Introduction-to-Perioperative-Nursing.pdf

Introduction to Perioperative Nursing Phases of the Surgical Experience  Phases of the Surgical Experience The perioperative period begins when the patient is informed of the need for surgery, includes the surgical procedure and recovery, continues with discharge, and ends when the pati...

Introduction to Perioperative Nursing Phases of the Surgical Experience  Phases of the Surgical Experience The perioperative period begins when the patient is informed of the need for surgery, includes the surgical procedure and recovery, continues with discharge, and ends when the patient achieves his or her optimal level of postsurgical function.  Phases of the Surgical Experience Perioperative nurses provide care for surgical patients during the three distinct phases of the surgical experience (1) preoperative, (2) intraoperative, and (3) postoperative.  Phases of the Surgical Experience The word “perioperative” is used to encompass all three phases  The Preoperative Phase begins when the patient, or someone acting on the patient’s behalf, is informed of the need for surgery and makes the decision to have the procedure.  The Preoperative Phase During the preoperative phase, the patient is prepared physically and psychologically for surgery  The Preoperative Phase Nurses use information obtained from the chart review, preoperative assessment, and interview to prepare a plan of care for the patient.  The Preoperative Phase Nursing activities in the preoperative phase are directed toward patient support, teaching, and preparation for the procedure  The Intraoperative Phase begins when the patient is transferred to the operating room bed and ends with transfer to the postanesthesia care unit (PACU) or other area where immediate postsurgical recovery care is given  The Intraoperative Phase During the intraoperative period, the patient is monitored, anesthetized, prepped, draped, and the procedure is performed  The Intraoperative Phase Nursing activities in the intraoperative period focus on patient safety, emotional support, facilitation of the procedure, prevention of infection, and the patient’s satisfactory physiologic response to anesthesia and the surgical intervention.  The Postoperative Phase Begins with the patient’s transfer to the recovery unit and ends with return to an optimal level of functioning  The Postoperative Phase Nursing activities in the immediate postoperative phase center on support of the patient’s physiologic systems Roles of the Perioperative Nurse Perioperative nurses function in various roles, including those of manager/director, clinical practitioner (e.g., scrub nurse, circulating nurse, clinical nurse specialist, registered nurse first assistant [RNFA]), educator, and researcher Roles of the Perioperative Nurse In these roles, the perioperative nurse’s responsibilities include, but are not limited to, the following: Roles of the Perioperative Nurse Patient assessment before, during, and after surgery Patient and family teaching Patient and family support and reassurance Patient advocacy Roles of the Perioperative Nurse Performing as scrub or circulating nurse during surgery Control of the environment Efficient provision of resources Coordination of activities related to patient care Roles of the Perioperative Nurse Communication, collaboration, and consultation with other healthcare team members Maintenance of asepsis Ongoing monitoring of the patient’s physiologic and psychological status Supervision of ancillary personnel Roles of the Perioperative Nurse Additional responsibilities that promote personal and professional growth and contribute to the profession of perioperative nursing include, but are not limited to, the following Roles of the Perioperative Nurse Participation in professional organization activities Participation in research activities that support the profession of perioperative nursing Exploration and validation of current and future practice; pursuing evidence to support practice  Roles of the Perioperative Nurse Participation in continuing education programs to enhance personal knowledge and to promote the profession of perioperative nursing Certification to validate excellence in nursing practice Functioning as a role model for nursing students and perioperative nursing colleagues Mentoring, precepting, and instructing other perioperative nurses  Examples of Nursing Activities in the Perioperative Phases of Care Preoperative Phase Preadmission Testing 1. Initiates initial preoperative assessment 2. Initiates education appropriate to patient’s needs 3. Involves family in interview 4. Verifies completion of preoperative diagnostic testing 5. Verifies understanding of surgeon-specific preoperative orders (e.g., bowel preparation, preoperative shower) 6. Discusses and reviews advance directive document 7. Begins discharge planning by assessing patient’s need for postoperative transportation and care  Examples of Nursing Activities in the Perioperative Phases of Care Preoperative Phase Admission to Surgical Center 1. Completes preoperative assessment 2. Assesses for risks for postoperative complications 2. Reports unexpected findings or any deviations from normal 3. Verifies that operative consent has been signed 5. Coordinates patient education and plan of care with nursing staff and other health team members 6. Reinforces previous education 7. Explains phases in perioperative period and expectations 8. Answers patient’s and family’s questions  Examples of Nursing Activities in the Perioperative Phases of Care Preoperative Phase In the Holding Area 1. Identifies patient 2. Assesses patient’s status, baseline pain, and nutritional status 3. Reviews medical record 4. Verifies surgical site and that it has been marked per institutional policy 5. Establishes IV line 6. Administers medications if prescribed 7. Takes measures to ensure patient’s comfort 8. Provides psychological support 9. Communicates patient’s emotional status to other appropriate members of the health care team  Examples of Nursing Activities in the Perioperative Phases of Care Intraoperative Phase Maintenance of Safety 1. Maintains aseptic, controlled environment 2. Effectively manages human resources, equipment, and supplies for individualized patient care 3. Transfers patient to operating room bed or table 4. Positions patient based on functional alignment and exposure of surgical site 5. Applies grounding device to patient 6. Ensures that the sponge, needle, and instrument counts are correct 7. Completes intraoperative documentation  Examples of Nursing Activities in the Perioperative Phases of Care Intraoperative Phase Physiologic Monitoring 1. Calculates effects on patient of excessive fluid loss or gain 2. Distinguishes normal from abnormal cardiopulmonary data 3. Reports changes in patient’s vital signs 4. Institutes measures to promote normothermia  Examples of Nursing Activities in the Perioperative Phases of Care Intraoperative Phase Psychological Support (Before Induction and When Patient is Conscious) 1. Provides emotional support to patient 2. Stands near or touches patient during procedures and induction 3. Continues to assess patient’s emotional status  Examples of Nursing Activities in the Perioperative Phases of Care Postoperative Phase Transfer of Patient to Postanesthesia Care Unit 1. Communicates intraoperative information: a. Identifies patient by name b. States type of surgery performed c. Identifies type and amounts of anesthetic and analgesic agents used d. Reports patient’s vital signs and response to surgical procedure and anesthesia e. Describes intraoperative factors (e.g., insertion of drains or catheters, administration of blood, medications during surgery, or occurrence of unexpected events) f. Describes physical limitations g. Reports patient’s preoperative level of consciousness h. Communicates necessary equipment needs i. Communicates presence of family or significant others  Examples of Nursing Activities in the Perioperative Phases of Care Postoperative Phase Postoperative Assessment Recovery Area 1. Determines patient’s immediate response to surgical intervention 2. Monitors patient’s vital signs and physiologic status 3. Assesses patient’s pain level and administers appropriate pain-relief measures 4. Maintains patient’s safety (airway, circulation, prevention of injury) 5. Administers medications, fluid, and blood component therapy, if prescribed 6. Provides oral fluids if prescribed for ambulatory surgery patient 7. Assesses patient’s readiness for transfer to in-hospital unit or for discharge home based on institutional policy  Examples of Nursing Activities in the Perioperative Phases of Care Postoperative Phase Surgical Nursing Unit 1. Continues close monitoring of patient’s physical and psychological response to surgical intervention 2. Assesses patient’s pain level and administers appropriate pain-relief measures 3. Provides education to patient during immediate recovery period 4. Assists patient in recovery and preparation for discharge home 5. Determines patient’s psychological status 6. Assists with discharge planning  Examples of Nursing Activities in the Perioperative Phases of Care Postoperative Phase Home or Clinic 1. Provides follow-up care during office or clinic visit or by telephone contact 2. Reinforces previous education and answers patient’s and family’s questions about surgery and follow-up care 3. Assesses patient’s response to surgery and anesthesia and their effects on body image and function 4. Determines family’s perception of surgery and its outcome IV, intravenous.  Surgical Classifications The decision to perform surgery may be based on facilitating a diagnosis (a diagnostic procedure such as biopsy, exploratory laparotomy, or laparoscopy), a cure (e.g., excision of a tumor or an inflamed appendix), or repair (e.g., multiple wound repair).  Surgical Classifications It may be reconstructive or cosmetic (such as mammoplasty or a facelift) or palliative (to relieve pain or correct a problem—such as debulking a tumor to achieve comfort, or removal of a dysfunctional gallbladder).  Surgical Classifications In addition, surgery might be rehabilitative (e.g., total joint replacement surgery to correct crippling pain or progression of degenerative osteoarthritis.)  Surgical Classifications Surgery can also be classified based upon the degree of urgency involved: emergent, urgent, required, elective, and optional Surgical Classifications Principles of Aseptic and Sterile Techniques Spaulding’s Levels of Importance of Patient Care Items Critical. Any item entering the bloodstream, body tissues underlying the skin, and mucous membranes must be sterile Semicritical. Sterility is less critical for items that come into contact with intact skin or mucous membranes. These items are clean and safe to handle with bare hands Noncritical. Items that will come into contact with only intact skin or mucous membranes in an area remote from the surgical site may be cleaned, terminally disinfected, and stored unsterile between patient uses. What Is the Difference Between Aseptic and Sterile Techniques? The terms aseptic and sterile are not synonymous, although aspects of both are closely related. An object can be aseptic without being sterile. Asepsis literally means “without dirt,” and it implies the absence of pathogenic microorganisms that cause infection. Aseptic and sterile techniques are based on sound scientific principles and are carried out primarily to prevent the transmission of microorganisms that can cause infection. The degree of processing, whether disinfected or sterile, depends on the importance of the item’s use in patient care. Aseptic Technique It is impossible to exclude all microorganisms from the environment, but for the safety of both patients and personnel, every effort is made to minimize and control these microorganisms. Microorganisms are present in the air and on animate and inanimate objects at all times. The methods by which microbial contamination is contained in the environment are referred to as aseptic technique. Aseptic Technique Key elements of asepsis include the following facts: Aseptic technique is sometimes referred to as clean technique. Items have been cleaned and decontaminated so they are safe to handle with clean, bare hands. Items in use in patient care are handled with examination gloves for the protection of both the caregiver and the patient. Items have been cleaned, decontaminated, disinfected, or terminally sterilized without a wrapper, and stored in a clean, dry place. Aseptic Technique Key elements of asepsis include the following facts: Items may start out sterile but are not maintained or used under sterile conditions. Skin preps may be packaged sterile, but skin cannot be sterilized. The process is aseptic. Contamination is contained. Extraneous contamination is avoided. Items are set up on clean towels or drapes and used with examination gloves. Items are not sterile or maintained sterile during use. Extraneous contamination is avoided. Aseptic Technique Key elements of asepsis include the following facts: Disposable items are not cleaned and reused for another patient. Items are classified as semicritical or noncritical by Spaulding’s classification of the importance of patient care items. Items can be used outside the confines of the restricted area. Items are used on intact skin or mucous membranes. Items are not used when the patient’s vascular system will be entered. Sterile Technique Sterile technique incorporates many processes associated with asepsis but to a higher, more controlled degree. In sterile technique all microorganisms must be maintained at an irreducible minimum meaning as low as absolutely possible. Even in the restricted area the room air has a microbial count that we cannot eliminate. We try as hard as possible to minimize the room traffic and maintain environmental controls to maintain the sterile field Sterile Technique Essential elements of sterile technique include the following factors: Items are used only in a sterile field in the restricted area. Items are used by sterile team members wearing appropriate sterile attire. Items are used in areas of the patient’s body where the site has been prepped. Items may be used in invasive surgery. Items may be used in body areas with nonintact skin and membranes and may enter the patient’s vascular system. Sterile Technique Essential elements of sterile technique include the following factors: Items are classified as critical according to Spaulding’s level of importance of patient care items. Items have been cleaned, decontaminated, and packaged before sterilization. Items processed by sterilization are stored wrapped and remain so until use by a sterile team member. Sterile Technique Essential elements of sterile technique include the following factors: Items are for individual patient use only. Reusable items can be reprocessed and resterilized for use with another patient. Disposable items are discarded after use. If opened and unused, disposable items are discarded. Items that become contaminated are discarded and replaced immediately. Standard Precautions Standard precautions (formerly referred to as universal precautions) protect health care workers from contact with blood and body fluids of all patients. Standard precautions include the following considerations: All body fluids Handwashing Barrier clothing Handling of used patient care equipment and linen Occupational exposure to bloodborne pathogens Patient placement and management Standard Precautions The following list involves standard precautions: 1. Protective barriers and personal protective equipment (PPE) 2. Prevention of puncture injuries 3. Management of puncture injuries 4. Oral procedures 5. Care of specimens 6. Decontamination 7. Laundry 8. Waste 9. Handwashing 10.No touching of mucous membranes 11.Prophylaxis Principles of Sterile Technique Sterile technique is the foundation of modern surgery. The patient is the center of the sterile field, which includes the personnel wearing sterile attire and the areas of the patient, operating bed, and furniture that are covered with sterile drapes. The level of the surgical site is the central focus of the level of the sterile field. Strict adherence to the recommended practices of sterile technique reflects the surgical conscience of the perioperative team and is mandatory for the safety of the patient and personnel in the environment. Principles of Sterile Technique The principles of sterile technique are applied under the following conditions: In preparation for an invasive procedure by sterilization of necessary materials and supplies In preparation of the sterile team to handle sterile supplies and intimately contact the surgical site by scrubbing, gowning, and gloving In the creation and maintenance of the sterile field, including skin preparation and draping of the patient In the maintenance of sterility throughout the entire surgical procedure; breaches in sterility are remedied immediately In terminal decontamination, disinfection, and sterilization at the conclusion of the surgical procedure Principles of Sterile Technique Only Sterile Items Are Used Within the Sterile Field If there is any doubt about the sterility of any item, it should be considered unsterile and therefore should not be used. The phrase “when in doubt, throw it out” applies to this situation. Examples of questionably sterile items include, but are not limited to, the following situations: If a sterilized package is found in a contaminated area If uncertain about the actual timing or operation of the sterilizer. If an unsterile person or object comes into close contact with a sterile table and vice versa If a sterile table or unwrapped sterile items are not under constant observation If the integrity of the packaging material is not intact If a sterile package wrapped in a material other than plastic or another moisture-resistant barrier becomes damp or wet. If a sterile package wrapped in a pervious woven material drops to the floor or other area of questionable cleanliness. Principles of Sterile Technique Sterile Personnel Are Gowned and Gloved Gowns are considered sterile only from the chest to the level of the sterile field in the front, and from 2 inches above the elbows to the cuffs on the sleeves Self-gowning and gloving should be done from a separate sterile surface to avoid dripping water onto sterile supplies or a sterile table. Closed gloving technique is preferred. The stockinette cuffs of the gown are enclosed beneath sterile gloves. Sterile people must keep their hands in sight at all times and at or above waist level or the level of the sterile field Hands are kept away from the face and the elbows are kept close to the sides. The hands are never folded under the arms because of perspiration in the axillary region. Sterile people are aware of the height of team members in relation to each other and the sterile field. Principles of Sterile Technique Tables Are Sterile Only at Table Level Because tables are sterile only at table level, OR personnel must adhere to the following procedures: Only the top of a sterile, draped table is considered sterile. The edges and sides of the drape extending below table level are considered contaminated. The Mayo stand, when covered by a sterile drape, may be placed over the sterile field. Anything falling or extending over the table or OR bed edge, such as a piece of suture or suction tip, is contaminated. When unfolding or applying a sterile drape, it is unfolded away from the sterile person and the part that drops below the table surface is not brought back up to table level. Cords, tubing, and other materials are secured on the sterile field with a nonperforating clip to prevent them from sliding over the edge of the operating bed. Principles of Sterile Technique Sterile Personnel Touch Only Sterile Items or Areas; Unsterile Personnel Touch Only Unsterile Items or Areas Sterile team members maintain contact with the sterile field by means of sterile gowns and gloves. The unsterile circulating nurse does not directly contact the sterile field. Supplies are brought to sterile team members and opened by the circulating nurse using aseptic technique. The circulating nurse ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces. Principles of Sterile Technique Unsterile Personnel Avoid Reaching Over the Sterile Field; Sterile Personnel Avoid Leaning Over an Unsterile Area The Edges of Anything That Encloses Sterile Contents Are Considered Unsterile The Sterile Field Is Created as Close as Possible to the Time of Use Sterile Areas Are Continuously Kept in View Sterile Personnel Keep Well Within the Sterile Area Sterile Personnel Keep Contact with Sterile Areas to a Minimum Unsterile Personnel Avoid Sterile Areas Destruction of the Integrity of Microbial Barriers Results in Contamination Microorganisms Must Be Kept to an Irreducible Minimum Sterilization Bacterial endospores (e.g., clostridia and bacillus) are the most resistant of all living organisms because of their capacity to withstand external destructive agents. Although the physical or chemical process by which all pathogenic and nonpathogenic microorganisms (including endospores) are destroyed is not absolute, supplies and equipment are considered sterile when all parameters have been met during a sterilization process. Sterilization versus Disinfection Pathogenic microorganisms, as well as those that do not normally invade healthy tissue, are capable of causing infection if introduced mechanically into the body. Standardized procedures that are based on accepted principles and practices are necessary for the sterilization or disinfection of all supplies and equipment used for patient care in the perioperative environment. Following established protocols for instrument processing helps minimize the patient’s risk for infection of the surgical site. Sterilization versus Disinfection A sterile item has been exposed to a sterilization process to render it free of all living microorganisms, including endospores. As long as sterility is maintained, this process renders items safe for contact with nonintact tissue and for exposure to the vascular system without transmitting infection. The sterilization process should provide assurance that an item can be expected to be free of known viable pathogenic and nonpathogenic microorganisms, including endospores. Sterilization versus Disinfection For items and materials that cannot be sterilized, disinfectants are used to kill as many microorganisms in the environment as possible. Methods of Sterilization Reliable sterilization depends on the contact of the sterilizing agent with all surfaces of the item to be sterilized. Selection of the agent used to achieve sterility depends primarily on the nature of the item to be sterilized. The time required to kill endospores in the available equipment then becomes critical. Sterilization processes are either physical or chemical, and each method has its advantages and disadvantages Methods of Sterilization The following are available sterilizing agents (sterilants): 1. Thermal (physical) a. Steam under pressure/moist heat b. Hot air/dry heat Methods of Sterilization The following are available sterilizing agents (sterilants): 2. Chemical a. Ethylene oxide gas b. Formaldehyde gas and solution c. Hydrogen peroxide plasma/vapor d. Ozone gas e. Acetic acid solution f. Glutaraldehyde solution g. Peracetic acid 0.2% solution h. Hypochlorous acid (electrochemical conversion process) Methods of Sterilization The following are available sterilizing agents (sterilants): 3. Radiation (physical) a. Microwave (nonionizing) b. X-ray (ionizing) PREOPERATIVE ASSESSMENT The goal in the preoperative period is for the patient to be as healthy as possible. Every attempt is made to assess for and address risk factors that may contribute to postoperative complications and delay recovery A plan of action is designed so that potential complications are averted. Before any surgical treatment is initiated, a health history is obtained, a physical examination is performed during which vital signs are noted, and a baseline is established for future comparisons PREOPERATIVE ASSESSMENT Nutritional and Fluid Status Optimal nutrition is an essential factor in promoting healing and resisting infection and other surgical complications. Assessment of a patient’s nutritional status identifies factors that can affect the patient’s surgical course, such as obesity, weight loss, malnutrition, deficiencies in specific nutrients, metabolic abnormalities, and the effects of medications on nutrition. PREOPERATIVE ASSESSMENT Nutritional and Fluid Status Any nutritional deficiency should be corrected before surgery to provide adequate protein for tissue repair. Assessment of a patient’s hydration status is also essential. Dehydration, hypovolemia, and electrolyte imbalances can lead to significant problems PREOPERATIVE ASSESSMENT Nutritional and Fluid Status Any nutritional deficiency should be corrected before surgery to provide adequate protein for tissue repair. Assessment of a patient’s hydration status is also essential. Dehydration, hypovolemia, and electrolyte imbalances can lead to significant problems PREOPERATIVE ASSESSMENT Nutritional and Fluid Status Any nutritional deficiency should be corrected before surgery to provide adequate protein for tissue repair. Assessment of a patient’s hydration status is also essential. Dehydration, hypovolemia, and electrolyte imbalances can lead to significant problems PREOPERATIVE ASSESSMENT Respiratory Status The patient is educated about breathing exercises and the use of an incentive spirometer, if indicated, to achieve optimal respiratory function prior to surgery. The potential compromise of ventilation during all phases of surgical treatment necessitates a proactive response to respiratory infections. PREOPERATIVE ASSESSMENT Respiratory Status Surgery is usually postponed for elective cases if the patient has a respiratory infection. Patients with underlying respiratory disease (e.g., asthma, chronic obstructive pulmonary disease) are assessed carefully for current threats to their pulmonary status. Patients who smoke are urged to stop 30 days before surgery to significantly reduce pulmonary and wound healing complications PREOPERATIVE ASSESSMENT Cardiovascular Status Patient preparation for surgical intervention includes ensuring that the cardiovascular system can support the oxygen, fluid, and nutritional needs of the perioperative period. If the patient has uncontrolled hypertension, surgery may be postponed until the blood pressure is under control. At times, surgical treatment can be modified to meet the cardiac tolerance of the patient. PREOPERATIVE ASSESSMENT Immune Function An important function of the preoperative assessment is to determine the presence of infection or allergies. Routine laboratory tests used to detect infection include the white blood count (WBC) and the urinalysis. Surgery may be postponed in the presence of infection. The patient is asked to identify any substances that precipitated previous allergic reactions, including medications, blood transfusions, contrast agents, latex, and food products, and to describe the signs and symptoms produced by these substances PREOPERATIVE ASSESSMENT Previous Medication Use A medication history is obtained because of the possible interactions with medications that might be given during surgery and the effects of any of these medications on the patient’s perioperative course PREOPERATIVE ASSESSMENT Previous Medication Use A medication history is obtained because of the possible interactions with medications that might be given during surgery and the effects of any of these medications on the patient’s perioperative course PREOPERATIVE ASSESSMENT Previous Medication Use A medication history is obtained because of the possible interactions with medications that might be given during surgery and the effects of any of these medications on the patient’s perioperative course Informed Consent Informed consent is the patient’s autonomous decision about whether to undergo a surgical procedure. Voluntary and written informed consent from the patient is necessary before nonemergent surgery can be performed to protect the patient from unsanctioned surgery and protect the surgeon from claims of an unauthorized operation or battery. Consent is a legal mandate, but it also helps the patient to prepare psychologically, because it helps to ensure that the patient understands the surgery to be performed Informed Consent Many ethical principles are integral to informed consent. Informed consent is necessary in the following circumstances: Invasive procedures, such as a surgical incision, a biopsy, a cystoscopy, or paracentesis Procedures requiring sedation and/or anesthesia A nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient Procedures involving radiation Blood product administration Informed Consent Valid Informed Consent Voluntary Consent Valid consent must be freely given, without coercion. Patient must be at least 18 years of age (unless an emancipated minor), a physician must obtain consent, and a professional staff member must witness patient’s signature. Informed Consent Valid Informed Consent Incompetent Patient Legal definition: individual who is not autonomous and cannot give or withhold consent (e.g., individuals who are cognitively impaired, mentally ill, or neurologically incapacitated). Informed Consent Valid Informed Consent Informed Subject Informed consent should be in writing. It should contain the following: Explanation of procedure and its risks Description of benefits and alternatives An offer to answer questions about procedure Instructions that the patient may withdraw consent A statement informing the patient if the protocol differs from customary procedure Informed Consent Valid Informed Consent Patient Able to Comprehend If the patient is non-English speaking, it is necessary to provide consent (written and verbal) in a language that is understandable to the client. A trained medical interpreter may be consulted. Alternative formats of communication (e.g., Braille, large print, sign interpreter) may be needed if the patient has a disability that affects vision or hearing. Questions must be answered to facilitate comprehension if material is confusing. PREOPERATIVE NURSING INTERVENTIONS A wide range of interventions are used to prepare the patient physically and psychologically and to maintain safety. Beginning with the nursing history and physical examination, listing of medications taken routinely, history of allergies, and surgical and anesthetic histories, the patient’s overall health status and level of experience and understanding may be established. PREOPERATIVE NURSING INTERVENTIONS Providing Patient Education Each patient’s education is individualized, with consideration for any unique concerns or learning needs. Multiple education strategies should be used (e.g., verbal, written, return demonstration), depending on the patient’s needs and abilities. Preoperative education is initiated as soon as possible, beginning in the physician’s office, in the clinic, or at the time when diagnostic tests are performed. PREOPERATIVE NURSING INTERVENTIONS Providing Patient Education Deep Breathing, Coughing, and Incentive Spirometry Mobility and Active Body Movement Pain Management PREOPERATIVE NURSING INTERVENTIONS Providing Patient Education Preoperative Instructions to Prevent Postoperative Complications 1. Diaphragmatic Breathing 2. Coughing 3. Leg Exercises 4. Turning to the Side 5. Getting Out of Bed PREOPERATIVE NURSING INTERVENTIONS Providing Psychosocial Interventions Reducing Anxiety and Decreasing Fear Respecting Cultural, Spiritual, and Religious Beliefs PREOPERATIVE NURSING INTERVENTIONS Maintaining Patient Safety Protecting patients from injury is one of the major roles of the perioperative nurse PREOPERATIVE NURSING INTERVENTIONS Preparing the Bowel Enemas are not commonly prescribed preoperatively unless the patient is undergoing abdominal or pelvic surgery. In this case, a cleansing enema or laxative may be prescribed the evening before surgery and may be repeated the morning of surgery. The goals of this preparation are to allow satisfactory visualization of the surgical site and to prevent trauma to the intestine or contamination of the peritoneum by fecal material IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS 1. Administering Preanesthetic Medication 2. Maintaining the Preoperative Record 3. Transporting the Patient to the Presurgical Area 4. Attending to Family Needs REFERENCES Goodman, T. & Spry, C. (2016). Essentials of perioperative nursing. (6th ed.). Jones & Bartlett Learning: USA Hinkle, J.L. & Cheever, K.H. (2017). Brunner & Suddarth's Textbook of Medical-surgical nursing. (15th ed.). Lippincott: USA Berry and Kohns Operating Room Techniques 13th edition 2017 by Elsevier, Inc.