Perioperative 

Nursing

n Prepared by : Venus A . Donasco ,

R.N.
Operating room
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Specific objectives :
1 . define related terms
2 . identify the types of surgery
3 . enumerate the phases of perioperative
nursing
4 . cite the roles / responsibilities of
the nurse in each phase
5 . name the members of the surgical team
6 . differentiate Ga and LA
7 . understant the principles of aseptic
technique
8 . appreciate the role of a healthcare
provider in caring patients undergoing
surgery
We are a tradition of
excellence..
Definition of terms:
PERIOPERATIVE NURSING
vRefers to the total span of
surgical intervention
vIncludes ward admission,
anesthesia, surgery and recovery
SURGERY: any procedure
performed on the human
body that uses instruments
to alter tissue or organ
integrity


Perioperative nurse
ØResponsible for maintaining a
safe environment for the
surgical patient before, during,
and immediately following
surgery
 Purposes of surgery
 Diagnostic
 Curative  CURATIVE: repair or
 Restorative/reconstructive removal of a diseased
 Palliative
organ
 RESTORATIVE: correct
 Cosmetic
a disease process

 PALLIATIVE: relieve the
DIAGNOSTIC: determines the symptoms but do not
origin of the presenting cure the disease
symptoms  COSMETIC: improve

person’s appearance
 Types of  EMERGENCY: performed
surgery immediately to preserve life
A. DEGREE OF URGENCY
ii. EMERGENCY

iii. ELECTIVE  ELECTIVE: planned for
iv. URGENT
v. REQUIRED correction of nonacute problem
B. DEGREE OF RISK


i. MAJOR
ii. MINOR  URGENT: necessary for clients
iii. AGE
health to prevent additional
iv. NUTRITIONAL STATUS
v. MEDICATIONS problem from developing
vi. MENTAL STATUS 
C. EXTENT OF SURGERY


i. SIMPLE  REQUIRED: has to be performed

ii. RADICAL
at some point, can be pre-

schedule
Tradition for excellence....
 Degree of risk
Minor
Major surgery
surgery
 Involves high  Involves little
degree of risk risk
 Longer and 

extensive  Oftendone with

general
anesthesia
3. Age

4 . NUTRITIONAL STATUS

5 . MEDICATIONS

6 . MENTAL STATUS
Phases of perioperative
nursing
n 1. perioperative
n

n 2. intraoperative
n

n 3. post-operative phase
Perioperative nursing
Begins when the patient makes the decision
to have a surgery and ends when the patient
has been transferred to an oR bed
Important things to consider:

1.Stop ASA 7-10 days prior to surgery

2.Stop herbals 2-3 weeks before surgery
3.No smoking 4-8 weeks, stop smoking at least
24 hrs before surgery
4. Monitor immunocompromised
patient closely for S / S of
infection before surgery
5 . control HPN prior to
surgery if possible
6 . obesity increases risk and
severity of complications
7 . if patient has acute renal
problems , surgery is
contraindicated
Specific considerations :
a . Diabetes mellitus
- at risk for hyperglycemia and
hypoglycemia
b . Long term use of
corticosteroid - adrenal
insufficiency
c . Uncontrolled thyroid disease
- overactive : thyrotoxicosis
- underactive : respiratory
depression
 Surgical consent:purpose and
components
informed consent:
 > a legal procedure to ensure that a
patient or client knows all of the
risks and costs involved in
 a treatment


> elements include informing the

client of the nature of the
treatment , possible alternative
treatments , and the potential risks
and benefits of the treatment
Components/guidelines of
informed consent
v Client’s full name, surgeon, the
purpose,
 risks and clients signature
v
v in order for informed consent to be
considered valid, the client must
be competent and the consent
should be given voluntarily.
 surgeon: responsible for
obtaining informed
consent

nurse: serves as an advocate

and a witness
Patient should not be
sedated or coerced
prior to obtaining the
consent
if client decides against the surgery , the


nurse is obligated to inform the surgeon in

order to prevent unwanted treatment
COMMON ORDEr Preop
1. CLIENTS ROUTINE MEDICATIONS
2. SPECIFIC PREPARATION ORDERED BY
THE DOCTOR
2.1 nebulization
2.2 I.V. Therapy
2.3 NPO status
2.4 Pre-op meds
 PRE-OP CHECKLIST
Client has ID band and allergy
bracelet
Informed consent is signed and
witnessed
Diagnostic and laboratory test
results
Client voided
Document height and weight
Vital signs before exiting the
ward
Pre - op meds given
Additional pre-op care:
vCheck policy and procedure
regarding dentures, glasses and
hearing aids
vProper attire includes: JEWELRY
OFF, NAIL POLISH, MAKE-UP AND
CONTACT LENS
§ MAKE SURE THAT PATIENT HAS
WORN THE FOLLOWING prior to
surgery:
§ OR gown ( hospital gown)
§ Hair cover
ØMake sure pre - op meds are
given
ensure all documentation and
pre - operative procedures and
orders are complete

ØSend entire medical record or chart to

the Operating room with patient
 Interventions for
intraoperative patients
Nurse’s role: SAFETY AND
STERILITY

ANESTHETIC NURSE: concerned
with ensuring that drugs are
drawn up and administered
safely

Checking procedures and consent
has been obtained
Intraoperative phase
 Begins when the client is
transferred to the operating
room bed and ends when the
patient is transferred to the
PACU

 Monitored , anesthesized , prepped ,
and draped

 Operation / surgery is peformed
 Members of the surgical team
1. SURGEON


üHead of the surgical team

üMakes the major decision



2. Surgical assistant



3. ANESTHESIOLOGIST

> is a physician with at least 4 years of advanced
training in anesthesia


ü
4. Certified registered nurse anesthetist
§ Qualified health care professional
who administer anesthesia

Functions :


§ Maintain the person airway

§
§ Ensure that the person has an
adequate O2 and CO2 exchange


§ Infuse blood , medications and

fluids as necessary
5. Circulating nurse
 ACTS AS THE MANAGER OF THE OR


Functions include:


Ø Check all equipments are working

properly
Ø Prepares and autoclave instrument
Ø Alert team members of any break in the
sterile technique
Ø Do skin preparation
Ø Document the specific activity
throughout the operation
Ø Verify consent and coordinate with the
team
 6. Scrub nurse
§ Participates directly
during the procedure


§ Setting up the OR and

making certain that
the environment is
STERILE


§ Maintains an accurate
count of sponges,
sharps and instruments
on the sterile field
and count the same
materials together
with the circulating
nurse
 7 . Holding area nurse


8 . Operating room

technician
 Operating room attire
 OR gown / scrub suits


 Masks


 Gloves


 Foot socks


 Headgear / headcover
Aseptic technique
1. STERILIZE all supplies used for
sterile procedures , when in doubt ,
consider an object unsterile


2 . When putting on sterile gloves ,

DO NOT TOUCH the outside of
barehands , when wearing STERILE
GLOVES , ONLY TOUCH STERILE
ARTICLES


3 . The outer wrappings and edges of
packs that contain sterile items are
not sterile
They should be opened or handled by the
person who is not wearing sterile gloves

Open sterile packages with the edges of the
wrapper directed away from your body to
avoid touching your uniform or reaching
over a sterile field

Touch only the outside of the sterile
wrapper
Once a sterile pack has been opened , use it ,
if it is not used , rewrap and resterilize
it
 4 . Avoid
Ø8. store sterile packages


sneezing ,
in dry areas coughing , or
talking
directly over
 Guide to aseptic a sterile
field or
9 . be constantly aware of
techniques object

need for clean



5 . Do not


surroundings reach across

or above a
sterile field
 or wound
10 . hold sterile objects 

6 . Avoid
and gloved hands ABOVE


spilling
solutions on a
WAIST LEVEL or level to sterile setup
the sterile field 

7 . A sterile


field should
 be away from
> since it cannot be drafts , fans
and windows
sterilized , any object
that touches is is
considered CONTAMINATED !
Have a special receptacle
or waxed paper to
receiver contaminated
 ANESTHESIA
Ø Comes from a
greek word Anesthesia machine


Ø “ ANESTHESIS”
Ø NEGATIVE
SENSATION


Ø INDUCED STATE
OF PARTIAL OR
TOTAL LOSS OF
SENSATION,
Ø
Ø Blocks
transmission of
nerve impulses
Ø
Ø Suppresses
reflexes
Ø
Ø Promot muscle
 Types of anesthesia

General anesthesia
 Local anesthesia


Sensory nerve impulse

 Reversible loss of transmission from a
anesthesia specific body area or
 Induced by inhibiting regions is briefly
neuronal impulses in disrupted
several areas of the 
CNS
Client remains

conscious and able to
 State can be achieved by follow instructions
a single or a 
combination of agents Gag and cough reflex
 remain intact
 CNS is depressed
resulting to AMNESIA,
ANALGESIA,
unconsciousness with
Administration of g.a
§ INTRAVENOUS  INHALATION
ANESTHESIA ANESTHESIA
§ Ø A mixture of
volatile liquids
 or gas and
> Client experience

oxygen is used
unconscious 30 Ø There is ease in
seconds after IV administration
administration and elimination

Ø Can be
administered
thru a mask or
ETT

INTRAVENOUS 
INHALATION
 Stages of anesthesia
stage Start point End-point Physical reaction Nsg.
interventions

I. onset Anesthetic Loss of consciousness Drowsy, dizzy, possible Close OR doors, keep
administration visual & auditory room quiet, be with the
hallucinations patient
II. excitement Loss of consciousness Loss of eyelid reflexes Increase in ANS Remain quiet
activity, irreg RR Assist anesthesia as
needed
III. Surgical Loss of eyelid reflexes Loss of most reflexes, Pt. Is unconscious, Begin preparation when
anesthesia depression of VS muscles are relaxed, no ct. Is breathing well with
blink or gag reflex stable VS
IV. danger Functions excessively Respiratory and Client is not breathing, If arrest occurs, respond
depressed circulatory failure heartbeat may or may immediately to assist in
not be present establishing airways and
other procedures
Complications of LA and
GA
Assess for CNS stimulation, CNS
and cardiac depression,
restlessness, excitement,
incoherent speech, headache,
blurred vision, metallic taste,
N/V, seizures, increase PR, RR and
BP
 Treatment of
complications
 Establish an open airway

 Give oxygen

 Notify the surgeon

 Fast-acting barbiturate is usual
treatment

If toxic reaction is untreated,

unconsciousness, hypotension, apnea,
cardiac arrest and death may result
Post - operative
phase
 Transfer of patient from
the OR to the PACU/RR


§ begins when the ward

nurse assisting RR
personnel in
transferring the patient
to the bed in his room
§
§ continues until the
patient is discharged
from the care of the
surgeon
 Post-op patient care
 1. position and safety
 Spinal anesthesia: flat on bed for 8 hrs

 Not fully conscious: side-lying position
and raise side rails

 2.vital signs
 Monitor and note any alterations
 Check for any symptoms of complications
3. level of consciousness
>ASSESS PTS . REACTION TO
STIMULI and ability to move
extremities

 4. intravenous fluids

 Assess the type and amount of solution

 Tubing and the infusion rate
 Check doctor’s order
5. Wound
> check dressing , note the
color and amount of
drainage / bleeding
6. color and temperature
vObserve for paleness and cyanosis
v
v7 . comfort
ØAssess for pain , nausea and vomiting
Ø
ØNote duration , location and intensity
 General post - op nursing
implications
MONITOR VS ENSURE PROPER
 NUTRITION
ADMINISTER THERAPY OF
ANALGESICS PRN CLIENTS
 
ADMINISTER IV INSTRUCT PATIENT
FLUIDS AS ORDERED ON TAKE HOME
 MEDS, WOUND
CARE SUPPLIES

AND
APPOINTMENT
 “ PERIOPERATIVE
NURSING IS NOT
JUST A TECHNICAL
WORK ANYONE CAN
DO !”

“ IF YOU CAME


THROUGH YOUR
SURGERY IN GOOD
SHAPE , THANK A
PERIOPERATIVE
NURSE ”
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 THANK YOU AND HAVE A NICE DAY !!!




 PREPARED BY : VENUS A.
DONASCO , R . N.
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