Perioperative Nursing Concepts

Perioperative Nursing Overview

• The perioperative period spans from patient notification of needed surgery through recovery and resumption of usual activities.
• Comprised of three phases: preoperative, intraoperative, and postoperative.

Preoperative Phase

• Begins with patient decision for surgery; ends upon transfer to operating room bed.
• Involves physical and psychological preparations, diagnostic studies, and medical regimens.
• Focuses on patient teaching, support, and preparation.

Intraoperative Phase

• Starts with the patient in the operating room bed; ends with transfer to the PACU.
• Includes monitoring, anesthesia administration, prep, draping, and surgery.
• Nursing priorities include patient safety, infection prevention, and managing response to anesthesia.

Postoperative Phase

• Begins upon transfer to the recovery unit; concludes with resolution of surgical sequelae.
• Nursing care emphasizes supporting physiological recovery.
• Later stages focus on reinforcing discharge information for patients and caregivers.

Surgical Environment and Attire

• Surgical suites are sterile, cool, and accessible only to authorized personnel.
• Aseptic techniques are critical, requiring cleanliness and sterility of the environment and equipment.
• Areas are divided into three zones:
  • Unrestricted Zone: Street clothes allowed
  • Semi-Restricted Zone: Scrub attire required
  • Restricted Zone: Sterile attire including caps, masks, and shoe covers.

Surgical Attire Guidelines

• OR attire consists of close-fitting cotton clothing, scrubs, gowns, and jackets.
• Knitted cuffs on sleeves prevent shedding of organisms.
• Ensure garments are free of wetness and soil; change soiled items as needed.

Mask Usage

• Masks required in the restricted zone to filter microorganisms and reduce infection risk.
• High filtration masks protect against postoperative wound infections.

Surgical Team Members

• Scrub Nurse: Prepares setup, assists during surgery, and manages instrument counting to prevent retained foreign bodies.
• Circulating Nurse: Non-scrubbed RN facilitating supply management, responding to requests, and liaising between scrubbed staff and external personnel.

Anesthetic Agents

• Anesthesia leads to partial or complete sensation loss, potentially with or without consciousness loss.
• Inhalation anesthesia is favored for its controllability and is influenced by pulmonary ventilation.
• Three classifications of anesthetic agents:
  • General: Causes total loss of consciousness.
  • Regional/Block: Targets specific body regions.
  • Local: Primarily affects a small, specific area.