1

• Cardiopulmonary function

• Bowel function

• Urinary function

• Nutritional status

• Physical limitations

Laboratory & Diagnostic Studies....cont 1

• Vital sign: temperature, pulse, respirations, blood pressure

• Hemoglobin & Hematocrit• White blood cell count• Blood typing and cross matching• Serum electrolytes• Urinalysis• Chest X ray• Electrocardiogram

Psychological assessment….cont 1

Anxiety :

• Reason

• Support system

• Coping mechanism

Visual Analog AnxietyThe VAS measuring fear of anesthesia correlated well with the STAI (Spielberger State-Trait Anxiety Inventory) score (r = 0.55; P < 0.01)

Intraoperative assessment• Review preoperative assessment• Assessment during surgical procedure:

vital signs, blood loss, skin color, drainage, sponges, instruments and sharps nurse perioperative

• Wound dressings, respiratory status, drainage tubes for patency, collection chambers for amounts, infusion lines

Postoperative assessment

• Vital signs, color, activity level, neurologic status

• Level consciousness, dressings and drainage, pain level, parenteral infusion, patient safety, type of procedure

Aldrette Recovery Scoring System

2. Nursing DiagnosesPreoperative• Focus: specific physical disease or injury

process requiring surgical intervention, ex: gas exchange, impaired, related to cancer of the lung

Intraoperative• General factor: specific procedure, type of

anesthesiaPostoperative• Complications of surgery, high risk nursing

diagnoses

Preoperative

Anxiety

Body image disturbance

Intolerance activity

Sleep pattern

High risk of injury

Knowledge deficit

•Skin integrity•Sedation

Intraoperative

Hypothermia

Impaired skin integrity

Fluid volume

Impaired gas

Decreased cardiac output

Tissue perfusion

High risk for injury

•Neuromuscular•Nasocomial•Tissue perfusion

Postoperative

Ineffective airway

Infection

Comfort

Injury

Impaired gas exchange

Body image disturbance

High Risk

3. Planning

Focus :

1. Absence of infection

2. Maintenance of skin integrity

3. Absence of adverse effects

4. Maintenance of fluid and electrolyte balance

5. Knowledge by the patient

6. Rehabilitation process

Implementation

Preoperative…………..(1)

• Patient and family education

• Patient preparation

• Obtaining required baseline assessment data, laboratory & diagnostic work, and consent for surgical procedures

Intraoperative………….(2)• Performance in the scrub

person’s role• Performance in the

circulating nurse’s role• Management of personnel,

material and environment• Maintenance of a safe,

aseptic environment

Regional Anesthesia• Local

– Epidural– Infltration– Nerve Block– Spinal – Topical

• Anesthetic agents – Xylocaine, Novocain,

carbocaine• Topical

– Dermoplast (benzocaine)– cocaine– ethyl chloride

• Inhalation or intravenous route

• 3 phase:

1. Induction phase

2. Maintenance phase

3. Emergence phase

General Anesthesia

Anastesia

• Geriatric concerns

• Consciousness

• Hepatic, cardiac respiratory and renal decline

• Heart diseases, renal, and pulmonary

Complication of Intraoperative

• Hypoventilation

• Oral Trauma - endotracheal intubation

• Hypotension

• Bradikardia, Cardiac dysrhythmia

• Hypothermia

• Peripheral nerve damage

Intraoperative - Complications • Malignant hyperthermia - due to abnormal

and excessive intracellular collection of Ca+ resulting in hypermetabolism and increased muscle contraction.

• Signs and Symptoms - high fever, tachycardia, muscle rigidity, heart failure, pseudotetany, and CNS damage.

• Treatment of Malignant Hyperthermia

Discontinue inhalent anesthetic, Give Dantrium, oxygen, dextrose 50%, diuretic, antiarrhythmics, sodium bicarbonate, and hypothermic measures-cooling blanket, iced IV saline or iced saline lavage of stomach, bladder, rectum.

PostoperativePostoperative…………….(3)• Monitoring and evaluating the patient’s

status• Managing patient care, including pain,

fluid status, cardiopulmonary status, positioning

• Assessing nutritional status and needs• Providing rehabilitation, counseling,

and emotional support

Complication of Postoperative

• Hipotensi• Dysrhythmia• Trombosis vena• Emboli Pulmonal• Distensi abdomen

• Immobility with skin integrity

• Urinary retention • Urinary tract

infection• Wound infection,

dehiscence, hemorrhage evisceration,

Post operative Care

• Psychological – Anxiety– Altered body image– Finances, Family responsibility– Future changes

Discharge Plans

• Educate the client, family and psychosocial support– Wound care– Manifestation of a wound infection– How and when to take temperature– Limitation and restriction of activity– Control of pain

Evaluation

• Patient outcomes

• Patient’s level of accomplishment for each expected outcomes

References• Kindler, CH.(2000).The Visual Analog Scale Allows Effective

Measurement of Preoperative Anxiety and Detection of Patients’ Anesthetic Concerns.IARS. Diakses dari http://www.anesthesia-analgesia.org/content/90/3/706.full

• Fairchild, S.S, et al. (1996). Perioperative Nursing: Principles and Practices. New York: Lippincot

• V. Buchh, B. Saleem, F. Reshi, A. Hashia, S. Gurcoo, A. Shora & S. Qazi : A Comparison of total intravenous anaesthesia ( TIVA ) to conventional general anaesthesia for day care surgery. The Internet Journal of Anesthesiology. 2009 Volume 22 Number 1. Diakses dari http://www.ispub.com/journal/the_internet_journal_of_anesthesiology/volume_22_number_1/article/a-comparison-of-total-intravenous-anaesthesia-tiva-to-conventional-general-anaesthesia-for-day-care-surgery.html

Thank You

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