The following text is generated using the keywords: Preoperative, intraoperative, and postoperative phases of surgery.
The perioperative period is the time span that covers the preparation, execution, and recovery of a surgical procedure. It consists of three phases: preoperative, intraoperative, and postoperative. Each phase has its own goals, challenges, and nursing interventions.
The preoperative phase starts from the decision to have surgery until the patient is transferred to the operating room. The main goals of this phase are to assess the patient’s physical and psychological readiness for surgery, to provide education and counseling, to obtain informed consent, to reduce the risk of complications, and to plan for postoperative care. Some of the nursing interventions in this phase are:
– Obtaining a comprehensive health history and physical examination, including allergies, medications, previous surgeries, comorbidities, and family history.
– Performing diagnostic tests such as blood tests, urine tests, electrocardiogram, chest x-ray, etc., as ordered by the surgeon or anesthesiologist.
– Providing preoperative teaching about the surgical procedure, anesthesia, pain management, wound care, mobility, nutrition, and discharge instructions.
– Addressing the patient’s fears, anxieties, expectations, and coping strategies.
– Ensuring that the patient has no food or drink for a specified time before surgery (usually 6 to 8 hours).
– Administering preoperative medications such as antibiotics, anticoagulants, sedatives, etc., as prescribed.
– Verifying the patient’s identity, surgical site, and procedure using a checklist and marking the operative site with an indelible marker.
– Transporting the patient to the operating room and handing over the care to the surgical team.
The intraoperative phase begins when the patient is received in the operating room and ends when the patient is transferred to the post-anesthesia care unit (PACU). The main goals of this phase are to maintain asepsis, homeostasis, hemostasis, and safe anesthesia administration. Some of the nursing interventions in this phase are:
– Preparing the operating room with sterile instruments, equipment, supplies, and medications.
– Assisting with patient positioning, draping, skin preparation, and monitoring devices.
– Performing a time-out before incision to confirm the patient’s identity, surgical site, and procedure with all members of the surgical team.
– Acting as a scrub nurse or a circulating nurse depending on the role assigned. The scrub nurse prepares and maintains the sterile field and assists the surgeon by passing instruments, sutures, and supplies. The circulating nurse manages the operating room environment and coordinates the activities of the surgical team. He or she also documents the intraoperative events and communicates with other departments as needed.
– Monitoring the patient’s vital signs, fluid balance, blood loss, urine output, and level of consciousness throughout the surgery.
– Anticipating and responding to any emergencies or complications that may arise during surgery such as bleeding, infection, hypotension, hypoxia,
anaphylaxis , cardiac arrest , etc .
– Collaborating with the anesthesiologist or anesthetist to ensure smooth induction , maintenance , and reversal of anesthesia .
– Applying dressings , drains , casts , or splints as indicated .
– Transporting the patient to the PACU and handing over the care to the recovery nurse .
The postoperative phase starts when the patient is admitted to the PACU and ends when the patient is discharged from the hospital or clinic . The main goals of this phase are to promote wound healing , prevent infection , manage pain , restore function , and facilitate discharge planning . Some of the nursing interventions in this phase are :
– Assessing the patient’s airway , breathing , circulation , level of consciousness , surgical site , drains , dressings , pain , temperature , pulse oximetry , blood pressure , etc . , at regular intervals .
– Administering postoperative medications such as analgesics , antibiotics , antiemetics , etc . , as prescribed .
– Providing oxygen therapy , suctioning , oropharyngeal airway , or endotracheal tube as needed .
– Encouraging early mobilization , deep breathing , coughing , incentive spirometry , leg exercises , etc . , to prevent complications such as atelectasis , pneumonia , thromboembolism , etc .
– Providing adequate hydration , nutrition , and elimination support .
– Educating the patient and family about postoperative care , wound care , activity restrictions , medication regimen , follow-up appointments , and signs and symptoms of complications .
– Evaluating the patient’s readiness for discharge and providing discharge instructions and referrals as appropriate .
The perioperative period is a critical time for the patient undergoing surgery . The nurse plays a vital role in ensuring the safety , comfort , and well-being of the patient throughout the three phases of surgery . By applying the principles of perioperative nursing , the nurse can provide holistic and evidence-based care to the patient and facilitate a positive surgical outcome .
– AORN (Association of periOperative Registered Nurses) (2023) Guidelines for Perioperative Practice. Denver, CO: AORN.
– Brunner, L.S., Smeltzer, S.C.O., Bare, B.G., Hinkle, J.L. and Cheever, K.H. (2021) Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 15th edn. Philadelphia, PA: Wolters Kluwer.
– Ignatavicius, D.D. and Workman, M.L. (2022) Medical-Surgical Nursing: Patient-Centered Collaborative Care. 10th edn. St. Louis, MO: Elsevier.
– Lewis, S.L., Bucher, L., Heitkemper, M.M., Harding, M.M., Kwong, J., Roberts, D. and Hagler, D. (2021) Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 11th edn. St. Louis, MO: Elsevier.
– Potter, P.A., Perry, A.G., Stockert, P.A. and Hall, A.M. (2022) Fundamentals of Nursing. 10th edn. St. Louis, MO: Elsevier.