1. PERI-OPERATIVE NURSING
THREE PHASES
PRE-OPERATIVE
INTRA-OPERATIVE
POST-0PERATIVE

2. GENERAL INFORMATION
Pre-operative begins when the decisions for surgical intervention is made and ends when the patient is transferred to the operating room
Intra-operative begins when the patient is transferred to the surgery & ends when transferred to the recovery room
Post-operative begins when the patient is admitted to the recovery room & ends with follow up evaluation in the clinical setting or home

3. PRE-OPERATIVE SURGERY
Carolyn Frye-Shegog

4. GENERAL INFORMATION PURPOSE OF SURGERY SURGERY SETTINGS
INFORMED CONSENT

5. CLASSIFICATION OF SURGERY
ACCORDING TO PURPOSE:
DIAGNOSTIC
CURATIVE
PALLIATIVE
RECONSTRUCTIVE
PREVENTIVE
EXPLORATORY
COSMETIC

6. MAJOR AND MINOR SURGERY

7. TERMINOLOGY ECTOMY: REMOVAL OF AN ORGAN RRHAPHY: SUTURE OF A PART
SCOPY: LOOKING INTO
OSTOMY : MAKING AN OPINING
PLASTY :REPAIR OR RESTORE
OTOMY: CUTTING INTO

8. AMBULATORY SURGERY ADVANTAGES:
Less psychological distress associated with hospitalization
Decreased exposure to hospital infections
Economic savings
Consumer satisfaction

9. FACTORS AFFECTING ADAPTATION TO SURGERY
AGE:
NEUROENDOCRINE RESPONSE:
SURGICAL PROCEDURE:
PREVIOUS HOSPITALIZATIONS AND SURGERIES:
SPIRITUAL BELIEFS:
TYPE OF ADMISSION

10. PSYCHOSOCIAL REACTIONS TO SURGERY:
EMOTIONAL RESPONSES TO SURGERY:
FEAR OF THE UNKNOWN
FEAR OF ANESTHESIA;
FEAR OF PAIN: UNIVERSAL –FEAR OF MUTILATIONS OR ALTERED BODY IMAGE
FEAR OF DEATH
FEAR OF SEPARATION AND ROLE CHANGE

11. NON VERBAL COMMUNICATION OF FEARS AND ANXIETIES
RAPID SPEECH
JOKING
MAKING LIGHT OF SITUATION
WITHDRAWAL

12. NURSES ROLE
RECOGNIZING AND UNDERSTANDING PSYCHOSOCIAL REACTIONS TO SURGERY:

13. PRE-OPERATIVE NURSING ASSESSMENT
PSYCHOLOGICAL ASSESSMENT:
Social History: smoking, alcohol consumption, occupation etc.
Family health history
Past health history & home medication:

14. MEDICATIONS CON’T STEROIDS-should not be stopped abruptly
Antidepressants can increase hypotensive effects of anesthesia
Antibiotics such as neomycin, kanamycin can combine with certain anesthetics & lead to respiratory paralysis
Insulin dosage may need to be adjusted-check with the physician
ASA thins blood so may increase post-op bleeding
Antihypertensives & cardiac drugs can’t be stopped abruptly
Check for the use of OTC drugs for glaucoma

15. PHYSIOLOGICAL ASSESSMENT
Respiratory
HX of dyspnea, coughing, hemoptysis
COPD, or URI
Smoker?
Record baseline breath sounds
Diagnostic tests;; ABG’S CXR, FPT’S

16. CARDIOVASCULAR HX OF CARDIO OR CEREBRAL VASCULAR DISEASE PACEMAKER
ARTIFICIAL VALVES
ANTICOAGULANT THERAPY

17. CNS: (ENTRAL NERVOUS SYSTEM)
HX of stroke, TIA’S,
NEUROMUSCULAR DISORDERS SUCH AS MYASTHENIA GRAVI,
ESPECIALLY IMPORTANT TO ASSESS MENTAL STATUS
LOC

18. PRE-OPERATIVE NURSING CARE
PRE – OPERATIVE TEACHING
THE NURSE IS RESPONSIBLE TO:
FIND OUT WHAT PT. KNOWS
INCLUDE FAMILY
USE SIMPLE TERMS
EVALUATE PT. UNDERSTANDING
USE AUDIOVISUAL AIDS
ASK FOR RETURN DEMONSTRATION

19. PRE-OPERATIVE TEACHING
USUAL TOPICS COVERED
Preoperative tests
Preoperative routines
Schedule
PACU
FAMILY DIRECTIONS
POSTOP THERAPIES
PAIN MANAGEMENT
DIET

20. PRE-OPERATIVE NURSING ASSESSMENT
PSYCHOLOGICAL ASSESSMENT
SOCIAL HISTORY
FAMILY HEALTH HISTORY
PAST HEALTH HISTORY
PHYSIOLOGICAL HISTORY

21. PREOPERATIVE PHYSICAL PREPARATION
PRE-OP PHYSICAL PREPARATION
NUTRITIONAL
NIGHT BEFORE SURGERY, LIGHT MEAL OR LIQUID DIET
SPECIFIC IV FLUIDS
NPO AFTER MIDNIGHT
POSSIBILITY OF LIGHT BREAKFAST ON DAY OF

22. PRE-OP PHYSICAL PREP Intestinal NPO Enemas until clear Laxatives
Antibiotics to decrease intestinal flora

23. PRE-OP PHYSICAL PREP Skin prep Bathe before surgery
Shaving operative site
Scrub with betadine/other antiseptic

24. Three important components of consent form
Adequate disclosure
Sufficient comprehension
Voluntary consent