CARE OF CLIENTS REQUIRING SURGERY

(PERIOPERATIVE NURSING)
SURGERY Surgery is any procedure
performed on the human body that uses
instruments to alter tissue or organ integrity.
PERIOPERATIVE NURSING connotes the
delivery of patient care in the
PREOPERATIVE, INTRAOPERATIVE, and
POSTOPERATIVE periods of the patients
surgical experience through the framework
of the nursing process.
PHASES
Preoperative phase begins when the
decision to have surgery is made and ends
when the client is transferred to the OR
table.
Intraoperative phase begins when the
client is transferred to the OR table and end
when the client is admitted to the PACU (Post
Anesthesia Care Unit)
Postoperative phase begins with the
admission of the client to the PACU and end
when the healing is complete.
CONDITION REQUIRING SURGERY

Obstruction or blockage
Perforation rupture of an organ or an
artery
Erosion wearing away f the surface
of a tissue
Tumors abnormal growth

TYPES OF SURGERY
1. Purpose/ Reasons
2. Degree of urgency necessity to
preserve the clients life, body part, or
body function.
3. Degree of risk involved in surgical
procedure is affected by the clients
age, general health, nutritional status,
use of medications, and mental status.
4. Extent of surgery simple and radical.
PURPOSE

1. DIAGNOSTIC to verify suspected

diagnosis. (e.g.: Breast biopsy,
Laparoscopy, Bronchoscopy)
2. EXPLORATORY to estimate the extent
of the disease (e.g.: Exploratory and
Laparotomy)
3. CURATIVE to remove or repair
damaged or diseased organs or
tissues
a. ABLATIVE involves removal of
diseased organs or tissue (e.g.:
Appendectomy, Partial
gastrectomy, Amputation)
b. RECONSTRUCTIVE partial or
complete restoration of a
damaged organ (e.g.: Scar
revision, Plastic surgery, Skin
graft, Internal fixation
fracture)
c. CONSTRUCTIVE repair of a
congenitally defective organ
(e.g.: Cleft palate)
d. PALLIATIVE relives symptoms
(e.g.: Colostomy, Nerve root
resection)
URGENCY
1. EMERGENCY must be performed
immediately to preserve function or
life of the patient
2. IMPERATIVE / URGENT Necessary for
clients health to prevent additional
problem from developing; not
necessarily an emergency.
3. PLANNED / REQUIRED has to be
performed at some point; can be prescheduled.
4. OPTIONAL surgery that the patient
requested
5. ELECTIVE is performed when surgical
intervention is the preferred treatment
for a condition that is not imminently
life threatening or to improve the
clients life
DEGREE OF RISK
1. MAJOR involves a high degree risk
2. MINOR normally involves little risk
EFFECTS OF SURGERY TO THE PERSON

Stress response is elicited increase

heart rate, blood pressure and blood
sugar, bronchial dilation
Defense against infection is lowered
Vascular system is disrupted
Organ functions are disturbed
Body image may disturbed
Lifestyle may change

FACTORS IN THE ESTIMATION OF

SURGICAL RISK
1. PHYSICAL AND MENTAL CONDITIONS OF
CLIENT
a. Age
b. Nutritional Status
c. State of fluid and electrolyte
balance
d. General health
e. Types of drug taken regularly
f. Mental health
g. Economic and occupational status
2. THE EXTENT OF DISEASE
3. THE MAGNITUDE OF THE REQUIRED
OPERATION
4. RESOURCES AND PREPARATION OF THE
SURGEON, NURSES, AND HOSPITAL
PSYCHOLOGICAL FEARS COMMON
FEARS

Fear of the unknown

Pain
Anesthesia
Disfigurement
Separation from loved ones
Alterations in roles or lifestyle

PHYSICAL ASSESSMENT

Nursing history
Health history
Lifestyle
Coping patterns and support
Pre-operative physical assessment
Pre-surgical screening test

NURSING HISTORY

Current health status

Allergies

Cardiovascular system
Respiratory system
Renal system
Neurological system
Musculoskeletal system
Nutritional status
Gerontological considerations

Physical assessment/clinical
manifestations

PRE-OPERATIVE NURSING CARE

ASSESSMENT

Medications list all current medications

Previous surgeries
Understanding of the surgical procedure
and anesthesia
Smoking
Alcohol and other-altering substances
Coping
Social resources
Cultural considerations

General survey gestures and body

movements may reflect decreased energy
or weakness caused by illness.
Cardiovascular system alterations in
cardiac status are responsible for as
many as 30% of perioperative death.
Respiratory system a decline in
ventilator function, assessed through
breathing pattern and chest excursion,
may indicate a clients risk for respiratory
complications.
Renal system abnormal renal function
can altered fluid and electrolyte balance
and decrease the excretion of
preoperative medications and anesthetic
agents.
Neurologic system a clients LOC will
change as a result of general anesthesia
but should return to the preoperative LOC
after surgery.
Musculoskeletal system deformities may
interfere with Intraoperative and
postoperative positioning. Avoid
positioning over an area where the skin
shows signs of pressure over bony
prominences.

Gastrointestinal system alteration in

function after surgery may result in
decreased or absent bowel sound and
distention.
Head and neck the condition of oral
mucous membranes reveals the level of
hydration.

INFORMED CONSENT

This is to protect the surgeon and the

hospital against claims that unauthorized
surgery has been performed of the
potential risks of complications involved
Protect the patient from undergoing
unauthorized surgery
Nature and intention of the surgery
Name and qualifications of the person
performing the surgery.
Risk, including tissue damage,
disfigurement, or even death
Chances of success
Possible alternative measures
The right of the client to refuse consent or
later withdraw consent.

PSYCHOLOGICAL PREPARATION FOR

SURGERY

RESPIRATORY PREPARATION includes x-ray

order by the surgeon
CARDIOVASCULAR PREPARATION ECG,
Blood test
RENAL PREPARATION Routine urinalysis
PRE-OPERATIVE TEACHING
The education plan should begin with
assessment, including baseline knowledge of
the patient and family, readiness to learn,
barriers to learning, patient and family
concern and learning styles and preferences.
The content focuses n information that will
increase patients familiarity with procedural
events. This includes surgical experience
(procedural), what the patient may
experience (Sensory) and what actions may
help decrease anxiety (behavioral).
ON THE NIGHT OF SURGERY
PREPARING FOR ANESTHESIA
PROMITING REST AND SLEEP

A. Preparation for hospital admission

B. Preoperative Visits
PSYCHOSOCIAL CONSIDERATIONS

Level of anxiety
Coping ability
Support systems

ANXIETY

The nurse must consider the patients

family and friends when planning
psychological support.
Empowering their sense of control.
Activities that decreasing anxiety are
deep breathing, relaxation exercise,
music therapy, massage.
Use of medication to relive anxiety.

PHYSIOLOGIC PREPARATION

BARBITURATES
o Pentobarbital
Anticonvulsants
Sedatives
o Phenobarbital
NON-BARBITURATES

ON THE DAY OF THE SURGERY

EARLY MORNING CARE

Vital signs taken and recorded

promptly
Provide oral hygiene
Remove jewelry and dentures
Remove nail polish
Make sure that the patient has not
taken food for the last 10 hours
Remove clients clothing and dress in
clean gown

PRE-OPERATIVE MEDICATIONS

Generally administered 60-90 minutes

before induction of anesthesia
PURPOSE:
o To allay anxiety
o To decrease the flow of
pharyngeal secretions
o Reduce the amount of
anesthesia to be given

TYPES OF PRE-OPERATIVE
MEDICATIONS

SEDATIVES
TRANQUILIZERS
NARCOTIC ANALGESIA
VAGOLYTIC OR DRYING
AGENT
PHENERGAN