What is Perioperative Nursing?  To Improve Appearance.

Cosmetic surgeries are

Surgery is a medical specialty
performed to enhance
that involves the use of operative
physical appearance.
techniques to investigate or treat
pathological conditions such as  To Repair or Remove
diseases or injuries. It can also Traumatized Tissue and
serve various purposes, including Structures. This includes
improving bodily functions, surgical interventions to
enhancing appearance, or address injuries and restore
repairing unwanted ruptured areas. function.
Surgical procedures range from
 To Relieve Symptoms
minor, routine operations to
or Pain. Palliative surgeries
complex, life-saving interventions.
aim to alleviate symptoms
Surgery can be performed for a without necessarily curing the
variety of reasons, each aimed at disease.
addressing specific health concerns
Perioperative nursing encompas
and improving patient outcomes.
ses a broad range of nursing duties
 To Cure an Illness or related to the surgical
Disease. This involves management of patients. It
removing diseased tissue or involves the care provided to
organs to eliminate the patients before, during, and
underlying cause. after surgery. This specialized area
of nursing requires registered
 To Visualize Internal
nurses to collaborate closely with
Structures During
other surgical healthcare
Diagnosis. This helps in
professionals as part of a cohesive
accurately diagnosing conditi
team. Perioperative nursing has
ons by allowing direct
three phases:
examination of internal
structures. Preoperative Phase
 To Obtain Tissue for Preoperative Phase
Examination. Biopsies are
phase starts when the decision
performed to collect tissue
for surgery is made and ends
samples for
when the patient is transferred
diagnostic evaluation.
from the operating room.
 To Prevent Disease or
Key responsibilities include:
Injury. Prophylactic surgeries
are done to prevent potential  Pre-admission Testing.
health issues. Conduct initial assessments,
begin patient education,
 verify tests and surgeon-  Monitoring fluid-balance,
specific orders, and cardiopulmonary data,
assess postoperative care and vital signs.
needs.
Postoperative Phase
 Admission to Surgical
begins when the patient is
Center.
admitted to the recovery area and
Complete preoperative assess
ends with a follow-up evaluation in
ments, check for
a clinical setting or at home.
complications, confirm signed
consent, reinforce teaching, Key responsibilities include:
and develop a care plan.  Communication and Repor
 In Holding Area. Assess ting. Communicate
patient status, verify surgical intraoperative details,
site, establish IV lines, including surgery type,
administer medications, anesthetic used, and patient
ensure comfort, and provide response.
psychological support.  Postoperative Assessment.
Communicate the patient’s Monitor the patient’s
emotional status to the immediate response,
healthcare team. physiological status,
Intraoperative Phase and pain levels. Ensure safety
and administer prescribed
starts when the patient is
treatments.
transferred to
the surgery department and ends  Transfer to Surgical
when they are admitted to the Unit/Ward. Continue
recovery area. Key responsibilities monitoring, provide
include: education, and assist with
recovery and
 Maintaining an aseptic
discharge planning.
environment and managing
resources.  Home or Clinic. Provide
follow-up care, reinforce
 Positioning the patient and
teaching, and assess the
ensuring correct counts of
patient’s response
sponges, needles, and
to surgery and anesthesia.
instruments.
Classifications of Surgical
 Completing
Procedures
intraoperative documentation.
Surgical procedures are classified
based on urgency, purpose, and
risk. These classifications help
determine the degree of risk and These surgeries restore
the necessity of the surgery. function in congenital
anomalies.
Based on Purpose
Examples: cleft palate repair
 Diagnostic
and closure of atrial-septal
determine the cause of an defect.
illness and confirm a
 Exploratory.
diagnosis.
These surgeries estimate the
Examples:biopsy and
extent of disease or confirm a
exploratory laparotomy.
diagnosis.
 Ablative/Curative.
Examples: exploratory
remove diseased parts or laparotomy and pelvic
organs. Examples: laparotomy.
gastrectomy, thyroidectomy,
 Aesthetic.
and appendectomy.
These surgeries improve
 Palliative.
physical features within the
These surgeries relieve normal range. Example:
symptoms without curing the breast augmentation.
disease.
Based on Urgency
 Examples: colostomy and
 Elective. These surgeries are
debridement of necrotic
pre-planned and can be
tissue.
delayed without negative
 Reconstructive. effects.
These surgeries restore Examples:tonsillectomy, herni
function to traumatized or a repair, cataract extraction,
malfunctioning tissue and mammoplasty, face lift,
improve self-concept. and cesarean section.
Examples: skin grafts,plastic s  Urgent. These surgeries are
urgery, and scar revisions. necessary for the client’s
 Transplant. health and are usually
performed within 24 to 48
These surgeries replace hours.
diseased or malfunctioning
organs or structures. Examples: gallbladder remova
l, amputation, colon resection,
 Constructive. coronaryartery bypass,
and tumor removal.
  Emergent. These surgeries sterilized. This ensures that
must be done immediately to any tools, equipment, or
preserve the client’s life, body materials that come into
part, or body function. contact with the patient or
Examples include control surgical field are free from
of hemorrhage, repair contaminants.
of trauma, perforated ulcer,
 Sterile vs. Non-Sterile
intestinal obstruction,
Interaction. Sterile
and tracheostomy.
individuals should
Sterile Technique only touch sterile items, and
non-sterile individuals should
Sterile technique is a set of specific
only touch non-sterile items.
practices and procedures
This separation prevents
performed to ensure an
cross-contamination between
environment free from all
sterile and non-sterile areas.
microorganisms. This technique is
crucial in medical and surgical  Maintaining Sterility.
settings to prevent infections and
Sterile personnel must avoid
ensure patient safety. It involves
unsterile areas, keeping at
meticulous methods such as hand
least a 12-inch distance from
washing, using sterilized
them. This precaution helps
instruments, wearing sterile gloves
maintain the integrity of the
and gowns, and maintaining a
sterile field.
sterile field. Adhering to sterile
technique is essential for  Questionable Sterility. If
healthcare professionals to there is any doubt about an
minimize the risk of contamination item’s sterility, it should be
and promote optimal patient considered unsterile. This
outcomes. conservative approach
minimizes the risk of
Principles of Sterile Technique
introducing contaminants into
Adhering to sterile technique the sterile field.
principles is crucial
 Sterile Zones on Gowns.
in perioperative nursing to prevent
Gowns are sterile from the
infections and ensure patient
front waist to the shoulder
safety. These principles guide the
and sleeves up to 2 inches
behavior and practices of the
above the elbows. Knowing
surgical team to maintain a sterile
the sterile zones helps staff
environment.
avoid accidental
 Sterilization. All items used contamination.
in surgery must be pre-
 Hand Positioning. Hands Excessive contact increases
should remain visible and the risk of contamination.
above waist level. Avoid
 Observers. Observers
touching the face to prevent
(e.g., student nurses) should
contamination from areas that
stay in the room until the
are not sterile.
procedure ends and minimize
 Handling Sterile Items. Do chatter. Any questions should
not fold arms, and discard any be directed to the circulating
items dropped below the nurse. This ensures minimal
waist. Folding arms and disruption and maintains
dropped items can lead to focus on the sterile
contamination. environment.
 Movement in Sterile Areas. Sterile Members
Sterile staff should stay within
Sterile members of the surgical
sterile zones. When passing
team are crucial in maintaining a
others, face them or turn your
sterile environment and performing
back to non-sterile personnel,
the surgery.
face sterile zones, and ensure
non-sterile individuals step  Surgeon. The surgeon leads
aside. This minimizes the risk the surgical team and
of accidental contamination. specializes in specific types of
surgeries.
 Sneezing and Coughing.
Step back and turn your head  Certified Surgical
away to prevent Technologist. This
contamination. Sneezing professional prepares and
or coughing can spread manages sterile supplies and
droplets that may carry assists surgeons during
bacteria or viruses. procedures. Their roles can
range from handing
 Operating Room Protocol.
instruments to acting as
Sterile staff should remain in
primary assistants.
the operating room and avoid
wandering. This helps Non-Sterile Members
maintain a controlled and Non-sterile members of the
sterile environment. surgical team support the sterile
 Minimizing Contact. Limit team and manage various aspects
contact with sterile zones, of patient care and surgical
avoiding leaning on tables, procedures.
draped patients, or trays.  Anesthesiologist. The
anesthesiologist
 administers pain-relief drugs contact. Present gloves to the
and continuously monitors the surgeon without touching
patient’s response throughout their skin.
the surgery.
Assessment
 Registered Nurse (Circulat
The assessment of a surgical
or).
patient involves gathering data
This nurse manages patient
based on the duration and severity
care during surgery, assists
of the underlying problem and the
the anesthesiologist,
involvement of other body
maintains records, and
systems. This information is crucial
provides items to the sterile
for creating specific care plans,
team as needed.
determining relevant diagnostic
Gowning and Gloving studies, and identifying
Procedure additional nursing diagnoses.
The gowning and gloving Key areas of assessment include:
procedure is essential to maintain
 Circulation. History of
sterility before entering the
cardiac issues, heart failure,
operating room.
pulmonary edema, and
1. Entering the Operating peripheral vascular disease;
Room. After completing a changes in heart rate.
hand scrub, enter the
 Ego Integrity. Feelings
operating room with hands
of anxiety, fear, anger, or
raised to avoid contamination.
apathy; restlessness and
2. Drying Hands and Arms. changes in heart and
Use a sterile towel to dry your respiratory rates.
hands and arms. Drop the
 Elimination. History
towel afterward.
of kidney or bladder condition
3. Gowning. Pick up the gown, s, use of diuretics or laxatives.
let it unfold, and locate the
 Food/Fluid. History of
arm holes. Insert your hands
pancreatic insufficiency
into the sleeves while another
or diabetes; signs
(non-scrubbed) individual
of malnutrition and dry
assists you in wearing it.
mucous membranes.
4. Assisting the Surgeon.
 Respiration. History of
Retrieve a gown from the
infections, chronic respiratory
sterile pack and present it to
conditions, persistent cough,
the surgeon. After they insert
or smoking; changes
their arms, release the gown
in respiratory rate.
without making non-sterile
  Safety. Allergies, immune decreased WBC count
deficiencies, cancer history, suggests viral processes and
family history of malignant may indicate a dysfunctional
hyperthermia, autoimmune immune system.
diseases, hepatic disease, and Low hemoglobin (Hb)
history of blood transfusions; suggests anemia or blood
signs of infection like fever. loss, impairing
tissue oxygenation and
 Teaching/Learning. Use of
reducing the Hb available to
various medications, OTC
bind
drugs, and substances; risks
with inhalation anesthetics,
include liver damage, coagula
possibly necessitating a
tion issues, anesthesia compli
crossmatch or blood
cations, and potential
transfusion. An elevated
postoperative withdrawal.
hematocrit (Hct) may
Diagnostic Studies indicate dehydration, while
Preoperative diagnostic studies are decreased Hct suggests fluid
essential for evaluating the overload.
patient’s health status and  Prothrombin Time (PT) /
preparing for surgery. These tests Activated Partial
help identify any underlying Thromboplastin Time
conditions or potential (aPTT). These tests assess
complications that need to be the
addressed before patient’s coagulation status.
administering anesthetic agents. Prolonged coagulation times
The specific tests required depend may interfere with
on the type of operative procedure, intraoperative and
underlying medical conditions, postoperative hemostasis,
current medications, age, and while hypercoagulation
weight of the patient. increases the risk
General preoperative of thrombosis formation,
diagnostic requirements may especially when combined
include: with dehydration and
decreased mobility associated
 Complete Blood with surgery.
Count (CBC). An elevated
white blood cell (WBC) count  Chest X-ray. A chest x-
indicates an inflammatory ray should be free of
process, which may be infiltrates and pneumonia and
diagnostic for conditions is used to identify masses
like appendicitis. A and chronic obstructive
pulmonary disease (COPD).
Depending on the patient’s which is crucial for recovery
specific needs and health and healing.
status, additional tests may
 Electrocardiogram (ECG).
include:
Abnormal ECG findings
 Blood Urea Nitrogen (BUN) require attention before
and Creatinine (Cr). These administering anesthetics to
tests evaluate kidney avoid complications.
function.
 Urinalysis. The presence of
 Glucose. Monitoring blood WBCs or bacteria in
glucose levels is crucial, the urine indicates infection.
especially for patients An elevated specific gravity
with diabetes. may reflect dehydration.
 Arterial Blood Gases  Pregnancy Test. Positive
(ABGs). ABGs assess the results affect the timing of the
patient’s current respiratory procedure and the choice of
status, which is particularly pharmacological agents.
important for smokers and
 ECG. This test detects
patients with chronic lung
abnormal heart rhythms and
diseases.
other cardiac issues that need
 Electrolytes. Electrolyte to be addressed
imbalances impair organ before surgery.
function. For example,
Nursing Priorities
decreased potassium affects
cardiac muscle contractility, Nursing priorities are essential to
leading to decreased cardiac ensure comprehensive care for
output. patients undergoing surgery. These
priorities focus on both physical
 Liver Function Tests. These
and emotional aspects of patient
tests assess the health of
care.
the liver, which is essential for
metabolizing drugs and 1. Reduce Anxiety and
maintaining hemostasis. Emotional Trauma.
Providing emotional support
 Thyroid Studies. These
and reassurance to alleviate
evaluate thyroid function,
preoperative and
which can impact metabolism
postoperative anxiety.
and overall health.
2. Provide for Physical
 Nutritional Studies. These
Safety. Ensuring the patient’s
tests assess the
safety through proper
patient’s nutritional status,
positioning, monitoring, and
 adherence to sterile  Injury Prevented. All
techniques. measures are taken to avoid
any new injuries during the
3. Prevent Complications.
hospital stay and after
Implementing strategies to
discharge.
avoid potential complications
such as infections,  Complications
thromboembolism, and Prevented/Minimized.
respiratory issues. Effective strategies are
implemented to prevent or
4. Alleviate Pain.
minimize any postoperative
Managing pain effectively
complications.
through medication and non-
pharmacological methods to  Pain Relieved/Controlled.
ensure patient comfort. The patient’s pain is managed
effectively, allowing for a
5. Facilitate Recovery
comfortable recovery.
Process. Supporting the
patient through the recovery  Wound Healing/Organ
process with appropriate Function Progressing
interventions and monitoring. Toward Normal. The
patient’s wound is healing
6. Provide Information.
appropriately, and organ
Educating the patient about
function is improving as
the disease process, surgical
expected.
procedure, prognosis, and
treatment needs to empower  Disease Process/Surgical
them with knowledge and Procedure, Prognosis,
understanding. and Therapeutic Regimen
Understood. The patient and
Discharge Goals
their caregivers understand
Discharge goals are set to ensure the disease process, the
that patients are prepared to leave surgical procedure performed,
the healthcare facility safely and the prognosis, and
with confidence in managing their the therapeutic regimen to be
health at home. followed.
 Patient Dealing  Plan in Place to Meet
Realistically with Current Needs After Discharge. A
Situation. The patient comprehensive plan is
demonstrates an developed to address the
understanding and patient’s needs post-
acceptance of their health discharge, including follow-up
condition and surgical appointments, home care,
outcomes.
medications, and lifestyle
modifications.