Risk for infection non-irritated, and free The patient is free of Interventions/Activities

of bruising, signs and

Risk for impaired skin Implements aseptic
other than surgical symptoms of physical technique.
integrity related to incision. injury.
Classifies surgical
positioning, Function, sensation, The patient is free from wound.
immobilization, motion, and respiratory signs and
pressure, status will be Assesses susceptibility
maintained or symptoms of injury for infection.
and/or shearing forces related to
improved from baseline Performs skin
Risk of injury related positioning. preparations.
assessment.
to surgical environment, The patient is free from Protects from cross-
extraneous Skin remains smooth,
intact, non-reddened, signs and contamination.
objects and equipment non-irritated and free of symptoms of laser, Monitors for signs and
bruising. electrical, and symptoms of infection.
(laser, electrical and
Sensation, motions, and radiation injury. Minimizes the length of
use of x-rays/radiation) function will be invasive procedure
Risk of hypothermia The patient is at or planning
maintained or improved returning to
from baseline. care.
Interim Outcome
Statement normothermia at the
Core body temperature conclusion Administers prescribed
will remain within prophylactic
Surgery is performed
expected range. of the immediate treatments.
using aseptic technique
and in a manner to postoperative
Outcome Statement Initiates traffic control.
prevent period.
crosscontamination. The patient is free of Administers care to
signs and PNDS Nursing Care invasive device sites.
Skin remains smooth, Plan: Intraoperative
intact, non-reddened, symptoms of infection.
Administers care to Implements protective Monitors body
wound sites. measures to prevent temperature.
injury due
Identifies physical Evaluates response to
alterations that may to electrical sources. thermoregulation
affect procedure-
specific positioning. Implements protective
measures to prevent
Positions the patient. injury due

Implements protective to laser sources.

measures to prevent
skin or tissue injury due Implements protective
to thermal, chemical, or measures to prevent
mechanical injury due

sources. to radiation sources.

Evaluates for signs and Records devices

symptoms of injury to implanted during
skin and invasive procedure.

tissue. Performs required

counts.
Uses supplies and
equipment within safe Evaluates for signs and
parameters. symptoms of laser,
electrical,
Evaluates for signs and
symptoms of injury as a and radiation injury.
result of Implements
positioning. thermoregulation
measures.

NURSING DIAGNOSES
Based on the assessment
data, some major nursing
diagnoses may
include the following:
ronmental conditions in the
OR
•Risk for injury related to
anesthesia and surgery
•Disturbed sensory
perception (global) related
to general
anesthesia or sedation
Goals for care of the
patient during surgery
include reducing anx-iety,
preventing positioning
injuries, maintaining safety,
main-taining the patient’s
dignity, and avoiding
complications.
Nursing Interventions
aging and answering
questions provide a sense
of professionalismand
friendliness that can help
the patient feel secure.
When dis-cussing what the
patient can expect in
surgery, the nurse
usescommon, basic
communication skills, such
as touch and eye con-tact,
to reduce anxiety. Attention
to physical comfort
(warmblankets, position
changes) helps the patient
feel more comfort-able.
Telling the patient who else
will be present in the OR,
howlong the procedure is
expected to take, and other
details helps thepatient
prepare for the experience
transient discomfort oreven
permanent injury is clear
because many positions are
awk-ward. Hyperextending
joints, compressing arteries,
or pressing onnerves and
bony prominences usually
results in discomfort
simplybecause the position
must be sustained for a
long period (Meeker&
Rothrock, 1999). Factors to
consider include the
following:
•The patient should be in
as comfortable a position
as possi-
ble, whether asleep or
awake.

REDUCING ANXIETY and gain a sense of •The operative field must

•Anxiety related to
expressed concerns due to
surgery or OR
environment
•Risk for perioperative
positioning injury related to
envi-
The OR environment can control.
be adequately exposed.
seem cold, stark, and PREVENTING
frightening to thepatient, •An awkward position,
who may be feeling INTRAOPERATIVE
undue pressure on a body
isolated and apprehensive. POSITIONING INJURY
Intro-ducing yourself, The patient’s position on the part, or
addressing the patient by operating table depends on
use of stirrups or traction
name warmly the sur-gical procedure to
andfrequently, verifying be performed as well as on should not obstruct the
details, providing his or her physicalcondition vascular
explanations, and encour- (Fig. 19-3). The potential for
 paddedshoulder braces
supply. cal deformity (Curet, 2000).
(see Fig. 19-3B).
•Respiration should not be •The patient needs gentle individualized plan of
patient care. The
impeded by pressure of restraint before induction in
intraoperative nurse
arms on case usesthe focused
preoperative nursing
the chest or by a gown that of excitement. assessment documented
The usual position for on thepatient record. This
constricts the neck or
surgery, called the dorsal includes assessment of
chest. recumbentposition, is flat physiologic status(eg,
on the back. One arm is health–illness level, level of
•Nerves must be protected
positioned at the side ofthe consciousness),
from undue pressure. table, with the hand placed psychosocial sta-tus (eg,
palm down; the other is anxiety level, verbal
Improper carefullypositioned on an
positioning of the arms, communication problems,
armboard to facilitate copingmechanisms),
hands, legs, or feet may intravenous infusion
cause seri-ous injury or physical status (eg,
offluids, blood, or surgical site, skin condition
paralysis. Shoulder braces medications. This position
must be well paddedto andeffectiveness of
is used for most ab- preparation; immobile
prevent irreparable nerve dominal surgeries except
injury, especially when joints), and ethical con-
for surgery of the cerns (Chart 19-3).
theTrendelenburg position gallbladder and pelvis(see
is necessary. Fig. 19-3A).
•Precautions for patient The Trendelenburg
position usually is used for
safety must be observed, surgery on thelower
particularly abdomen and pelvis to
obtain good exposure by
with thin, elderly, or obese displacingthe intestines into
patients, or those with a the upper abdomen. In this
position, the headand body
physi- are lowered. The patient is
held in position by