Perioperative Nursing

Preoperative Phase

• The nurse acts as a witness to the patient's signature on an informed consent form, verifying informed consent was obtained.
• It is the surgeon's responsibility to explain the surgery.
• Medications that increase intraoperative risk include warfarin, metformin, ibuprofen, and lisinopril.
  • Warfarin increases bleeding risk.
  • Metformin increases the risk of lactic acidosis with contrast.
  • Ibuprofen increases bleeding risk
  • Lisinopril increases hypotension risk.
• All medications should not be taken preoperatively, specifically with food, especially antidiabetic or anticoagulant medications.
• Conditions that increase the risk of latex allergy include allergy to bananas and avocados, long-term healthcare employment, and multiple surgeries.

Intraoperative phase

• Postoperative atelectasis risk can be reduced by encouraging the use of an incentive spirometer, which expands lung capacity and prevents alveolar collapse.
• The purpose of the "time out" in the operating room is to verify correct patient identity, surgical site, and procedure.
• Components of Universal Protocol include preoperative checklist completion, marking surgical site, performing a "time out", and confirming consent signed.
• Actions that reduce the risk of intraoperative injury during patient positioning include using padded positioning devices, avoiding bony prominences and securing extremities.
• Potential complications of general anesthesia include hypothermia, laryngospasm, malignant hyperthermia, and respiratory depression.
• Dantrolene is the antidote for malignant hyperthermia.

Post-Anesthesia Care (PACU)

• Maintaining a patent airway is the nurse's priority during the immediate post-anesthesia phase.
• A blood pressure of 88/56 mmHg, cool clammy skin, and low urine output are classic signs of hypovolemia secondary to hemorrhage.
• Assessments included in the Aldrete Score include: Respiratory effort, activity/mobility, oxygen saturation, and consciousness.
• The lateral position helps prevent aspiration in the post-anesthesia patient by promoting drainage of secretions.
• A patient shivering with a core temperature of 95°F (35°C) should have warm blankets or a Bair Hugger applied.

Postoperative Care (Surgical Unit)

• Actions that help prevent postoperative venous thromboembolism (VTE) include encouraging early ambulation, applying sequential compression devices (SCDs), administering low-dose anticoagulants as ordered, and elevating legs above the level of the heart.
• Absent bowel sounds and abdominal distension in a postoperative patient with abdominal surgery require immediate intervention, as they may indicate paralytic ileus or obstruction.
• Symptoms to report immediately in a post-op patient include sudden wound dehiscence, fever of 101°F at 24 hours post-op, new onset of confusion, and urine output < 30 mL/hr.
• Incentive spirometry supports optimal respiratory function in the postoperative period by promoting lung expansion and preventing complications like pneumonia or atelectasis.
• Actions that support safe discharge from PACU to the surgical floor include the patient being awake or arousable, oxygen saturation ≥ 92% on room air or low flow O2, minimal bleeding at the surgical site, and vital signs stable for at least 15-30 minutes.
• A patient reporting severe abdominal pain and "popping" at the surgical site, with an open wound and protruding intestines, requires the nurse to cover the wound with a sterile saline-moistened dressing.
• Factors that place a post-op patient at greater risk for complications include age 78, obesity, diabetes mellitus, and smoking history.
• A urine output of 25 mL/hr for 2 hours should be addressed first.
• Regular use of an incentive spirometer improves lung expansion and helps prevent atelectasis and pneumonia.
• The lateral recovery position is the best position to promote drainage and oxygenation in a patient recovering from general anesthesia.
• Nursing interventions promoting wound healing in a post-op patient include maintaining glycemic control, encouraging a protein-rich diet, and administering antibiotics as prescribed.
• If a patient refuses to ambulate due to pain, offering pain medication and assisting with ambulation is the best action.
• Symptoms that may indicate postoperative infection include redness at the incision site, purulent drainage, and a sudden increase in temperature 48 hours post-op.
• Restlessness is the most concerning for oxygenation in a post-op patient.
• Only the patient should press the PCA button to avoid overdose.
• Difficulty breathing requires immediate action. It may indicate a high spinal block that can paralyze respiratory muscles.
• An SpO2 of 89% on 2L nasal cannula requires immediate assessment/intervention.
• Administering prescribed antiemetics is the best strategy for reducing post-op nausea and vomiting (PONV).
• Considerations for pain management in elderly post-op patients: underreporting pain, increased sensitivity to narcotics, cognitive changes, and monitoring non-verbal signs.
• If a post-op patient is drowsy, RR = 8/min, and difficult to arouse, naloxone (Narcan) should be administered to reverse respiratory depression from opioid overdose.
• Patients at the highest risk for delayed wound healing include those with poorly controlled diabetes, obesity, patients on long-term corticosteroids, and those with peripheral vascular disease.
• Nursing actions supporting infection prevention in the post-op period include maintaining a clean, dry surgical dressing, teaching the patient to report fever or foul drainage, performing hand hygiene before wound care, and administering prescribed antibiotics.
• Giving a full handoff report is the nurse's primary responsibility when transporting a post-op patient from PACU to the unit.
• Maintaining NPO and reassessing later is the best action for a post-op patient with nausea and an order to advance diet as tolerated.
• Responsibilities of the nurse during the immediate post-op period include assessing for pain, monitoring for bleeding, promoting deep breathing and coughing, and checking IV fluids and drains.