By: Omaimah Qadhi

 Perioprative nursing: ALL nursing functions associated with the patient`s surgical experience. Incorprate all the three phases: 1. Preoprative. 2. Intraoprative. 3. postoprative.

A. Preoprative phase: decision for surgical intervention is made till the patient transferred to the OR (operating room). B. Intraoprative phase: begins from patient taken to OR and ends when the patient is transferred to the recovery room. C. Postoprative phase: begins from recovery room and ends with the follow up evaluation in the clinical sitting (e.g. clinic).

Of surgery? May be for diagnosis ( e.g. biopsy). May be exploratory (e.g. laparotomy). May be for reconstruction (e.g. mammoplasty). May be palliative to relieve pain (give example)

1. Emergency: NO DELAY e.g. to maintain life, maintain function or to stop hemorrhage from gunshot, intestinal obstruction, or stab wound (bleeding). 2. Urgent: within hours (bleeding from doudnal ulcer). 3. Planned: scheduled weeks or months. 4. Elective: not necessary (hernia).

5. optional: requested by the patient e.g. plastic surgery. What are RISK factors:  Patient`s: age, obesity, malnutrition, immobility, hypovolemia, …….  Nature of the patient`s condition e.g. malignancy.  Location of the condition e.g. heart.

 Assessment  Diagnosis.  Planning and goals.  Intervention.

(physiological and psychological). a) Psychological nursing assessment: stress response, pain, disturbance of body image, anxiety of unknown, ……., dependency). b) Physiological nursing assessment: demographic data, pain, infection, ………, lab results.

e.g. knowledge deficit regarding preoperative procedures, postoperative procedure, or complications. Give other examples !!

Mainly relief of preoprative anxiety, less pain, decrease fear, increased knowledge about the postoprative experience, no complications.

 Psychological aspect: explain procedure (pre, intra, and postoprative, orientation about the health care setting (hospital, clinic)  Providing informed consent.

 Physiologic aspects before the surgery day (correct diet, ↓ weight, solve any fluid imbalance, if anemia give blood, any chronic disease, treat infection).

 Preoperative teaching: 1) deep breathing and coughing (IS)

2) Turning and moving, leg exercise. 3) Transferring from bed. 4) Pain management. Preparing the patient the evening before the surgery. Hygiene Includes: bath or scrubbing, Shaving ??, observe and document the surgical site, NPO, IVFs.

enema for GI surgeries, NGT may be needed. Patient will be seen by the anesthetist for Res, cardio, neuro examination. Relaxing measurements (quite environment, clean bed Provide sleeping measures, may be sleeping meds.

 V/S  ID band.  Skin preparation.  Special stat orders.  Confirm NPO status.  Empty bladder (amount if indicated).  No rings, earrings, bracelet, NO NEWLLERY.  NO nail polish (WHY.??).  Donning hospital gown.  LAB results (WHY) ECG for old and cardiac pts (why??).  Available packed red blood cells (PRBCs).  Pre-anesthesia medication.  Checklist (why).

1. Circulating nurse: Prepares the OR, equipments, supplies and ascertain its working. Call for patient on time. Verifies the pt, explains and reassures the pt. Allergies ?? Complete MR.

 Assist transferring pt to OR table.  Positions patient properly.  Counts sponges, gauzes, needles before using and when wound is getting closed.

o Assist the scrub nurse and the surgeon by tying gowns.  assist the scrub nurse in maintaining sterile field, in arranging the table.  OBSERVE the sterile field cautiously and REPORT any breaking.  Cares for any surgical specimen.  Document operative record.  Prepares the skin on the operating sign.

 Scrub nurse:  Performs surgical hand scrub.  Dons sterile gown and gloves aseptically.  Arrange sterile supplies and instruments, check for functionality.  Counts sponges, needles with the circulating nurse.

o Gowns gloves the surgeon when entering the room. o Assist with surgical draping of the patient. o Maintain sterile field. o Observe and correct for any breakage in the aseptic technique. o Handles instruments to the surgeon correctly.

1. General anesthesia. 2. Regional or spinal. 3. Local anesthesia.

 Assessment: Respiratory. Circulatory. Neurologic. Urinary status. Comfort. Drainage (surgical site, tubes, drains). Safety (side rails, securing drains, tubes, IVs). Mobility (leg, body). IVFs (site, rate, type). psychological. Equipments (function e.g chest tube, foly`s catheter).

Nursing diagnosis:  Ineffective airway clearance related to depressing medications and anesthesia.  Acute pain related to surgical incision.  What else???

Planning: expected outcomes. Immediate and long term outcomes.  No complications.  Healthy incision site no infection and normal healing.  No sever weight loss.

 No constipation ( regular bowl motion).  Less pain.  At discharge patient education (home health care, community resources, prescribed activities, follow-up information)