1. Chapter 27 Perioperative Care

2. Question
Is the following statement true or false?
Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart.

3. Answer
True.
Antiembolism stockings compress superficial veins and capillaries, redirecting more blood to larger and deeper veins, where it flows more effectively toward the heart.

4. 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

5. 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

6. Types of Surgery According to Urgency

7. 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

8. Preoperative Period (cont’d)
Inpatient surgery (cont’d)
Anesthesiologist: physician who administers chemical agents that temporarily eliminate sensation and pain
Anesthetist: nurse specialist who administers anesthesia under the direction of a physician

9. Question Removal of a cataract falls under which type of surgery?
a. Required
b. Emergency
c. Urgent
d. Elective

10. Answer
a. Required
The type of surgery conducted for the removal of a cataract is called “required surgery.” Surgery for relieving an intestinal perforation is an example of an “emergency surgery.” Removal of a malignant tumor is an example of an “urgent surgery.” Removal of a superficial cyst is known as an “elective surgery.”

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

12. Advantages and Disadvantages of Outpatient Surgery

13. 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

14. Preoperative Period (cont’d)
Laser surgery
Used as an alternative to many previously conventional surgical techniques such as reattaching the retina, removing skin tattoos, and revascularizing ischemic heart muscle

15. Preoperative Period (cont’d)
Laser surgery (cont’d)
Advantages
Cost effectiveness
Reduced need for general anesthesia
Minimal blood loss
Less time recuperating

16. Preoperative Period (cont’d)
Laser surgery (cont’d)
Laser technology requires unique safety precautions such as eye, fire, heat, and vapor protection
Various safety measures are taken during laser surgery

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

18. Surgical Consent Form

19. 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

20. Question
Which of the following types of surgeries is used for removal or replacement of defective tissues to restore function?
a. Palliative
b. Exploratory
c. Curative
d. Diagnostic

21. Answer
c. Curative
Curative surgery is used for the purpose of removal or replacement of defective tissues to restore function. Relief of symptoms or enhancement of function without cure is called palliative surgery. Exploratory surgery is a more extensive means to diagnose a problem. Removal and study of tissues to make a diagnosis is called diagnostic surgery.

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

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

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

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

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

27. Preoperative Checklist

28. Intraoperative Period
Receiving room
Operating room
Surgical waiting area

29. Intraoperative Period (cont’d)
Anesthesia
General: central nervous system
Regional: specific area of the body
Local
Spinal, epidural, peripheral nerve blocks
Conscious sedation: clients are sedated, a state of relaxation and emotional comfort but not unconsciousness; client can respond verbally and physically

30. Question
Which of the following postoperative complications is a protrusion of abdominal organs through separated wounds?
a. Wound infection
b. Adynamic ileus
c. Dehiscence
d. Evisceration

31. Answer
d. Evisceration
A postoperative complication in which abdominal organs protrude through separated wounds is called evisceration. A wound infection indicates proliferation of pathogens at or beneath the incision. An adynamic ileus signifies lack of bowel activity, and dehiscence indicates separation of incisional edges.

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

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

34. Pneumatic Compression Device

35. 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

36. 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

37. General Gerontologic Considerations
Chronic health concerns in older clients may increase preoperative/postoperative periods
Muscle atrophy occurs in older adults who have been on bed rest as little as 1 or 2 days; range-of-motion exercises can maintain mobility
Important to assess client’s support system for care at home; client may need home rehabilitation services or extended care admission

38. General Gerontologic Considerations (cont’d)
Wound healing may occur more slowly due to impaired circulation and oxygenation; poor hydration and nutrition
Postoperative signs and symptoms may be more subtle or delayed; change in mental status may be early indicator of infection
Cardiac status of older adults is monitored carefully after surgery