PERI-OPERATIVE PERI-OPERATIVE NURSINGNURSING

THREE PHASESTHREE PHASES

PRE-OPERATIVEPRE-OPERATIVEINTRA-OPERATIVEINTRA-OPERATIVEPOST-0PERATIVEPOST-0PERATIVE

GENERAL GENERAL INFORMATIONINFORMATION

1.1. Pre-operative begins when the decisions for Pre-operative begins when the decisions for surgical intervention is made and ends when surgical intervention is made and ends when the patient is transferred to the operating roomthe patient is transferred to the operating room

2.2. Intra-operative begins when the patient Intra-operative begins when the patient is transferred to the surgery & ends is transferred to the surgery & ends when transferred to the recovery roomwhen transferred to the recovery room

3.3. Post-operative begins when the patient Post-operative begins when the patient is admitted to the recovery room & ends is admitted to the recovery room & ends with follow up evaluation in the clinical with follow up evaluation in the clinical setting or homesetting or home

PRE-OPERATIVE PRE-OPERATIVE SURGERYSURGERY

Carolyn Frye-ShegogCarolyn Frye-Shegog

GENERAL GENERAL INFORMATIONINFORMATION

• PURPOSE OF SURGERYPURPOSE OF SURGERY

• SURGERY SETTINGSSURGERY SETTINGS

• INFORMED CONSENTINFORMED CONSENT

CLASSIFICATION OF CLASSIFICATION OF SURGERYSURGERY

ACCORDING TO PURPOSE:ACCORDING TO PURPOSE: DIAGNOSTICDIAGNOSTICCURATIVECURATIVEPALLIATIVEPALLIATIVERECONSTRUCTIVERECONSTRUCTIVEPREVENTIVEPREVENTIVEEXPLORATORYEXPLORATORYCOSMETICCOSMETIC

MAJOR AND MINOR MAJOR AND MINOR SURGERYSURGERY

TERMINOLOGYTERMINOLOGY ECTOMY: REMOVAL OF AN ORGANECTOMY: REMOVAL OF AN ORGAN

RRHAPHY: SUTURE OF A PARTRRHAPHY: SUTURE OF A PART

SCOPY: LOOKING INTOSCOPY: LOOKING INTO

OSTOMY : MAKING AN OPININGOSTOMY : MAKING AN OPINING

PLASTY :REPAIR OR RESTOREPLASTY :REPAIR OR RESTORE

OTOMY: CUTTING INTO OTOMY: CUTTING INTO

AMBULATORY SURGERYAMBULATORY SURGERY• ADVANTAGES:ADVANTAGES:

• Less psychological distress associated with Less psychological distress associated with hospitalizationhospitalization

• Decreased exposure to hospital infectionsDecreased exposure to hospital infections• Economic savingsEconomic savings• Consumer satisfactionConsumer satisfaction

FACTORS AFFECTING FACTORS AFFECTING ADAPTATION TO SURGERYADAPTATION TO SURGERY• AGE:AGE:• NEUROENDOCRINE RESPONSE:NEUROENDOCRINE RESPONSE:• SURGICAL PROCEDURE:SURGICAL PROCEDURE:• PREVIOUS HOSPITALIZATIONS PREVIOUS HOSPITALIZATIONS

AND SURGERIES:AND SURGERIES:• SPIRITUAL BELIEFS:SPIRITUAL BELIEFS:• TYPE OF ADMISSIONTYPE OF ADMISSION

PSYCHOSOCIAL PSYCHOSOCIAL REACTIONS TO SURGERY:REACTIONS TO SURGERY:

EMOTIONAL RESPONSES TO SURGERY:EMOTIONAL RESPONSES TO SURGERY:

FEAR OF THE UNKNOWNFEAR OF THE UNKNOWN FEAR OF ANESTHESIA;FEAR OF ANESTHESIA; FEAR OF PAIN: UNIVERSAL –FEAR OF FEAR OF PAIN: UNIVERSAL –FEAR OF

MUTILATIONS OR ALTERED BODY IMAGEMUTILATIONS OR ALTERED BODY IMAGE FEAR OF DEATHFEAR OF DEATH FEAR OF SEPARATION AND ROLE FEAR OF SEPARATION AND ROLE

CHANGECHANGE

NON VERBAL NON VERBAL COMMUNICATION OF COMMUNICATION OF

FEARS AND ANXIETIESFEARS AND ANXIETIESRAPID SPEECHRAPID SPEECHJOKING JOKING MAKING LIGHT OF SITUATIONMAKING LIGHT OF SITUATIONWITHDRAWALWITHDRAWAL

NURSES ROLE NURSES ROLE • RECOGNIZING AND RECOGNIZING AND

UNDERSTANDING PSYCHOSOCIAL UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:REACTIONS TO SURGERY:

PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING ASSESSMENTASSESSMENT

PSYCHOLOGICAL ASSESSMENT:PSYCHOLOGICAL ASSESSMENT:

• Social History: smoking, alcohol Social History: smoking, alcohol consumption, occupation etc.consumption, occupation etc.

• Family health history Family health history

• Past health history & home Past health history & home medication: medication:

MEDICATIONS MEDICATIONS CON’TCON’T

• STEROIDS-should not be stopped abruptlySTEROIDS-should not be stopped abruptly• Antidepressants can increase hypotensive Antidepressants can increase hypotensive

effects of anesthesiaeffects of anesthesia• Antibiotics such as neomycin, kanamycin can Antibiotics such as neomycin, kanamycin can

combine with certain anesthetics & lead to combine with certain anesthetics & lead to respiratory paralysisrespiratory paralysis

• Insulin dosage may need to be adjusted-check Insulin dosage may need to be adjusted-check with the physicianwith the physician

• ASA thins blood so may increase post-op ASA thins blood so may increase post-op bleedingbleeding

• Antihypertensives & cardiac drugs can’t be Antihypertensives & cardiac drugs can’t be stopped abruptlystopped abruptly

• Check for the use of OTC drugs for glaucomaCheck for the use of OTC drugs for glaucoma

PHYSIOLOGICAL PHYSIOLOGICAL ASSESSMENTASSESSMENT

RespiratoryRespiratory

HX of dyspnea, coughing, hemoptysisHX of dyspnea, coughing, hemoptysisCOPD, or URICOPD, or URISmoker?Smoker?Record baseline breath soundsRecord baseline breath soundsDiagnostic tests;; ABG’S CXR, FPT’SDiagnostic tests;; ABG’S CXR, FPT’S

CARDIOVASCULARCARDIOVASCULAR• HX OF CARDIO OR CEREBRAL HX OF CARDIO OR CEREBRAL

VASCULAR DISEASEVASCULAR DISEASE• PACEMAKERPACEMAKER• ARTIFICIAL VALVESARTIFICIAL VALVES• ANTICOAGULANT THERAPYANTICOAGULANT THERAPY

CNS: (ENTRAL NERVOUS CNS: (ENTRAL NERVOUS SYSTEM)SYSTEM)

• HX of stroke, TIA’S,HX of stroke, TIA’S,• NEUROMUSCULAR DISORDERS NEUROMUSCULAR DISORDERS

SUCH AS MYASTHENIA GRAVI,SUCH AS MYASTHENIA GRAVI,• ESPECIALLY IMPORTANT TO ESPECIALLY IMPORTANT TO

ASSESS MENTAL STATUSASSESS MENTAL STATUS• LOCLOC

PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING CARECARE

• PRE – OPERATIVE TEACHINGPRE – OPERATIVE TEACHINGo THE NURSE IS RESPONSIBLE TO:THE NURSE IS RESPONSIBLE TO:

o FIND OUT WHAT PT. KNOWSFIND OUT WHAT PT. KNOWSo INCLUDE FAMILYINCLUDE FAMILYo USE SIMPLE TERMSUSE SIMPLE TERMSo EVALUATE PT. UNDERSTANDINGEVALUATE PT. UNDERSTANDINGo USE AUDIOVISUAL AIDSUSE AUDIOVISUAL AIDSo ASK FOR RETURN DEMONSTRATIONASK FOR RETURN DEMONSTRATION

PRE-OPERATIVE PRE-OPERATIVE TEACHINGTEACHING

USUAL TOPICS COVEREDUSUAL TOPICS COVEREDPreoperative testsPreoperative testsPreoperative routinesPreoperative routinesScheduleSchedulePACUPACUFAMILY DIRECTIONSFAMILY DIRECTIONSPOSTOP THERAPIESPOSTOP THERAPIESPAIN MANAGEMENTPAIN MANAGEMENTDIETDIET

PRE-OPERATIVE NURSING PRE-OPERATIVE NURSING ASSESSMENTASSESSMENT

• PSYCHOLOGICAL ASSESSMENTPSYCHOLOGICAL ASSESSMENT• SOCIAL HISTORYSOCIAL HISTORY

• FAMILY HEALTH HISTORYFAMILY HEALTH HISTORY

• PAST HEALTH HISTORY PAST HEALTH HISTORY

• PHYSIOLOGICAL HISTORYPHYSIOLOGICAL HISTORY

PREOPERATIVE PHYSICAL PREOPERATIVE PHYSICAL PREPARATIONPREPARATION

PRE-OP PHYSICAL PREPARATIONPRE-OP PHYSICAL PREPARATIONNUTRITIONAL NUTRITIONAL NIGHT BEFORE SURGERY, LIGHT NIGHT BEFORE SURGERY, LIGHT

MEAL OR LIQUID DIETMEAL OR LIQUID DIETSPECIFIC IV FLUIDSSPECIFIC IV FLUIDSNPO AFTER MIDNIGHTNPO AFTER MIDNIGHTPOSSIBILITY OF LIGHT BREAKFAST POSSIBILITY OF LIGHT BREAKFAST

ON DAY OFON DAY OF

PRE-OP PHYSICAL PREPPRE-OP PHYSICAL PREP• IntestinalIntestinal

NPONPO

Enemas until clearEnemas until clear

LaxativesLaxatives

Antibiotics to decrease intestinal floraAntibiotics to decrease intestinal flora

PRE-OP PHYSICAL PREPPRE-OP PHYSICAL PREP• Skin prepSkin prep

• Bathe before surgeryBathe before surgery

• Shaving operative siteShaving operative site

• Scrub with betadine/other antisepticScrub with betadine/other antiseptic

Three important Three important components of consent components of consent

formform

1.1. Adequate disclosureAdequate disclosure

2.2. Sufficient comprehensionSufficient comprehension

3.3. Voluntary consentVoluntary consent