Professional Documents
Culture Documents
The Perioperative Nursing
The Perioperative Nursing
c. Postoperative Phase
Microsurgical or laser technology Evaluation
Transplantation of mechanical Appraises the quality of nursing
devices (pacemaker) care during preop and
Reattachment of body parts intraoperative phase.
Use of robots Determines of the expected
outcomes (A,P,I).
4 domains of perioperative
nursing *OR environment should
S – Safety (aseptic technique be safe for both the
practices) surgical team and the
P – Physiologic responses (reflexes patient.
and consciousness are altered)
B- Behavioral (cognitive function Q – Quality improvement
or logic of pt. is impaired) as an ongoing process
H – Health Care System (hospital U - Understanding
protocols) regulations, standards,
policies, and procedures
that provide guidelines
for acceptable practices.
Perioperative Period A - Accountability for
a. Preoperative Phase – decision to one’s action
have surgery > transport to OR L - Legal rights of
table. patients
b. Intraoperative Phase – OR table > I – Individualized patients
RR/PACU care
c. Postoperative Phase – PACU > T- Technical competence
full recovery Y – Your surgical and
ethical conscience.
Nursing Process into Phases of
Perioperative Nursing Surgical Conscience
a. Preoperative Phase Awareness inner voice for
Assessment and Planning conscientious practice
Identify actual or potential Four Major Type of
problems (Physiologic/psychologic) Pathologic Processes
Determines the Nsg Dx and Requiring Surgical
expected outcome Intervention
Plans and prioritize the nsg O – Obstruction
intervention. P – Perforation
b. Intraoperative Phase E – Erosion
Implementation T – Tumors
>Carries out plan of care with
skill, efficiency and Anastomosis – cutting of defective
effectiveness. intestine.
d. Elective – not absolutely
necessary for survival
Classification of Surgical e. Optional – requested by the client.
Procedures f. Day (Ambulatory Surgery) done
1. PURPOSE on out-patient.
a. Diagnostic – Presence
b. Exploratory – Extent SURGICAL RISKS
c. Curative – Treat I. GENERAL RISK FACTORS
c.1 Ablative – removal of O – Obesity
the diseased organ F – Fluid, electrolyte and
c.2 Constructive - Used nutritional problems
for the restoration or A – Age
repair of a function or P- Presence of dse
appearance P – Pharmacotherapy
c.3 Reconstructive – (concurrent or prior)
Repair of a damaged N – Nature of the
organ condition of the pt.
d. Palliative – release of L – Location of the
reduces pain or the symptoms condition
but not really curing., M – Magnitude and
urgency of the surgical
2. DEGREE OF RISK procedure
a. Major Surgery M – Mental attitude of the
H – High Risk person toward surgery
E – Extensive C – Caliber of the
L – Large Amount of Blood professional staff and
Loss healthcare facilities
P – Prolonged
M – May handle or remove SURGICAL SETTINGS
vital organs Surgical suites
E – Extreme sick of Ambulatory care settings
complications Clinics
b. Minor Surgery Physician offices
L – Less risk Community setting
O – Obviously not prolonged Homes
W – With few serious
complications Perioperative Activities
Assessement
3. URGENCY Identify actual/ potential prolems
a. Emergency – done immediately Planing specific are
b. Imperative – done within 24 to 48 Preoperative teaching
hours Consent – should be signed
c. Planned/Required – weeks or Preoperative Health History
months (ABCDE)
A. Allergy Cough with sputum production must
B. Bleeding tendencies be assessed for color, consistency,
C. Cortisone or steroid amount, and color
D. Diabetes Mellitus PND – Paroxysmal Nocturnal Dyspnea
E. Emboli R Bronchus – common site of
aspiration
Physiologic Assessment Cricothyroidotomy - also known as
Age cricothyrotomy, is an important
Presence of pain emergency procedure that is used to
Nutritional Status, F &E balance obtain an airway when other, more
Infection routine methods (eg, laryngeal mask
Organ function (CP, Renal, GI, airway [LMA] and endotracheal
Liver, Endo, Neuro, Hematologic) intubation) are ineffective or
Use of medications contraindicated.
Presence of trauma Tracheostomy - is a medical procedure
— either temporary or permanent —
Preoperative Screening Test that involves creating an opening in the
CBC – determine Hg, Hct and infx neck in order to place a tube into a
Blood Type – in cases of blood person's windpipe. The tube is inserted
transfusion through a cut in the neck below the
S. Electrolyte – evaluate F/E vocal cords. This allows air to enter the
lungs.
Diagnostic Procedure
o Virtual endoscopy DISORDERS OF THE LOWER
o Optical imaging RESPIRATORY SYSTEM
o CT Scan and MRI
o Direct laryngoscopy CHRONIC OBSTRUCTIVE
examination PULMONARY DISEASE (COPD)
Refers to a disease characterized by
Management airflow limitation that is not fully
o Radiation therapy reversible. The airflow limitation is
o Chemotherapy generally progressive and is normally
o Surgery: associated with an inflammatory
response of the lungs due to irritants.
Partial Laryngectomy - A
COPD includes chronic bronchitis
portion of the larynx is and pulmonary emphysema.
removed along with one vocal Chronic Bronchitis - is a chronic
cord and the tumor. inflammation of the lower respiratory
Complications: Change tract characterized by excessive
in voice quality or mucous secretion, cough, and
hoarseness of voice. dyspnea associated with recurring
Total Laryngectomy - infections of the lower respiratory
Laryngeal structures are tract characterized by three primary
removed, including cartilage, symptoms: chronic cough, sputum
and two or three rings of the production, and dyspnea on
exertion.
trachea.
Clinical Manifestations:
Complications:
Blue bloater
permanent loss of voice, Usually insidious, developing
salivary leak, wound over a period of years.
infection, stomal stenosis Presence of a productive cough
and dysphagia. lasting at least 3 months a year
for 2 successive years.
Nursing Interventions Production of thick, gelatinous
o Arrange for clients with sputum; greater amounts
laryngectomies to meet with produced during superimposed
members of support groups infections
o Establish a method for Wheezing and dyspnea as
disease progresses.
communication before surgery
o Maintain airway; have suction
Emphysema - is a complex lung
equipment at bedside. disease characterized by
destruction of the alveoli, o Dyspnea, decreased exercise
enlargement of distal airspaces, tolerance.
and a breakdown of alveolar o Cough may be minimal,
walls. There is a slowly except with respiratory
progressive deterioration of lung infection.
function form many years before C CS
the development of illness. A Allergens
Two Types of Emphysema:
a. Panlobular Emphysema - L Long
destruction of respiratory Respiration
bronchiole, alveolar duct Infxn
and alveolus.
o All air spaces within the o Sputum expectorational mild.
lobule are essentially o Barrel chest - increased
enlarged, but there is little anteroposterior diameter of
inflammatory disease. chest due to air trapping
o Hyperinflated with diaphragmatic
(hyperexpanded) chest, flattening.
marked dyspnea on Diagnostic Procedure for COPD
exertion, and weight loss o Spirometry - is used to evaluate
typically occur. airflow obstruction.
o Negative pressure is o ABG levels - decreased PaO2,
required during inspiration pH, and increased CO2.
to move air into an out of o CXR - in late stages,
the lungs. hyperinflation, flattened
o Expiration becomes active diaphragm, increased
and requires muscular
effort. Inflammation, hypertrophy, hypersecretion, loss of
b. Centrilobular elasticity.
(Centroacinar)
Emphysema - pathologic RF:
changes take place mainly
in the center of the
secondary lobule,
preserving the peripheral
portions of the acinus.
o There is derangement of
ventilation-perfusion ratios,
producing chronic
hypoxemia, hypercapnia,
polycythemia, and Chronic Bronchitis
episodes of right-sided heart Airways
failure. Chronic Inflammation
o Leads to central cyanosis Bronchial walls thickening
and respiratory failure, and Narrowing of the airways
patient also develops Result: hypoxemia (decrease PaO2)
peripheral edema. Respiratory Acidosis
Clinical Manifestations
o Pink puffer Emphysema
Alveolar destrxn Long-acting beta2-adrenergic
Decreasein are for gas agonists
exchange Leukotriene modifiers
Air trapping (loss of elastic (inhibitors)
recoil bullae)
Increased work of breathing Nursing Interventions:
(barrel chest) Assesses the patient’s
respiratory status by
monitoring the severity of
C - Cyanosis, increased CO2, Cardiac symptoms, breath sounds,
Dysrhythmias (decreased O2) peak flow, pulse oximetry,
O - Decreased O2 > Hypoxemia > and VS.
decreased SPO2, Orthopnea, Administer medications as
P - Prolonged expiration, Pulmonary HTN prescribed and monitor the
(partial SPO2 below 55 mmHg) patient’s responses to those
D - Dyspnea, SOB, decrease in BW medications.
Administer flds if the patient
is dehydrated emphasize
ASTHMA is a chronic inflammatory adherence to the prescribe
disease of the airways that causes airway therapy, preventive measures,
hyper responsiveness, mucosal edema, and and the need to keep follow-
mucus production is reversible and diffuse up appointments with health
airway inflammation that leads to airway care providers.
narrowing.
Clinical Manifestation:
3 most common symptoms:
Cough
Dyspnea
Wheezing
Chest tightness, diaphoresis,
tachycardia, and a widened
pulse pressure, hypoxemia
and central cyanosis.
Pharmacologic Therapy
2 General classes of
medications:
a. Quick relief medications –
for immediate Tx.
a.1. Short-acting beta2-
adrenergic agonists like
Albuterol, (Poventil, Ventolin),
Levalbuterol (Xopenex) and
Pirbuterol (Maxair)
b. Long-acting medications to
achieve and maintain control of
persistent asthma.
Corticosteroids