Perioperative Nursing (PreOp)

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PERIOPERATIVE

NURSING



U S G

SURGERY

Branch of medicine that encompasses

preoperative, intraoperative, and postoperative

care of patients. The discipline of surgery is

both an art and a science.



SURGICAL PROCEDURE

Invasive incision into body tissues or a

minimally invasive entrance into a body cavity

for either therapeutic or diagnostic purposes

during which protective reflexes or self-care

abilities are potentially compromised



CONDITIONS REQUIRING

SURGERY

OBSTRUCTION

PERFORATION

EROSION

TUMOR



TYPES OF SURGERY

According to Purpose

Diagnostic

Exploratory

• Ablative

• Reconstructive

• Constructive

Curative

Palliative



TYPES OF SURGERY

According to Degree of Risk

Major Surgery

• Involves vitalorgans

• Prolonged

Minor Surgery

• Involves non-vital parts

• Generally not prolonged

• Lesser blood loss• Lesser complications



TYPES OF SURGERY

According to Urgency

Emergent

Urgent

Required

Elective

Optional

Without delay

Within 24-30 hours

Within few weeks or months

Failure to have surgery is not catastrophic

Personal preference



AMBULATORY SURGERY

OUTPATIENT, SAME-DAY or SHORT-STAY

surgery

Laparosopic and minimally invasive surgery Admission to an inpatient hospital setting for

less than 24 hours

Requires Preadmission Testing (PAT)

Admitted in preoperative holding area of the

Operating Room and stays in the Post-

Anesthesia Care Unit (PACU) prior to

discharge



SURGICAL TERMINOLOGIES

Suffixes Meaning

-ectomy excision; removal -otomy cut into or incision

-ostomy make artificial opening

-plasty plastic repair

-orrhaphy suturing; repair




Root Word Meaning

angio vessel

aorto aorta

arterio artery

cardio / corono heart

phlebo vein

cholecysto gallbladder

colo or colono colon

duodeno duodenum

esophago esophagus

gastro stomach

hepato liver

ileo ileum

Root Word Meaning

jejuno jejunum

oro / stomato mouth

pancreato pancreas

pharyngo pharynx

choledocho common bile duct

cholangio common bile duct

lapar abdomen

procto rectum

ano anus

adreno adrenal gland

hypophyso pituitary gland

thyro thyroid




Root Word Meaning

orchio / orchido testis

oophoro ovary

salphingo fallopian tube

cervico cervix

colpo / vagino vagina

hystero / utero uterus

mammo breast

lymphadeno lymph node

spleno spleen

nephro / reno kidney

uretero ureter

cysto / vesico urinary bladder

Root Word Meaning

pyelo renal pelvis

urethro urethra

balano penisprostato prostate

scroto scrotum

vaso vas deferens

arthro joint

chondro cartilage

costo rib

cranio skull

ligamento ligament

myo / myoso muscle




Root Word Meaning

osteo bone

pelvo pelvis

spondyl vertebratendino tendon

cerebello cerebellum

cerebro cerebrum

encephalo brain

neuro nerve

alveolo alveoli

broncho bronchial tube

epiglotto epiglottis

rhino nose

Root Word Meaning

phreno diaphragm

pneumono/pulmo lung

tracheo tracheaauro /oto ear

myringo/tympano eardrum

oculo/ophthalmo eye

phako eye lens

retino retina

blephar eyelid

cheilo lip

palato/urano palate

cutaneo/dermo skin




Abbreviation/ Acronym

Meaning

MRM Modified Radical Mastectomy

ORIF Open Reduction Internal Fixation

ADSF Anterior Decompression Spinal Fusion

ECCE ExtraCapsular Cataract Extraction

TAHBSO Total Abdominal Hysterectomy Bilateral Salphingo-

oophorectomy

TURP TransUrethral Resection of the Prostate

CS Ceasarean Section

AKA Above the Knee Amputation

BKA Below the Knee Amputation

CABG Coronary Artery Bypass Graft

APR Abdomino-Perineal Resection



PERIOPERATIVE NURSING

Refers to activities performed by the

professional nurse which encompasses a

client’s total surgical experience



PHASES OF PERIOPERATIVE

NURSING

PostOperative Phase

IntraOperative Phase

PreOperative Phase



PREOPERATIVEPHASE



PREOPERATIVE PHASE

Begins at the time of decision for surgeryand ends when the client is transferred tothe OR

This period is used to physically andpsychologically prepare the client for

surgery

The nurse plays a major role in clientteaching and in relieving the client’s and

the family’s anxieties



PREOPERATIVE PHASE:

GOALS OF CARE

Assessing and correcting physiologic and psychologic

problems that might increase surgical risk

Giving the person and significant others completelearning/ teaching guidelines regarding surgery

Instructing and demonstrating exercises that will benefit

the person during post-op period

Planning for discharge and any projected changes in

lifestyle due to surgery



PSYCHOLOGIC PREPARATION:

CAUSES OF FEARS

Fear of pain

Fear of anesthesia, vulnerability while unconscious

Fear of death

Fear of disturbance of body image

Worries: loss of finances, employment, social and family

roles

The MOST DEVASTATINGFEAR of a surgical client is

the

FEAR OF THE UNKNOWN.




MANIFESTATIONS OF FEARS

Anxiousness

Confusion

Anger

Tendency to exaggerate

Sad, evasive, tearful, clinging

Inability to concentrate

Short attention span Failure to carry out simple directions

Dazed




NURSING INTERVENTIONS

Assess client’s fears, anxieties, support systemsand patterns of coping

Establish a trusting relationship with the client andsignificant others

Encourage verbalization of fears

Explain routine procedures and allow client to askquestions

Provide spiritual care if appropriate



LEGAL ASPECT OF

PREOPERATIVE PHASE

All invasive proceduresrequires for an

INFORMEDCONSENT



SURGICAL CONSENT

OPERATIVE PERMIT / INFORMED

CONSENT

A document describing that the client has full

knowledge of the instructions of the exact

surgical procedure to be performed and has

given permission to have the procedureperformed on him



SURGICAL CONSENT

The SURGEON is the ultimate responsible for

obtaining the surgical consent.

The Surgeon must inform the patient of the

benefits, alternatives, possible risks,

complications, disfigurement, disability and

removal of body parts.



VALID SURGICAL CONSENT

Consent should be FREELY GIVEN, withoutcoercion

The patient signing the consent must beMENTALLY COMPETENT and of LEGAL AGE(at least 18 years of age).

For minors or mentally incompetent patient,the parent, legal guardian, spouse or relativenext of kin will sign the consent

EMANCIPATED MINORS (minors who are

married and self-sufficient) can sign their ownconsent



VALID SURGICAL CONSENT

It must be witnessed by an authorized person –

a nurse or another doctor

It is part of the nurse’s role as a witness and a

client advocate to confirm that the client

understands information given

It must be obtained before the patient receivessedation

It has been signed at least a day before the

surgery



SURGICAL CONSENT

In an emergency, permission via the

telephone is acceptable. Have a secondlistener on phone when telephone

permission being given.



SURGICAL CONSENT

CONSENTS ARE NOT NEEDED for

emergency care if all four of the following

criteria are met:

There is an immediate threat to life

Experts agree that it is an emergency Client is unable to consent

A legally authorized person cannot be

reached



Case Analysis

A client is brought to the ER after being hit

by a car. The name of the client is notknown. The client has sustained a severe

head injury and multiple fractures and is

unconscious. An emergency craniotomy is

required. In regard to informed consent for

the surgical procedure, what is the best

nursing action?



Case Analysis

A client, 22 year old female, is brought to

the ER with an apparent head injury after being involved in a serious motor vehicle

accident. She is unconscious on arrival

and exhibits signs of increasing ICP. He is

accompanied by an adult friend and

fiancé. What is the best nursing action on

a legal stand point?



PREOPERATIVE ASSESSMENT:

NURSING HISTORY

Allergies

Bleeding tendencies

Cortisone use

Diabetes MellitusEmboli



PREOPERATIVE ASSESSMENT

Nutritional and Fluid Status

Dentition

Drug or Alcohol Use Respiratory Status

Cardiovascular Status

Hepatic and Renal Function Endocrine Function

Immune Function




PREVIOUS MEDICATION USE

Agents Effects of Interactions with Anesthesia /Surgery

Corticosteroids

Prednisone (Deltasone)

Cardiovascular collapse may occur if

discontinued suddenly

Diuretics

Hydrochlorothiazide

(HydroDIURIL)

Respiratory depression may occur with

anesthesia use

Phenothiazines

Chlorpromazine(Thorazine) Increases hypotensive effects of anesthesia

Tranquilizers

Diazepam(Valium)

Anxiety, tension and seizures may occur

when withdrawn suddenly

Insulin Intravenous insulin may be needed to

regulate blood glucose level during surgery




PREVIOUS MEDICATION USE

Agents Effects of Interactions with Anesthesia / Surgery

Antibiotics

Erythromycin(Ery-Tab)

Risk for respiratory paralysis when combined with

muscle relaxant

Anticoagulants

Warfarin(Coumadin)

Increases the risk of bleeding during the intraoperative

and postoperative period

Antiseizure agents Intravenous administration is needed to prevent seizure

during surgery

Thyroid Hormone

Levothyroxine sodium

(Levothroid)

Intravenous administration may be needed during the

postoperative period to maintain thyroid levels

Opioids Chronic use may alter response to analgesic agents



PREOPERATIVE ASSESSMENT

All diagnostic examination should be

completed before surgery which include:

Chest X-ray

ECG

Complete Blood Count (CBC)

Coagulation studies

Urinalysis



PREOPERATIVE TEACHINGS

Assess the client’s level of understanding of surgical procedure and its implications

Answer questions, clarify and reinforceexplanations given by surgeon

Explain routine pre and post procedures andany special equipment to be used



PREOPERATIVE TEACHINGS

Demonstrate exercises that prevents

postoperative complications

Deep breathing / Diaphragmatic breathing

Coughing

Incentive Spirometry

Leg Exercises

Turning to Side



PHYSICAL PREPARATION

THE DAY BEFORE SURGERY

Withholding food and fluid

Preparing the Bowel Preparing the Skin



IMMEDIATE PREOPERATIVE


Hospital gown is worn that is left untied and

open in the back

Braid long hair and remove hair pins

Provide oral care

Inspect the mouth and remove dentures or

plates

Remove eyeglasses and prosthetic devices



IMMEDIATE PREOPERATIVE


Remove make-up

Remove all jewelry and body piercings Remove nail polish

Obtain baseline vital signs

Complete the Preoperative Checklist Administer Preop Medications as ordered

VRP MEDICAL CENTER163 EDSA Mandaluyong City

VRP MEDICAL CENTER 163 EDSA Mandaluyong City



163 EDSA, Mandaluyong City

PRE-OPERATIVE CHECKLIST

Name of Patient _______________________________

Room No. ________________

Attending Physician _____________________________ SURGERY Contemplated ________________________

Anesthesiologist _______________________________

Date of Surgery_______________ Time ____________ Consent for Surgery Yes No

Anesthesia Consent Yes To O.R.External Preparation ____________________________

(Specify Area)EnemaVoidedFoley Catheter Nasogastric Tube (NGT)IVF Line

Removed:Dentures Nail PolishWigs LipstickHairpins Jewelry

Laboratory Results:CBC Stool ExamBlood Typing Request for BloodUrinalysis Reserved

Prepared

X-Ray Results X-Ray PlatesHistoryPhysical ExaminationECG

Vital SignsBlood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________

Temperature ___________________________

Others: ______________________________________ ______________________________________

Pre-Operative MedicationDrug Dosage Route Time

____________________________________________ ____________________________________________ ____________________________________________

Signature of Floor Nurse _________________________

Signature of OR Nurse __________________________

V-GWU-016-03

163 EDSA, Mandaluyong City

PRE-OPERATIVE CHECKLIST

Name of Patient _______________________________

Room No. ________________

Attending Physician _____________________________ SURGERY Contemplated ________________________

Anesthesiologist _______________________________

Date of Surgery _______________ Time ___________ Consent for Surgery Yes No

Anesthesia Consent Yes To O.R.External Preparation ____________________________

(Specify Area)EnemaVoidedFoley Catheter Nasogastric Tube (NGT)IVF Line

Removed:Dentures Nail PolishWigs LipstickHairpins Jewelry

Laboratory Results:CBC Stool ExamBlood Typing Request for BloodUrinalysis Reserved

Prepared

X-Ray Results X-Ray PlatesHistoryPhysical ExaminationECG

Vital SignsBlood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________

Temperature ___________________________

Others: ______________________________________ ______________________________________

Pre-Operative MedicationName Dosage Route Time

____________________________________________ ____________________________________________ ____________________________________________

Signature of Floor Nurse _________________________

Signature of OR Nurse __________________________

V-GWU-016-03



PREANESTHETIC MEDICATION

PREOP MEDICATION

Usually given 30 to 45 minutes before thepatient is transported to the OR or “On call to

OR”

Given in the holding area of the OR for

ambulatory surgery

PURPOSES OF PREOP



PURPOSES OF PREOP

MEDICATIONS

To allay fear and anxiety

To produce some amnesia To reduce reflex irritability

To raise the pain threshold

To lower the body metabolism To decrease respiratory and mouth secretions

COMMON PREOP



COMMON PREOP

MEDICATIONS

Sedative andTranquilizers

Narcotic Analgesics

Anticholinergics

Histamine-receptor antagonists

Secobarbital

Diazepam (Valium)

Morphine

Meperidine HCl (Demerol)

Atropine sulfate

Scopolamine

Cimetidine (Tagamet)



Before Administration of Preop

Medication

Check for drug allergy

Ensure the surgical consent has been signed Instruct the patient to void

Obtain the baseline vital signs



After Administration of Preop

Medication

Instruct the patient to stay in bed

Raise the side rails up to ensure safety



SAFETY PROTOCOLS

Joint Commission on Accreditation of

Healthcare Organizations (JCAHO)

2003 Universal Protocol for Preventing Wrong

Site, Wrong Procedure, Wrong Person

Surgery

2009 National Patient Safety Goals

n versa ro oco or reven ng rong



n versa ro oco or reven ng rongSite, Wrong Procedure, Wrong Person

Surgery

Preoperative verification process

Marking the operative site in an unambiguousmanner

“Time Out”

2009 N ti l P ti t S f t



2009 National Patient Safety

Goals

Improve the accuracy of patient identification

Improve effectiveness of communication amongcaregivers

Improve safety of using medications Reduce the risk of health care-associated

infections

Accurately and completely reconcile medications

across continuum of care Reduce the risk of patient harm resulting from falls

Reduce the risk of influenza and pneumococcaldisease in institutionalized older adults

2009 National Patient Safet



2009 National Patient Safety

Goals

Reduce the risk of surgical fires

Implement applicable National Patient SafetyGoals and associated requirements by

components and practitioner sites Encourage patient’s active involvement in their

own care as a patient safety strategy

Prevent health care-associated pressure ulcers

Identify safety risks inherent in the organization’spatient population

Improve recognition and response to changes in apatient’s condition

O



Patient Transport to the Operating

Room

The patient is transferred to the holding area

or presurgical suite in a bed or a stretcher

about 30 to 60 minutes before the anesthetic is

given

The stretcher should be comfortable with a

small pillow and sufficient blankets Ensure safety during transport

Perioperative Nursing (PreOp)

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