LEARNING OUTCOMES administration, potential adverse

effects and nursing interventions

Part 1: Pre-operative Care
 Described the special considerations for
 Discuss the different diseases the older adult patient during surgery
conditions requiring surgery  Value the roles of the perioperative
 Classify surgical procedures according nurse in providing quality care for the
to purpose, degree of risk and urgency surgical patient
 Describe the different operative risk
Part 3: Postoperative Care
and effects of surgery to the patient
 Interpret the significance of data 1. Discuss the nursing assessment and
related to the pre operative patient’s management of the postoperative
health status patient during
 Described the nursing role in the a. Admission to the postoperative care
physical, psychologic, and educational unit (recovery unit)
preparation of the surgical patient b. Transfer from the post-anesthesia care
 Discuss the components and purpose unit to the surgical unit
of written inform consent for surgery c. Pre discharge period
 Discuss the preparation for the surgical 2. Described the etiology, nursing
patient days before surgery, on the assessment and nursing management of
evening before the surgery, and on the potential discomforts and complications
day of the surgery during the postoperative
 Identify the types and indications of 3. Identify the components of
preoperative medications predischarge patient teaching for the
 Described the special considerations of post operative patient
preoperative preparation for the older 4. Appreciate the roles of the nurses in
adult surgical patient providing quality care for the post
operative patient
Part 2: Intraoperative Care

 Described the physical environment of

the operating department and the Perioperative Nursing
proper attire for each area
Goal of Perioperative Nursing Practice
 Described the physical environment of
the operating room and the holding  To assist clients and their families and
area significant others to achieve a level of
 Identify the functions of the members wellness equal
of the surgical team
 Discus the nursing management of the Nurses Roles
patient undergoing surgery, before  To prepare the patient for surgery,
surgery, and post surgery caring for the patient during surgery
 Described the basic principles of aseptic and facilitating the patient recovery
technique used in the operating room following surgery
 Discuss the different types of
anesthesia, techniques of
PERIOPERATIVE PERIOD Surgery may be required for the following
conditions
 Surgery is the art and science of treating
disease, injuries, and deformities by  P-Perforation. Rupture of an organ,
operation ans instrumentation (appendicitis, rupture uterus)
 Perioperative period is divided into  O- Obstruction. Impairment to the flow
three phases: Preoperative, Intra of vital fluids, ex. Blood, urine, bile, CSF
operative and post operative period  E-Erosion- Wearing off a surface or
membrane- ex PUD
1. PREOPERATIVE PHASE- extends from the
 T-Tumors-abnormal growth of tissues-
time the patient is admitted to the surgical unit,
breast tumor, bone tumor, lung and
to the time he/she prepared physically,
brain tumor
psychologically, spiritually and legally for the
surgical procedure, until he/she is transported
into the operating room.
CLASSIFICATION OF SURGICAL PROCEDURES
a. Admission to the Surgical unit
Surgical procedures may be classified according
b. Preparation physically, psychologically,
to purpose, degree of risk, urgency and surgical
spiritually and legally for the surgical
setting
procedure
c. Transport to OR ACCORDING TO PURPOSE
2. INTRAOPERATIVE PHASE- extend from the 1. Diagnostic- to confirm the presence of a
time the patient is admitted to the OR, to the disease condition (biopsy)
time of administration of anesthesia, surgical
procedure is done, until he/she is transported 2. Exploratory- to determine the extent of
to the recovery room/post anesthesia care unit disease condtion.
(PACU) 3. Curative. To treat the disease condition
a. Admission to the OR Types of Curative Surgeries
b. Anesthesia, Surgery
c. Recovery Room/ PACU 3.1 Ablative- involves the removal of an organ.
Suffix used is “Ectomy”
3. POSTOPERATIVE extends from the time the
patient is admitted to the RR, to the time he is Ex
transported back into the surgical unit, Appendectomy- removal of appendix
discharge from the hospital, until the follow up Hysterectomy-removal of uterus
care Oophorectomy-removal of the ovary
Mastectomy- removal of the breast
a. Admission to RR/PACU Pneumonectomy- removal of the lung
b. Back to surgical unit Tonsillectomy- removal of the tonsils
c. DISCHARGE Cholecystectomy-removal of the gall bladder
d. Follow up care
3.2. Constructive-involves repair of congenitally
defective organ. Suffixes used are “plasty”,
“orrhaphy, “pexy”
Ex:
PREOPERATIVE CARE
Cheiloplasty- repair of cleft lip  extensive and prolonged. Involves a
Uranoplasty- repair of cleft palate considerable period of time
Herniorrhaphy- repair of hernia  involve large amount of blood loss
Orchidopexy- repair of undescended testes  vital organs are manipulated or
removed
3.3. Reconstructive- involves repair of a damage  has a risk of occurrence of
organ. Ex. Plastic surgery after severe burns, complications
scar revision
2. Minor Surgery

 ex: Appendectomy, tonsillectomy,

4. Palliative
blepharoplasty
 to relieve distressing signs and  the procedure is not prolonged
symptoms, not necessarily to cure the  involves lesser risk
disease  does not involve complciations
 ex: Colostomy, debridement of necrotic
tissue, resection of nerve roots
According to Urgency
5. Preventive
1. Emergency
 to inhibit the transformation of
precancerous lesions or benign tumors  should be done immediately to save the
to malignant tumors client’s life or limb
 ex: removal of fibrocystic breast mass  ex: emergency hysterectomy due to
before it becomes malignant, removal ruptured uterus, emergency
of nasal polyps to prevent cancer, amputation of the limb due to crushing
removal of mole before it becomes injury, emergency appendectomy due
malignant to acute appendicitis
6. Cosmetic improvement- nose-face-breast 2. Imperative
lifting, blepharoplasty (repair of eyelids),
liposuction procedure  should be done within 24-48 hours
 ex: profusely bleeding peptic ulcer,
evaluation of blood clots from the brain
ACCORDING TO DEGREE OF 3. Planned Required
RISK/MAGNITUDE/EXTENT
 this procedure is necessary for the well
1. Major Surgery being of the client
 may be scheduled weeks or months
 ex: Craniotomy, open heart surgery,
 ex: Tonsillectomy, thyroidectomy,
pneumonectomy; total abdominal
cataract extraction
hysterectomy with bilateral salphibgo-
oophorectomy 4. Elective
Criteria for Major Surgery  the procedure is not absolutely
necessary for survival. Delay or
 high risk of morbidity or mortality
omission will not cause adverse effect
 ex: removal of simple non toxic goiter
5. Optional  Obesity
 Fluids and electrolytes imbalances
 it is requested by the patient. It is  Presence of disease
usually for aesthetics purposes  Concurrent or prior pharmacotherapy
 ex: rhinoplasty (repair of the nose),
blepharoplasty (repair of the eyelids) OTHER FACTORS
 Nature of the disease condition
ACCORDING TO SURGICAL SETTING
 Location of the condition
1. Inpatient Surgery  Magnitude and urgency of the surgical
procedure
 patients who are admitted to the  Mental attitude of the person toward
hospital are usually admitted a day the surgery
before or on the day of the surgery  Caliber of the professional staff and
(same day admission) health care facilities

2. Ambulatory Surgery
1. GENERAL RISK FACTORS
 called same day or outpatient surgery
 is conducted in emergency
Aging
departments, endoscopy department,  Geriatric priority- older clients have less
doctor’s clinics, surgical clinics and physiologic reserve than younger adults
outpatient surgery units in the hospital Danger
 these procedures can be performed  Potential for injury is greater in the ages
under general, regional or local  Effect of the medication is greater in the
anesthetic older persons
 usually take 2 hours, require les than 3-  Medications such as morphine and
4 hours stay in the PACU. Do not barbiturates may cause confusion,
require overnight stay in the hospital disorientation and respiratory
 Some patients needs to stay in the depression
hospital overnight after surgery but less
Therapeutic Approach
than 24 hours known as 23 hour stay
 Use lesser doses for therapeutic effect
Suffixes for Surgical Procedures  Anticipate problems from chronic
Ectomy-excision or removal of (appendectomy) disorders (DM, anemia)
Lysis- Destrcution of (adhesiolysis)  Adjust nutritional intake to higher
Orrhaphy- Repair or suture of (herniorrhaphy) CHON and vitamins
Oscopy- looking into (gastroscopy)  Set patterns in eating or sleeping
Ostomy- creation of opening (Colostomy)
Otomy- Cutting into or incision of Obesity
(Choledochotomy) Danger
Plasty- repair or reconstruction of  Increased difficulty in technical aspects
(mammoplasty) of performing surgery; wound
dehiscence is greater
THE SURGICAL RISKS  Infection prone because lessened
resistance
1. GENERAL RISK FACTORS  Post operative Pneumonia and other
 Aging pulmonary complications- obese patient
tends to hypo ventilate
  Cardiovascular compromise due to  Avoid fluid overlaod
increase demand of the heart  Prevert prolong immobilization
 Increases the possibility of renal, biliary,  Change position
hepatic and endocrine disorders  Use antiembolic hose
 Decreased ability to conserve heat due  Note hypoxia and initiate therapy
to radiant heat loss
 Altered response to many drugs and Presence of DM
anesthetics Danger
 Decrease the ambulation  Hypetglycemia increased
catecholamines and glucocorticoids due
Therapeutic Approach to surgical stress
 Weight reduction  Poor wound healing
 Anticipate related complications
 Be alert for respiratory complications Approach
 Abdominal splinting when moving or  Recognize ss and sx of ketoacidosis and
coughing glucosuria
 Accurate or ideal dose of medications  Monitor blood glucose and prepare to
 Use proper body mechanics to move administer insulin
client
 Avoid IM injections Presence of Alcoholism
 Early dietary consultation Danger
 Alcoholism is accompanied by problems
Poor Nutrition of malnutrition
Danger  May also have an increased tolerance to
 Impairs wound healing anesthetics
 Increases the risk of infection and shock
Presence of Pulmonary and Upper Respiratory
Approach Disease
 Improve the nutritional status before Danger
and after surgery (enteral or parenteral  May contribute to hypoventilation
feedings) leading to Pneumonia and atelectasis
 Repair of dental carries and proper Approach
mouth hygiene  Treat preoperatively to reduce the risk
Fluids and electrolytes imbalances of atelectasis and pneumonia and
Danger prevent depression from narcotics
 Dehydration and electrolyte imbalances
Approach Concurrent or prior pharmacotherapy
 Assess F and E stats Danger
 Rehydrate  Hazards exist when certain medications
 Monitor electrolyte imbalnces are given concomitantly with others
 Monitor I and O including herbal substances
Presence of disease Approach
Danger  Notify health care provider and
 Presence of cardiovascular is at risk to anesthesiologist if patient is taking any
dysrhythmias, shock or CA during of the ff drugs
surgery  Antibiotics, antidepressants,
Approach phenothiazines, diuretics, steroids and
 Maintain diligence assessment anticoagulants
OTHER RISK FACTORS to SURGERY  blood coagulation disorders are at risk
 Nature of the disease condition to have hemorrhage and shock during
 Location of the condition and after surgery.
 Magnitude and urgency of the surgical  History of bleeding, or diagnosis such as
procedure hemophilia or sickle cell anemia
 Mental attitude of the person toward  Manifestations such as bruises,
the surgery
excessive bleeding or nose bleeding
 Caliber of the professional staff and
 Hepatic and renal disease. Bleeding and
health care facilities
anemia are the common problems in
EFFECTS of SURGERY to PATIENTS these conditions
 Stress response  Abnormal bleeding time, Prothrombin
 Defense against infection is lowered time and platelet count.
 Vascular system is disrupted USE of MEDICATIONS and ALLERGIES
 Organs functions are disturbed
 Body image may be altered  Herbal preparations- gingko biloba,
 Lifestyle may change garlic, ginger and ginseng may prevent
blood clotting as it increases the risk of
bleeding
PRE OPERATIVE NURSING ASSESSMENT  Diuretics
 Penicillin and aminoglycosides- muscle
Physiologic Assessment of the client undergoing relaxant may cause respiratory
Surgery depression
 Age- may increase surgical risks includes  Anticoagulants, aspirin, NSAIDS may
malnutrition, anemia, dehydration, increase the risk of bleeding during
atherosclerosis, COPD, HTN and DM intaoperative and postoperative periods
 Presence of pain-  Allergies todrugs, foods, chemical and
 Nutritional status- diet history, general pollen
appearance pf the patient, comparing  History of hay fever, latex allergy
the present weight with ideal body PHYSICAL EXAMINATION
weight. Lab test can assist in nutritional
assessment such as albumin,  Done before surgery or on the day of
hemoglobin, and hematocrit, BUN and surgery
creatinine clearance.  All relevant findings must be
 Fluids and electrolytes balance documented and reported immediately
 Infection
 Cardiovascular function
 Pulmonary Function PRESENCE of TRAUMA
 Renal function
 Trauma like fractures, contusions,
 Gastrointestinal function
lacerations, stab wounds should be
 Liver function
assessed and documented prior to
 Endocrine function
surgery
Hematologic function
COMMON PRE-OPERATIVE DIAGNOSTICS TEST Nursing Interventions

 URINALYSIS  Explore the client feelings

 Chest X-Ray  Allow the client to speak openly about
 Blood studies-CBC fears and concerns
 Electrolytes  Give accurate information regarding
 ABG, Oximetry surgery
 PT, PTT, INR, platelet  Provide empathetic support
 Blood glucose  Consider the persons cultural and
 Creatinine religious preferences
 BUN
HOPE
 Serum albumin
 Electrocardiogram  Is a psychologic factor related to
 Pulmonary function studies surgery that is a positive factor.
 Liver function test
 Blood typing and crossmatching Legal Aspects of Surgical Interventions: Written
 HcG Informed Consent (Operative permit, Surgical
Permit)

Purposes:
PSYCHOSOCIAL ASSESSMENT of the CLIENT
UNDERGOING SURGERY

FEAR

 Fear of unknown
 Fear of anesthesia
 Fear of pain
 Fear of death
 Fear of disturbance of body image
 Fear and worries from loss of financies,
employment, social and family roles
 Signs- anxiousness, bewilderment,
tendency to exaggerate, anger,
sadness, tearful, clinging behavior,
inability to concentrate, short
attention span, failure to carry out
simple directions
 Dazed appearance

ANXIETY

 Due to knowledge deficit

 When surgical interventions are in
conflict with the patients culture and
religious belief