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SCR 110 PRE-POST OP CARE Summary
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PRE-POST OP CAREPREOPERATIVE CARE
PERIOPERATIVE NURSING
- care of clients before, during, and a3er surgery ClassificaKon of Surgery
and other invasive procedures
• By Body system - useful for determining the
postopera9ve risk of infec9on; e.g. surgical incisions
The preopera)ve phase - begins with the decision
that enter the gastrointes9nal (GI), respiratory, or
to have surgery and lasts un9l the pa9ent is
genitourinary tracts have a higher risk for infec9on
transferred to the OR bed -> nursing care includes
than do surgeries on other body systems
care that is provided before (decision to have
• Purpose
surgery) through surgery to recovery.
- DiagnosKc: confirm or rule out a diagnosis (biopsy)
The intraopera)ve phase - begins when the pa9ent
- Abla9ve: removal of a diseased body part
is transferred to the OR bed and lasts un9l transfer
(colostomy)
to the postopera9ve recovery area (Post-Anesthesia
- PalliaKve: relieve discomfort or other disease
Care unit (PACU – RECOVERY ROOM)
symptoms without producing a cure (nerve root
destruc9on for chronic pain)
• Surgery will be done in a variety of seJngs,
- ReconstrucKve: restore func9on (rotator cuff
including hospitals, freestanding surgical centers,
repair)
surgical centers aGached to hospitals, and the
- CosmeKc: improve appearance
health care provider’s office.
- Transplant: replaces a malfunc9oning body part,
9ssue, or organ
The postopera)ve phase - lasts from admission to
- Procurement: An organ or 9ssue is harvested from
the recovery area to complete recovery from
someone pronounced brain dead for
surgery.
transplanta9on into another person
• It is important to prac9ce strict surgical asepsis,
document care, and paKent safety in all phases of
• By degree/urgency
care. - Emergency: requires transport to the opera9ng
• EffecKve teaching and discharge planning prevent
suite as soon as possible to preserve the pa9ent’s
or minimize complica9ons and ensure quality
life or func9on. The surgical team is summoned,
outcomes.
and prepara9ons are made rapidly (Internal
hemorrhage, rupture of an organ, and trauma)
- Urgent: scheduled within 24 to 48 hours to alleviate
symptoms, repair a body part, or restore func9on.
(Removal of a cancerous breast and internal fixa9on
of a fracture)
- ElecKve: recommended course of ac9on, but the
condi9on is not 9me sensi9ve; may delay surgery to
gather informa9on, consider op9ons, or organize
“Near Events”
- serious and costly errors resul9ng in severe care for the family (repair of a torn ligament and
removal of rectal polyps)
consequences for the pa9ent, and are mostly
preventable. Medicare no longer reimburses
• Seriousness/Risk
ins9tu9ons for care related to such complica9ons - Major: high degree of risk; poten9al for significant
- surgery on wrong body part, wrong pt, wrong
blood loss, a prolonged or complicated procedure,
surgery on pt, DVT or PE a3er total knee/hip
surgery involving vital organs (coronary artery
replacement, etc.
bypass gra3, nephrectomy (removal of a kidney),
and colon resec9on)
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,- Minor: performed on an outpa9ent basis; li^le risk • MedicaKons-
and usually has few complica9ons (include breast 1) Certain herbal and alternaKve medicaKons can
biopsy and inguinal hernia repair) increase the risk for cardiac dysrhythmias secondary
to potassium loss; interfere with metabolism of
PaKent Risk Factors and Strengths anesthe9cs because of their effects on the liver;
• Age (the very young and very old are generally more
increase the poten9al for excessive bleeding; decrease
at risk of complica9ons because of their
cerebral blood flow; cause hypertension; or increase
physiological status).
- Older adults: increased risk because they have the effects of opioids and sympathe9c nervous system
less physiological reserve and o3en have s9mulants.
comorbid condi9ons (other illness not related to 2) Alcohol and other drugs interact with anesthe9c
the surgery); decreased kidney func9on, agents and medica9ons to create adverse effects
diminished immune func9on, decreased bone 3) Habitual substance abusers may have a cross-
and lean body mass, increased peripheral tolerance to anesthe9c and analgesic agents, causing
vascular resistance, decreased cardiac output, them to need higher than normal doses.
decreased cough reflex, and increased 9me
required for wound healing • Allergies: Pa9ents may be allergic to medicaKons
such as anKbioKcs (e.g., penicillin) and analgesics
• Type of wound - preexis9ng wounds (e.g., from (e.g., codeine), tape, latex, and soluKons used in
trauma) and the wounds (incisions) created by the surgery.
surgical procedure can pose a risk for infec9on • DM & CVD : the presence of diabetes and
• PreexisKng condiKons - Medical and surgical cardiovascular disease generally decrease wound
history (e.g. Immuno-competence => risk infec9on; healing ability and are at an increased risk of
fluid and electrolyte imbalance influenced by stress infecKons.
& pre-exis9ng condi9ons; obstruc9ve sleep apnea
=> par9al or complete respiratory obstruc9on) Surgical Risks of MedicaKons
- Acute: Acute infec9ons, UTI • AnKcoagulants: precipitate hemorrhage
- Chronic: Cardiovascular diseases, chronic • DiureKcs: electrolyte imbalances, respiratory
respiratory diseases, coagula9on disorders, depression from anesthesia
diabetes mellitus, liver disease, neurological • Tranquilizers: increase hypotensive effects of
disorders, nutri9onal disorders, renal disorders anesthe9c agents
• Personal habits • Adrenal steroids: abrupt withdrawal may cause
- Substance abuse can increase surgical risk. cardiovascular collapse
- Smoking affects pulmonary func9on • AnKbioKcs in “mycin” group: respiratory paralysis
- Long-term alcohol use contributes to liver disease, when combined with certain muscle relaxants
increasing the risk for bleeding.
• Coping paGerns and support systems Pre-Op Assessment
• NutriKonal status (ability to chew, swallow , To iden9fy the pa9ent’s normal preopera9ve func9on
regurgita9on, obesity, e.g. bariatric clients (reduces to recognize, prevent, and minimize possible
ven9latory and cardiac func9on =risk of embolus, postoperaKve complicaKons.
atelectasis, pneumonia) • Nursing history
- compromised nutriKonal status can lead to - Conduct an ini9al interview to collect a paKent
impaired 9ssue repair and decreased resistance to history. If a pa9ent is unable to relate all of the
infec9on necessary informa9on, rely on family members as
- obesity can impact on respiratory and cardiac resources
- Health history. chronic disease states that can
func9on during surgery.
• AcKviKes of daily living - Occupa9on cause poten9al problems for the surgical pa9ent.
◦ Past illnesses: bleeding disorders, diabetes,
cardiac disease, respiratory disease, liver
2 of 20 PRE-POST OP CARE
, disease, use of street drugs, and ◦ Self-concept - iden9fy personal strengths/
immunological disorders. weaknesses
◦ Surgeries and Reasons for surgery ◦ Body image – what pa9ents perceive will
- Physical status result from surgery concerns about sexuality
- Allergies. Drugs, latex, food, and contact
- MedicaKons • Physical ExaminaKon
PrescripKons - an9bio9cs, an9dysrhythmic, - General survey - Pre-op vital signs, including blood
an9coagulants, an9convulsants, pressure while siJng and standing, and pulse
an9hypertensives, cor9costeroids, and insulin. oximetry provide important baseline data with
These medica9ons have special implica9ons for which to compare altera9ons that occur during and
the surgical pa9ent. Postopera)vely and at a3er surgery.
discharge, ensure that pa)ents con)nue their - Head and neck – check for loose or capped teeth,
medica)on regimen. dentures, prostheKcs, piercings that must be
Over the counter removed.
Herbs - Integumentary – Inspect skin and boney
Street drugs prominences
- Knowledge and understanding of the surgery and - Thorax and lungs - breathing paGern and chest
anesthesia. Ask, “What was your response? excursion
Was your pain controlled? Did you experience - Heart and vascular system - apical pulse and listen
nausea? Did any postopera)ve complica)ons to heart sounds. Assess peripheral pulses, capillary
occur?” refill, and color.
- Cultural and spiritual factors. diverse responses to - Abdomen - Assess for distension, bowel sounds,
surgical procedures bowel movements.
- Access to social resources. Family, friends, home - Neurological status - Assess LOC
environment – need support for - DiagnosKc screenings
transportaKon, nutriKon, laundry, cleaning • Chest x-ray (not required to all)
etc. • Electrocardiography (ECG) - dysrhythmias
- Coping strategies. past stress management • Complete blood cell count (CBC) - anemia,
techniques; specific family members and immune func9on, platelet count
friends for support • Electrolyte levels - imbalances which affect
- Substance use (alcohol tobacco, drugs) cardiac and other organ func9on and fluid balance
Smoking -> increases amount and thickness of • Urinalysis (UA) - detect UTI, glucose, protein in
mucus. General anesthesia also increases airway urine
irrita9on and s9mulates pulmonary secre9ons • FasKng blood sugar - diabetes
Alcohol ingesKon and substance use/abuse -can • Metabolic panel - underlying health problems
experience adverse reac9ons to anesthesia
because of cross-tolerance to anesthesia drugs, Analysis/Nursing Diagnosis
need higher amounts, are o3en undernourished
and may have liver disease, portal hypertension, • Anxiety. mild, moderate, severe, or at panic level;
esophageal varices and may have withdrawal may be related to the current change in health
post-op. status or due to concerns about being unable to
- OccupaKon history – effects on recovery, ability to provide care for loved ones; symptoms such as
return to work, need for social services (financial) restlessness, trembling, increased pulse, and other
and/or occupa9onal therapist defining characteris9cs.
- PreoperaKve pain assessment. describe their • Fear. related to the unknown outcome of the
perceived tolerance to pain, past experiences, and surgery, to learning the diagnosis a3er a diagnos9c
prior successful interven9ons procedure, and to the prospect of pain during and
- EmoKonal health. Assure pa9ents of their right to a3er surgery; Use this nursing diagnosis only if more
ask ques9ons and seek informa9on. than rou9ne interven9ons are needed
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