Perioperative Nursing Care Overview

Student Learning Outcomes

• Conduct comprehensive preoperative assessments to identify health and surgical risks.
• Consider special needs in preoperative care for older adults, obese patients, and those with disabilities.
• Understand legal and ethical aspects of obtaining informed consent for surgeries.
• Implement nursing teaching measures to reduce infection and complications post-surgery.
• Collaborate with surgical teams to optimize care during intraoperative interactions.
• Recognize adverse effects related to surgery and anesthesia.
• Compare various anesthesia types and their implications for nursing responsibilities.
• Utilize the nursing process for enhancing patient outcomes in the intraoperative setting.
• Describe post-anesthesia care nurse responsibilities in preventing immediate complications post-surgery.
• Differentiate between postoperative care for ambulatory and hospitalized patients.
• Identify and assess common postoperative complications and their early detection indicators.
• Consider gerontologic factors in postoperative management.
• Understand factors affecting wound healing.

Perioperative Care Phases

• Preoperative Phase: Involves procedures and education to minimize complications, enhance comfort, and encourage patient involvement.
• Intraoperative Phase: Begins with the entrance to the surgical suite; nursing focus is safety, advocacy, and collaboration.
• Postoperative Phase: Starts in the post-anesthesia recovery area and continues until discharge.

Preoperative Nursing Interventions

• Obtain detailed patient history and assess for risk factors, including age, chronic illnesses, malnutrition, and obesity.
• Verify informed consent with the patient.
• Perform a baseline assessment including height and weight.
• Confirm NPO (nothing by mouth) status.

Medications in the Preoperative Phase

• Anesthesia Types: Inhalation, intravenous, regional (spinal, epidural), and topical.
• Prophylactic Antibiotics: Administered to prevent infection.
• Anticholinergics: Used to dry secretions.
• Sedatives: May be given preoperatively.

Client Education Preoperative Phase

• Address patient fears and anxieties.
• Discuss medication protocols, especially regarding anticoagulants.
• Explain diagnostic tests and procedures including ECG, chest X-rays, and pregnancy tests for females.
• Provide instructions on post-surgical recovery techniques like using an incentive spirometer and performing leg exercises.

Intraoperative Phase

• Nursing focus on safety (avoiding falls, maintaining airway), client advocacy, and effective communication with the health team.
• Universal Protocol: Includes verification of procedures, marking surgical sites, and conducting a “time out” to confirm readiness.

Intraoperative Nursing Interventions

• Maintain a sterile environment and ensure strict asepsis.
• Apply grounding devices to prevent electrical burns.
• Monitor for complications such as malignant hyperthermia and remain vigilant for surgical complications.

Postoperative Phase Monitoring

• Conduct ongoing assessments in the PACU, focusing on:
  • Pulmonary: Verify airway, assess breath sounds, encourage deep breathing.
  • Circulatory: Compare vital signs to baseline and assess tissue perfusion.
  • Neurological: Monitor consciousness levels and reflexes.
  • Genitourinary: Track fluid intake/output and urinary status.
  • Gastrointestinal: Check for bowel sounds and distention.
  • Integument: Assess skin coloration, wound condition, and drainage.

Common Postoperative Complications

• Atelectasis: Symptoms include tachycardia and shallow breathing; interventions involve early ambulation and deep breathing exercises.
• Respiratory Depression: Monitor respiratory patterns and manage narcotic levels; use antagonists as needed.
• Hypoxia: Monitor vitals, administer oxygen, and address underlying issues.
• Nausea: Employ comfort measures, antiemetic therapy, and NG tube if necessary.
• Urinary Retention: Commonly linked to anesthesia; encourage voiding and utilize bladder scans.
• Hypotension: Manage with IV fluids and monitor for signs of shock.
• Wound Complications: Assess and treat wound issues including infection, dehiscence, and delayed healing, utilizing splinting and proper wound care techniques.

Special Considerations

• Thrombophlebitis: Symptoms include redness and tenderness; encourage ambulation and use compression devices.
• Urinary Tract Infection: Promote hygiene, limit catheter use, and maintain hydration.
• Wound Infection: Signs include purulent drainage; implement appropriate wound care and antibiotic therapy.

Nursing Responsibilities

• Verify all IV fluids and drainage.
• Facilitate pain management and thermoregulation.
• Discharge instructions for ambulatory surgery patients are critical for successful recovery.

This quiz covers the essential aspects of perioperative nursing care, including preoperative assessments, considerations for special populations, and the legal and ethical implications of informed consent. It emphasizes understanding risk factors and teaching strategies to enhance patient safety before surgery.