Module 5: Perioperative Care- Includes
Pre-Operative; Intra-Operative;
Post-Operative
preoperative phase
The first phase of surgery
-Begins when patient is scheduled for surgery; ends at time of transfer to surgical suite
-Nurse functions as educator, advocate, promoter of health and safety.
intraoperative phase
The second phase of surgery
-Care provided to the patient by the
surgical team during surgery.
Circulating nurse: The patient’s advocate and a liaison between scrubbed personnel and the
surgical team will often accompany the patient to the PACU.
Postoperative Phase
The third phase of surgery
-Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICU and
ends when the patient has complete recovered from the surgical procedure.
Types of surgeries
diagnostic, curative, restorative, palliative, cosmetic
diagnostic surgery
Done to provide data for a diagnosis of the problem (e.g., mass biopsy, exploratory
laparotomy).
curative surgery
Cures; alleviates a problem (e.g., appendectomy).
,restorative surgery
Performed to improve a patient's functional ability
Total knee replacement
Finger re-implantation
pallative surgery
ex: retard tumor growth, decrease size of tumor, decrease side effects from obstruction or
pressure
cosmetic surgery
any medical operation which is intended to improve a person's appearance rather than their
health
The Association of PeriOperative Registered Nurses' (AORN) Standards and Recommended
Practices
are integrated in clinical practice
the goal of the standard is patient safety.
Surgery- Diversity Considerations
•Life Span: Older adults and children have a greater risk associated with surgery.
•Culture, Ethnicity, and Religion: Cultural influences, beliefs, and practices could influence
how a patient responds to surgery and pain.
•Disability: Any disorder that causes extreme anxiety, hinders the ability to understand,
interferes with coping with the stress of surgery, and impedes the patient’s ability to respond
appropriately can increase the risks for surgery and postoperative complications.
•Morphology: Malnutrition can lead to a delay in wound healing, infection, fluid and
electrolyte imbalances, and fatigue. Obesity can cause significant mechanical difficulty for
the surgeon.
Surgical Risk Factors
General health
Medications - reconciliation
Mental and cognitive status
Nutrition
Cardiac disorders
Blood coagulation
disorders
, Respiratory disorders
Renal disorders
Liver disease
Diabetes mellitus
Review of current health status
•When a person is in a poor state of health, the surgery could be delayed or cancelled.
•When a patient's risk for infection is high, antibiotics are given prophylactically prior to
surgery to allow for the medication to reach therapeutic levels in the tissue.
when are antibiotics given before surgery
one hour before
Illicit Drugs/Nicotine Impact on Surgery
Smoking puts a person at risk for reactive airway disease, which could contribute to
complications such as larynogospasm.
Certain drugs change the way anesthetics work during surgery; common drugs that are
abused include cocaine, marijuana, alcohol, and opiates.
laryngospasm
the sudden spasmodic closure of the larynx
Medications Impact on Surgery
Can increase surgical risk and affect how the patient responds to the stress of surgery or
anesthetics.
During assessment, the nurse questions the patient about all (herbal, OTC, etc.) medications
taken at home
Disorders that impact the cognitive function such as schizophrenia, dementia, developmental
delay, and mental retardation impact a person's ability to interpret and understand.
Cardiovascular Disease Impact on Surgery
Increase the risk of surgery
Disorders such as myocardial infarction, dysrhythmias, and hypertension are managed or
controlled prior to surgery.
Renal Disorders Impact on Surgery
Pre-Operative; Intra-Operative;
Post-Operative
preoperative phase
The first phase of surgery
-Begins when patient is scheduled for surgery; ends at time of transfer to surgical suite
-Nurse functions as educator, advocate, promoter of health and safety.
intraoperative phase
The second phase of surgery
-Care provided to the patient by the
surgical team during surgery.
Circulating nurse: The patient’s advocate and a liaison between scrubbed personnel and the
surgical team will often accompany the patient to the PACU.
Postoperative Phase
The third phase of surgery
-Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICU and
ends when the patient has complete recovered from the surgical procedure.
Types of surgeries
diagnostic, curative, restorative, palliative, cosmetic
diagnostic surgery
Done to provide data for a diagnosis of the problem (e.g., mass biopsy, exploratory
laparotomy).
curative surgery
Cures; alleviates a problem (e.g., appendectomy).
,restorative surgery
Performed to improve a patient's functional ability
Total knee replacement
Finger re-implantation
pallative surgery
ex: retard tumor growth, decrease size of tumor, decrease side effects from obstruction or
pressure
cosmetic surgery
any medical operation which is intended to improve a person's appearance rather than their
health
The Association of PeriOperative Registered Nurses' (AORN) Standards and Recommended
Practices
are integrated in clinical practice
the goal of the standard is patient safety.
Surgery- Diversity Considerations
•Life Span: Older adults and children have a greater risk associated with surgery.
•Culture, Ethnicity, and Religion: Cultural influences, beliefs, and practices could influence
how a patient responds to surgery and pain.
•Disability: Any disorder that causes extreme anxiety, hinders the ability to understand,
interferes with coping with the stress of surgery, and impedes the patient’s ability to respond
appropriately can increase the risks for surgery and postoperative complications.
•Morphology: Malnutrition can lead to a delay in wound healing, infection, fluid and
electrolyte imbalances, and fatigue. Obesity can cause significant mechanical difficulty for
the surgeon.
Surgical Risk Factors
General health
Medications - reconciliation
Mental and cognitive status
Nutrition
Cardiac disorders
Blood coagulation
disorders
, Respiratory disorders
Renal disorders
Liver disease
Diabetes mellitus
Review of current health status
•When a person is in a poor state of health, the surgery could be delayed or cancelled.
•When a patient's risk for infection is high, antibiotics are given prophylactically prior to
surgery to allow for the medication to reach therapeutic levels in the tissue.
when are antibiotics given before surgery
one hour before
Illicit Drugs/Nicotine Impact on Surgery
Smoking puts a person at risk for reactive airway disease, which could contribute to
complications such as larynogospasm.
Certain drugs change the way anesthetics work during surgery; common drugs that are
abused include cocaine, marijuana, alcohol, and opiates.
laryngospasm
the sudden spasmodic closure of the larynx
Medications Impact on Surgery
Can increase surgical risk and affect how the patient responds to the stress of surgery or
anesthetics.
During assessment, the nurse questions the patient about all (herbal, OTC, etc.) medications
taken at home
Disorders that impact the cognitive function such as schizophrenia, dementia, developmental
delay, and mental retardation impact a person's ability to interpret and understand.
Cardiovascular Disease Impact on Surgery
Increase the risk of surgery
Disorders such as myocardial infarction, dysrhythmias, and hypertension are managed or
controlled prior to surgery.
Renal Disorders Impact on Surgery
