
Management and treatment of the
PERI-OPERATIVE
Client
 Hospital / Surgery
 Definitions
 Surgery
 Perioperative Nurses
 Three Perioperative Phases
 Preoperative
 Intraoperative
 Postoperative
 INTERVENTIONS
for
PRE-OPERATIVE CLIENTS
 Types of Surgery

Diagnostic

Curative

Palliative

Reconstructive

Cosmetic

Transplant
 Types of Surgery
 Emergent
 Urgent
 Elective
 Inpatient
 Outpatient
 Types of Surgical Facilities

Hospitals (Large & Small)

Ambulatory Care

Free-standing Surgical Centers

Doctors’ Offices
 Surgeon Responsibilities

Primary Physician

Surgical Intervention

Setting

Diagnostic Tests

Consent

Outcomes and Risk
 Major role of the Surgeon
Preoperative Nursing Care
Pre-op Assessment

Health History
 Pre-Op Assessment
Psychosocial Aspects

Coping ability

Anxiety level

Support system

Common fears
Physiological Aspects

Purpose

Lab data

Radiographic assessment

Other diagnostic assessments

Factors which influence risk
 Nursing Management
Surgical Consent Forms

Purpose

Components
 Common Orders

Client’s routine medications

Specific preparations ordered by
Physician

NPO status

Preoperative medication
 Pre-Operative Phase
ALL OTHER PREPARATIONS MUST BE COMPLETED BEFORE GIVING PRE-OP MEDS!
 Pre-Op Medications
1.
Routine meds usually held
2.
Routine meds usually given
3.
Pre-op meds
a. Common meds

Narcotics

Sedatives - Hypnotic

Anti- cholinergics

Amnesics
 Pre-Op - Checklist
 Nurse completes check - list
for inpatient or outpatient surgery
 Nurse signs off to
Anesthesia/Circulator
 Nurse places documentation on chart
and includes
 INTERVENTIONS
for
INTRA-OPERATIVE PATIENTS
 Intra-operative
 Holding Area

Operating Room (OR)

Nurses’ Roles
 Surgical Team Members
 Surgeon
 Surgical Assistant
 Anesthesiologist
 Certified Registered Nurse
Anesthetist (CRNA)
 Circulating Nurse
 Scrub Nurse
 Specialty Team
Types of Anesthesia
General
Given inhalation and intravenous

CNS depressed:

Risk for Cardiac and respiratory

Induction

Maintenance

Emergence
Phases
 Types of Anesthesia

Monitored Controlled Anesthesia
(MAC)

Regional

Conscious Sedation

Anesthesia
Medication

Unconsciousness

Analgesia

Reflex loss

Muscle relaxation

amnesia

Care of Client (Elderly)
 INTERVENTIONS
for
POST-OPERATIVE PATIENTS
 Post-operative

Transfer from OR to PACU
PACU
Report to PACU nurse
Assessment
 Prevention/Complications
Cardiovascular

Hemorrhage, Hypovolemic Shock

Deep Venous Thrombosis (DVT)

Pulmonary Embolism

Complications
Respiratory

Atelectasis

Prevention

Aspiration
 Complications
Elimination

Problems effects Anesthesia, lack of activity, pain meds

Urine Elimination

Bowel Elimination

Discharge from PACU
Based on:
Respirations
Energy
Alertness
Circulation
Temperature
Discharge from PACU to
Ambulatory Surgical Unit

Discharge from PACU to
General Surgical Unit
 Complications
General Post-Op
AMBULATION:
the single most significant measure to prevent complications
 Stress Related to Surgery
General Adaptation Syndrome
Sympathetic Effects
1.
Manifestations
 Continue (GAS)

bronchial dilation

 water and sodium retention

After 24 hours, post-op diuresis

 ADH  fluid retention

Electrolyte imbalances
 Effects of  Cortisol

 protein catabolism

 immune response

 platelets
 Discharge

Home care preparation

Health teaching

Psychosocial preparation

Health care resources
 Wound Healing

Healing

Wound Drainage

Wound Disruptions

Sutures

Acute Pain
 Types of Drains

Penrose
T-Tube
Jackson-Pratt
Hemo-vac

Recording

Communication
 Healing

Primary Intention

Secondary Intention

Tertiary Intention
 Wound Drainage

Serous

Sanguineous

Purulent
 Wound Disruption

Dehiscence

Evisceration
Types of Skin Closures
a.
Sutures
Interrupted
Continuous Sutures
Staples
Steri-strips
Retention Sutures
Retention Bridge
 Acute Pain

Adequate Pain Control

Client participation in pain control
 Promotion of Recovery

Discharge Instructions

Follow-up plans

Home Care

Wound Care

Prescriptions

Contact Person

Follow-up Appointment
Questions ?????