1. Chapter 27 Perioperative Care

3. 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

4. Preoperative Period
Starts when client, or his family in an emergency situation, learn that surgery is necessary (the physician decided that operation is required)
Ends when client is transported to the operating room

5. Types of Surgery According to Urgency

6. Preoperative Period (cont’d)
Inpatient surgery
Term used for procedures performed on a client who is admitted to the hospital, expected to remain at least overnight, and needs nursing care for more than 1 day after surgery
Clients who have inpatient surgery undergo prior laboratory and diagnostic tests

7. Preoperative Period (cont’d)
Outpatient surgery
Term used for operative procedures performed on clients who return home the same day

8. Preoperative Period (cont’d)
Outpatient surgery (cont’d)
Clients remain in the outpatient surgical suite for a brief time and get discharged by midafternoon or early evening when:
The client is awake and alert
Vital signs are stable
Oral fluids are retained

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

10. Surgical Consent Form

11. Preoperative Period (cont’d)
Immediate preoperative care
1. Nursing assessment (Hx, physical assessment, understandig)
Surgical risk factors
Age Low Hgb & RBCs
Cardiopulmonary disease
Malnutrition Chronic Dz
Dehydration

12. Preoperative Period (cont’d)
Immediate preoperative care (cont’d)
Preoperative teaching
Deep breathing (Atelectasis & pneumonia)
Coughing
Leg exercises (thrombus)
Postoperative pain management

14. Preoperative Period (cont’d)
Immediate preoperative care (cont’d)
Physical preparation
Skin preparation
Elimination (catheter, urinate, enema, laxatives_
Food and fluid restrictions (clear fluid 2, light breakfast 6, heavy meal8)

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

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

17. Preoperative Checklist

19. Postoperative Period Immediate postoperative care (1st 24 Hrs)
Initial postoperative assessments (PACU):
LOC VS
Effectiveness of respiration
Condition of wound & dressing
Drains
IV solutions
Pain Catheter

20. Continuing Postop care
Preparing the room
Monitoring for complications:
Airway obs., Shock, Hypoxemia,….
Continuing postoperative care
Food and oral fluid intake (When???????)

21. Postoperative Period (cont’d)
Continuing postoperative care (cont’d)
Promoting venous circulation
?????, Leg exercises, Antiembolism socks,leg elevation, fluid.
Wound management (Reinforcement)
Elimination

22. Pneumatic Compression Device

23. 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

24. 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