Perioperative care pre intra post operation

Pre intra post operation nursing care

1. Perioperative nursing

2. Phases of Perioperative nursing
Perioperative nursing:
 Is the delivery of nursing care through the
framework of the nursing process.
 It includes collaboration of the health care
team, making nursing referrals, and
delegating and supervising nursing care.
Perioperative phases/ periods are:
1.Preoperative period.
2.Intraoperative period.
3.Postoperative period.

3. Perioperative Nursing

4. Nurse role in Preoperative
phase
The preoperative phase begins when the decision to have
surgery is made, and ends when the pt is transferred to
the operating table.
The nurse actions include:
•Ensuring that the consent form is signed and serves as a
witness for the signature.
Assessment:
1.Collect preoperative assessment data (current health
status, allergies, medications, previous surgeries,
understanding of the surgical procedure, social resources).
2.Perform a brief but complete physical assessment.
3.Identify actual or potential health problems (e.g.:
respiratory infection, irregular HR).

5. 4. Routine Preoperative screening tests
Follow up the surgeon or the
anesthesiologist orders &
obtain the results prior to
surgery (Routine or
Diagnostic Tests).
CBC.
Blood grouping & cross
matching.
Serum electrolytes (Na
+
, K
+
,
Mg
+2
, Cl
-
).
Fasting blood glucose..
BUN & Creatinine..
LFT….
Urinalysis…
Chest X-ray..
ECG..
Pregnancy test

6. 5.Physical Preparation
Nutrition & fluids:
•Measure fluid intake accurately…
•NPO: STOP clear fluids 2 hr before procedure….
Light breakfast( tea & toast) 6 hr before procedure.
Heavier meal 8 hr before procedure.
Elimination:
•Cleansing enema may be ordered (helps postoperative constipation, &
contamination of the surgical area with feces.
•Foley’s catheter may be ordered/ empty bladder.
Hygiene:
•Bath/ shower the evening (and/or) morning of surgery.
•Nails should be trimmed and polish removed, and all cosmetics.
•Remove all hair pins/ clips, Put on operating gown and surgical cap.
Vital signs.

8. 6.Preoperative teaching:
It is a vital part of nursing care.
Dimensions of preoperative teaching:

9. Food & fluid restrictions
(8 hr before surgery).
Remove jewelry, make
up and prostheses (eye
glasses, dentures,
hearing aids).
Deep breathing, leg
exercises teaching.
Bowel preparation.
Skin preparation.
Preoperative
medications.
Individual therapies;
IV therapy, urinary
catheter, antiemboli
stockings.
The preoperative teaching is often provided:
•Before the day of surgery.
•On admission or the day of surgery.
•Before discharge from the PAU.
•Forms of preoperative teaching: (videos, verbal and
written instructions).
Preoperative instructions include:

10. Nurse role in Intra Operative phase
It begins when the client is transferred to the operating
table and ends when the client is admitted to the post
anesthesia care unit (PACU)/ (Recovery room).
The nurse actions include:
Assessment:
Confirms the clients identity, & assess the client’s physical
& emotional status.
Evaluates the client’s knowledge.
The client’s response to preoperative medications.
Placement & patency of tubes.

12. Nurse role in Post Operative phase
The Post operative phase begins with the admission of
the client to the PACU, and ends when healing is
complete.

13. Positioning:
•On the side with face slightly down, with no pillow.
Maintain maximum chest expansion:
•Elevate the upper arm on a pillow.
•Artificial airway is maintained in place.
Help the client turn, cough & take deep breaths (V/S
stable).
Document the client’s arrival & all assessments.
Identify and manage the collaborative problems.
Return the pt to the nursing unit or the outpatient
surgery discharge area. (stabilized health status).

15. Moving in bed
If moving to the Lt for example:
Flex the knees
Splint the wound by the Lt hand or a small
pillow.
Push with the Rt foot, & grasp Lt side rail with
the Rt hand.
Come to a sitting position by using the Rt
arm & hand, swinging the feet over the edge
of bed.

16. Leg exercises
Alternate dorsiflexion & plantar flexion of the
knee.
Flex & extend the knees & press back the
knees into the bed while dorsiflexing the feet.
Raise & lower the legs alternately from the
surface of the bed. Flex the knee of the stable
leg and extend the knee of the moving leg.

17. Deep breathing & coughing exercises
Q 2hr. In sitting position.
Support the incision with clasped hands & firmly
rolled pillow.
Place the palms on the border of rib cage & inhale
slowly through the nose until greatest expansion is
achieved.
Instruct the pt to take 5 deep inhalations, hold the
breath for few sec. then cough voluntarily once or
twice.

18. Post operative problems