1. By: Katie Helms, April Greene, Erin Mosher & Wyatt Withers

2. Why perioperative care is important?  To care for the patient before, during, and after surgery  To address patients concerns, fears, and anxieties about surgery  To ensure comfort before and after surgery  Identify the learning needs to patient and family  To ensure a quick recovery with minimal complications  To prepare the patient both physically and psychologically for surgery

3. Assessment  Obtain a health history  Perform a physical health assessment  Identify risk factors and allergies  Identify patient’s medications and treatment’s  Determine the teaching and psychosocial needs of both the patient and family  Identify any postsurgical support and referral needs of the patient

4. Pain Management  Gather past experiences with pain and how they manage pain at home  Ensure that the patient isn’t in any pain before surgery  Discuss the availability of analgesic medication postoperatively  Ensure the patient understands the patient controlled analgesia  Explore alternative methods to reduce pain:  Position change  Massage  Relaxation/diversion  Guided imagery  Meditation  Have patient express when pain level reaches a 5 on the 1-10 pain scale  Medication can be given or adjusted

5. 3 Phases of Perioperative Care 1. Preoperative  Begins when the decision to have surgery is made  Ends when the patient is transferred to the OR or procedural bed 2. Intraoperative  Begins when the patient is transferred to the OR bed  Ends with the transfer to the postoperative recovery area 3. Postoperative  Begins when the patient is transferred to the recovery room  Ends when the patient are completely recovered from surgery, and the last follow-up physician visit

6. Preoperative Care  Check patient’s chart for type of surgery and review medical orders  Gather any supplies needed  ALWAYS perform hand hygiene  Identify patient and close curtains to ensure patient safety  Ensure patient understands surgery  Witness the signature of signed consent form  Encourage the patient to express concerns or fears  Answer the questions within our scope of practice  If necessary contact physician/surgeon for any further questions

7. Breathing Exercises  Deep Breathing  Deep Breathing with Coughing  Incentive Spirometer  Importance:  Breathing exercises help to keep lungs clear of fluid and buildup postoperatively  Prevents complications and alterations in cardiovascular and respiratory function  Patient should informed of these exercises prior to surgery

8. Splinting  Education about splitting is important:  Protect the incision  Give more comfort to patient when sitting and laying in bed  Help patient to comfortably sit up and turn in bed without affecting incision site  Keep the pain level as low as possible

9. Preoperative Concerns:  Leg exercises/Anti-embolism stockings  Important for increasing circulation and blood flow  Important to maintain muscle strength  Dietary/Fluid Restrictions  NPO= nothing by mouth  Important to make sure stomach contains minimal gastric secretions in order to reduce risk of aspiration.  Skin Preparation  Ask patient to bathe and use antiseptic solution  Make sure the surgical site is clean to help prevent infection  Intestinal Preparation  Prepare bowel; sometimes laxatives or enema is needed.  Important to reduce intestinal bacteria

10. Postoperative Care  Identify patient and close curtains or door to ensure privacy  ALWAYS preform hand hygiene  Get patient into semi or high fowlers or sideline position  Check all vitals  Temperature  Pulse  Respiratory rate  Pulse Ox  Blood Pressure  Ensure that patient is awake and oriented to check mental status  Check dressings around incision site for drainage or bleeding

11. Patient Comfort  Ensure that the patient is:  Warm  Comfortably positioned  Pain has been assessed  Medications have been administered or adjusted as needed.

12. Ongoing Care  Vitals should be obtained at specific intervals  Make sure patient is doing breathing/coughing exercises and using the incentive spirometer  Ensure that any continuing concerns or anxieties about recovery are addressed  Ensure that patient’s overall well being is addressed  Promote optimal wound healing

13. References: Lynn, P. (2011). Clinical Nursing Skills (3rd ed., pp. 277-303). Philadelphia, PA: Wolters Kluwer. Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of Nursing (7th ed., pp. 817-838). Philadelphia, PA: Wolters Kluwer.