PERIOPERATIVE NURSING

Venus Sofia J. Balatero, RN, USRN

Perioperative Nursing
Perioperative nursing is not just "technical work anyone can do". Perioperative nurses are skilled, knowledgeable RNs that care for patients before, during, and after surgery. The fundamental nursing values (knowledge, skills, and judgment) are ever present and are the basis of the quality of care that surgical patients have relied on and can expect.

Perioperative Nursing

The patient is the center of the sterile field

Perioperative Nursing
The OR team usually consists of: Surgeon: Scrubbed and in surgical attire to perform the surgery Anesthesia provider: Masked and in clean scrub attire to administer the anesthesia - During the procedure the anesthesiologist monitors the patients vital signs and is responsible for keeping the surgeon aware of the patients condition. The anesthesiologist determines when the patient may be moved to the post anesthesia recovery stretcher after the surgical procedure has been completed. This person usually checks the patients airway and vital signs before taking the patient to the post anesthesia recovery room.

Perioperative Nursing
The OR team usually consists of: Surgical assistant (first assistant):

Can be another physician, a nurse, or physicians assistant (PA) who is scrubbed, in sterile attire, and assists the surgeon to ligate, suction, and suture Scrub nurse: Scrubbed and in sterile attire; prepares the instrument tray and passes the instruments, sponges, needles, and sutures to the surgeon Circulating nurse: In clean scrub attire and mask; assure that sterility is maintained at all times; obtains supplies, delivers materials, pours solutions, handles specimens, positions the client and surgical drapes, and disposes of soiled items

Perioperative Nursing

PHASES Perioperative Intraoperative Postoperative

Perioperative Nursing
PREOPERATIVE PHASE
Begins when the decision is made to undergo surgical intervention and it ends when the patient is transferred to the OR bed During this phase, the perioperative nurse performs the assessment, determines the nursing diagnoses, identifies potential outcomes and develops a plan of care The perioperative nurse plans, prioritizes, and initiates the patient care necessary for the attainment of the desired outcomes

Perioperative Nursing
INTRAOPERATIVE PHASE -Begins with the placement of the patient on the OR bed and continues until the patient is admitted to a postprocedure or postoperative area -Implementation of the plan and evaluation of care continues during this phase.

Perioperative Nursing
POSTOPERATIVE PHASE -Begins with admission of the patient to a postprocedure or postanethesia area, which may be a postanesthesia care unit (PACU) or an intensive care unit (ICU). -Patients admitted to the facility on an ambulatory 1-day-stay basis may return to the ambulatory unit. As indicated by his condition, the patient will transfer from the immediate postoperative patient care division for progressive stages of self-care on a surgical unit before being discharged from the hospital. -The postoperative phase ends when the surgeon discontinues follow-up care -Evaluation, the sixth component of the nursing process, is completed during this phase

Perioperative Nursing
Phase Preoperative From To

Decision for surgical Transfer to intervention Operating Room Admission to Recovery Room

Intraoperative Received in Operating Room

Postoperative Admission to recovery Room

Follow-up Evaluation

Type of Surgery acc. to URGENCY

Type of Surgery

Optional Elective Planned/ Required Urgent/ Imperative Emergency

Time requirement for surgery At the preference of patient; surgery not needed At the convenience of patient as failure to have surgery is not catastrophic Within a few weeks as surgery is important Within 24-48 hours

Example Cosmetic surgery Liposuction Excision of superficial cyst Cataract extraction Cancer surgery

Immediately without delay to Intestinal maintain life or organ, Obstruction remove damage, stop bleeding

Type of Surgery acc. to PURPOSE

Type of Surgery

Purpose

Example

Diagnostic
Exploratory

To confirm diagnosis

Excision and biopsy To estimate the extent of the Exploratory disease and confirm Laparotomy diagnosis as well
Hysterectomy Repair of cleft lip or palate Episiorrhapy Rhizotomy and chordotomy (for pain relief)

Curative -Ablative Removal of diseased organ -Constructive Repair of congenital defects -Reconstructive Restoration of damaged organ Palliative Relieves symptom but does not cure the disease

Type of Surgery acc. to SERIOUSNESS

Type of Surgery

Extent of Surgery Surgery that involves minimal (few) complications and minimal blood loss Extensive surgery that involves serious risk and complications (and loss of blood) as it involves major organs

Minor Major

Sterile Technique

Sterile Technique
Strict adherence to sound principles of sterile technique and recommended practices is mandatory for the safety of the patient. This adherence reflects ones surgical conscience. Principles remain the same; it is the degree of adherence to them that varies.

Principles of Sterile Technique

Sterile persons have scrubbed and are gowned and gloved; unsterile person have not. Only Sterile Items Are Used Within the Sterile Field. If you are in doubt about the sterility of anything, consider it not sterile. Gowns Are Considered Sterile Only from the Waist to Shoulder Level Front and the Sleeves Tables Are Sterile Only at Table Level

Principles of Sterile Technique

Persons Who Are Sterile Touch Only Sterile Items of Areas; Persons Who Are Not Sterile Touch Only Unsterile Items or Areas Unsterile Persons Avoid Reaching over a Sterile Field; Person Avoid Leaning over an Unsterile Area Edges of anything that encloses Sterile Contents are Considered Unsterile Sterile Field is Created as close as Possible to time of Use

Principles of Sterile Technique

Sterile Areas are Continuously Kept in View Sterile Persons Keep well within the Sterile Area - They do not walk around or go outside room - Sterile Persons keep Contact wit Sterile Areas to a Minimum Unsterile Persons Avoid Sterile Areas Destruction of Integrity of Microbial Barriers Results in Contamination - Strike-through is soaking of moisture through unsterile layers to sterile layers or vice-versa. Microorganism Must be kept to an Inducible Minimum

Perioperative Nursing
PATIENTS SKIN PREP - done after patient has been anesthetized and positioned on the operating table, skin of the operative site and extensive area surrounding it is mechanically cleansed again with an antiseptic agent immediately prior to draping

Perioperative Nursing

PATIENTS SKIN PREP - Responsibility: The first assistant is the person who scrubs the patient after he has scrubbed his own hands and arms

Perioperative Nursing
PATIENTS SKIN PREP - Scrub skin, starting at site if incision, with a circular motion or over widening circles to the periphery. Use enough pressure and friction to remove dirt and microorganisms from skin and pores. - Discard sponge after reaching periphery. Never bring a soiled sponge back toward center of area

Perioperative Nursing
Contaminated Areas within the Operative Field:
- Umbilicus, stoma, draining sinuses, skin ulcer, vagina, anus, colostomy, (In all contaminated areas, follow general rule of scrubbing the most contaminated area last of with a separated sponge

Layers of Tissue
The five main layers of abdominal tissue from the outer most are: Skin Subcutaneous Fascia Muscle Peritoneum

PACU

PACU
The post anesthesia recovery room is rarely called an intensive care unite, but it is. Everyday is a real challenge to PACU nurses because many kinds of situations occur. They are expected to have good knowledge of both medical and surgical procedures because they care for patients with all types of medical and surgical problems. The nurses must be calm and in full command of the situation but know their limitations The PACU nurse works under the direction of the anesthesiologist or surgeon. The nurse must carry out simultaneously four assignments: - Observation of the patient - Evaluation of those observations - Performance of the necessary treatment - Reporting and recording observations and treatment Total care of the patient requires both-in-depth study and experience in post anesthesia recovery nursing.

PACU
The PACU nurse must totally evaluate the patient and record the finding. This evaluation is done every 15 minutes or more often, depending on the patients conditions. Airway Vital signs Color Skin Level of consciousness Fluid and electrolyte balance Dressings, tubes, drains, or casts Position Safety measure Physicians orders Comfort of the patient Reporting and Recording

PACU
POSTOPERATIVE COMPLICATION Circulatory problems - Shock - Hemorrhage - Femoral phlebitis or thrombosis Pulmonary complications - Atelectasis Urinary complications - Urinary retention - Urinary incontinence

Perioperative Nursing
How to describe an operation - the terminology used to describe all operations is a composite of basic Latin or Greek terms. - describe the organ to be operated on
lapar-, abdomen (laparus = flank);

nephro-, kidney pyelo-, renal pelvis cysto-, bladder chole-, bile/the biliary system col(on)-, large bowel hystero-, uterus thoraco-, chest rhino-, nose masto/mammo-, breast

Perioperative Nursing
describe any other organs or things involved in the procedure docho-, duct angio-, vessel (blood- or bile-carrying) litho-, stone describe what is to be done -otomy, to cut (open) -ectomy, to remove -plasty, to change shape or size -pexy, to change position -raphy, to sew together -oscopy, to look into -ostomy, to create an opening in (stoma = mouth) -paxy, to crush -graphy/gram, image (of)

Perioperative Nursing
Add any terms to qualify how or where the procedure is done percutaneous, via the skin; trans-, across; antegrade, forward; retrograde, backwards.

Choledochoduodenostomy: an opening between the bile duct and the duodenum Rhinoplasty: nose reshaping Bilateral mastopexy: breast lifts Percutaneous arteriogram: arterial tree imaging by direct puncture injection Loop ileostomy: external opening in the small bowel with two sides Flexible cystourethroscopy: internal bladder and urethral inspection