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- 1. 1 PERIOPERATIVE NURSING Definition: Thisis a specialty in nursing that comprises the total care giving to patients in the preoperative, intraoperative and postoperative periods of patients surgical experience through the framework of nursing process.
- 2. 2 PERIOPERATIVE NURSING CARE Theseare the total care given to a surgical patients or clients throughout his/her surgical experience, it could be at home or in the hospital. PERIOPERATIVE NURSE He or She is a nurse specialist that deals with the total care of surgical patients through preoperative, intraoperative and postoperative care.
- 3. 3 PHASES OF PERIOPERATIVENURSING • 1. Preoperative phase: this phase started from when the patients is confirmed to undergo a surgical procedure till the patient is transferred to OR table. • 2. Intraoperative phase: begins when the patient is transferred to OR table and end when the patient is admitted in the PACU. • 3. Postoperative phase: this begins in the PACU and end when the surgical wound healing is complete.
- 4. 4 WHAT IS SURGERY •Is a surgical procedure performed on a patients in order to remove, repair or replace any damaged part of the body or performed to manage patients current health challenges.
- 5. 5 TYPES OF SURGERY. Surgerycan be grouped into three main types; According to the purpose/reasons. According to the degree of urgency. According to the degree of risk.
- 6. 6 TYPE OF SURGERY(PURPOSE) Diagnostics: enable us to confirm the causes of a particular ailments. Corrective: is the act of removing or excision the diseased part of the body. Reconstructive: for restoration of functions or malfunctioning tissues from diseases/trauma. Ablative: removal of disease body part. Palliative: relieve or reduced pain from diseases especially those diseases that cannot be cure. Transplant: replace malfunctioning organs or structures. Cosmetics: performed to improve personal appearance.
- 7. 7 URGENCY AS ATYPE OF SURGERY Emergency: Performed immediately to preserve function or the life of the patients. Elective: Is done when the surgical procedure is the best treatment for the patients that the condition is not imminently life threatening. Required: Has to be performed at some point but can be pre- scheduled.
- 8. 8 TYPE OF SURGERY(ACCORDINGTO DEGREE OF RISK ) 1.Major surgery High risk/greater risk for infection Extensive Prolonged Large amount of blood loss Vital organ may be handled or removed
- 9. 9 (ACCORDING TO DEGREEOF RISK CONT….. 2. Minor surgery Generally not prolonged Leads to few or little complications Involves less risk
- 10. 10 AMBULATORY SURGERY/SAME-DAY SURGERY/OUTPATIENT SURGERY Advantages: Reduces length of hospital stay and cuts costs Reduces stress for the patient Less incidence of hospital acquired infection Less time lost from work by the patients; minimal disruption on the patients activities and family life
- 11. 11 AMBULATORY SURGERY CONT……. Disadvantages: Less time assess the patient and perform preoperative teaching Less time to establish rapport Less opportunity to assess for late postoperative complication
- 12. 12 Examples of ambulatorysurgery Teeth extraction Circumcision Vasectomy Cyst removal Tubal ligation Lump excision. etc.
- 13. 13 SURGICAL RISK Obesity Poor nutrition Fluid and electrolyte Age Presence of disease (cardio vascular dsc.. DM, respiratory dsc.) Concurrent or prior pharmacotherapy
- 14. 14 Other factors; Natureof condition Magnitude / urgency of surgery Mental attitude of the patient Caliber of the health care team
- 15. 15 PREOPERATIVE PHASE Goals Assessingand correcting physiologic and psychology problem that may increase surgical risk. Giving the person and significant others complete learning /teaching guideline regarding surgery. Instructing and demonstrating exercises that will benefits the person during postop period. Planning for discharge and any projected charges in lifestyle due to surgery.
- 16. 16 Physiologic assessment ofthe client undergoing surgery Presence of pain Nutritional, fluid and electrolyte balance Cardiovascular / pulmonary function Renal function Gastrointestinal / liver function •
- 17. 17 Physiologic assessment cont… Endocrine function Neurological function Hematologic function Use of medication Presence of trauma and infection
- 18. 18 Routing Preoperative ScreeningTest TEST RATIONALE Blood grouping/x matching RBC, Hgb, are important to the oxygen carrying capacity of blood, WBC are indicator of immune function. Serum electrolyte Determined in case blood transfusion is required during or after surgery Clotting profile Measure time required for clotting to occur FBS High level may indicate undiagnosed DM
- 19. 19 Screening Test cont…… TESTRATIONALE Urinalysis Determine urine composition Chest x-ray Evaluate resp. status/heart size ECG Identify preexisting cardiac problem BUN/creatinine Evaluate renal function
- 20. 20 Psychosocial assessment andcare Causes of fears of the preoperative clients fear of unknown (anxiety) fear of anesthesia fear of pain fear of death Fear of disturbance on body image Worries – loss of finances, employment, social, and family roles.
- 21. 21 Manifestation of fears anxiousness anger tendency to exaggerate sad, evasive, tearful, clinging, inability to concentrate short attention span failure to carry out simple direction
- 22. 22 NURSING INTERVENTION TOMINIMIZE ANXIETY • Explore clients feelings • allow client to speak openly about fears/concerns • give accurate information regarding surgery(brief, direct to the point and in simple terms) • give empathetic support • consider person`s religious preference and arrange for visit by a priest /minister as desired
- 23. 23 INFORMED CONSENT Purposes: • Toensure that the client understand the nature of treatment including the potential complication and disfigurement (explained by AMD) • To indicate the client’s decision was made without pressure to protect the client against unauthorized procedure. • To protect the surgeon and hospital against legal action by a client who claim that an authorized procedure was performed.
- 24. 24 Circumstance requiring consent •Any surgical procedure where scalpel, scissors, suture, hemostats of electrocoagulation may be used. • Radiologic procedures, particularly if contrast materials is required • Entrance into body cavity. • General anesthesia, local infiltration and regional block.
- 25. 25 Essential element ofinformed consent • The diagnosis and explanation of the condition. • A fair explanation of the procedure to be done and used and the consequences • A description of alternative treatment or procedure • A description of the benefit to be expected • The prognosis if recommended care, procedure is refused.
- 26. 26 Requisite for validityof informed consent • Written permission is best and legally accepted. • Signature is obtained with the clients’ complete understanding of what to occur. • Adult patients sign their own operative permit before sedation. • For minors, parents or someone standing on their behalf, gives the consent. • For mentally ill and unconscious patients, consent must be taken from the parents or legal guardian or follow hospital rules on that.
- 27. 27 Requisite for validityof informed consent cont….. • If the patient is unable to write, an “X” is accepted if there is a witness to his mark. • A witness is desirable – nurse, physician or authorized persons. • When an emergency situation happened, no consent is necessary because inaction at such time may cause greater injury, therefore, permission via telephone is accepted and pet on record but consent must be signed within 24hrs
- 28. 28 PREOPERATIVE CARE • Physicalpreparation • Before surgery • Correct any dietary deficiencies • Reduce an obese persons weight • Correct fluid and electrolyte imbalances
- 29. 29 • Physical preparation •Before surgery • Restore adequate blood volume with BT. • Treat chronic diseases. • Halt or treat any infectious process. • treat an alcoholic person with vit , supplementation ,IVF or fluids if dehydrated
- 30. 30 PREOPERATIVE TEACHING • IncentiveSpirometry • Encouraged to use incentive spirometer about 10 to 12 times per hour • Deep inhalations expand alveoli which prevents atelectasis and other pulmonary complications. • There is less pain with inspiratory concentration than with expiratory concentration.
- 31. 31 Diaphragmatic Breathing. • Refersto a flattening of dome of the diaphragm during inspiration, with resultant enlargement of upper abdomen as air rushes in, during expiration, abdominal muscles contract. • In semi – fowler’s position, with your hand loose fist, allow to rest lightly on the front of lower ribs. • Breathe out gently and fully as the ribs sink down and inward toward midline.
- 32. 32 Diaphragmatic Breathing cont…. •Then take a deep breath through the nose and mouth letting the abdomen rise as the lungs fill with air, hold breath for a count of 5. • Exhale and let out all the air through the nose and mouth • Repeat this exercise 15 times with a short rest after each group of 5.
- 33. 33 Coughing • Promote removalof chest secretions. • Interface his finger and place hands proposed incision site this will act as space that will not harm the incision. • Lean forward slightly while sitting in bed • Breath, using diaphragm. • Inhale fully with mouth slightly open. • With mouth open, take in a deep breath and quickly give 1-2 strong coughs.
- 34. 34 • Turning • Changingposition from back to side – lying (vice-versa) stimulates circulation, encourages deeper breathing and relieve pressure areas. • Help the patient or move a side if assistance is needed. • Place the uppermost leg in a flexed position comfortably between the legs. • Make sure that the patient is turned from one side to the back and unto the other side every 2hours.
- 35. 35 • Foot andLeg Exercise. • Moving the legs improves circulation and muscle tone. • Help the patient lie supine, instruct patient to bend a knee and raise the foot-hold it a few seconds and lower it to the bed. • Repeat above about 5times with one leg and then with the other. Repeat the set 5times every 3-5 hours. • Then have the patient lie on one side and exercise the legs by pretending to pedal a bicycle. • For foot exercise, trace a complete circle with the great toe.
- 36. 36 • Turning Slide. •Turn on your side with the uppermost leg flexed most and supported on a pillow. • Grasp the side rails as an aid to maneuver to the side.
- 37. 37 Preparing the patientthe evening before surgery • Preparing the skin • Have a full bath to reduce micro- organism in the skin • Hair should be removed within 1-2mm of the skin to avoid skin breakdown, use electric clipper is preferable. Preparing the G.I tract • NPO, cleansing enema as required
- 38. 38 ASA (AMERICAN SOCIETYOF ANESTHESIOLOGIST) GUIDELINES FOR PREOPERATIVE FASTING. Liquid and food intake Minimum fasting period Clear liquids 2 Breast milk 4 Nonhuman milk 6 Light meal 6 Regular/heavy meals 8
- 39. 39 Preparing for anesthesia •Avoid alcohol and cigarette smoking at least 24hrs before surgery • Promoting rest and sleep • Administer sedatives as ordered • Preparing the person on the day of surgery • Early AM care • Awaking 1hr before preop medications
- 40. 40 Preparing for anesthesiacont…. • Morning bath, mouth wash • Provide clean gown • Remove hair pins, braid long hair, cover hair with cap if available • Remove dentures colored nail polish, hearing aid, contact lenses, jewelries • Take baseline vital sign before preop medication
- 41. 41 Preparing for anesthesiacont…. • Check ID band, skin prep • Check for special orders-enema, IV line • Check NPO • Have client void before preop medication • Continue to support emotionally • Accomplished preop care checklist
- 42. 42 PREOPERATIVE MEDICATION • Goals: •To aid in the administration of anesthetics. • To minimize respiratory tract secretion and changes in heart rate • To relax the patient and reduce anxiety
- 43. 43 Commonly used preopmeds. • Tranquilizers & sedatives • Midazolam • Diazepam • Lorazepam • Diphenhydramine
- 44. 44 Commonly used preopmeds….. • Analgesics • Nalbuphine, (nubain) • Anticholinergics • Atropine sulfate • Proton pump inhibitors • Omeprazole • Rabiprazole
- 45. 45 Transporting the patientto the OR • Adhere to the principle of maintaining the comfort and safety of the patient • Accompany or attendants to the patient`s bedside for introduction and proper identification • Assist in transferring the patient from bed to stretcher • Complete the chart and preoperative checklist • Make sure that the patient arrive in the OR at the proper time
- 46. 46 PATIENT`S FAMILY • Directto the proper waiting room. • Tell the family that the surgeon will probably contact them immediately after the surgery. • Explain reason for long interval of waiting and anesthesia prep, skin prep surgical procedure, RR. • Tell the family what to expect postop when they see the patient.