Perioperative Care Overview

Perioperative Care Overview

• Perioperative care encompasses preoperative, intraoperative, and postoperative phases of surgery
• Each phase involves distinct procedures and considerations for patient safety and well-being

Preoperative Care

• Involves activities prior to surgical intervention
• Includes patient interview for health history, assessment of emotional state, and readiness for surgery
• Aims to identify and mitigate potential risk factors
• Includes obtaining informed consent
• Medical testing (CMP, CBC, PT/PTT/INR, LFTs, T&S, blood glucose, albumin, hCG, EKG, ECHO, chest x-ray)
• Preoperative teaching

Surgical Settings

• Majority of surgeries are performed as ambulatory (same-day) procedures
• Some complex procedures are done in-hospital
• Reasons for surgery include diagnosis, cure, palliative care, prevention, or cosmetic improvement

Patient Interview

• Gathering patient health information
• Clarifying information regarding surgery and anesthesia
• Assessing patient's emotional state and readiness for the procedure

Risk Factors

• Age (young or old)
• Coagulation/hemorrhages
• Obesity
• Sleep apnea and airway concerns
• Pregnancy
• Immunodeficiency
• Nutritional status (delayed wound healing)
• Fluid and electrolyte imbalances
• Negative outcomes (Sepsis, DVT, PE, PNA, Ileus, delirium, death)

Health History

• Gathering patient's past medical and surgical history
• Previous surgical complications
• Menstrual and obstetric (for women) history
• Family history of anesthesia complications
• Medication reconciliation (identifying important meds)
• Allergies
• Review of systems (head-to-toe)
• Physical assessment
• Diagnostics (substance use, drug use)

Common Preoperative Diagnostic Studies

• Complete metabolic profile (CMP)/Basic metabolic profile (BMP)
• Complete blood count (CBC)
• Prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR)
• Liver function tests (LFTs)
• Type and screen/crossmatch (T&S)
• Blood glucose
• Albumin
• Human chorionic gonadotropin (hCG)
• Electrocardiogram (EKG)
• Echocardiogram (ECHO)
• Chest radiography

Preoperative Teaching

• Improves patient satisfaction
• Reduces postoperative fear, anxiety, and stress
• Addresses patient concerns throughout surgery process
• Emphasizes safety, sensory process, and procedural knowledge

Informed Surgical Consent

• Patient understanding of diagnosis, proposed treatment, risks and complications, probability of success, alternatives, and prognosis if surgery is not successful
• Patient consent must be voluntary
• Obtained by the surgeon, witness signature by the nurse
• Medical emergency may override the need for consent if life is threatened

Preparation Day of Surgery

• Verifying informed consent
• Confirming Non-Fasting (NPO) status (with aspiration precautions)
• Vital sign measurements
• Skin preparation
• Removing prosthetics
• Administering pre-op medications (antibiotics, pain/anxiety meds)
• Safe transportation (if same-day)
• Patient marking the site for surgeons

Preoperative Preparation for People with IDD

• Using visual aid like pictures and videos to explain the process
• Tours of the OR facility
• Identifying close contacts to offer support
• Utilizing a communication aid like a PECS board or talking mat during the preparation

Informed Surgical Consent for IDD

• Evaluating cognitive capacity and adaptive skills
• Assessing patient's ability to make decisions at a particular time
• Involving individuals closest to the patient
• Identifying a surrogate if patient is unable to make a decision

Preference order for surrogate selection

• Spouse (unless separated)
• Adult child
• Parent/step-parent
• Adult sibling
• Other adult relative
• Other adult who displays care and concern for the patient

Preoperative Phase: Gerontologic Considerations

• Decreased skin elasticity
• Complications from pre-existing medical conditions
• Varying response to medications
• Decreased kidney function for waste excretion

Nursing Management: Intraoperative

• Preparation of the operating room
• Positioning the patient (after administration of anesthesia)
• Preparing surgical site (antimicrobial cleansing and draping)
• Completing a time-out and surgical checklist

Surgical Team: Registered Nurse

• Circulating Nurse (not sterile)
• Supports intraoperative procedures
• Maintains a sterile environment
• Documentation of supplies in the surgical field

Surgical Team: Surgeon

• Physician who performs the surgical procedure.
• Responsibility for surgical patient care
• Assessment of preoperative medical history
• Directs preoperative testing
• Obtaining informed consent
• Marking the surgical site
• Ensuring patient safety
• Manages postoperative care

Surgical Team: Surgeon's Assistant

• MD, RNFA, PA, Resident/fellow, medical student
• Assists the surgeon
• Holds retractors
• Helps with hemostasis and suturing
• May perform designated surgical procedures under direct supervision

Surgical Team: Anesthesia Care Provider

• Anesthesiologist or CRNA
• Administers anesthetic agents
• Manages airway, vitals and anesthesia
• Maintains physiological homeostasis throughout surgery

Anesthesia Types

• Moderate sedation (conscious sedation) includes administering anti-anxiety and pain medication and maintaining patent airway
• General anesthesia is usually a combination of gases and IV meds that cause loss of consciousness. It requires advanced airway management

Gerontologic Anesthetic Considerations

• Anesthetic drugs need careful titration due to possible impaired absorption, metabolism and excretion
• Poor communication may alter patient response to anesthesia
• Increased risk of complications from tape, electrodes, and warming/cooling blankets
• Need appropriate precautions for osteoporosis and perioperative hypothermia

Postoperative Surgical Phase: Phase 1

• Airway management: checking for stridor, cough, gag, swallowing, breathing patterns, respiratory rate, oxygen saturation(SpO2), work of breathing (WOB), and absence of apnea
• Assess vital signs (q15min or more frequently)
• Physical exam
• Neurological assessment
• Dressing assessment

Postoperative Surgical Phase: Phase 2

• Preparing patients for discharge
• Reviewing written post-op instructions, teachings, and medication instructions
• Ensuring patients/family fully understand instructions and verbalize their comprehension
• Post anesthesia recovery precautions
• Discharge instructions (driving, alcohol, activities)
• Patient discharge to responsible adult

Postoperative Assessment

• Assess vital signs and conduct focused assessment (respiratory, cardiac, wound) for potential complications.
• Examine skin integrity and wound condition for any issues
• Observe metabolic/glucose functioning
• Evaluating gastrointestinal and genitourinary functioning
• Watch for pain/comfort; encourage reporting of pain.
• Identify potential postoperative complications (airway obstruction, hypoxemia, etc.)

Common Postoperative Complications

• Airway obstruction (tongue falling back, secretions, laryngospasm, stridor)
• Hypoxemia (low SpO2)
• Atelectasis, pulmonary edema, PE, aspiration, bronchospasm
• Hypoventilation
• Pain

Postoperative Complications and Nursing Interventions

• DVT/PE: Anticoagulants & ambulation
• Gastric Ulcers: PPI
• Pneumonia/atelectasis: Pulmonary toilet, oral care, and ambulation
• Electrolyte Imbalance: Monitor I&O, and electrolytes levels
• Hemorrhage/bleeding: Monitor BP, HR, I&O

Postoperative Assessment

• Respiratory function (patency, rate, rhythm, symmetry, mucus membranes)
• Preventing circulatory complications (heart rate, rhythm, blood pressure, capillary refill, urine output, and peripheral pulses)
• Achieving rest and comfort (pain control, side effects, and temperature regulation)
• Neurological function (LOC, delirium, gag reflex, and pupil reflexes)

Postop Care: Implementation

• Maintaining fluid and electrolyte balance (IV, I&O, baseline lab values)
• Promoting normal bowel elimination and adequate nutrition (monitor bowel movement and prevent ileus)
• Promoting urinary elimination (monitor urine output)
• Promoting wound healing (checking skin for rashes, abrasions, burns, and drainage).
• Maintaining/enhancing self-concept (observe patients for behaviors that reflect any alteration in self-concept after hospitalization)

Restorative and Continuing Cares

• Preparing for Discharge
• Wound care
• Diet/activity restrictions
• Medications and complications
• Home care or rehab facility needs

This quiz covers the essential aspects of perioperative care, including preoperative, intraoperative, and postoperative phases. It highlights procedures, patient safety considerations, and the importance of thorough patient interviews. Understanding these concepts is crucial for anyone involved in surgical care.