peri-operative care

Peri operative nursing is a nursing specialty that works with patients who are having injuries, invasive procedures. Peri-operative nurses work closely with surgeons, anesthesiologists, nurse anesthetist, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, post operative care primarily in the operating theater. The nurse assesses the patient data; establishing nursing diagnosis; identifies desired patient outcome; develop and implements a plan of care; and evaluates that care in terms of outcomes achieved by the patient
All aspects of peri operative care is described.

-preoperative care
-postoperative care

Role of nurse in pre operative nursing:
1.Pre operative assessment.
2.Obtaining informed consent.
3.Pre operative teaching.
4.Physical preparation of patients.
5.Psychological preparation
6.Informed Consent

POST OPERATIVE CARE: Post operative phase begins when the client is admitted to the post operative unit and ends with the client’s post operative evaluation in the physician’s office.
GOAL:
Restore homeostasis and prevent complication.
Maintain adequate cardio vascular and tissue perfusion
Maintain adequate respiratory function
Maintain adequate nutrition and elimination
Maintain adequate fluid electrolyte balance
Maintain adequate renal function
Promote adequate rest, comfort, and safety
Promote adequate wound healing
Promote and maintain activity and mobility
Provide adequate psychological support.

TRANSFER FROM OPERATION ROOM:
After sending the patient to operating room, prepare a bed to receive the patient undergone surgery.
Receive the patient without disturbing the devices attached to the patient.
Assessment A- Airway, B- Breathing, C- Circulation, C- Consciousness, S- Safety, D- Dressing, D- Drainage, D- Drugs , E- Elimination F- Foods, F- Fluids P- Pain.
Ask the theater staff about any complications during surgery.
Check vital signs.
Check the operation site for bleeding, discharge, etc. if drainage tube are filled.
Keep the patient well covered to prevent draught
Never leave the patient alone to prevent injury from fall
Observe the patient for swallowing reflexes
Quickly observe the functioning of all devices and make sure that they are in its functioning order.
Check the doctor’s order for other instruction and treatment.
POST OPERATIVE COMPLICATIONS:
Haematological: Hemorrhage
Respiratory: Atelectesis, Pneumonia, Pulmonary Embolism
Cardiovascular: Hypertension, cardiac dysrhythmias, venous thrombosis
Urinary: Urinary retention
Gastrointestinal: Constipation
Neurological: CVA/Stroke
Immunological: Infection
Wound healing: infection
Psychological: Body image problrms
POST OPERATIVE NURSING CARE:
Maintaining Respiratory function:
i.Encourage diaphragmatic breathing exercise at least every two hours while clients are awake
ii.Instruct to use incentive spirometers for maximum inspiration
iii.Encourage early ambulation
iv.Change position every one two hours.

1. Case Scanario : Miss. Chowdhury, 15 years old young girl comes to Emergency Department with fever, severe pain in right illac fossa radiating to Mc Burney’s point, associated with rebound tenderness, and vomitting. What is the probable surgery?

2. Pre- Operative & Post Operative Care Susmita Halder M.Sc. Nursing 1st Year CON BSMC, Bankura

3. Surgery Surgery can be defined as the art and science of treating diseases, injuries and deformities by operation and instrumentation. Surgical procedures are named according to : 1.The involved body part, organ, location. 2.The suffix that describes what is done during the procedure.

4. SURGICAL PROCEDURES: ECTOMY- Removal by cutting( Appendectomy) Lysis- Destruction of(electrolysis) Orrhapy- Suture of or repair (herniorraphy) Oscopy- Looking into(endoscopy) Ostomy- Formation of a permanent artificial opening(colostomy) Otomy- Incision or cutting into(tracheotomy) Plasty- Formation or repair(mammoplasty)

5. INDICATION FOR SURGERY: C – Correction of defects A – Alteration of form R- Restoration of function D- Diagnosis and treatment

6. SETTINGS FOR SURGERY: Inpatient settings: Hospital Outpatient settings: Hospital based ambulatory surgical centers. Free standing surgical centers Physicians’' offices Ambulatory care centers.

7. COSMETIC PALLIATIVE RECONSTRUCTIVE ABLATIVE DIAGNOSTIC BASED ON PURPOSE CONSTRUCTIVE

8. EMERGENCY URGENT BASED ON URGENCY OPTIONAL ELECTIVE

9. MINOR MAJOR Based on RISK

10. simple radical Based on Extent of surgery

11. 01 Pre Operative Care

12. PREOPERATIVE CARE Preoperative care of the patient begins as soon as the surgeon makes a diagnosis and decide that an operation is necessary for the patient which continues until the client has reached the operating area.

13. Goals of pre-operative care 1.Assessing and correcting physiologic and psychological problems that may increase surgical risk. 2.Giving the person and significant others complete learning / teaching guidelines regarding surgery. 3.Instructing and demonstrating exercises that will benefit the person during post operative period. 4.Planning for discharge and any projected changes in lifestyle due to surgery.

14. Role of nurse in pre operative nursing: 1.Pre operative assessment. 2.Obtaining informed consent. 3.Pre operative teaching. 4.Physical preparation of patients. 5.Psychological preparation 6. Informed Consent

15. Pre operative assessment:

16. Informed Consent Purpose: To ensure that the client understands the nature of the treatment including the potential complications and disfigurement. To indicate that the client’s decision was made without pressure. To protect the client against unauthorized procedure. To protect the surgeon and hospital against legal actions by a client who daims that an unauthorized procedure was performed.

17. Informed subject refers to informed consent in writing which should contain the following points oExplanation of procedure and its risks oDescription of benefits and alternatives oAn offer to answer questions about procedure oInstructions that the patient may withdraw consent o f statement informing the patient that if the protocol differs from the customary procedure

18. Pre-operative teaching

19. Incentive spirometer

20. Diaphragmatic breathing

21. Coughing and Splitting

22. Turning Foot and leg exercise Early ambulation.

23. REVIEW PRE OPRATIVE LABORATORY AND DIAGNOSTIC STUDIES :  Ø Complete blood count Ø Blood type and cross match Ø Serum electrolytes Ø Urinalysis Ø Chest x rays. Ø Electro cardiogram. Ø Other tests related to procedure or client’s medical conditions like prothrombine time, urea, creatinine, other radiographic studies.

24. REVIEW OF PATIENT HISTORY  History of present illness and reason for surgery. Past medical history Medical conditions(acute or chronic) Previous hospitalization and surgeries History of any past problem with anesthesia. Allergies. Present medications. 

25. REVIEW OF PATIENT HISTORY  Substance use: alcohol, tobacco, drugs Review of system Ability to communicate Vital signs Level of consciousness: confusion, drowsiness, unresponsiveness Weight and height Ability to move/ ambulatory Level of exercise Prostheses Circulatory status

26. PREPARATION OF THE PATIENT IN THE EVENING BEFORE SURGERY: Preparing the skin. Preparing the G I tract Preparing for anaesthesia Promoting rest and sleep : administer sedatives as ordered.

27. PREPARATION OF THE PATIENT ON THE DAY OF SURGERY:  Awaken 1 hour before pre operative medications. Morning bath, mouth wash Provide clean gown. Remove hair pins, braid long hair, cover hair with cap if available. Remove dentures , colored nail polish hearing aid, contact lenses jewelleries. Take baseline vital signs before pre operative medication.

28. PREPARATION OF THE PATIENT ON THE DAY OF SURGERY:  Check ID band, skin preparation. Check for special orders enema, IV line Check NPO Have client void before pre operative medication Continue to support emotionally. Accomplished “pre operative checklist"

29. PHYSICAL PREPARATION OF THE PATIENT:

30. P re Operative Nursing Care

31. 2 Post Operative Care

32. Post operative phase begins when the client is admitted to the post operative unit and ends with the client’s post operative evaluation in the physician’s office. Post Operative Care

33. Restore homeostasis and prevent complication. Maintain adequate cardio vascular and tissue perfusion Maintain adequate respiratory function Maintain adequate nutrition and elimination Maintain adequate fluid electrolyte balance Maintain adequate renal function Promote adequate rest, comfort, and safety Promote adequate wound healing Pomote and maintain activity and mobility Provide adequate psychological support. GOAL:

34. After sending the patient to operating room, prepare a bed to receive the patient undergone surgery. Receive the patient without disturbing the devices attached to the patient. Assessment A- Airway, B- Breathing, C- Circulation, C- Consciousness, S- Safety, D- Dressing, D- Drainage, D- Drugs , E- Elimination F- Foods, F- Fluids P- Pain. Ask the theater staff about any complications during surgery. Check vital signs. TRANSFER FROM OPERATION ROOM:

35. Check the operation site for bleeding, discharge, etc. if drainage tube are filled. Keep the patient well covered to prevent draught Never leave the patient alone to prevent injury from fall Observe the patient for swallowing reflexes Quickly observe the functioning of all devices and make sure that they are in its functioning order. Check the doctor’s order for other instruction and treatment. TRANSFER FROM OPERATION ROOM:

36. Haematological: Hemorrhage Respiratory: Atelectesis, Pneumonia, Pulmonary Embolism Cardiovascular: Hypertension, cardiac dysrhythmias, venous thrombosis Urinary: Urinary retention Gastrointestinal: Constipation Neurological: CVA/Stroke Immunological: Infection Wound healing: infection Psychological: Body image problrms POST OPERATIVE COMPLICATIONS:

37. Post Operative Nursing Care

38. Post Operative Nursing Care

39. BIBLIOGRAPHY : Basser P. Shebeer, Khan S Yasmin, A concise Textbook of advanced Nursing Practice, Second Edition, EMMESS, Medical Publishers, Banglore, 2019 Clement I. Basic Concept of Nursing procedure . Third Edition. Jaypee Brothers Medical Publishers (p) LTD. New Delhi. 2018. Jacob Annamma et al. Clinical nursing Procedures: The art of Nursing Practice. Third edition. Jaypee The Health Science Publishers.New Delhi.2025. Kaur Brar Navdeep, Rawat HC. Textbook of Advanced Nursing Practice, First Edition. Jaypee Brothers Medical Publishers (p) LTD. New Delhi 2015 Nancy.SR. Stephanie’s Principles and practice of Nursing. Sixth edition. N R Brothers Publishers.Indore. TNAI. Fandamentals of Nursing; a Procedure manual.First edition. Secretary General on behalf of the TNAI. New Delhi.2009 www. Slide share.net ( Peri Operative Nursing)

40. tHANK YOU!