2. WORDS TO PONDER.ü
ambulatory surgery: may include outpatient
- (or same-day) surgery that does not require
an overnight hospital stay or short stay, with
admission to an inpatient.
informed consent: the patient’s autonomous
decision about whether to undergo a surgical
procedure; based on the nature of the
condition, the treatment options, and the
risks and benefits involved.
3. WORDS TO PONDER.ü
intraoperative phase: period of time from
when the patient is transferred to the
operating room table to when he or she is
admitted to the postanesthesia care unit
(PACU)
perioperative phase: period of time that
constitutes the surgical experience; includes
the preoperative, intraoperative, and
postoperative phases of nursing care
4. WORDS TO PONDER.ü
postoperative phase: period of time that
begins with the admission of the patient to
the PACU and ends after a follow-up
evaluation in the clinical setting or home
preadmission testing (PAT): diagnostic
testing performed before admission to the
hospital
5. WORDS TO PONDER.ü
preoperative phase: period of time from
when the decision for surgical intervention is
made to when the patient is transferred to
the operating room table
6. Perioperative and
Perianesthesia Nursing
The special field known as perioperative and
perianesthesia nursing includes a wide variety
of nursing functions associated with the
patient’s surgical experience during the
perioperative period. Perioperative and
perianesthesia nursing addresses the
nursing roles relevant to the three phases of
the surgical experience: preoperative,
intraoperative, and postoperative.
7. Preoperative phase
begins when the decision to proceed with
surgical intervention is made and ends with
the transfer of the patient onto the operating
room table.
establishing a baseline evaluation of the
patient before the day of surgery by carrying
out a preoperative interview
8. Preoperative phase
ensuring that necessary tests havebeen or
will be performed (preadmission testing)
arranging appropriate consultative services
providing preparatory education about
recovery from anesthesia and postoperative
care
9. Intraoperative Phase
begins when the patient is transferredonto
the operating room table and ends when he
or she is admitted to the postanesthesia care
unit (PACU)
providing for the patient’s safety
maintaining an aseptic environment
10. Intraoperative Phase
ensuring proper function of equipment
providing the surgeon with specific
instruments and supplies for the surgical
field, and completing appropriate
documentation
11. Intraoperative Phase
providing emotionals upport by holding the
patient’s hand during general anesthesia
induction
assisting in positioning the patient on the
operating room table using basic principles of
body alignment
12. Postoperative Phase
begins with the admission of the patient to
the PACU and ends with a follow-up
evaluation in the clinical setting or at home
maintaining the patient’s airway
monitoring vital signs
13. Postoperative Phase
assessing the effects of the anesthetic agents
assessing the patient for complications
providing comfort and pain relief
14. Postoperative Phase
nursing activities then focus on promoting
the patient’s recovery
initiating the teaching
follow-up
15. GENETICS IN NURSING
PRACTICE—Perioperative
Nursing
Nurses who are caring for patients undergoing surgery
need to take various genetic considerations into account
when assessing patients throughout the perioperative
experience. For example, surgical outcomes may be altered
by genetic conditions that may cause complications with
anesthesia, including the following:
Malignant hyperthermia
Central core disease (CCD)
Duchenne muscular dystrophy
Hyperkalemic periodic paralysis
King-Denborough
16. Preparation for Surgery
INFORMED CONSENT – The nurse may ask
the patient to sign the form and may witness
the patient’s signature. It is the physician’s
responsibility to provide appropriate
information.
protects the patient from unsanctioned
surgery
protects the surgeon from claims of an
unauthorized operation
17. Criteria for Valid Informed
Consent
Voluntary Consent - valid consent must be
freely given, without coercion.
Incompetent Patient - legal definition:
individual who is not autonomous and cannot
give or withhold consent (eg, individuals who
are mentally retarded, mentally ill, or
comatose)
18. Criteria for Valid Informed
Consent
Informed Subject - Informed consent should be
in writing. It should contain the following:
Explanation of procedure and its risks
Description of benefits and alternatives
An offer to answer questions about procedure
Instructions that the patient may withdraw consent
A statement informing the patient if the protocol
differs from customary procedure
19. Criteria for Valid Informed
Consent
Patient Able to Comprehend - Information
must be written and delivered in language
understandable to the patient. Questions
must be answered to facilitate
comprehension if material is confusing.
20. Categories of Surgery Based
on Urgency
I. Emergent—
Patient requires immediate attention; disorder
may be life-threatening
Without delay
Severe bleeding
Bladder or intestinal obstruction
Fractured skull
Gunshot or stab wounds
Extensive burns
21. Categories of Surgery Based
on Urgency
II. Urgent—
Patient requiresprompt attention
Within 24–30 h
Acute gallbladder infection
Kidney or ureteral stones
22. Categories of Surgery Based
on Urgency
III. Required—
Patient needs to have surgery
Plan within a few weeks or months
Prostatic hyperplasia without bladder obstruction
Thyroid disorders
Cataracts
23. Categories of Surgery Based
on Urgency
IV. Elective—
Patient should have surgery
Failure to have surgery not catastrophic
Repair of scars
Simple hernia
Vaginal repair
24. Categories of Surgery Based
on Urgency
V. Optional—
Decision rests with patient
Personal preference
Cosmetic surgery
25. Nutrients Important for
Wound Healing
Protein
To replace the lean body mass lost during the
catabolic phase after stress
To restore blood volume and plasma proteins lost
through exudates, bleeding from the wound, and
possible hemorrhage
To replace losses resulting from immobility
(increased excretion)
To meet the increased needs for tissue repair and
resistance to infection
26. Nutrients Important for
Wound Healing
Calories
To replace losses related to lack of oral intake and
hypermetabolism during catabolic phase after
stress
To spare protein
To restore normal weight
27. Nutrients Important for
Wound Healing
Water
To replace fluid lost through vomiting,
hemorrhage, exudates, fever, drainage, diuresis
To maintain homeostasis
28. Nutrients Important for
Wound Healing
Vitamin C
Important for capillary formation, tissue
synthesis, and wound healing through
collagen formation
Needed for antibody formation
29. Nutrients Important for
Wound Healing
Thiamine, niacin, riboflavin, Folic acid,
vitamin B12
Requirements increase with increased metabolic
rate
Needed for cell proliferation and therefore tissue
synthesis
Important for maturation of red blood cells
Impaired folic acid synthesis associated with the
use of some antibiotics; impaired vitamin B12
absorption associated with the use of some
antibiotics
30. Nutrients Important for
Wound Healing
Vitamin A
Important for tissue synthesis, wound healing,
and immune function
Enhances resistance to infection
32. Nutrients Important for
Wound Healing
Zinc
Needed for protein synthesis and wound healing
Needed for normal lymphocyte and phagocyte
response
33. Risk Factors for Surgical
Complications
Hypovolemia
Dehydration or electrolyte imbalance
Nutritional deficits
Extremes of age (very young, very old)
Extremes of weight (emaciation, obesity)
Infection and sepsis
Toxic conditions
Immunologic abnormalities
