perioperative nursing (preop)
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PERIOPERATIVE
NURSING
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U S G
SURGERY
Branch of medicine that encompasses
preoperative, intraoperative, and postoperative
care of patients. The discipline of surgery is
both an art and a science.
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SURGICAL PROCEDURE
Invasive incision into body tissues or a
minimally invasive entrance into a body cavity
for either therapeutic or diagnostic purposes
during which protective reflexes or self-care
abilities are potentially compromised
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CONDITIONS REQUIRING
SURGERY
OBSTRUCTION
PERFORATION
EROSION
TUMOR
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TYPES OF SURGERY
According to Purpose
Diagnostic
Exploratory
• Ablative
• Reconstructive
• Constructive
Curative
Palliative
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TYPES OF SURGERY
According to Degree of Risk
Major Surgery
• Involves vitalorgans
• Prolonged
Minor Surgery
• Involves non-vital parts
• Generally not prolonged
• Lesser blood loss• Lesser complications
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TYPES OF SURGERY
According to Urgency
Emergent
Urgent
Required
Elective
Optional
Without delay
Within 24-30 hours
Within few weeks or months
Failure to have surgery is not catastrophic
Personal preference
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AMBULATORY SURGERY
OUTPATIENT, SAME-DAY or SHORT-STAY
surgery
Laparosopic and minimally invasive surgery Admission to an inpatient hospital setting for
less than 24 hours
Requires Preadmission Testing (PAT)
Admitted in preoperative holding area of the
Operating Room and stays in the Post-
Anesthesia Care Unit (PACU) prior to
discharge
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SURGICAL TERMINOLOGIES
Suffixes Meaning
-ectomy excision; removal -otomy cut into or incision
-ostomy make artificial opening
-plasty plastic repair
-orrhaphy suturing; repair
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SURGICAL TERMINOLOGIES
Root Word Meaning
angio vessel
aorto aorta
arterio artery
cardio / corono heart
phlebo vein
cholecysto gallbladder
colo or colono colon
duodeno duodenum
esophago esophagus
gastro stomach
hepato liver
ileo ileum
Root Word Meaning
jejuno jejunum
oro / stomato mouth
pancreato pancreas
pharyngo pharynx
choledocho common bile duct
cholangio common bile duct
lapar abdomen
procto rectum
ano anus
adreno adrenal gland
hypophyso pituitary gland
thyro thyroid
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SURGICAL TERMINOLOGIES
Root Word Meaning
orchio / orchido testis
oophoro ovary
salphingo fallopian tube
cervico cervix
colpo / vagino vagina
hystero / utero uterus
mammo breast
lymphadeno lymph node
spleno spleen
nephro / reno kidney
uretero ureter
cysto / vesico urinary bladder
Root Word Meaning
pyelo renal pelvis
urethro urethra
balano penisprostato prostate
scroto scrotum
vaso vas deferens
arthro joint
chondro cartilage
costo rib
cranio skull
ligamento ligament
myo / myoso muscle
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SURGICAL TERMINOLOGIES
Root Word Meaning
osteo bone
pelvo pelvis
spondyl vertebratendino tendon
cerebello cerebellum
cerebro cerebrum
encephalo brain
neuro nerve
alveolo alveoli
broncho bronchial tube
epiglotto epiglottis
rhino nose
Root Word Meaning
phreno diaphragm
pneumono/pulmo lung
tracheo tracheaauro /oto ear
myringo/tympano eardrum
oculo/ophthalmo eye
phako eye lens
retino retina
blephar eyelid
cheilo lip
palato/urano palate
cutaneo/dermo skin
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SURGICAL TERMINOLOGIES
Abbreviation/ Acronym
Meaning
MRM Modified Radical Mastectomy
ORIF Open Reduction Internal Fixation
ADSF Anterior Decompression Spinal Fusion
ECCE ExtraCapsular Cataract Extraction
TAHBSO Total Abdominal Hysterectomy Bilateral Salphingo-
oophorectomy
TURP TransUrethral Resection of the Prostate
CS Ceasarean Section
AKA Above the Knee Amputation
BKA Below the Knee Amputation
CABG Coronary Artery Bypass Graft
APR Abdomino-Perineal Resection
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PERIOPERATIVE NURSING
Refers to activities performed by the
professional nurse which encompasses a
client’s total surgical experience
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PHASES OF PERIOPERATIVE
NURSING
PostOperative Phase
IntraOperative Phase
PreOperative Phase
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PREOPERATIVEPHASE
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PREOPERATIVE PHASE
Begins at the time of decision for surgeryand ends when the client is transferred tothe OR
This period is used to physically andpsychologically prepare the client for
surgery
The nurse plays a major role in clientteaching and in relieving the client’s and
the family’s anxieties
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PREOPERATIVE PHASE:
GOALS OF CARE
Assessing and correcting physiologic and psychologic
problems that might increase surgical risk
Giving the person and significant others completelearning/ teaching guidelines regarding surgery
Instructing and demonstrating exercises that will benefit
the person during post-op period
Planning for discharge and any projected changes in
lifestyle due to surgery
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PSYCHOLOGIC PREPARATION:
CAUSES OF FEARS
Fear of pain
Fear of anesthesia, vulnerability while unconscious
Fear of death
Fear of disturbance of body image
Worries: loss of finances, employment, social and family
roles
The MOST DEVASTATINGFEAR of a surgical client is
the
FEAR OF THE UNKNOWN.
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PSYCHOLOGIC PREPARATION:
MANIFESTATIONS OF FEARS
Anxiousness
Confusion
Anger
Tendency to exaggerate
Sad, evasive, tearful, clinging
Inability to concentrate
Short attention span Failure to carry out simple directions
Dazed
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PSYCHOLOGIC PREPARATION:
NURSING INTERVENTIONS
Assess client’s fears, anxieties, support systemsand patterns of coping
Establish a trusting relationship with the client andsignificant others
Encourage verbalization of fears
Explain routine procedures and allow client to askquestions
Provide spiritual care if appropriate
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LEGAL ASPECT OF
PREOPERATIVE PHASE
All invasive proceduresrequires for an
INFORMEDCONSENT
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SURGICAL CONSENT
OPERATIVE PERMIT / INFORMED
CONSENT
A document describing that the client has full
knowledge of the instructions of the exact
surgical procedure to be performed and has
given permission to have the procedureperformed on him
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SURGICAL CONSENT
The SURGEON is the ultimate responsible for
obtaining the surgical consent.
The Surgeon must inform the patient of the
benefits, alternatives, possible risks,
complications, disfigurement, disability and
removal of body parts.
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VALID SURGICAL CONSENT
Consent should be FREELY GIVEN, withoutcoercion
The patient signing the consent must beMENTALLY COMPETENT and of LEGAL AGE(at least 18 years of age).
For minors or mentally incompetent patient,the parent, legal guardian, spouse or relativenext of kin will sign the consent
EMANCIPATED MINORS (minors who are
married and self-sufficient) can sign their ownconsent
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VALID SURGICAL CONSENT
It must be witnessed by an authorized person –
a nurse or another doctor
It is part of the nurse’s role as a witness and a
client advocate to confirm that the client
understands information given
It must be obtained before the patient receivessedation
It has been signed at least a day before the
surgery
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SURGICAL CONSENT
In an emergency, permission via the
telephone is acceptable. Have a secondlistener on phone when telephone
permission being given.
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SURGICAL CONSENT
CONSENTS ARE NOT NEEDED for
emergency care if all four of the following
criteria are met:
There is an immediate threat to life
Experts agree that it is an emergency Client is unable to consent
A legally authorized person cannot be
reached
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Case Analysis
A client is brought to the ER after being hit
by a car. The name of the client is notknown. The client has sustained a severe
head injury and multiple fractures and is
unconscious. An emergency craniotomy is
required. In regard to informed consent for
the surgical procedure, what is the best
nursing action?
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Case Analysis
A client, 22 year old female, is brought to
the ER with an apparent head injury after being involved in a serious motor vehicle
accident. She is unconscious on arrival
and exhibits signs of increasing ICP. He is
accompanied by an adult friend and
fiancé. What is the best nursing action on
a legal stand point?
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PREOPERATIVE ASSESSMENT:
NURSING HISTORY
Allergies
Bleeding tendencies
Cortisone use
Diabetes MellitusEmboli
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PREOPERATIVE ASSESSMENT
Nutritional and Fluid Status
Dentition
Drug or Alcohol Use Respiratory Status
Cardiovascular Status
Hepatic and Renal Function Endocrine Function
Immune Function
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PREOPERATIVE ASSESSMENT:
PREVIOUS MEDICATION USE
Agents Effects of Interactions with Anesthesia /Surgery
Corticosteroids
Prednisone (Deltasone)
Cardiovascular collapse may occur if
discontinued suddenly
Diuretics
Hydrochlorothiazide
(HydroDIURIL)
Respiratory depression may occur with
anesthesia use
Phenothiazines
Chlorpromazine(Thorazine) Increases hypotensive effects of anesthesia
Tranquilizers
Diazepam(Valium)
Anxiety, tension and seizures may occur
when withdrawn suddenly
Insulin Intravenous insulin may be needed to
regulate blood glucose level during surgery
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PREOPERATIVE ASSESSMENT:
PREVIOUS MEDICATION USE
Agents Effects of Interactions with Anesthesia / Surgery
Antibiotics
Erythromycin(Ery-Tab)
Risk for respiratory paralysis when combined with
muscle relaxant
Anticoagulants
Warfarin(Coumadin)
Increases the risk of bleeding during the intraoperative
and postoperative period
Antiseizure agents Intravenous administration is needed to prevent seizure
during surgery
Thyroid Hormone
Levothyroxine sodium
(Levothroid)
Intravenous administration may be needed during the
postoperative period to maintain thyroid levels
Opioids Chronic use may alter response to analgesic agents
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PREOPERATIVE ASSESSMENT
All diagnostic examination should be
completed before surgery which include:
Chest X-ray
ECG
Complete Blood Count (CBC)
Coagulation studies
Urinalysis
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PREOPERATIVE TEACHINGS
Assess the client’s level of understanding of surgical procedure and its implications
Answer questions, clarify and reinforceexplanations given by surgeon
Explain routine pre and post procedures andany special equipment to be used
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PREOPERATIVE TEACHINGS
Demonstrate exercises that prevents
postoperative complications
Deep breathing / Diaphragmatic breathing
Coughing
Incentive Spirometry
Leg Exercises
Turning to Side
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PHYSICAL PREPARATION
THE DAY BEFORE SURGERY
Withholding food and fluid
Preparing the Bowel Preparing the Skin
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IMMEDIATE PREOPERATIVE
NURSING INTERVENTIONS
Hospital gown is worn that is left untied and
open in the back
Braid long hair and remove hair pins
Provide oral care
Inspect the mouth and remove dentures or
plates
Remove eyeglasses and prosthetic devices
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IMMEDIATE PREOPERATIVE
NURSING INTERVENTIONS
Remove make-up
Remove all jewelry and body piercings Remove nail polish
Obtain baseline vital signs
Complete the Preoperative Checklist Administer Preop Medications as ordered
VRP MEDICAL CENTER163 EDSA Mandaluyong City
VRP MEDICAL CENTER 163 EDSA Mandaluyong City
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163 EDSA, Mandaluyong City
PRE-OPERATIVE CHECKLIST
Name of Patient _______________________________
Room No. ________________
Attending Physician _____________________________ SURGERY Contemplated ________________________
Anesthesiologist _______________________________
Date of Surgery_______________ Time ____________ Consent for Surgery Yes No
Anesthesia Consent Yes To O.R.External Preparation ____________________________
(Specify Area)EnemaVoidedFoley Catheter Nasogastric Tube (NGT)IVF Line
Removed:Dentures Nail PolishWigs LipstickHairpins Jewelry
Laboratory Results:CBC Stool ExamBlood Typing Request for BloodUrinalysis Reserved
Prepared
X-Ray Results X-Ray PlatesHistoryPhysical ExaminationECG
Vital SignsBlood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________
Temperature ___________________________
Others: ______________________________________ ______________________________________
Pre-Operative MedicationDrug Dosage Route Time
____________________________________________ ____________________________________________ ____________________________________________
Signature of Floor Nurse _________________________
Signature of OR Nurse __________________________
V-GWU-016-03
163 EDSA, Mandaluyong City
PRE-OPERATIVE CHECKLIST
Name of Patient _______________________________
Room No. ________________
Attending Physician _____________________________ SURGERY Contemplated ________________________
Anesthesiologist _______________________________
Date of Surgery _______________ Time ___________ Consent for Surgery Yes No
Anesthesia Consent Yes To O.R.External Preparation ____________________________
(Specify Area)EnemaVoidedFoley Catheter Nasogastric Tube (NGT)IVF Line
Removed:Dentures Nail PolishWigs LipstickHairpins Jewelry
Laboratory Results:CBC Stool ExamBlood Typing Request for BloodUrinalysis Reserved
Prepared
X-Ray Results X-Ray PlatesHistoryPhysical ExaminationECG
Vital SignsBlood Pressure _________________________ Pulse Rate_____________________________ Respiration ____________________________
Temperature ___________________________
Others: ______________________________________ ______________________________________
Pre-Operative MedicationName Dosage Route Time
____________________________________________ ____________________________________________ ____________________________________________
Signature of Floor Nurse _________________________
Signature of OR Nurse __________________________
V-GWU-016-03
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PREANESTHETIC MEDICATION
PREOP MEDICATION
Usually given 30 to 45 minutes before thepatient is transported to the OR or “On call to
OR”
Given in the holding area of the OR for
ambulatory surgery
PURPOSES OF PREOP
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PURPOSES OF PREOP
MEDICATIONS
To allay fear and anxiety
To produce some amnesia To reduce reflex irritability
To raise the pain threshold
To lower the body metabolism To decrease respiratory and mouth secretions
COMMON PREOP
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COMMON PREOP
MEDICATIONS
Sedative andTranquilizers
Narcotic Analgesics
Anticholinergics
Histamine-receptor antagonists
Secobarbital
Diazepam (Valium)
Morphine
Meperidine HCl (Demerol)
Atropine sulfate
Scopolamine
Cimetidine (Tagamet)
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Before Administration of Preop
Medication
Check for drug allergy
Ensure the surgical consent has been signed Instruct the patient to void
Obtain the baseline vital signs
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After Administration of Preop
Medication
Instruct the patient to stay in bed
Raise the side rails up to ensure safety
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SAFETY PROTOCOLS
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
2003 Universal Protocol for Preventing Wrong
Site, Wrong Procedure, Wrong Person
Surgery
2009 National Patient Safety Goals
n versa ro oco or reven ng rong
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n versa ro oco or reven ng rongSite, Wrong Procedure, Wrong Person
Surgery
Preoperative verification process
Marking the operative site in an unambiguousmanner
“Time Out”
2009 N ti l P ti t S f t
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2009 National Patient Safety
Goals
Improve the accuracy of patient identification
Improve effectiveness of communication amongcaregivers
Improve safety of using medications Reduce the risk of health care-associated
infections
Accurately and completely reconcile medications
across continuum of care Reduce the risk of patient harm resulting from falls
Reduce the risk of influenza and pneumococcaldisease in institutionalized older adults
2009 National Patient Safet
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2009 National Patient Safety
Goals
Reduce the risk of surgical fires
Implement applicable National Patient SafetyGoals and associated requirements by
components and practitioner sites Encourage patient’s active involvement in their
own care as a patient safety strategy
Prevent health care-associated pressure ulcers
Identify safety risks inherent in the organization’spatient population
Improve recognition and response to changes in apatient’s condition
O
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Patient Transport to the Operating
Room
The patient is transferred to the holding area
or presurgical suite in a bed or a stretcher
about 30 to 60 minutes before the anesthetic is
given
The stretcher should be comfortable with a
small pillow and sufficient blankets Ensure safety during transport
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