Pre/Intra/Post-Operative Nursing

• Study notes for pre-operative, intra-operative, and post-operative nursing care

Preoperative Checklist

• Ensure completion and confirmation of necessary steps before surgery.
• Labs, medical history, fasting status, and informed consent must be confirmed.

Informed Consent

• The doctor who performs the procedure is responsible for explaining it.
• Nurses can reinforce teaching about the procedure, but cannot do the primary education for consent.
• In emergency situations, consent can be obtained from two doctors.
• Informed consent must be signed before administering any medications.

Confirm Labs

• Abnormal lab results should be reported immediately.
• Verify all labs and imaging are completed prior to surgery.

Medical History

• A detailed medical history should be taken, with focus on any prior issues with anesthesia.
• Review herbal medications, as they can interact with other medications.

Fasting Status

• Confirm the patient has adhered to NPO guidelines.

Intraoperative - Intra Op

• Focus on surgical time out and sterile field management.

Surgical Time Out

• Before the procedure starts, verify patient identity, procedure, and surgical site.

Sterile Field Management

• The circulating nurse is not sterile, while the scrub nurse is sterile.
• If the sterility of an item is questionable, consider it non-sterile.
• Avoid touching blue sterile drapes.
• Restricted areas (completely sterile): require booties, cap, gown, and mask.
• Semi-restricted areas: require scrubs and a mask.
• Unrestricted areas: permit street clothes.
• Maintain a 1-inch border around the sterile field and do not reach more than 1 foot over it.
• Corrective actions should be taken immediately if sterility is compromised.
• The circulating nurse documents the procedure and time out and is in charge of the surgery.
• The scrub nurse manages sterile instruments and sponges, maintaining sterility and ensuring correct sponge count.

Post Operative - Post Op

• Focus on recovery room monitoring and complications.

Recovery Room Monitoring

• Monitor vital signs for stability, airway clearance, and oxygenation.
• Vital signs should be checked every 15 minutes for the first hour, then every 30 minutes for the next two hours.

Complications

• Potential complications include ineffective airway clearance, inadequate bowel sounds, dehiscence, evisceration, infection, and hemorrhage.

Ineffective Airway Clearance

• May present as swelling, decreased breath sounds, or shortness of breath (SOB).
• Interventions include elevating the head of the bed (HOB), administering oxygen, teaching deep breathing techniques and use of an incentive spirometer (IS), and notifying the healthcare provider.

Inadequate Bowel Sounds

• Bowels may be hypoactive due to medications and NPO status, which is normal.
• Absence of bowel sounds can indicate a medical emergency; notify the provider immediately.

Dehiscence and Evisceration

• Cover with sterile saline and gauze and call the doctor immediately.
• Dehiscence involves the opening of the surgical wound down to the fat layer.
• Evisceration involves the opening of the surgical wound with organs protruding.

Infection

• Signs and symptoms include redness, swelling, purulent discharge, heat, elevated temperature, increased respiratory rate, increased white blood cell count, and odor.
• Obtain cultures before administering antibiotics.

Hemorrhage

• Presents as bleeding and pooling of blood; monitor vital signs closely.

Pain Management

• Assess and manage postoperative pain effectively.
• Assess patient-reported pain levels and administer analgesics as prescribed.
• Manage pain proactively, intervening at a pain level of 5 rather than waiting for it to become uncontrollable.
• Educate patients on the safe use of PCA pumps, emphasizing that only the patient should administer the medication.
• Watch for respiratory depression which is a side effect with opioids.
• Non-pharmacologic methods include movement, meditation, music, imagery, and family support.