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Perioperative nursing is a uniquely exciting specialty area focused on care for

patients undergoing any type of surgery. The nurses provide care pre-operatively
(before), intra-operatively (during), and post-operatively (after surgery).

Fundamental nursing skills are the foundation for perioperative nurses, however,
their education continues beyond the basic nursing programs. Perioperative
classes are available at many different sites throughout the country to prepare
nurses for a career in Perioperative Nursing.

Perioperative nursing encompasses caring for the patient as a whole being,

taking into account physiological, psychological, sociocultural, and spiritual
issues. The perioperative nurse is responsible for patient safety throughout the
surgery.

Clinical competency as well as outstanding organizational and interpersonal skills

are required.

Nurses working in the perioperative arena:

’ Provide patient care before, during, and after surgery

’ Ensure patient safety
’ Advocate for the best interests of the patient
’ Educate/teach patient and family
’ Collaborate with members of the surgical team and other health care
providers
’ Serve as nurse liaisons between the OR and patients' families and friends
to provide support and communication

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Nurses caring for patients before and after surgery are also known as
Perianesthesia nurses. The specialty practice of perianesthesia nursing
embraces the care of the surgical patient and family throughout the
perianesthesia course.

The pre-anesthesia phase comprises pre-admission and day-of-surgery care of

the patient. Interviewing and assessment skills are used to identify possible or
actual patient problems prior to surgery.

The perianesthesia nurse prepares the patient for surgery

     

ºuring surgery (or intra-operatively) there are two nursing roles providing care to
the surgical patient:

The "circulating" nurse is responsible for

patient safety during the surgical procedure.
The circulating nurse coordinates care of the
patient with the surgeon, scrub nurse/tech,
and anesthesia provider. The circulating
nurse also provides assistance to the surgical
team throughout the surgical procedure.

The "scrub" nurse supports the surgeon by passing instruments during the
operation while also maintaining patient safety.

    

After surgery, a post-anesthesia care nurse will attend the patient in the Post-
Anesthesia Care Unit (PACU). These nurses have extensive experience in
intensive care nursing, a background that is necessary in caring for patients who
have a wide variety of illnesses and surgical procedures.

The post-anesthesia nurse focuses on patient care immediately after surgery is

complete.

Basic, life-sustaining needs of the patient are the highest priority. Post-
anesthesia nurses also teach patients and families about postoperative care in
the home.

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‡ Close operating room
Anesthetic ºrowsiness/
doors
administration to ºizziness
 loss of Auditory and visual
‡ Keep room quiet
‡ Standby to assist
consciousness hallucinations
client
Increase in ‡ Remain quiet at
Loss of
autonomic client¶s side
consciousness to

#$% loss of eyelid activity, Irregular ‡ Assist anaesthetist if
breathing, client may necessary
reflexes
struggle
Loss of eyelid Unconsciousness, ‡ Begin preparation
 $& reflexes relaxation of only
to loss of most muscles, when anaesthetist
' reflexes diminished gag and indicates stage 3 has
and depression of blink reflexes been reached and
 vital client is breathing well
function with stable vital signs.
‡ If arrest occurs; assist
immediately in
ºepression of vital
Client is not establishing airway,
function to
breathing, heartbeat provide cardiac arrest
  respiratory
may or may not be tray, drugs, syringes,
and circulatory
present long needles, assist
failure
surgeon with closed or
open cardiac massage.


Anesthesia is sometimes divided into stages and some of the stages are further
divided into planes.

Stage 1 anesthesia is the period between administration of an anesthetic and

loss of consciousness. In people there is reported to be some disorientation
prior to the loss of consciousness but in pets this is rarely obvious.

Stage 2 anesthesia is the period after loss of conciousness. In this stage there
is sometimes uncontrolled movement, delirium, breath holding, irregular
respiration, whining or howling and dilation of the pupils. This stage can be
worrisome and most anesthetic protocols seek to keep this period as short as
possible without endangering the patient.

Stage 3 anesthesia is the level at which surgery can be performed. The

transition from Stage 2 to Stage three is usually denoted by the return of regular
respiration, constriction of the pupils and the stopping of involuntary motion or
vocalization by the patient. Stage 3 anesthesia is divided into four planes:

In Plane 1 Stage 3 anesthesia the patient still has blink reflexes and swallowing
reflexes but has regular respiration with good chest motion. This stage would be
considered "light" for surgical anesthesia.

In Plane 2 Stage 3 anesthesia the patient loses the blink reflexes, the pupils
become fixed in one position (usually central) and respiration is still regular with
good use of the chest muscles and diaphragm. This is the plane at which most
veterinarians are comfortable performing surgery.

In Plane 3 Stage 3 anesthesia, the patient starts to lose the ability to use the
chest muscles and abdominal muscles for respiratory efforts, so breathing
becomes shallow and assisted ventilation is best when the patient must be
maintained at or near this level in order to allow control of pain in surgeries that
are unusually painful (such as extensive abdominal exploratories).

In Plane 4 Stage 3 anesthesia, the patient does not use the chest muscles and
abdominal muscles at all, which means that all respiratory effort is produced by
the diaphragm. This plane of anesthesia is very close to the point where the
patient will stop breathing entirely and it should be avoided.

Stage 4 anesthesia is basically an anesthetic crisis. It is the time between

respiratory arrest and death from circulatory collapse. Assisted ventilation is
absolutely essential in this stage, as well as support for the circulatory system
through IV fluid administration and medications to stimulate respiration and the
cardiovascular system. Hopefully, this stage of anesthesia is never encountered
in practice.

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Surgical procedures are commonly grouped according to: Urgency, Risk,

Purpose

’ ºegree of Urgency
 Elective
 Emergency

’ ºegree of Risk
 Major
 Minor

’ Purpose
 Category 1 ± Surgery involving the loss of a body part, organ, or
function
 Category 2 ± Surgery involving the removal of a tumor, cyst, or
foreign body
 Category 3 ± Surgery performed for diagnostic purposes
 Category 4 ± Surgery for insertion, removal, or application of a
prosthesis, graft, transplanted organ, or therapeutic device
 Category 5 ± Surgery for reconstruction or cosmetic revision
 Category 6 ± Surgery to establish drainage or reestablish a
passageway

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’ General Anesthesia
 Loss of all sensation and consciousness. Administered by iV
infusion or inhalation

’ Regional Anesthesia
 Topical anesthesia
 Local anesthesia
 Nerve block
 IV block ( Bier block)
  Spinal anesthesia or subarachnoid block
 Epidural block



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’ a : two
’ À

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À : related to the brain
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’   : related to the uterus
’   : related to the abdominal cavity
 Etymology actually refers to soft, fleshy part of abdominal wall. The term
À
 is probably more accurate and used in America.
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a
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 and 
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À : related to the testicle
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’ 
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’ À
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#

’ À
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’  : fusion of two parts into one, stabilization
’ À
 : surgical removal. The term 'resection' is also used, especially when
referring to a tumor.
’ 
 : similar to
’ 
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’ 
À
 : viewing of, normally with a scope
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 or 
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 or 
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’  : to fix or secure
’  : to modify or reshape (sometimes entails replacement with a prosthesis)
’   : to strengthen, usually with suture
’   : recording or representation of a specified thing
Ê