Surgical Experience Phases and Responsibilities

Perioperative Nursing Management: Preoperative Phase

• Perioperative nursing encompasses the entire surgical experience, including preoperative, intraoperative, and postoperative phases.
• The preoperative phase starts when the decision for surgery is made and ends with transfer to the operating room.
• Learning objectives include defining perioperative terms, identifying reasons for surgery, classifying surgery by urgency, performing a comprehensive preoperative assessment to identify surgical risk factors, and understanding informed consent.
• Teaching plans are designed to promote postoperative recovery and prevent complications.
• Preoperative nursing measures decrease infection risk and other postoperative complications.
• Immediate preoperative preparation involves patient attire, hair management, and removal of valuables/dentures.
• Surgical indications include diagnostic, curative, reparative, reconstructive/cosmetic, and palliative.
• Emergency surgery requires immediate intervention, potentially life-threatening.
• Urgent surgery necessitates prompt attention within 24-30 hours.
• Required surgery is needed within a few weeks to months.
• Elective surgery is scheduled without immediate threat.
• Optional surgery is based on patient preference.
• Preoperative assessment includes psychosocial, general physical, nutritional, and other factors.
• Psychosocial assessment focuses on anxieties and knowledge deficits related to surgery.
• General physical assessment involves history taking, diagnostic tests, and physical examination.
• Nutritional assessment involves measuring height/weight, skin folds, etc., and correcting nutrient deficiencies.
• Chemical substance use includes managing intoxication cases.
• Respiratory status assessment includes smoking cessation, treatment of infections, and blood gas analysis for patients with pulmonary problems.
• Cardiovascular conditions warrant avoiding sudden position changes and prolonged immobilization.
• Liver and kidney function tests are assessed preoperatively due to their role in medication removal.
• Identifying previous allergies and any immuno-suppression drug use is necessary.
• Endocrine function monitoring is critical for patients with diabetes and those taking corticosteroids.
• Preoperative medication history is essential to understand the possible effects and drug interactions.

Informed Consent

• Voluntary and informed consent is crucial before surgery.
• Consent protects the patient from unauthorized surgery and the surgeon from claims of unauthorized procedures.

Preoperative Patient Education

• Deep breathing and coughing exercises promote lung ventilation and blood oxygenation.
• Splinting the incision line minimizes pressure and controls pain.
• Leg and foot exercises are crucial for maintaining mobility.
• Turning to the side, getting out of bed, and pain control using preanesthetic medications are emphasized.
• Anticipating pain relief and using prophylactic antibiotics are important considerations in the preoperative period.

General Preoperative Nursing Interventions

• Seven primary national patient safety goals should inform perioperative care protocols.
• Ensuring accurate patient identification, efficient communication, safe medication and infusion pump use, and reducing infections is stressed.
• Patient records, including informed consent, laboratory reports, and nursing records, are essential.
• Food and water intake is withheld 8-10 hours before surgery to prevent aspiration.
• Intestinal preparation (cleansing enemas/laxatives) facilitates visualization and prevents contamination.
• Preoperative skin preparation involves warm baths, using povidone-iodine soap, and using electric clippers for hair removal.
• Immediate preoperative interventions involve dressing, hair covering, and removal of dentures and jewelry.
• Valuables are safely stored per hospital policy.
• Patients (excluding those with urologic disorders) should void before surgery.
• Indwelling catheters are connected to closed drainage systems when necessary.
• Preanesthetic medications are given 15-20 minutes before transport to the operating room, including maintaining side rails in a safe position and keeping a quiet/calm environment.

Expected Patient Outcomes

• Expected outcomes include relief of anxiety, decreased fear, understanding of the surgical intervention, and absence of preoperative complications.

Intraoperative Phase

• The surgical team consists of the patient, anesthesiologist, surgeon, intraoperative nurses, and surgical technician.
• Anaesthesiologist's role includes patient pre-op assessment, anesthetic agent administration/monitoring, and maintaining vital signs.
• Intraoperative nurses coordinate personnel, prioritize patient safety, perform scrub nurse and circulation nurse duties, and maintain surgical standards.
• Circulating nurses verify consent, check medical records, ensure OR cleanliness, supervise equipment function, and verify supplies.
• Scrub nurses use aseptic techniques to perform surgical hand scrubs. Surgical gowns are donned aseptically, special equipment/sterile tables are prepared, and equipment is counted.
• Anaesthesia is a state of narcosis, analgesia, relaxation, and reflex loss produced by pharmacologic agents.
• General anesthesia blocks awareness centers to produce unconsciousness and loss of sensation, using inhaled volatile liquids(e.g., Fluothane) or intravenous agents. Administration methods and advantages/disadvantage differences between the two methods are outlined.
• Regional anesthesia, which includes epidural, spinal, and local conduction blocks delivers blockage from specific nerves. Advantages and Disadvantages of the methods, including complications associated with epidural and spinal anesthesia, and various types of local applications are covered.
• Potential complications during surgery include nausea, vomiting, hypoxia, hypothermia, and malignant hyperthermia.

Postoperative Phase

• Postoperative assessment prioritizes respiratory and circulatory status and neurological response, surgical site observation for bleeding, comfort level (pain, nausea), psychological factors (patient's questions); safety, and equipment functioning.
• Monitoring of vital signs, including temperature for initial 24 hours, is important.
• Respiratory, circulatory, neurological, comfort, psychological, safety, and equipment functioning must be monitored.
• Nursing interventions focus on promoting lung expansion with deep breathing, coughing, and splinting, promoting comfort with opioids, antiemetics, pain relief measures, reducing causes other than the surgery, relieving abdominal distension and hiccups , managing body temperature, and avoiding injuries and complications.
• Nutritional status focuses on providing fluids (water, fruit juices) and appropriate soft/solid food as tolerated.
• Urine output is monitored, with interventions to aid normal voiding as necessary.
• Early ambulation and bed exercises help restore mobility.
• Maintaining anxiety levels and psychological well-being is prioritised.
• Patient education is an important element; and at discharge, the patient & significant others are coached on management strategies.
• Complications (early and later) for postoperative patients are described, including abdominal distention, atelectasis, and hypostatic pneumonia, hypoxia, shock, urinary retention, wound hemorrhage, thrombophlebitis, wound infections, wound dehiscence, and wound evisceration.
• Management of shock is described involving non-invasive (e.g., pressure/modified Trendelenburg) and invasive methods (e.g., fluids/medications) including ongoing assessments for treatment adjustments.
• Outcomes include absence of complications.