Chapter 27 Perioperative Care

Introduction to Operative Care Perioperative care is care that clients receive before, during, and after surgery Nurses assume general responsibilities when caring for clients during the preoperative, intraoperative, and postoperative periods of perioperative care

Preoperative Period Starts when client, or his family in an emergency situation, learn that surgery is necessary Ends when client is transported to the operating room

Types of Surgery According to Urgency

Preoperative Period (cont’d) Informed consent Permission for a procedure that a client gives after an explanation of the risks, benefits, and alternatives

Surgical Consent Form

Preoperative Period (cont’d) Preoperative blood donation Autologous transfusion: self-donated blood Directed donors: blood donors chosen from among the client’s relatives and friends If directed donation not used, it is available for use by other clients

Preoperative Period (cont’d) Immediate preoperative care Nursing assessment Surgical risk factors Low hemoglobin and red cells Cardiopulmonary disease Malnutrition Dehydration

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Preoperative teaching Deep breathing Coughing Leg exercises Postoperative pain management

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Physical preparation Skin preparation Elimination Food and fluid restrictions

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Physical preparation (cont’d) Care of valuables Surgical attire Disposition of dentures and prostheses

Preoperative Period (cont’d) Immediate preoperative care (cont’d) Preoperative medications Psychosocial preparation Preoperative checklist

Preoperative Checklist

Postoperative Period Immediate postoperative care Initial postoperative assessments Preparing the room Monitoring for complications Continuing postoperative care Food and oral fluid intake

Postoperative Period (cont’d) Continuing postoperative care (cont’d) Promoting venous circulation Pneumatic compression device Antiembolism hose Wound management Elimination

Pneumatic Compression Device

Postoperative Period (cont’d) Continuing postoperative care (cont’d) Discharge instructions How to care for the incision site Signs of complications to report Which foods to consume or avoid When and where to return for a medical appointment

Nursing Implications Applicable nursing diagnoses Deficient knowledge, fear, acute pain Risk for ineffective therapeutic regimen management, infection, impaired gas exchange, deficient fluid volume Ineffective breathing pattern, airway clearance Impaired skin integrity, disturbed body image