Outline- PERIOPERATIVE NURSING

ambulatory surgery: includes outpatient, same-day, or short-stay surgery that does not require an
overnight hospital stay
bariatrics: having to do with patients who are obese
:is the branch of medicine that deals with the causes, prevention, and treatment of obesity.
bariatric surgery: is done when diet and exercise haven't worked or when you have serious health
problems because of your weight.
:also known as Gastric bypass and other weight-loss surgeries.
***In general, bariatric surgery could be an option for you if:

Your body mass index (BMI) is 40 or higher (extreme obesity).

Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2
diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of
weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

Below 18.5 Underweight

18.5 – 24.9 Normal or Healthy Weight
25.0 – 29.9 Overweight
30.0 and Above Obese
***Note:

informed consent: the patient’s autonomous decision about whether to undergo a surgical procedure,
based on the nature of the condition, the treatment options, and the risks and benefits involved
:is when a healthcare provider — like a doctor, nurse, or other healthcare
professional — explains a medical treatment to a patient before the patient agrees to it. This type of
communication lets the patient ask questions and accept or deny treatment.
***Post-anesthesia Care Unit: After receiving anesthesia for a surgery or procedure, a patient is sent to
the PACU to recover and wake up. The PACU is a critical care unit where the patient's vital signs are
closely observed, pain management begins, and fluids are given.
minimally invasive surgery: surgical procedures that use specialized instruments inserted into the body
either through natural orifices or through small incisions
preadmission testing: diagnostic testing performed before admission to the hospital

PERIOPERATIVE PHASE/NURSING: period of time that constitutes the surgical experience;

includes the preoperative, intraoperative, and postoperative phases of nursing care
***3 phases:
  preoperative phase: period of time from when the decision for surgical intervention is made to
when the patient is transferred to the operating room table.
 intraoperative phase: period of time that begins with transfer of the patient to the operating
room area and continues until the patient is admitted to the post-anesthesia care unit
: begins from the time the client is admitted to the room where the operation will be
done, to the time anesthesia is administered, the performance of the surgical procedure and until the client
is transported to the recovery room or to the post-anesthesia care unit (PACU).

 postoperative phase: period of time that begins with the admission of the patient to the post-
anesthesia care unit and ends after follow-up evaluation in the clinical setting or home.

Association of periOperative Registered Nurses, formerly known as the Association of Operating

Room Nurses (still abbreviated AORN) and the American Society of PeriAnesthesia Nurses
(ASPAN) – recommended practice standards in which the perioperative activities are based.

AORN had also published a conceptual model of patient care.

Helps delineate the relationships between various components
of nursing practice and patient outcomes into four domains.
The model is used to depict the relationship of nursing process
components to the achievement of optimal patient outcomes.
FOUR DOMAINS ACCORDING TO CONCEPTUAL MODEL OF PATIENT CARE:
1. Safety reflect phenomena of concern to perioperative nurses and are
2. Physiological composed of nursing diagnoses, interventions, and outcomes
3. Behavioral
4. Health care systems - consists of structural data elements and focuses on clinical processes and
outcomes.
 TECHNOLOGY AND ANESTHESIA
Innovative high-definition microsurgical and laser technology- enable increasingly minute repairs
of tissue resulting in accelerated tissue regeneration.
Sophisticated bypass equipment and minimally invasive techniques (i.e., robot-assisted
technology) have changed many surgeries, such as abdominal aortic aneurysm bypass surgery, into
outpatient procedures
SURGICAL CLASSIFICATIONS

 For diagnosis (diagnostic procedures/surgeries) - may be recommended when the person has
signs that something may be wrong – for example, they may report unusual symptoms or have a
positive test result. Ex: breast lump biopsy, exploratory laparotomy, or laparoscopy.
 For cure (curative surgeries) - to cure a disease or promote recovery from an illness, injury or
impairment. Ex: excision of a tumor or an inflamed appendix
 For repair (can be reconstructive/cosmetic and palliative)

Ex: mammoplasty or a facelift to relieve pain or correct a problem.

Ex: debulking a tumor to achieve
comfort, or removal of a
dysfunctional gallbladder
**Surgical excision - They will inject the area under the growth with a
numbing medicine or anesthetic. In addition to preventing pain, the anesthetic
will cause the growth to rise upward, making it easier to remove. Then they will cut the growth off with a
sharp razor using multiple horizontal cuts.
**Surgical debulking - During the operation, the surgeon examines the inside of the abdomen (in case of
ovarian cancer) and the abdominal organs for signs of cancer. The surgeon aims to remove as much of the
cancer as possible if it has spread to other areas in the pelvis or abdomen.

 Rehabilitative surgery - procedures primarily aimed at correcting disfigurement and symptoms.

Ex: total joint replacement surgery to correct crippling pain or progression of degenerative
osteoarthritis.
SURGICAL CLASSIFICATIONS BASED UPON THE DEGREE OF URGENCY INVOLVED:
 EXAMPLES OF NURSING ACTIVITIES IN THE PERIOPERATIVEPHASES OF CARE

 Preoperative Phase

Preadmission Testing
1. Initiates initial preoperative assessment
2. Initiates education appropriate to patient’s needs
3. Involves family in interview
4. Verifies completion of preoperative diagnostic testing
5. Verifies understanding of surgeon-specific preoperative orders (e.g.,
bowel preparation, preoperative shower)
6. Discusses and reviews advance directive document
7. Begins discharge planning by assessing patient’s need for
postoperative transportation and care

Admission to Surgical Center

1. Completes preoperative assessment
2. Assesses for risks for postoperative complications
3. Reports unexpected findings or any deviations from normal
4. Verifies that operative consent has been signed
5. Coordinates patient education and plan of care with nursing staff and other health team
members
6. Reinforces previous education
7. Explains phases in perioperative period and expectations
8. Answers patient’s and family’s questions

In the Holding Area

1. Identifies patient
2. Assesses patient’s status, baseline pain, and nutritional status
3. Reviews medical record
4. Verifies surgical site and that it has been marked per institutional policy
5. Establishes IV line
6. Administers medications if prescribed
7. Takes measures to ensure patient’s comfort
8. Provides psychological support
9. Communicates patient’s emotional status to other appropriate
members of the health care team

 Intraoperative Phase

Maintenance of Safety
1. Maintains aseptic, controlled environment
2. Effectively manages human resources, equipment, and supplies for individualized patient care
3. Transfers patient to operating room bed or table
4. Positions patient based on functional alignment and exposure of surgical site
5. Applies grounding device to patient
6. Ensures that the sponge, needle, and instrument counts are correct
 7. Completes intraoperative documentation

Physiologic Monitoring
1. Calculates effects on patient of excessive fluid loss or gain
2. Distinguishes normal from abnormal cardiopulmonary data
3. Reports changes in patient’s vital signs
4. Institutes measures to promote normothermia

Psychological Support (Before Induction and When Patient is

Conscious)
1. Provides emotional support to patient
2. Stands near or touches patient during procedures and induction
3. Continues to assess patient’s emotional status

 Postoperative Phase

Transfer of Patient to Postanesthesia Care Unit

1. Communicates intraoperative information:
a. Identifies patient by name
b. States type of surgery performed
c. Identifies type and amounts of anesthetic and analgesic agents used
d. Reports patient’s vital signs and response to surgical procedure and anesthesia
e. Describes intraoperative factors (e.g., insertion of drains or catheters, administration of
sblood, medications during surgery, or occurrence of unexpected events)
f. Describes physical limitations
g. Reports patient’s preoperative level of consciousness
h. Communicates necessary equipment needs
i. Communicates presence of family or significant others

Postoperative Assessment Recovery Area

1. Determines patient’s immediate response to surgical intervention
2. Monitors patient’s vital signs and physiologic status
3. Assesses patient’s pain level and administers appropriate pain-relief measures
4. Maintains patient’s safety (airway, circulation, prevention of injury)
5. Administers medications, fluid, and blood component therapy, if prescribed
6. Provides oral fluids if prescribed for ambulatory surgery patient
7. Assesses patient’s readiness for transfer to in-hospital unit or for discharge home based on
institutional policy (e.g., Aldrete score)

Surgical Nursing Unit

1. Continues close monitoring of patient’s physical and psychological response to surgical
intervention
2. Assesses patient’s pain level and administers appropriate pain-relief measures
3. Provides education to patient during immediate recovery period
4. Assists patient in recovery and preparation for discharge home
5. Determines patient’s psychological status
6. Assists with discharge planning
Home or Clinic
1. Provides follow-up care during office or clinic visit or by telephone contact
2. Reinforces previous education and answers patient’s and family’s questions about surgery and
follow-up care
3. Assesses patient’s response to surgery and anesthesia and their effects on body image and
function
4. Determines family’s perception of surgery and its outcome IV, intravenous.

SPECIAL CONSIDERATIONS DURING THE PERIOPERATIVE PERIOD

GERONTOLOGIC CONSIDERATIONS

**older adult patients have less physiologic reserve (i.e., the ability of an organ to return to
normal after a disturbance in its equilibrium) than younger patients.

Respiratory and cardiac complications- leading causes of postoperative morbidity and mortality
in older adults
Nutrients Important for Wound Healing