Perioperative Nursing Overview

Perioperative Nursing Phases

• Preoperative phase: Time from decision for surgery until transfer to operating room.
• Intraoperative phase: Time from operating room transfer to admission to postanesthesia care unit (PACU).
• Postoperative phase: Time from admission to PACU until follow-up evaluation.

Classifications of Surgery

According to Purpose

• Diagnostic: Used to confirm a suspected diagnosis (e.g., biopsy).
• Exploratory: Determines the extent of disease (e.g., exploratory laparotomy).
• Curative: Removal or repair of damaged or diseased organs or tissues.

Types of Curative Surgery

• Ablative: Removal of diseased organs (e.g., appendectomy, hysterectomy).
• Reconstructive: Restoration of damaged organs (e.g., plastic surgery after burns).
• Constructive: Repair of congenitally defective organs.
• Palliative: Relief of pain and distressing symptoms.

According to Degree of Risk

• Major surgery: High risk, prolonged duration, significant blood loss, vital organs involved.
• Minor surgery: Lower risk, shorter duration, few serious complications.

According to Urgency

• Emergency: Requires immediate action (e.g., gunshot wound).
• Urgent: Needs to be done within 24-48 hours (e.g., appendectomy).
• Required: Necessary within weeks to months (e.g., addressing chronic alcohol use).

Factors Affecting Surgical Risk

• Age: Infants and elderly at higher risk.
• Nutritional status: Both malnourishment and obesity increase risk.
• Fluid and electrolyte balance: Dehydration and hypovolemia can complicate surgery.
• General health: Ongoing infections increase operative risks.
• Mental health and economic status also play a role.

Preoperative Considerations

• Informed Consent: Must be in writing; includes procedure explanation, risks, benefits, alternatives, opportunity for questions, withdrawal rights, and any deviations from standard protocol.
• Valid Consent: Given freely, by those over 18 unless an emancipated minor, obtained by a physician, and witnessed.

Patient Teaching and Interventions

• Important preoperative teachings: deep breathing, coughing, incentive spirometry, mobility exercises, and pain management strategies.
• Psychosocial interventions aimed at reducing anxiety and respecting cultural beliefs.
• Preoperative interventions: administering medications, maintaining records, supporting family needs.

Immediate Preoperative Interventions

• Administer preanesthetic medications and transport patients to presurgical areas.
• Focus on patient safety, nutrition, fluid management, skin preparation, and bowel preparation.

Preoperative Instructions

• Withholding food before surgery is primarily aimed at preventing aspiration.
• Encouragement of diaphragmatic breathing, coughing, and leg exercises to prevent complications.

Physiological Preparation

• Incentive spirometry recommended for lung expansion and prevention of atelectasis.
• Turn, cough, and deep breathe exercises every two hours, avoiding in some types of surgery.

Night Before and Day of Surgery

• Skin preparation may include shaving against hair growth.
• Patients instructed to be NPO after midnight and may require enemas.
• Comfort measures to promote rest include a well-ventilated room, cleanliness, and potential sleep medications.

Pre-Operative Medications

• Administered 60-90 minutes pre-anesthesia, addressing anxiety, secretions, and reducing anesthesia needs.
• Types include:
  • Sedatives: To lower anxiety and consistent blood pressure (e.g., Phenobarbital).
  • Tranquilizers: Lowers anxiety (e.g., Thorazine).
  • Narcotic analgesics: Reduces anxiety and required narcotics during surgery (e.g., Morphine sulfate).
  • Vagolytic agents: Reduces respiratory secretions (e.g., Atropine sulfate).