Prof.

Joseph
Bahian Abang,
AHSE, BSN, RN, MAN (c)
Major in Nursing
Supervision and
Administration

The Core Concepts

of
Perioperative
Nursing

Surgery
Terminology
-ectomy
-otomy
-oscopy
-ostomy
-oplasty
-rrhapy

Purpose of Surgery
(DPACTC)
Diagnostic
Palliative
Ablative
Constructive
Transplant
Curative

Degree of Urgency
(EURE)
Emergency
Urgent
Required
Elective

Degree of Risk
(MM)
Major
Minor
Affected by factors such as:
GAMeMeNu
General health condition
Age
Medications
Mental status
Nutrition

Surgical Settings
(SACPHC)
Surgical suites
Ambulatory care setting
Clinics
Physician offices
Homes
Community setting

Perioperative Nursing
3 Phases
Preoperative Phase
Intraoperative Phase
Post-operative Phase

PRE-OPERATIVE
PHASE

Collaborative Management
History and data collection
Age
Drugs and substance use
Medical history, including
cardiac and pulmonary
histories
Previous surgery and
anesthesia
Blood donations

 Physical Assessment/Clinical
Manifestations
Obtain baseline vital signs.
Focus on problem areas
identified by the clients
history on all body systems
affected by the surgical
procedure.
Report any abnormal
assessment findings to the

System Assessment
Cardiovascular system
Respiratory system
Renal/urinary system
Neurologic system
Musculoskeletal system
Nutritional status
Psychosocial assessment
Gerontological Considerations
Psychosocial considerations
Level of anxiety
Coping ability
Support systems

Gerontological Considerations
Take Note on the Functioning
of the Following Systems
Cardiovascular
Respiratory
Nervous
Renal
Gastrointestinal
Musculoskeletal
Integumentary

Laboratory Assessment
Urinalysis
Blood type and crossmatch
Complete blood count or
hemoglobin level and
hematocrit
Clotting studies (PT & PTT)
Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray examination

Nursing Considerations
Consent
Implementing Dietary
Measures
Administering Regularly
Scheduled Medications
Intestinal Preparation
Skin Preparation
Preparing the Client
Pre-operative Chart Review
Pre-operative Medications

Common Pre-operative
Medications
Versed Benzodiazepines
Fentanyl Narcotic/Opiate
Tagamet H2 receptor
antagonist
Reglan Antiemetics
Robinul Anticholinergics
Ancef - antiinfective,
antibiotic

Hazardous to Surgery
Antibiotics
Anti-depressants
Phenothiazines
Diuretics
Steriods
Anticoagulants

Pre-anesthesia Management
Physical Status Categories
ASA I:
Healthy patient with no
disease
ASA II: Mild systemic ds without fx
limitations
ASA III: Severe systemic ds
associated with
definite fx
limitations
ASA IV:
Severe systemic ds that is
a constant
threat to life.
ASA V:
Moribund pt. Who is not
expected to
survive without

INTRA-OPERATIVE
PHASE

Members of the Surgical

Team
Surgeon
Surgical assistant
Anesthesiologist
Certified registered nurse
anesthetist
Holding area nurse
Circulating nurse
Scrub nurse
Surgical technologist

Operating Room Attire

Scrub suit
Head cover (bonnet)
Shoe cover (OR Slipper)
Surgical mask
PPE
Aprons
Surgical gown
Surgical gloves
Gloves
Eyewear/face shield

3 Surgical Areas of the

Operating Room
Restricted area
Scrub suit, head cap, shoe
cover and mask
Semi-restricted area
Scrub suit, head cap, shoe
cover
Monitored Un-restricted
area/transition area
Scrub personnel may use
this area as the transition

Sterile vs. Asepsis Define:

Sterile
-free of microorganisms
including pores
Asepsis
-absence of microorganisms
that cause a disease.

Surgical Asepsis
Principles
1.Only sterile items are used within
the sterile field.
2.Sterile persons are gown and
gloved.
3.Tables are only sterile at Table
Level
4.Sterile Persons Touch ONLY Sterile
Items while Unsterile OR
Personnel Touch Only Unsterile
Items
5.Unsterile persons avoid reaching
over sterile field and sterile

7. Sterile field is set-up just

before a surgical procedure.
8. Sterile areas are continuously
kept in view.
9. Sterile persons keep well
within sterile area.
10. Sterile persons keep in
contact with sterile areas to
minimum.
11. Unsterile persons avoid
sterile areas
12. Destruction of integrity of

Types of Sterilization
Moist Heat
Autoclave
High speed sterilization
autoclave
Radiation
Radiation ionizing
energy
Chemical
Cidex, Sporocidin,

Types of Sterilization
Moist Heat
Autoclave
High speed sterilization
autoclave
Radiation
Radiation ionizing
energy
Chemical
Cidex, Sporocidin,

Types of Surgical Instruments

Graspers
Clamps and occluders
Retractors
Distractors, positioners and
stereotactic devices
Mechanical cutters (scalpels,
lancets, drill bits, rasps, trocars)
Dilators and specula
Suction tips and tubes
Sealing devices
Irrigation and injection needles,
tips and tubes

Types of Surgical
Instruments
Scopes and probes
Carriers and appliers
Ultrasound tissue
disruptors, and cutting
laser guides
Measurement devices

Surgical Instruments

Alias - None
Use - Grasping
Additional Info - Often used
for grasping soft tissue such
as breast tissue or bowel
tissue

Alias - US Retractor
Use - Tissue or Bone
Retraction
Additional Info - Common to
the both major and minor
orthopedic and general
surgery trays .

Alias - None
Use - Grasping
Additional Info - For grasping
soft tissue or bowel.

Alias - None
Use - Grasping
Additional Info - Often used
for grasping fascia during the
closure of abdominal surgery
or for closure and suturing of
large orthopedic procedures
such as total knee and total
hip replacement surgery.

Alias - Castro's
Use - Suturing
Additional Info - Castro viejo
needle drivers are most
common to Vascular,
Opthalmic, and delicate
Cosmetic Surgery. The come
in both locking and nonlocking varieties depending
on surgeon preference and

Alias - None
Use - Cutting
Additional Info - Common to
most surgical trays, used for
cutting dense tissue where
Metz scissors are too delicate.

Alias - None
Use - Self Retaining Retractor
Additional Info - Most
commonly used in orthopedic
and spine surgery.

Alias - None
Use - Cutting
Additional Info - Used for
cutting bone in othopedic and
spine surgery.

Alias - None
Use - Clamping
Additional Info - For both
permanent and temporary
ligation of vessels and
marking tissue for post
operative imaging.

Alias - None
Use - Cutting
Additional Info - For cutting
bone in spine and neuro surgery.

Alias - None
Use - Grasping
Additional Info - Used to
grasp bone or fascia.

Alias - None
Use - Retraction
Additional Info - For rectration
in large abdominal surgeries.

Alias - Metz
Use - Cutting
Additional Info - The most
common scissors use for
cutting tissue.

Alias - None
Use - Blunt Disection
Additional Info - None

Alias - None
Use - Suction
Additional Info - All of the holes
around the poole suction allow it
to suck up large amounts of fluid
without getting clogged. Perfect
after irrigating the abdominal
cavity.

Alias - Rich
Use - Retraction
Additional Info - Available in
multiple sizes as well as
single and double ended. This
is one of the most common
general surgery retractors.

Alias - Russians
Use - Grasping
Additional Info - A multi
purpose pick up in most
instrument sets.

Alias - Suture Scissors

Use - Cutting
Additional Info - General
purpose and suture cutting
scissors, normally not used on
tissue.

Alias - Self Retainer

Use - Retraction
Additional Info - Available
with both sharp and dull jaws.

Surgical Instrument
Considerations
Critical Instruments
Surgical instruments
Semi-critical instruments
Catheters, endoscope
materials
Non-critical Instruments
Bedpan, BP cuff

Anesthesia
Purpose
Blocks transmission of
nerve impulses
Suppress reflexes
Promotes muscle
relaxation
Controlled level of
unconsciousness

Types of Anesthesia
General Anesthesia
Stages of General
Anesthesia
Stage 1: onset/analgesia
Stage 2: excitement
Stage 3: operative/ surgical
anesthesia

General Anesthesia
Advantages:
Because the client is unconscious
rather then awake and anxious,
respiration and cardiac function are
readily regulated.
The anesthesia can be adjusted to
the length of the operation and the
clients age and physical status.
Disadvantage:
It depresses the respiratory and
circulatory systems.
Some clients become more anxious
about a general anesthetic that about

Regional Anesthesia
Methods of Delivery
Topical (surface)
Anesthesia
Local Anesthesia
(Infiltration)
Nerve Block
Intravenous block (Bier
block)

Surgical Positions (most

common)
Dorsal recumbent
Trendelenburg
Reverse Trendelenburg
Prone
Modified Fowler
Lithotomy
Lateral recumbent
Knee-chest
Kidney position
Jack knife (Kraske)

Layers of the Abdominal Cavity

Skin
Fascia
Camper's fascia - fatty
superficial layer.
Scarpa's fascia - deep fibrous
layer.
Muscle
Rectus abdominis
External oblique muscle
Internal oblique muscle
Transverse abdominal muscle
Fascia transversalis

Most Common Abdominal

Incisions
Vertical
midline, paramedian,
and wide paramedian
incisions
Transverse
Pfannenstiel
Maylard
Cherney

Sutures
Absorbable sutures
Surgical gut
Plain
Chromic
Fast absorbing
Polyglactin 910 (Vicryl)
Uncoated
Coated
Polyglycolic acid (Dexon)
Poliglecaprone (Monocryl)
Polydioxanone (PDS) (Quill)
Polyglyconate (Maxon)

Sutures
Non-Absorbable sutures
Natural
Silk
Cotton
Stainless-steel wire
(Flexon)
Nylon (Dermalon,
Surgilon)
Polypropylene (Prolene,

POST-OPERATIVE
PHASE

General post-operative
complications
Immediate:
Primary hemorrhage:
Basal atelectasis:
Shock:
Low urine output/Urinary
Retention:
Pneumonia:
Hypoxia:
Paralytic Ileus:

Early
Acute confusion:
Nausea and vomiting:
paralytic ileus
Fever
Secondary hemorrhage:
Pneumonia
Wound or anastomosis
dehiscence
Deep vein thrombosis (DVT)
Acute urinary retention
Urinary tract infection (UTI)
Post-operative wound infection

Late
Bowel obstruction due to
fibrous adhesions
Incisional hernia
Thrombophlebitis
Embolism
Wound evisceration and
dehiscence
Severe UTI
Severe Wound Infection

Post-operative fever
Days 0 to 2:
Mild fever (T <38 C) (Common)
Tissue damage and necrosis at
operation site
Hematoma
Persistent fever (T >38 C)
Atelectasis: the collapsed lung
may become secondarily
infected
Specific infections related to the
surgery, e.g. biliary infection
post biliary surgery, UTI post-

Days 3-5:
Bronchopneumonia
Sepsis
Wound infection
Drip site infection or
phlebitis
Abscess formation
DVT

After 5 days:
Specific complications
related to surgery, e.g.
bowel anastomosis
breakdown, fistula
formation
After the first week
Wound infection
Distant sites of infection,
e.g. UTI

Collaborative Management/ Assessment

Assess respiration.
Examine surgical area for bleeding
Monitor vital signs.
Assess for readiness to discharge
once criteria have been met.
Respiratory System
Airway assessment
Breath sounds
Cardiovascular Assessment
Vital signs
Cardiac monitoring
Peripheral vascular assessment
Neurologic System
Cerebral functioning

THANK YOU!!