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Foundations (NUR3130) Chapter 30 - Perioperative Nursing

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John Marsh
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Nova Southeastern University

Foundations (NUR3130)

Chapter 30 – Perioperative Nursing

Chapter 30- Perioperative Nursing
 Surgery may be done for a variety of reasons:
o To cure or minimize disease
o To diagnose the specific presence of a disease or condition
o To reconstruct or eliminate a defect
o To enhance form and function
o To palliate, or offer comfort, when cure is not possible
o To follow up or monitor an incurable disease process
o To offer a preventive option when disease is inevitable
 Perioperative Nursing  Nursing care provided for the patient before, during, and
after surgery
o One of the most significant roles of the perioperative nurse is that of
collaborator – the nurse interfaces directly and indirectly with experts in
surgery, anesthesia, pharmacy, respiratory therapy, laboratory and
radiology, rehabilitation, and other specialties
o Perioperative Nurse’s goal is to promote and assist the patient and family
to achieve a level of wellness equal to or greater than what they had prior
to the surgical procedure
 Surrounding the patient are 4 domains:
o 3 domains are integral to patient care:
 Safety, Physiologic Responses, Behavioral Responses
o The 4th domain represents the structural elements and other health system
activities that must be present to support safe, effective, high-quality
patient care:
 Health System
Phases of Perioperative Care (aka Perioperative Phases)
a) Preoperative Phase
a. Begins when the patient and surgeon mutually decide that surgery is
necessary and will take place
b. Ends when the patient is transferred to OR procedural bed
b) Intraoperative Phase
a. Begins when the patient is transferred to OR bed
b. Ends with transfer to the Post Anesthesia Care Unit (PACU)
i. The PACU is an area often adjacent to the surgical suite designed to
provide care for patients recovering from anesthesia or moderate
sedation/analgesia
1. Make sure patient isn’t in any pain and is waking up
2. Continue to monitor patient vital signs and make sure they are
not crashing
c) Postoperative Phase
a. Begins with admission to PACU or other recovery area
b. Ends with complete recovery from surgery and the LAST follow-up heath
care provider visit
i. Can last weeks, months, etc.
1. Phase I  providing patient care from a totally anesthetized
state to one requiring less acute nursing interventions
2. Phase II  preparing the patient for self-care or family care or
for care in a phase III extended care environment
3. Phase III  providing ongoing care for patient requiring
extended observation or intervention after transfer or discharge
from phase I or II
o HCP is responsible for working collaboratively with patient to make decision on
an elective surgery
 Educate patient on everything that goes on with the surgery and the risks
 Sometimes HCP will order meds on call (meds that needed to be given
before surgery)
o Anesthetist responsible to inform patient about what types of anesthesia is going
to be used and the risks associates
o Nurse Responsibility if there is anything that the nurse can answer, answer it
within the nurse’s scope of practice
 Can inform patient of preop process what is going to happen during
intra and post and what they should expect from the nurses when they are
hospitalized
 What we expect out of them post op pain control, moving
 Responsible to give the on call meds to patient for the OR when OR calls
and tell us they’re coming to get the patient
 Nurses sometimes need to be a patient’s advocate help guide them into
making decisions that are good for their health
 Responsible for making sure surgical check list is completed
 pre op checklist has preop education completion, consent given,
documentation of px valuables, pre op medication given, bowel emptied
o Preop Routines:
 Explain/ review informed consent form & make sure pt
doesn’t have any unanswered questions
 Make sure the patient has taken the medication ordered by
HCP
 Make sure you have the correct px blood type and having
blood on hold for surgery
 Make sure the px has identified the correct limb
 Review physical preparation  skin/ bowels/ NPO
 Discuss procedures immediately prior to transport and what
to expect in the OR
 Record vital signs prior to transfer
 Remove jewelry and valuables
 Document the items you took
 Do not document that it is a diamond ring say
that it is a “ crystal”
 Remove nail polish and makeup
 Remove dentures, eye glasses, hearing aids
 NPO  time patient began

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Foundations (NUR3130) Chapter 30 - Perioperative Nursing

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