Perioperative Nursing Overview

The Postoperative Phase

• Begins with the patient's transfer to the recovery unit and ends upon reaching an optimal level of functioning.
• Immediate postoperative nursing activities focus on supporting the patient’s physiologic systems.

Roles of the Perioperative Nurse

• Functions in multiple roles: manager/director, scrub nurse, circulating nurse, clinical nurse specialist, registered nurse first assistant, educator, and researcher.
• Responsibilities include:
  • Conducting patient assessments pre- and post-surgery.
  • Providing education and support to patients and families.
  • Acting as an advocate for patients.
  • Managing environmental control and resource provision during surgery.

Communication and Team Collaboration

• Essential for perioperative nurses to communicate and collaborate with other healthcare team members.
• Ongoing monitoring of both physiologic and psychological statuses of patients is crucial.

Professional Development

• Participation in professional organizations and research activities is encouraged.
• Continuous education and certification validate nursing excellence.
• Mentoring and training of other perioperative nursing staff contribute to the profession's growth.

Preoperative Phase Activities

• Preadmission Testing:

  • Initiates initial assessments, confirms understanding of preoperative orders, and begins discharge planning.

• Admission to Surgical Center:

  • Completes assessments to identify risks, reinforces education, and ensures consent is signed.

• Holding Area:

  • Identifies the patient, assesses status, establishes IV lines, administers medications, and provides psychological support.

Intraoperative Phase Activities

• Safety Maintenance:

  • Ensures an aseptic environment, positioning of the patient, and performs sponge, needle, and instrument counts.

• Physiologic Monitoring:

  • Monitors fluid balance, vital signs, and assesses response to surgery and anesthesia.

Surgical Classifications

• Surgeries may be classified based on purpose: diagnostic, curative, reparative, reconstructive, cosmetic, palliative, or rehabilitative.
• Urgency classifications include emergent, urgent, required, elective, and optional surgeries.

Principles of Aseptic and Sterile Techniques

• Critical items must be sterile; semicritical items can contact intact skin and need to be clean; noncritical items only require cleaning.
• Aseptic technique reduces the transmission of microorganisms; it focuses on cleanliness without necessarily achieving sterility.

Key Elements of Asepsis

• Clean, decontaminated items can be safely handled.
• Disposable items must not be reused.
• Environmental control minimizes microbial contamination.

Preoperative Assessment Considerations

• Nutritional and fluid status must be optimized before surgery to support tissue repair and prevent complications.
• Respiratory status education includes breathing exercises with an incentive spirometer; surgery may be postponed if an infection is present.
• Cardiovascular and immune function evaluations are essential to ensure the patient’s overall health and readiness for surgery.