at the end of this lecture, the learner will be able to Define the three phases of perioperative nursing. Identify the members and functions of the surgical team. Describe the principles of surgical asepsis. Differentiate the three phases of post-anesthesia care. Identify measures to manage postoperative complications.

1. PERIOPERATIVE
NURSING
Jamilah Saad Alqahtani
Nurse Lecturer, MSN, TOT, OR
Nurse Specialist, RGN, BSN

2. At the end of this lecture,
the student will be able to:
1. Define the three phases of perioperative nursing.
2. Identify the members and functions of the surgical
team.
3. Describe the principles of surgical asepsis.
4. Differentiate the three phases of post-anesthesia care.
5. Identify measures to manage postoperative
complications.

3. PERIOPERATIVE NURSING
0 A term used to describe the entire duration of surgery,
including what occurs before, during, and after the actual
operation.
0 Consists of 3 phases:
1. PREOPERATIVE PHASE: begins with the choice to have the
surgery and ends with the transfer of patient onto the
operating room (OR) table.
2. INTRAOPERATIVE PHASE: begins when the patient is
transferred onto the OR table and ends with admission to
Post-Anesthesia Care Unit (PACU).
3. POSTOPERATIVE PHASE: begins with the admission to the
PACU and ends with follow-up evaluation in the clinical
setting (surgical ward) or home.

4. PREOPERATIVE PHASE

5. What is informed consent?
0 Definition: the patient’s independent decision about
whether to undergo a surgical procedure.
0 Purposes:
(1.) to protect patient against illegal surgery; and
(2.) to protect surgical team from rights of an
unauthorized surgery.
0 The surgeon provides the clear and simple explanation of
surgery while the nurse witnesses the signature.
0 The surgeon informs the patient about the benefits, risks,
complications, or removal of body parts.

6. Who Can And Cannot Sign
The Informed Consent?
0The patient should be:
A. of legal age
B. is mentally capable
C. an emancipated minor
0The patient should not be:
A. a minor
B. incompetent
C. under the influence of drugs or alcohol
NOTE! In such case, the consent will be
signed by responsible family member or
legal guardian.

7. General Preoperative
Nursing Interventions
A. Provide Preoperative Teaching
1. Deep breathing exercises: for lung
expansion and oxygenation
2. Coughing exercises: to mobilize secretions
to prevent atelectasis and pneumonia.
3. Mobility and active body movement: for
circulation and respiration
4. Pain management
5. Cognitive coping strategies: to decrease
fear and achieve relaxation.
0 Imagery:
0 Distraction:
0 Music therapy:

8. General Preoperative
Nursing Interventions
B. Provide Psychosocial Interventions
1. Reducing Anxiety and Fear
0 Coping strategies
0 Concerns
0 Visit of family members and friends
2. Respecting Cultural, Spiritual and
Religious Beliefs
0 Some patients decline blood transfusions
for religious reasons.
0 Some are tolerant to pain while others are
expressive.

9. General Preoperative
Nursing Interventions
C. Maintain Patient Safety
1. Patient identification
2. Protect from falls
3. Effective communication
D. Manage Nutrition and Fluids
1. Withhold food and fluids before surgery to prevent
ASPIRATION.
E. Prepare the Bowel
1. Cleansing enema or laxative use
F. Prepare the skin
1. Skin prep decrease bacteria without injuring the
skin.
2. Remove hair only if its around the incision site and
it interferes with the surgery.

10. Immediate Preoperative
Nursing Interventions
0Patient changes into a hospital gown.
0Remove dentures (False teeth)
0Remove jewelries.
0Patient should void immediately before
going to OR.
0Maintain preoperative record or
checklist.
0Transport patient to the surgical
area. Patient safety is a priority.
0Attend to family needs.

11. INTRAOPERATIVE PHASE

12. A. The Surgical Team
1. Patient
2. Anesthesiologist or Nurse Anesthetist
0 Administer the anesthetic agent and monitors
patient during the entire surgery.
3. Surgeon
4. Nurses Perform the surgery
5. Assistants

13. 1. The Patient
0May feel relaxed and prepared for the
surgery
0May feel fearful and highly stressed
before the surgery
Fear of unknown
Fear of pain
Fear of death
Fear of changes in body structure or
function
0Subject to several risks like infection,
failure of surgery, complications, or
death.

14. 2. The Anesthesiologist and
Anesthetist
Anesthesiologist: a physician who specializes in the art and
science of anesthesiology.
Anesthetist: a qualified, trained health care professional,
mostly nurses, who administers anesthetic agents.
0 Assess the patient before surgery
0 Selects and administers the anesthesia
0 Intubates the patient if needed

15. 3. The Surgeon
0Performs the surgical procedure
0Act as the head of the surgical team
0A licensed physician (MD) or oral surgeon
(DMD)
Medicine degree (MD) dentist medicine degree (DMD)

16. 4. The Nurse
As a Scrub Nurse…
0Performs surgical hand scrub
0Setting up the sterile tables
0Preparing the sutures and special
equipment like laparoscope
0Assists the surgeon during surgery
0Counts all needles, sponges and
instruments with the circulating nurse
0Labels tissue specimen and sent to
laboratory by the circulating nurse.

17. 4. The Nurse
As a Circulating Nurse…
0 Works with surgeons, anesthesiologists and
other health care providers
0 Monitors activities of the surgical team
0 Checks the OR condition (lighting, supplies,
equipment, cleanliness and proper
temperature)
0 Verifies the surgical consent
0 Monitors aseptic practices of the team
0 Conducts “time out” to verify patient’s
name, procedure and surgical site in
cooperation of the team.

19. B. The Surgical Environment
The surgical area is divided into 3 zones to help decrease
microbes:
1. Unrestricted (outer) Zone: is where street clothes are
allowed; outside the theatre complex
2. Semirestricted (middle) Zone: is where attire consists of
scrub clothes and caps; inside the theatre complex but
outside the operating area
3. Restricted (inner) Zone: is where scrub clothes, shoe
covers, caps and masks are worn; inside the operating area

20. Nursing Practice in OR
1. Headgear should completely cover the hair
2. Shoes
0 Protection from spills or splashes and should be
changed if necessary
3. Masks
0 Worn at all times in the restricted zone
0 Should fit tightly
0 Should cover the nose and mouth completely
0 Should not affect with breathing, speech, or
vision
0 Should be changed between clients
0 Should not be worn outside the surgical
department
0 Must not be allowed to hang around the neck

21. Principles of Surgical
AsepsisPurpose: to prevent the contamination of
surgical wounds.
1. All materials used within the sterile
field must be sterile.
0 Sterile to sterile principle
0 Sterile to unsterile results in contamination
2. OR gowns are considered sterile in
front from the chest to the level of waist
or sterile field.
3. Sterile drapes are used to create a
sterile field.
4. Preserve the sterility of the items and
sterile field

22. Principles of Surgical
Asepsis
5. The movements of the surgical
team are from sterile to sterile
areas and from unsterile to
unsterile areas.
6. Whenever a sterile barrier is
broken, the area becomes
contaminated.
7. Every sterile field is constantly
monitored and maintained.
0Items of doubtful sterility must be
considered unsterile.
0Prepares sterile fields as close as
possible to the time of use.

23. C. The Surgical
ExperienceAnesthesia: a state of partial or complete loss of
consciousness, analgesia, relaxation, and reflex
loss. The main types of anesthesia are:
1. General Anesthesia
0 Patients is not arousable even to painful stimuli.
0 Patient cannot maintain pulmonary function and
require assistance like intubation and mechanical
ventilation.
0 Routes of administration: inhalation or
intravenous
2. Regional Anesthesia
0 Patient is awake and aware of the surroundings
unless sedated to relieve anxiety.
0 A quiet environment is therapeutic.

24. Types of Regional Anesthesia
A. Epidural Anesthesia
0 Injected into the epidural space that surrounds the dura
mater of the spinal cord.
0 Advantage: no headache results
0 Disadvantage: more challenging and may puncture the dura
mater
B. Spinal Anesthesia
0 Injected through the dura mater into the subarachnoid space
(between lumbar 4 and 5) surrounding the spinal cord.
0 Produce anesthesia of the lower extremities and lower
abdomen
0 Position: side-lying in a knee-chest position
0 Disadvantage: headache results

26. C. The Surgical Experience
3. Local Anesthesia
0Injected into the tissues at the planned incision
site.
0Advantages:
A. Simple and inexpensive
B. Needs minimal equipment
C. Postoperative recovery is short
D. Ideal for short and minor surgical
procedures
E. Undesirable effects of general anesthesia is
avoided

27. D. Potential Intraoperative
Complications
1. Nausea and Vomiting
0 Turn patient to the side and use a basin to collect vomitus
0 Give antiemetics preoperatively or intraoperatively
2. Anaphylaxis
0 Monitor patient for immediate or delayed anaphylactic reaction
3. Hypoxia
0 Monitor O2 status using pulse oximetry
4. Hypothermia
0 Increase OR temperature
0 warm IV fluids

28. POSTOPERATIVE PHASE

29. Post-Anesthesia Care Unit (PACU)
0 Also called recovery room or post anesthesia recovery
room.
0 PHASES of postanesthesia care
1. Phase 1 PACU: refers to immediate recovery phase
and provision of intensive nursing care.
2. Phase 2 PACU: patient is prepared for self-care or
hospital care
3. Phase 3 PACU: patient is prepared for discharge.

30. Nursing Management (PACU)
OBJECTIVES: to provide care until the (1.) patient’s motor
and sensory functions are back, (2.) is oriented, (3.) has
stable vital signs, and (4.) shows no evidence of bleeding or
complications.
1. Assess patient (at least every 15 minutes until stable)
2. Maintain patent airway
3. Maintain cardiovascular stability
4. Relieve pain and anxiety
5. Control nausea and vomiting
6. Determine readiness for discharge from PACU
0 Based from scoring system (Aldrete Score)
0 Score must be 8 to 10 before discharge

31. ALDRETE’SCORE

32. Potential Postoperative
Complications
1. Wound Dehiscence: is the separation or opening
of surgical incision or wound.
2. Wound Evisceration: is the protrusion of wound
contents or internal organs.
Causes:
A. Poor suturing
B. Vigorous coughing
C. Increasing age
D. Poor nutritional status
E. Obesity
F. Diabetes

33. Dehiscence and Evisceration
The earliest sign: A gush of bloody peritoneal
fluid from the wound.
Use of abdominal binder can provide support
and protection against dehiscence.
Nursing interventions:
A. Low fowler’s position
B. Cover protruding internal body structures
(intestines) with sterile dressings with saline
solution
C. Notify surgeon immediately
 DO NOT PUSH THE PROTRUDING BODY ORGAN
BACK

34. Potential Postoperative
Complications
3. Pneumonia
0 Encourage deep breathing and coughing exercises
4. Constipation
0 Increase fluid intake; engage in activities; intake of fibers
5. Urinary retention or urinary tract infection
0 Increase fluid intake; void regularly
6. Infection
0 Assess for manifestations of infection; give antibiotics
7. Hemorrhage or hematoma (clot)
0 Remove the clot; stop bleeding
8. Delayed healing
0 Perform wound dressing; treat hyperglycemia

35. Thank
You!
Any Questions ?