Peri-Operative CareNURS 2016

Stages of the Peri-Operative PeriodPre-Operative

From time of decision to have surgery until admitted into the OR theatre.

Stages of the Peri-Operative PeriodIntra-Operative

Time from entering the OR theatre to entering the Recovering Room or Post Anesthetic Care Unit (PACU)

Stages of the Peri-Operative PeriodPost-Operative

Time from leaving the RR or PACU until time of follow-up evaluation (often as opt-patient)

Some Suffixes Ectomy Otomy Oscopy Pathy Rhage Oma

Itis Logy Megaly Rhea Lysis Megaly

Some Prefixes Chole Lap Dys Cyst Lith

Carcin Neo Ortho Trans

A Few Terms Reduction Resection Bypass Excision I & D

Aspiration DVT Dehiscence Evisceration Paralytic Ileus

Classifications of Surgery I Emergency: immediately II Urgent: 24-30 hours III Required: need surgery in

upcoming weeks IV Elective: Should have V Optional: Not necessary – a choice

Pre-Operative Period Nursing Assessment

Nutritional and Fluid Status Drug and Alcohol use Respiratory Status CV Status Other system (renal, hepatic, immune Medications Psychosocial, spiritual and cultural beliefs

Pre-Operative Period Nursing Interventions

Teaching Physical Prep

Surgical Site Nutrition and Fluids Preanesthetic Medication

Psychosocial Support Reducing anxiety and addressing fears

Pre-Operative Period Teaching

Pain management Deep Breathing and Coughing Movement and Ambulation

Pre-Operative Period Pre-Op Checklist (figure 18.3, page 413)

Proper documentation complete Physical and chemical work-up complete Patient physically prepared Current condition

Intra-Operative Period Nursing Roles: Patient Advocate

Scrub nurse Responsible for ‘sterile’ work Monitor sterile integrity of procedure Monitors equipment (instruments, sutures, etc)

Circulating nurse Protects patient safety Monitors operating room conditions Monitors surgical team activities

Intra-Operative PeriodStages of Anesthesia

I: Beginning

II: Excitement

III: Surgical anesthesia

IV: Medullary Depression

Intra-Operative Period: Achieving Anesthesia

Inhalation Halothane and

methoxyflurane Administered via mask

or endotracheal tube Inducation and

recovery quite rapid

Intravenous Tranq/Sedatives Opioids Neuroleptanalgesics Dissociative Agents Barbiturates Nonbarbiturates

Intra-Operative PeriodAnesthesia is not always

General Regional Blocks Local infiltration

Intra-Operative PeriodComplications Nausea and vomiting Anaphylaxis Hypoxia Hypothermia Malignant Hyperthermia DIC

Post-Operative Period Immediate Post-Op

PACU Assist and monitor patient in post-anesthetic

stage Airway, circulation, hemorrhage, nausea/vomiting

Recovery Clinical Unit Discharge home

Post-Operative Period: Clinical Unit

Primary focus Neurological status Pain management Respiratory function Circulatory function Wound care Fluid Balance Nutritional status

Post-Operative PeriodImmediate Assessment Level of consciousness Vital Signs (q15 x 2,

q30, . . .) Wound Fluid Balance Pain

Post-Operative Period: Recovery: Day 1 to Discharge

Preventing Respiratory Complications

Relieving Pain Promoting Cardiac

Function Encouraging Activity Promoting Wound

Healing

Maintaining Body Temp

Monitoring GI Function

Managing Voiding Providing Support

Post-Operative Period: Complications Deep Vein Thrombosis Hematoma Infection Wound Dehiscence

Post-Operative Period Consider the list of Nursing Diagnosis

provided What nursing interventions would be

appropriate