١٤٤٢/١٢/٢٦ Keperawatan Intra-operatif

: Presented by
Mugi Hartoyo

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KEPERAWATAN INTRA OPERASI

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Fase intraoperatif dimulai sejak klien dipindahkan 
kekamar operasi dan berakhir saat klien dipindahkan

Keperawatan Intra-operatif
.keruang pemulihan (recovery room)
Dalam fase ini lingkup aktivitas keperawatan adalah 
pemeliharaan keselamatan klien, pemantauan fisiologis,
,dan dukungan psikologis
Pada fase ini perawat juga melaksanakan fungsinya 
”sebagai “scrub nurse” dan “sirculating nurse

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KEPERAWATAN INTRA OPERASI

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Aktivitas diruang operasi dipusatkan pada klien yang 
menjalani prosedur pembedahan , perhatian difokuskan

Keperawatan Intra-operatif
.pada reaksi psikologis dan fisiologis klien
Karena pembedahan biasanya merupakan pengalaman 
yang membuat stress, klien membutuhkan rasa aman,
dengan mengetahui bahwa ada orang yang memberikan
perlindungan (bertindak sebagai advokat) selama
prosedur dan ketika klien dianestesia maka klien akan
.merasa tenang dan nyaman

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 Pre-operative patient assessment.
 Duties of the Nurses in OR:

Keperawatan Intra-operatif
 Reception Nurse
 Anesthetic Nurse
 Circulating Nurse
 Scrub Nurse

 Discuss immediate and later postoperative care.

 Postoperative complications

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1. pre-operative phase:
Assessment.
Pre-operative medication.
IV Solution.
Pre-operative preparation.
Chart.
Signature of the nurse and other personnel
involved with preparing the client for
surgery
Transporting the client to the OR.

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1. Identified patient by asking him to say his
name and checks and corresponds with his
record and reporting list.
2. Reassures patients , creates quiet , calm
atmosphere to decrease patient
apprehensiveness .
3. Checks the preoperative assessment

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 Review preoperative laboratory and
diagnostic studies.
 Review the client’s health history and
preparation for surgery.
 Historyof present illness and reason for surgery.
 Past medical history.
 Assess the physical needs.
 Assess the psychological needs.
 Assess the culture needs.

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4. Confirms that the patient has signed the
operating consent.
5. Checks the time of administrative order
premedication and any adverse reaction is
reported to anesthetist.
6. Uses the check list to complete the
preparation for anesthesia and surgery.
7. Transfer patient to the anesthetic room.

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 Prepares safe environment for
induction of anesthesia.
 Checks suction apparatus , gas

supply , gas cylinder machine to be

well prepared for use.
 Checks O2 supply and emergency tray

in position.
 Checks and records all drugs required

by the anesthetist .

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 Arranges for the scrub nurse to see the
signed consent.
 Prepares inhalation trolley
 Assist in the transfer patient to

recovery room
 Cleans used equipment

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1. Managing the nursing care of the patient

and coordinating the needs of surgical
team members for each procedure, using
critical thinking skills.
2. Observes the procedure from a broad
perspective and helps team members
create.
3. Assess the patient’s condition before,
during, and after the procedure.

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4. Maintains a safe care environment.

5. Manages equipment use and delegates / directs
care provided by OR technicians.
6. Performs the role of scrub nurse when necessary.
7. Is responsible for directing and coordinating all
nursing care based on established clinical nursing
practices .
8. Continuously evaluates patients outcomes during
intra operative phase.

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1. Before scrubbing:
1. Assists circulating nurse in
preparation of operation theater.
2. After scrubbing:
1. Prepare the sterile instruments .
2. Performs proper draping.
3. Assess surgeons in wearing gowns and gloves.
4. Prepare appropriate needles and sutures.
5. Counts all swaps, sponges, and sterile instruments.

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3. Arranges sterile instruments in expected
orders for use.
4. Hands instruments to the surgeons and
helps to keep an eye on the patients
condition.
5. Listens carefully to what the surgeon is
saying.
6. Counts instruments before wound closure.

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 Risiko terhadap cedera berhubungan dengan .1
a. Lingkungan eksternal: struktur fisik, struktur
lingkungan, pemajanan peralatan,
instrumentasi, posisi, penggunaan zat/obat
.farmasi (anestesia)
:b. Lingkungan Internal
Hipoksia jaringan, perubahan faktor pembekuan,
.kondisi jantung, kondisi fungsi paru,ginjal dsb

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Resiko terhadap infeksi .2
Resiko terjadinya perubahan suhu tubuh .3
berhubungan dengan pemajanan
lingkungan,penggunaan zat-zat anestesi,
.umur dan umur yang ekstrem
Resiko terjadinya gangguan keseimbangan .4
volume cairan tubuh kurang dari kebutuhan
sampai dengan lebih dari kebutuhan tubuh

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  Immediate post operative period:

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Initial assessment:
 Airway patency

Keperawatan Intra-operatif
 Effectiveness of respiration

 Presence of artificial airways

 Mechanical ventilation, or supplemental oxygen

 Circulatory status, vital signs

 Wound condition, including dressings and drains

 Fluid balance, including IV fluids, output from catheters

and drains and ability to void
 Level of consciousness and pain
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  Later post operative period:

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Ongoing assessment:
 Respiratory function

Keperawatan Intra-operatif
 General condition

 Vital signs

 Cardiovascular function

 Fluid status

 Pain level

 Bowel and urinary elimination

 Dressings, tubes, drains, and IV lines

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 Ensures a patent airway
 Helps maintain adequate circulation
 Prevents or assist with the treatment of
shack
 Maintains proper position and function of
drain tubes and IV infusion
 Monitor for potential complications

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 Hemorrhage
 Shock
 Hypoxia
 Aspiration

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