Prepared by: Marisel Indon Prepared by: Marisel Indon LunaLuna

PERIOPERATIVE NURSING PERIOPERATIVE NURSING CARECARE

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OBJECTIVESOBJECTIVES

At the end of the presentation the participants will At the end of the presentation the participants will be able to:be able to:

1.1. Recognize the different phase of perioperative Recognize the different phase of perioperative nursing care.nursing care.

2.2. Identify the goal of care in each phasesIdentify the goal of care in each phases

3.3. Identify the different nursing role and Identify the different nursing role and responsibility.responsibility.

4.4. Effectively apply it in actual nursing practice for Effectively apply it in actual nursing practice for care and safety of the patientcare and safety of the patient

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Operating RoomOperating Room

Surgery a branch of medicine that treat

injuries, deformities or diseases by operation or manipulation

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IntroductionIntroduction

PERIOPERATIVE NURSING is the PERIOPERATIVE NURSING is the nursing care rendered to the total nursing care rendered to the total

surgical experience of the patientsurgical experience of the patient

33 PhasesPhases

11 . .Preoperative phasePreoperative phase

22 . .Intra operative phaseIntra operative phase

33 . .Post operative phasePost operative phase44

Pre-operative Phase

Pre-operative Phase

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Pre operative CarePre operative Care

Care rendered to the patient Care rendered to the patient from the time the decision from the time the decision

is made for surgical is made for surgical intervention to the time intervention to the time the patient is transfer to the patient is transfer to

the operating roomthe operating room..66

GOAL OF CAREGOAL OF CARE

To prepare the patient To prepare the patient physically, physically,

psychologically psychologically spiritually and legallyspiritually and legally..

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PHYSICAL PREPARATIONPHYSICAL PREPARATION1. Develop nursing history 1. Develop nursing history 2. Physical assessment ( P.E, V/S, Lab. 2. Physical assessment ( P.E, V/S, Lab.

Examination)Examination)3. Assessment for risk factors 3. Assessment for risk factors 4. Preparation of the operative site4. Preparation of the operative site Skin preparation:Skin preparation: a. scrubbing or taking a bath a. scrubbing or taking a bath b. shaving or hair removal b. shaving or hair removal Gastro intestinal tract preparation:Gastro intestinal tract preparation: a. NPO ( Nothing per Orem )a. NPO ( Nothing per Orem ) b. Bowel clearanceb. Bowel clearance Genitourinary tract preparation- Genitourinary tract preparation- 5. Some patients may benefit from a sleeping 5. Some patients may benefit from a sleeping

pills or tranquilizer.pills or tranquilizer. 88

Psychological and spiritual Psychological and spiritual preparationpreparation

Patients are often fearful or anxious about having Patients are often fearful or anxious about having surgery. surgery.

1.1. It is often helpful for the patient to express their It is often helpful for the patient to express their concerns concerns

2.2. Family needs to be included in psychological Family needs to be included in psychological preoperative carepreoperative care

3.3. Pastoral care or religious affair assistancePastoral care or religious affair assistance

Children may be especially fearful. Children may be especially fearful. 1.1. They should be allowed to have a parent with them They should be allowed to have a parent with them

as much as possibleas much as possible2.2. Encouraged to bring a favorite toy or blanket to the Encouraged to bring a favorite toy or blanket to the

hospital on the day of surgery. hospital on the day of surgery. 99

Legal preparationLegal preparation

Informed consent or operative permit - is the Informed consent or operative permit - is the process of informing the patient about the process of informing the patient about the surgical procedure and its benefits the surgical procedure and its benefits the risk, and possible complication the risk, and possible complication the anesthesia, and other treatment optionanesthesia, and other treatment option..

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Purpose of informed consentPurpose of informed consent

1.1. To ensure that the patient understands the To ensure that the patient understands the nature of the treatment. nature of the treatment.

2.2. To indicate that the patient’s decision was To indicate that the patient’s decision was made without pressure.made without pressure.

3.3. To protect the patient against unauthorized To protect the patient against unauthorized procedure.procedure.

4.4. To ensure that the procedure is performed on To ensure that the procedure is performed on the correct body part.the correct body part.

5.5. To protect the surgeon and hospital against To protect the surgeon and hospital against legal action by a patient who claims that an legal action by a patient who claims that an authorized procedure was performed.authorized procedure was performed. 1111

Obtaining a consentObtaining a consent

1.1. Adult patient with sounds mind sign consent Adult patient with sounds mind sign consent 2.2. Patient should be properly informed.Patient should be properly informed. Signature is Signature is

obtained with the patient’s complete understanding.obtained with the patient’s complete understanding.3.3. The surgeon is responsible for obtaining the consent.The surgeon is responsible for obtaining the consent.4.4. Older client and minors , mentally ill, need a legal Older client and minors , mentally ill, need a legal

guardian to sign the consent form.guardian to sign the consent form. 5.5. The nurse may witness the clients signing of the The nurse may witness the clients signing of the

consent consent 6.6. If patient is unable to write, thumb mark is If patient is unable to write, thumb mark is

acceptable if there is a witness to his mark.acceptable if there is a witness to his mark.7.7. Emancipated minors.Emancipated minors.

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Validity of a consentValidity of a consent

1.1. Written permission is required by lawWritten permission is required by law2.2. Adult mentally healthy are competent to sign there Adult mentally healthy are competent to sign there

consent consent 3.3. Minors – (18 and below) parents or legal guardian Minors – (18 and below) parents or legal guardian

signedsigned4.4. Mentally ill- parents or legal guardian, appointed by Mentally ill- parents or legal guardian, appointed by

the courtthe court5.5. Emergency- ( if patient is unconscious or no legal Emergency- ( if patient is unconscious or no legal

guardian, the medical practitioner is expected to act in guardian, the medical practitioner is expected to act in the patient's best interests until family can be found.the patient's best interests until family can be found.

6.6. A witness to the patient’s signature is required.A witness to the patient’s signature is required.7.7. If the patient is unable to write a thumb mark is If the patient is unable to write a thumb mark is

acceptable if there is a witness to his mark.acceptable if there is a witness to his mark.

“ “Validity may vary depend on the jurisdiction” Validity may vary depend on the jurisdiction” 1313

Some recent cases:

In April 2011 an ophthalmologist in Portland, operated on the wrong eye of a 4-year-old boy.

In December 2010, Beth Israel Deaconess Medical Center in Boston reported that neurosurgeons had performed three wrong-site spinal surgeries in a two-month period.

And after five wrong-site operations in less than three years, state officials in 2009 ordered that video cameras be installed in the operating rooms of Rhode Island Hospital in Providence, which was fined $150,000.

THE WASHINGTON POST

The Pain of Wrong Site SurgeryBy Sandra G. Boodman, June 20, 2011Based on state data, Joint

Commission officials estimate that wrong-site surgery occurs 40 times a week in U.S. hospitals and clinics. Last 2010, 93 cases were reported to the accrediting organization, compared with 49 in 2004.

Patient educationPatient education

1.1. A vital component of the surgical experience. A vital component of the surgical experience. 2.2. Designed to help the patient understand the Designed to help the patient understand the

surgical experience to minimize anxiety and surgical experience to minimize anxiety and promote full recovery from surgery and promote full recovery from surgery and

anaesthesia. anaesthesia. 3.3. Preoperative patient education maybe offered Preoperative patient education maybe offered

through conversation, discussion, audiovisual through conversation, discussion, audiovisual aids or videos & demonstrations.aids or videos & demonstrations.

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Post-operative exercisesPost-operative exercises

Incentive spirometry (10-12 times per hour)Incentive spirometry (10-12 times per hour)Coughing – promotes removal of chest secretionsCoughing – promotes removal of chest secretions

Deep breathing- decrease or lessen the pain Deep breathing- decrease or lessen the pain Turning – stimulates circulation and relieves Turning – stimulates circulation and relieves

pressure areaspressure areasFoot and leg exercise – improves circulation and Foot and leg exercise – improves circulation and

muscle tonemuscle tone

*SHOULD be taught to patient prior to Operation **SHOULD be taught to patient prior to Operation *

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Pre-operative medicationPre-operative medication

To aid in the administration of an To aid in the administration of an anesthetic, anesthetic,

minimize respiratory tract secretions minimize respiratory tract secretions and changes in heart rate and changes in heart rate

to relax the patient and reduce to relax the patient and reduce anxietyanxiety

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Types of Preoperative Types of Preoperative medicationmedication

1.1. Opiates – such as morphine and demerol Opiates – such as morphine and demerol

2.2. Anticholinergic – such as atrophine Anticholinergic – such as atrophine

3.3. Barbiturates/Tranquilizers – Barbiturates/Tranquilizers – pentobarbital pentobarbital

4.4. Prophylactic antibiotics – to be effective Prophylactic antibiotics – to be effective when bacterial contamination is when bacterial contamination is

expectedexpected..

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Admitting the patient to Admitting the patient to surgerysurgery::

1.1. Final Checklist/ Preoperative Final Checklist/ Preoperative checklistchecklist

2.2. Identification and verificationIdentification and verification

3.3. Review of patient recordReview of patient record

4.4. Consent formConsent form

5.5. Patient preparednessPatient preparedness

6.6. Transporting the patient to the ORTransporting the patient to the OR

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Intra-operative careIntra-operative care

The intra-operative phase extend from The intra-operative phase extend from the time the client is admitted to the the time the client is admitted to the

operating room, to the time of operating room, to the time of anesthesia administration, anesthesia administration, performance of the surgical performance of the surgical

procedure and until the client is procedure and until the client is transported to the recovery room or transported to the recovery room or

postanethesia care unit (PACU)postanethesia care unit (PACU) . .

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Surgical TeamSurgical Team

Scrub team or Scrub team or sterile teamsterile team

1.1. SurgeonSurgeon

2.2. Assistant Assistant surgeonsurgeon

3.3. Scrub nurseScrub nurse

Non sterile Non sterile none scrub none scrub teamteam

1.1. AnesthesioloAnesthesiologist and gist and technicianstechnicians

2.2. Circulating Circulating nursenurse

3.3. Others Others

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Throughout the surgical experience Throughout the surgical experience the nurse functions as the patient’s the nurse functions as the patient’s advocateadvocate

Goals of care:Goals of care:1.1. Safe administration of anesthesia, right Safe administration of anesthesia, right

patient, right procedure, correct site patient, right procedure, correct site 2.2. Homeostasis Homeostasis 3.3. Promote the principle of asepsisPromote the principle of asepsis4.4. HemostasisHemostasis

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Anesthesia classificationAnesthesia classification::A.A. General anesthesia-General anesthesia- is the loss of is the loss of

all sensation and consciousness. all sensation and consciousness.

B.B. Regional / Local Anesthesia-Regional / Local Anesthesia- The The client loss sensation in an area of client loss sensation in an area of the body but remains conscious. the body but remains conscious. ::

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Anesthesia ClassificationAnesthesia Classification

General anesthesiaGeneral anesthesia

administered by :administered by :

1.1. Intravenous Intravenous infusioninfusion

2.2. Inhalation of gases Inhalation of gases through a mask orthrough a mask or

3.3. through an endo- through an endo- tracheal tube tracheal tube inserted into the inserted into the trachea.trachea.

Regional / Local Regional / Local anesthesiaanesthesia

1.1. TopicalTopical

2.2. Local/infiltration Local/infiltration

3.3. Nerve blockNerve block

4.4. Intravenous blockIntravenous block

5.5. SpinalSpinal

6.6. Epidural Epidural

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44 Stages of anesthesiaStages of anesthesia

1.1. Stage I begins with the induction of anesthesia Stage I begins with the induction of anesthesia and ends with the patient's loss of and ends with the patient's loss of consciousness. consciousness.

2.2. Stage II, or REM stage,. From Loss of Stage II, or REM stage,. From Loss of consciousness to loss of lid reflex.consciousness to loss of lid reflex.

3.3. Stage III, or surgical anesthesia, Loss of lid Stage III, or surgical anesthesia, Loss of lid reflex to loss of most reflexreflex to loss of most reflex

4.4. Stage IV, or medullary stage, or overdose- it is Stage IV, or medullary stage, or overdose- it is marked by hypotension or circulatory failure. marked by hypotension or circulatory failure.

Note: Being aware of the different stages will Note: Being aware of the different stages will help us to better predict the course of event help us to better predict the course of event and act accordingly in emergency situation.and act accordingly in emergency situation.

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Intra operative complicationsIntra operative complications::

1.1. HypoventilationHypoventilation2.2. Oral traumaOral trauma3.3. HypotensionHypotension

4.4. Cardiac dysrhythmiaCardiac dysrhythmia5.5. HypothermiaHypothermia

6.6. Peripheral nerve damagePeripheral nerve damage7.7. Malignant hyperthermiaMalignant hyperthermia

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Principle of Aseptic techniquePrinciple of Aseptic technique

1. All items used within the sterile field must 1. All items used within the sterile field must be sterile. be sterile.

2. A sterile barrier that has been permeated 2. A sterile barrier that has been permeated must be considered contaminated.must be considered contaminated.

3. The edges of a sterile wrapper or 3. The edges of a sterile wrapper or container are considered unsterile once container are considered unsterile once the package is opened.the package is opened.

4. Gowns are considered sterile from chest 4. Gowns are considered sterile from chest to the level of the sterile field, and the to the level of the sterile field, and the sleeves to 2inches above the elbows.sleeves to 2inches above the elbows.

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Cont. principlesCont. principles

5. Tables are sterile at table level only.‡5. Tables are sterile at table level only.‡

6. Sterile persons and items touch only 6. Sterile persons and items touch only

sterile areas; unsterile persons andsterile areas; unsterile persons and

items touch only unsterile areas.‡items touch only unsterile areas.‡

7.Movement around the sterile field mus7.Movement around the sterile field must not contaminate the field. t not contaminate the field.

8. ‡All items and areas of doubtful 8. ‡All items and areas of doubtful sterility are considered contaminated.sterility are considered contaminated.

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WHO Safe Surgery Saves Lives Checklist.flv

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ReferencesReferences

Lippincott Manual of nursing Practice 8Lippincott Manual of nursing Practice 8thth Edition Edition MSD Gen Surgery F02AMSD Gen Surgery F02A American Nurses Association. Role of registered American Nurses Association. Role of registered

nurse in the management of patient receiving nurse in the management of patient receiving conscious sedation for short term therapeutic, conscious sedation for short term therapeutic, diagnostic or surgical procedure.diagnostic or surgical procedure.

Association of Perioperative Registered Nurses (2004) Association of Perioperative Registered Nurses (2004) AORN standards and recommended practices for AORN standards and recommended practices for perioperative nursing.perioperative nursing.

http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html#ixzz2ROUbDyRf

http://nursingcrib.com/http://nursingcrib.com/

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