Perioperative nursing care

PRE OPERATIVE and POST OPERATIVE RESPONSIBILITIES
PERIOPERATIVE NURSING CARE

A. Definition
Perioperative Period – Refers to events during the entire surgical period from preparation for surgery to recovery from the temporary effects of surgery and anesthesia.

B. PHASES of PERIOPERATIVE NURSING
1) Pre Operative Phase – begins when the decision for surgical intervention is made and ends with transfer of the client to the operating room.

2. INTRA OPERATIVE PHASE – begins when the client is transferred to the operating room bed and ends when the client is admitted to the post anesthesia recovery area or recovery room.

3. POST OPERATIVE PHASE – begins with the admission to the recovery room and ends with the resolution of surgical sequel
NURSING CARE RESPONSIBILITIES
A. Pre Operative Phase :
a) Nurse obtain a pre operative history and perform a physical assessment, gathering information about the patient.

C A R E P L A N S
C - current symptoms and discomfort
A - age
R - responses of family members / religious affiliations
E - Electrolyte and Fluid balance
P - previous surgery and anesthesia
L - liver function
A - allergies and reaction
N - nutritional status
S - social history

PRE OPERATIVE PHASE
•Carry out written order of surgeon
•Inform Staff (send OR slip on triplicate form)
•Carry out pre op orders of Anesthesiologist and suggestions of OR Nurse (consent, NPO time, hygiene, blood, clearance, meds, materials, ICU accomodation, etc.)

Common Pre Op Orders
•NPO time
4 hours before…….. Below 6 months
6 hours…………………. 6 months to 3y/o
8 hours…………………. 3 y/o and above
2. BLOOD ( consent and units)
3. ANTIBIOTICS (if a patient is for Exlap at 7:00am, the nurse must perform a skin test at 5:30am, ROD will read the result at 6:00am and give the initial dose if reading is negative.

4. IVF – must always be inserted at the upper extremities and must use the appropriate IV Catheter sizes.
5. Anesthesia orders
6. CP Clearance
7. ICU accommodation and ventilator if indicated
8. Frozen Section, IOC

Day of Surgery
•Give Antibiotics ANST / Doctor’s Order
•Accomplish pre-op checklist
•OR Nurse will fetch patient 30 minutes prior to schedule
INTRA OPERATIVE PHASE
•RR Nurse will inform the ward Nurse re: Patient’s transfer
•Ward Nurse Prepare (IV Stand, droplight, perfusor machine, O2 / vent set up )

POST OPERATIVE PHASE
Ward Nurse accompanies post op patient to room and makes initial assessment of the client after transfer:
1. Respiratory status
2. Cardiovascular status
3. Neurological status
4. surgical wound
5. Intravenous lines
6. Tubes (CTT, PD cath.,NGT/OGT, IFC, JP Drain)
7. positioning
8. Level pain
III. Goals and Intervention
A. Restore Homeostasis and Prevent Complications
•Monitor Vital signs
•Monitor wound for signs and symptoms of infection
•Monitor for shock
B. Maintain and Promote adequate airway and respiratory function
•Assist with turning, coughing and deep breathing every 1-2 hours

•Encourage and assist with early ambulation
•Monitor color consistency and odor of any sputum production
C. Maintain adequate cardiac function and Promote tissue perfusion
•Monitor for s/s of thrombophlebitis
•Monitor for s/s of M.I.
•Monitor for s/s of blood loss


D. Maintain Adequate Electrolyte and Fluid Balance and Adequate Renal Function
•Monitor I & O
•Report Abnormal serum electrolytes values
•Maintain patency of NGT / OGT
•Obtain an order for anti emetic if patient develops nausea and vomiting
•Administer replacement fluids as prescribed
•Monitor patency of urinary catheter
•Monitor signs / symptoms of UTI
•Monitor for bladder distention if urinary catheter is not present

•Promote Comfort and Rest
•Change client position, straighten bed linens or give a back rub
•Provide prescribed analgesics and assess effectiveness
•Promote Adequate Nutrition and Elimination
•Assess for return of bowel sounds
•Advanced prescribed diet as tolerated (DAT)
•Monitor for paralytic ileus

•Promote Wound Healing
•Assess wound for signs of infection
•Observe the wounds for signs of edema, bleeding or change in color
•Observe the wound for approximation of suture line
•Monitor drains and assess the color, consistency and amount of drainage
•Maintain strict asepsis when coming in contact with the wound
•Monitor for Wound Dehiscence

•Promote and Maintain Activity and Mobility
•Have client flex ankles and legs and reposition in bed if not contra indicated
•Encourage and assist with early ambulations as prescribed

•Provide Emotional Support and Foster Positive Body Image
•Provide Empathetic listening and encourage expression of feelings
•Provide specific written instructions

•Plan for Discharge
•Provide specific written instructions regarding
•Wound Care (signs of infections)
•Activity restrictions
•Dietary Instructions
•Post operative medication instruction
•Personal hygiene
•Follow up appointments with surgeon or Clinic.