1

Definition of Perioperative Nursing

The provision of nursing care by an RN

preoperatively, intraoperatively, and
postoperatively to a patient undergoing an
operative or invasive procedure.

MLNGCeleste, RN, MD
 Areas in Which
Perioperative Nursing
Is Practiced
Perioperative nursing is practiced in
Hospital operating rooms
Interventional radiology suites
Cardiac cath labs
Endoscopy suites
Ambulatory surgery centers
Trauma centers
Pediatric specialty hospitals
Physician offices MLNGCeleste, RN, MD
 Functions of the
Perioperative Nurse
Advocate
Protector
Teacher
Change agent
Manager of patient care

MLNGCeleste, RN, MD
Nursing Roles in the OR
Circulating Nurse
Scrub person
RN first assistant (RNFA)
Perioperative educator
Specialty team leader
Perioperative manager

MLNGCeleste, RN, MD
 Surgical Attire
Gowns
Gloves
Masks
Hair covering
Protective eyewear

MLNGCeleste, RN, MD
Goals of Patient Safety

Provide safe patient care

Knowledge of procedure
Ensure the correct patient, correct site, correct level, and correct
procedure
Knowledge of positioning
Adhere to safe medication administration guidelines
Perform surgical counts

Provide a safe environment

Adhere to asepsis
Promote coordinated and effective communication
MLNGCeleste, RN, MD
Phases of Perioperative period

PRE- operative phase

INTRA- operative phase

POST- operative phase

MLNGCeleste, RN, MD
 PRE-Operative Phase
Begins when the decision to
have surgery is made and ends
when the client is transferred to
the operating table

MLNGCeleste, RN, MD
INTRA-Operative Phase
Begins when the client is
transferred to the operating table
and ends when the client is
admitted to the post-anesthesia
unit

MLNGCeleste, RN, MD
Post-operative Phase
Begins with the admission
of the client to the PACU
and ends when healing is
complete

MLNGCeleste, RN, MD
 TYPES of SURGERY
According to PURPOSE

According to degree of
URGENCY

According to degree of RISK

 According to PURPOSE
Diagnostic Establishes a diagnosis
Eg. Biopsy, laparoscopy
Palliative Relieves or reduces pain or
corrects a problem
eg. Gastrostomy tube insertion
Ablative Removes a diseased body part
Eg. appendectomy
Constructive Restores function or appearance
Eg. Face lift
Transplant Replaces malfunctioning
structures eg. Kidney transplant
According to degree of URGENCY

Emergency Preserves function or life

surgery Performed immediately

Elective Performed when condition

surgery is not imminently life
threatening

MLNGCeleste, MD,RN 14
OTHER Indication for examples
Classification surgery
I.Emergent Without delay Trauma
life threatening (gunshot, etc.)
II Urgent 24-30 hrs AP,
Cholecystitis
III. Required Plan within Cataracts,
weeks or month thyroid
IV. Elective No emergency CS, hernia
V. Optional Personal Cosmetic
preference surgery
MLNGCeleste, MD,RN 15
Other types of Surgery
PROPHYLACTIC Prevents a more
PREVENTATIVE serious condition
from developing
INPATIENT Client has been in
SURGERY the hospital prior to
the decision to have
a surgery
OUTPATIENT Client enters the
SURGERY hospital to have
surgery done
 According to degree of RISK
Major Involves high degree of risk
Surgery Complicated or prolonged,
Large amount of blood loss
Minor Involves low risk
Surgery Produces few complications
Performed as day surgery
MLNGCeleste, RN, MD
 Activities in the Pre-op
Assessing the clients: Nursing history, physical and
emotional assessment, medication history
Identifying potential or actual health problems
(comorbidities)
Ensure necessary test were done including proper
referrals and consultation
Educate about recovery from anesthesia and
postoperative care
Providing pre-operative teaching
Ensure consent is signed
Start an IV infusion
Address questions of the patient and family
 Consent
The surgeon is responsible
for obtaining the consent
for surgery
No sedation should be
administered before
SIGNING the consent
The nurse may serve as
witness
 INFORMED CONSENT
EMANCIPATED MINOR
- below legal age of 18 but who is living
independently from parents or who is
already living in with a partner; with
children of their own
 Health factors (Preoperative) that may
affect the outcome of the Surgery
Nutritional status
Drug or alcohol abuse
Respiratory status
Cardiovascular status
Hepatic and renal Factors
Endocrine Function
Immune function
Previous medication use
Psychosocial factors
Spiritual and cultural beliefs
 Surgical Risk
Extremes of age
Malnourished
Obese
Co-morbid conditions (HPN,
cardiac disease, diabetes,
renal failure)
Concurrent medications (aspirin,
diuretic, insulin, antihypertensives,
steroids)
 Pre-operative Interventions

Secure consent (operative permit)

Obtain nursing history, PE and lab exam
Provide pre-operative teaching as to the
nature of surgery, what to expect and
ways to manage post-operative
discomforts
Perform physical preparations- shaving,
hygiene, enema, NPO, medications
 Pre-op nutrition
Assess order for NPO
Solid foods are withheld for
about 8 hours before general
anesthesia
Pre-op elimination
Laxatives, enemas or both may
be prescribed the night before
surgery
Have the client void
immediately BEFORE
transferring them to the OR
Foley catheter may be inserted
as ordered
Pre-op hygiene
Bathe the night or morning before
surgery with antiseptic soap
Shaving of the skin is usually done in
the OR
Removal of jewelry and nail polish

*CONTACT LENSES/ HEARING

AIDS/ DENTURES
Pre-op psychological
preparation
Be alert to the clients anxiety level
Answer questions or concerns
Allow time for privacy
 Preparing the skin (shaving,
using antiseptic solution)
Asking the patient to void
Administering Preanesthetic
medications
Transporting the patient to the
presurgical area
 Pre-operative medications
Pre-op Drugs Example Purpose
Anti- Diazepam To decrease nervousness
anxiety Promote relaxation
Anti- Atropine Decreases secretions
cholinergic Prevent bradycardia
Muscle Succinylcholine To promote muscle
relaxant relaxation
Anti-emetic Promethazine To prevent nausea and
vomiting

Antibiotic Cephalosporin To prevent infection

 Pre-operative medications

Pre-op Example Purpose

Drugs
Analgesic Meperidine To decrease pain and
(DEMEROL) decrease anesthetic
dose
Anti- Diphenhydramine To decrease
histamine (BENADRYL)
occurrence of allergy

H-2 Cimetidine To decrease gastric

antagonist (TAGAMET) fluid and acidity
 Pre-operative teaching
Leg exercises To stimulate blood circulation
Pre-operative teaching
in the extremities to prevent
thrombophlebitis

Deep breathing To facilitate lung aeration and

and Coughing secretion mobilization to
Exercises prevent atelectasis and
hypostatic pneumonia
Done every two to four hours
Positioning and To stimulate circulation,
Ambulation stimulate respiration, decrease
stasis of gas
Assisting patient to semi-Fowlers
position, leaning forward.
Having patient splint a chest or
abdominal incision by holding a
folded bath blanket or pillow
against the incision.
Telling patient to take a deep
breath and hold it for three
seconds.
Encouraging patient to "hack" out
three short coughs after holding
breath.
With mouth open, patient should
take a quick breath.
 Encouraging patient to cough
deeply once or twice and then take
another deep breath.
 An incentive spirometer helps
increase lung volume and
promotes inflation of the alveoli.
Assisting patient to semi-Fowlers
position.
Setting the volume goal indicator
on the spirometer.
 Patient holding the device and
placing lips around the mouthpiece
to create a seal, then taking a deep
breath in.
 The patient can observe progress
toward the goal by watching the
balls or diaphragm of spirometer
elevate or lights go on (depending
on equipment used). Have patient
repeat exercise 5 to 10 times every
1 to 2 hours while awake
Assisting patient to a semi-Fowlers
position with knees bent.
Raising patients right foot and
keeping it elevated for a few
seconds.
Extending the lower portion of the
leg.
Lowering the entire leg to the bed.
This exercise is repeated five times
with each leg.
Patient pointing toes of both feet
toward the foot of the bed, with
both legs extended.
Patient pulling toes toward chin, as
if a string were attached to them
 Having patient make circles with
both ankles, first one way and then
the other.
 Instructing patient to raise one
knee and reach across to grasp the
side rail on the side of the bed
toward which he or she will be
turning.
Helping patient to rollover while he
or she pushes with the bent leg and
pulls on the side rail.
Showing patient how to use a small
pillow to splint a chest or abdominal
incision while turning.
After patient is turned, providing
support with pillows behind the
patients back.
 Pre-operative screening test
CBC Determine Hgb and Hct, infection
Blood type Determined in case of blood
transfusion
Serum Evaluates the fluid and electrolyte
electrolytes status
FBS Evaluates diabetes mellitus
BUN, Creatinine Assess the renal function
ALT, AST, Evaluates the liver function
Bilirubin
Serum albumin Evaluates nutritional status
CXR and ECG Respiratory and Cardiac status
MLNGCeleste, RN, MD
Activities during the Intra-op

Provide patient safety, maintain an aseptic environment, ensure proper

function of the equipments, position the client, emotional support,
assisting the surgeon as scrub nurse, circulating nurse, nurse
assistant,
 Intra-operative phase interventions
Determine the type of surgery and
anesthesia used
Position client appropriately for
surgery
Assist the surgeon as circulating or
scrub nurse
Maintain the sterility of the surgical
field
Monitor for developing complications
Principles of Sterile Technique
MLNGCeleste, RN, MD
 Basic Guidelines in Surgical Asepsis
All materials in contact with the surgical
wound and used within the sterile field
must be sterile.
Gowns are considered sterile in front from
the chest to the level of the sterile field.
Sterile drape
Items should be dispensed to a sterile
field by methods that preserve the sterility
 Movement of the surgical team
are from sterile to sterile and
from unsterile to unsterile area
Movement around a sterile field
must not cause contamination of
the field
When a sterile barrier is
breached, the area , must be
considered contaminated
Operating Room Team
direct patient care team
The team is likely a symphony orchestra
Each person is an integral entity in
harmony with his colleagues
1. THE STERILE TEAM
2. THE UNSTERILE TEAM
MLNGCeleste, RN, MD
MLNGCeleste, RN, MD 64
The Sterile Team
Operating surgeon
Assistants to the surgeon: Another surgeon
(1st assist), surgical resident doctor (2nd
assist), RN assist (3rd assist)
Scrub Nurse
They:
Scrub their hands and arms
Don sterile gloves and gown
Enter the sterile field (all items for the surgical
procedure are sterilized)

MLNGCeleste, RN, MD
The Unsterile Team
Anesthesiologist or anesthetist
Circulating nurse
Technicians
They:
Dont enter the sterile field
Function outside of the sterile field
Maintain sterile technique

MLNGCeleste, RN, MD
 Functions of the nurse during OR procedure
Assists the surgeon
SCRUB NURSE Maintains sterility
Set up sterile tables, Prepares and Handles
instruments, sutures
Drapes patient
Counts sponges, needles, instruments
Wears sterile gown, gloves

Assists the Scrub nurse

CIRCULATING Positions the patient for
NURSE surgery
Positions any equipment
Monitors/coordinates all activities
Controls the physical and emotional
atmosphere in the room
Protects the pts safety and health
Scrub Nurse
Maintain safety of the sterile field
Knows the sterile and aseptic technique
Prepares the instruments
Assists the surgeon with the instruments
PRIVATE SCRUB NURSE (employed by the
surgeon)

MLNGCeleste, RN, MD 68
Circulating Nurse
Monitors/coordinates all activities
Controls the physical and emotional
atmosphere in the room

MLNGCeleste, RN, MD 69
MLNGCeleste, RN, MD 70
MLNGCeleste, RN, MD 71
MLNGCeleste, RN, MD 72
MLNGCeleste, RN, MD 73
 74
MLNGCeleste, RN, MD
MLNGCeleste, RN, MD 75
MLNGCeleste, RN, MD 76
SEDATION
MINIMAL SEDATION
MODERATE SEDATION
DEEP SEDATION
ANESTHESIA

77
 Levels of Sedation
Minimal sedation

- drug induced state in which a

patient can respond normally in
verbal commands

- cognitive function and

coordination may be impaired
Moderate sedation

- depressed level of
consciousness that does not
impair ability to maintain a
patent airway

- calm, sedate a patient

combined with analgesic

- Midazolam/Diazepam
Deep Sedation
- a drug induced state in
which a patient cannot be
easily aroused but can
respond purposefully
after repeated stimulation
- inhaled or intravenous
- Volatile anesthetic
(halothane, Isoflurane)
- Gas anesthetic (Nitrous
oxide)
 ANESTHESIA

absence of sensation

state of narcosis (severe

CNS depression produced by
pharmacological agents),
analgesia, relaxation and
reflex loss

81
 Loss of the ability to
maintain ventilatory
function

Client requires assistance

to maintain a patent airway.

Cardiovascular function
may be affected as well
82
 Anesthesia
- a state of narcosis, analgesia,
relaxation and reflex loss

General anesthesia
Loss of all sensation and
consciousness; cardiovascular and
ventilatory functions are impaired

Regional or Local anesthesia

Loss of sensation in ONE area with
consciousness present
Methods of Anesthesia Administration

Inhalation
Intravenous
Regional Anesthesia: Epidural & Spinal
Local Conduction Blocks: Local Infiltration
GENERAL ANESTHESIA
the patient is unconscious and does
not see, hear, or feel anything. It
provides pain relief, muscle relaxation,
and amnesia so you don't remember
the details of your surgery.

85
 GENERAL Anesthesia

Administered in two ways:

Inhalational
Intravenous

86
PURPOSES OF GENERAL ANESTHESIA
pain relief (analgesia)
blocking memory of the procedure (amnesia)
producing unconsciousness
inhibiting normal protective body reflexes to
make surgery safe and easier to perform
relaxing the muscles of the body

87
 Stages of General Anesthesia
Stage I (Beginning Anesthesia/ INDUCTION
PHASE)
- patient may still be conscious, senses inability to
move extremities
- patient feels warm, dizzy with a feeling of
detachment
- patient may have ringing, buzzing in the ear, still
conscious, sense inability to move extremities
- noises are exaggerrated
- avoid unnecessary noises or motions
 Stage II: Excitement
- time from loss of consciousness to loss
of reflexes
- Characterized by struggling,
shouting, talking, crying.
- pupils dilate, rapid pulse and
irregular RR
- restrain the patient
Stage III: SURGICAL ANESTHESIA
(MAINTENANCE PHASE)
- Surgical anesthesia is reached
- patient is unconscious and lies
quietly
- respirations and CR are regular
- may be maintained in hours
(if properly given)

*EMERGENCE PHASE
90
 Stage IV: Medullary Depression
- stage is reached when too much
anesthesia is given
- RR becomes shallow, pulse is
weak and thready, pupils widely
dilated and become unresponsive
to light, cyanotic
- Without proper treatment death
will follow
- Discontinue anesthetic abruptly,
cardiopulmonary support is
initiated
G A: INHALATIONAL
ADMINISTRATION

92
G A: INTRAVENOUS
ADMINISTRATION

93
 G A: HALOTHANE
is a powerful anesthetic and can easily
be overadministered.
Advantages: pleasant odor
Disadvantages: little pain relief
(combined with other agents to control
pain)
Adverse reactions:
cardiac dysrhythmia
Hepatotoxicity
94
 G A: ENFLURANE
(ETHRANE)
is less potent and results in a more rapid
onset of anesthesia and faster awakening
than halothane.
Adverse reaction: Increases ICP and the
risk of seizure (contraindicated among
patients with seizure disorders)

95
G A: ISOFLURANE (FORANE)
is not toxic to the liver but can cause some
cardiac irregularities.
Isofluorane is often used in combination
with intravenous anesthetics for
anesthesia induction.
Awakening from anesthesia is faster than
it is with halothane and enfluorane.

96
G A: SEVOFLURANE
Does not cause cardiac arrhythmias and
coughing that is why this is replacing
halothane for induction of pediatric clients

this agent is rapidly eliminated and allows

rapid awakening

97
NITROUS OXIDE (LAUGHING
GAS)
is a weak anesthetic and is used with other
agents, such as thiopental, to produce
surgical anesthesia.
It has the fastest induction and recovery and
is the safest because it does not slow
breathing or blood flow to the brain.
Adverse effect: it diffuses rapidly into air-
containing cavities and can result in a
collapsed lung (pneumothorax) or lower the
oxygen contents of tissues (hypoxia).

98
 LARYNGOSCOPE
Establishing AIRWAY PATENCY:
ENDOTRACHEAL INTUBATION

MLNGCeleste, MD,RN 101

MLNGCeleste, MD,RN 103
105
106
POST G.A. Effects
Headache
vision problems, including blurred
or double vision
shivering or trembling
muscle pain
dizziness, lightheadedness, or faintness
drowsiness
mood or mental changes
nausea or vomiting
sore throat
nightmares or unusual dreams
107
 Potential adverse effects of anesthesia

Myocardial depression, bradycardia

Anaphylaxis
CNS agitation, seizures, respiratory
arrest
Oversedation or under sedation
Agitation and disorientation
Hypothermia
Hypotension
Malignant hyperthermia
108
PRECAUTION

A complete medical history including

a history of allergies in family
members, is an important precaution.
Patients may have a potentially fatal
allergic response to anesthesia known
as malignant hyperthermia (a
muscular disorder induced by
anesthesia), even if there is no
previous personal history of reaction.
WARNING SIGN: TACHYCARDIA
109
Discharge Instructions post- GA
Do not consume alcohol
Do not drive a car or operate heavy
machinery
Do not sign any legal documents
Do not make any important decisions
Someone should stay with you at least
for the first 24 hours after your surgery.

110
 INTRAVENOUS
MEDICATIONS FOR G A
used to induce or maintain surgical anesthesia &
hypnosis with use of barbiturates,
benzodiazepines, hypnotics and opioid agents
nonexplosive, require little equipment and easy
to administer
useful for short procedures
disadvantage: respiratory depressants
EX : ketamine, thiopental (a barbiturate),
methohexital (Brevital), etomidate, propofol
(Diprivan) 116
 Commonly Used IV Medications
Medication Usage Advantage Disadvantage
Muscle Relaxant Intubation Rapid onset Myalgias,
Succinlcholine Short cases Short duration fasciculation, tissue
(Anectine) trauma, paralysis

Anxiolytic/Sedative Amnesia, Good sedation Prolonged duration,

Diazepam Hypnotic residual effects
Barbiturates Induction Offers good Cause
Thiopental induction laryngospasm
Dissociative Induction Pt maintains Large doses may
Anesthesia Short cases airway cause
Ketamine (ketalar) hallucination,respirat
ory depression
Opioid Analgesic Perioperative Inexpensive, good Dec in BP and RR
Morphine pain CV stability
Opioid Analgesic Postoperative Good CV stability
Fentanyl (sublimaze pain
MLNGCeleste, RN, MD
 REGIONAL Anesthesia
- a form of local anesthesia
- the patient is awake

TOPICAL Applied directly on the skin

INFILTRATION Injected into a specific area
of skin
NERVE BLOCK Injected around a nerve

SPINAL Low spinal anesthesia

Subarachnoid
EPIDURAL Epidural space is injected
with anesthesia
 INTRASPINAL ANESTHESIA
best reserved for operations below
the umbilicus e.g. appendectomy,
hernia repairs, gynecological and
urological operations and any
operation on the perineum or
genitalia.
1. epidural
2. intrathecal (subarachnoid)

120
INTRASPINAL ANESTHESIA
TETRACAINE

121
122
MLNGCeleste, RN, MD 123
124
EPIDURAL ANESTHESIA

126
 INTRATHECAL
(SUBARACHNOID)

127
 Patient Positioning
Provides optimal visualization

Provides optimal access for

assessing and maintaining
anesthesia and function

Protects patient from harm

MLNGCeleste, RN, MD
Position Patient during Surgery

Abdominal surgeries Supine

Bladder surgery Slightly trendelenburg

Perineal surgery Lithotomy

Brain surgery Semi-fowlers

Spinal cord surgeries Prone mostly

Lumbar puncture Side lying, flexed body

MLNGCeleste, RN, MD
A. ABDOMINAL SURGERY
1. Abdominal Laparotomy
2. Herniorrhaphy
3. Cholecystectomy
4. Pancreaticoduodenectomy (Whipples)
5. Pancreatectomy
6. Splenectomy
7. Bariatric Surgery
136
B. BREAST SURGERY
1. Mastectomy
2. Breast Biopsy
3. Mammoplasty
4. Breast Augmentation, Breast Repair,
Breast Lifting
137
C. OBSTETRIC & GYNECOLOGIC
SURGERY
1. D & C
2. Vaginal/Abdominal Hysterectomy
3. Perineorrhaphy
4. Salphingo-Oophorectomy
5. Tuboplasty of the Fallopian tubes
6. Ceasarian Section low transverse,
classical, Pfannensteil (bikini cut)
138
D. GENITOURINARY SURGERY
1. Circumcision
2. Vasectomy
3. Orchiectomy
4. Cystectomy
5. Transurethral Resection of the Prostate/Bladder
(TURP/TURB)
6. Nephrectomy
7. Ureterolithotomy
8. Pyelolithotomy

139
MLNGCeleste, RN, MD
 Activities in the POST-op
Maintain patent airway
Monitor VS
Assessing responses to surgery and anesthesia
Performing interventions to promote healing
Prevent complications
Planning for home-care
Assist the client to achieve optimal recovery
 POST Operative Interventions
Transfer the postoperative patient to the
PACU: anesthesiologist/anesthetist
Nursing Objective: provide care until the
patient recovers from the effects of
anesthesia, is oriented, has stable VS and
shows no evidence of hemorrhage or
other complications
ASSESS your patient
 PACU- Post-Anesthesia
Care/Recovery Unit

1. Immediate and continuous

assessment every 15 minutes
initially
2. Check airway patency, vital
signs, surgical site, drain,
recovery from anesthesia, pain
control, fluid status, postop
orders
3. When stable, discharge to
hospital room or home

MLNGCeleste, MD,RN 143

 POST Operative Interventions
Maintain patent airway
Maintain cardiovascular stability
Monitor vital signs and note for
early manifestations of
complications
Monitor level of consciousness
Maintain on PROPER position
NPO until fully awake, with passage
of flatus and (+) gag reflex
POST Operative Interventions
Monitor the patency of the drainage
Maintain intake and output monitoring
Care of the tubes, drains and wound
Ensure safety by side rails up
Pain medication given as ordered
Measures to PREVENT post-op
Complications
POST Operative Interventions
PARAMETERS to consider before
discharging a postop patient from PACU
1. ACTIVITY can move all 4
extremities
2. RESPIRATION can deep breath
and cough
3. CIRCULATION
4. CONSCIOUSNESS fully awake
5. COLOR - pink
Post-operative interventions
PAIN MANAGEMENT
Pain is usually greatest during the 12-
36 hours after surgery
Narcotic analgesics and NSAIDS may
be prescribed together for the early
period of surgery
Provide back rub, massage, diversional
activities, position changes
 Post operative interventions
POSITIONING
Clients who have spinal anesthesia is
usually placed FLAT on bed for 8-12
hours
Unconscious client is placed side lying
to drain secretions
Other positions are utilized BASED on
the type of surgery
 Post-operative Interventions
Some Examples of Position Post Op

Mastectomy Semi-fowlers, affected

arm elevated
Thyroidectomy Semi fowlers, head
midline
Hemorrhoidectomy Semi-prone, side-lying

Laryngectomy Fowlers

Pneumonectomy Lateral, affected side

Lobectomy Lateral, unaffected

side 149
 Post-operative Interventions
Some Examples of Position Post Op

Aneurysmal repair Fowlers 45 degrees

(abdomen)
Amputation of lower Flat, with stump
extremities elevated with pillow
Cataract surgery Fowlers 45 degrees

Supratentorial Fowlers
craniotomy
Infratentorial Flat on bed, supine
craniotomy
Spina bifida repair Prone 150
 Wound Care
Inspect dressing hourly
Change dressing daily
Inspect for signs of infection
redness, swelling, purulent
exudate (SEROUS EXUDATE
normal)
Maintain wound drainage
151
MLNGCeleste, MD,RN 153
 Diet
NPO usually immediately after surgery
Progressive diet

Assess the return of the bowel sounds

Post-operative Interventions
Hydration after NPO to maintain
fluid balance
Suction, either gastro or respiratory
to relieve distention, to remove
respiratory secretions
Diet progressive, usually given when
bowel sounds and gag reflex return
162
 Liquid Diet Vs Soft diet
Clear liquid Full liquid Soft diet
Coffee Clear liquid PLUS: All CL and FL
Tea Milk/Milk prod plus:
Carbonated Vegetable juices Meat
drink Cream, butter Vegetables
Bouillon Yogurt Fruits
Clear fruit Puddings Breads and
juice Custard cereals
Popsicle Ice cream and Pureed foods
Gelatin sherbet
163
Hard candy
Urinary Elimination

Offer bedpans
Allow patient to stand at the bedside
commode if allowed
Report to surgeon if NO URINE output
noted within 8 hours post-op
Post-operative Interventions
Deep breathing and coughing
exercises Q2-4 hours to remove
pulmonary secretions
Leg exercises Q 2 hours to
promote circulation
Ambulation ASAP prevents
respiratory, circulatory, urinary and
gastrointestinal complications

165
DEEP BREATHING
Aka ABDOMINAL
BREATHING
CHEST and ABDOMEN
ENLARGE OR EXPAND
Diaphragm is depressed
10 deep breaths each time
Deep breathing FULLY
EXPANDS THE ALVEOLI
166
CPT
Chest Physiotherapy
Chest physiotherapy is based on the
fact that mucus can be knocked or
shaken form the walls of the airways
and helped to drain from the lungs.

The usual PVD SEQUENCE is as

follows- POSITIONING, Percussion,
Vibration, and removal of secretions
by SUCTIONING or Coughing followed
lastly by oral hygiene
Chest Physiotherapy
PERCUSSION & VIBRATION

MLNGCeleste, RN, MD 169

VIBRATING

170
PERCUSSION

171
Incentive Spirometry

This operates on the principle that

spontaneous sustained maximal
inspiration is most beneficial to the
lungs and has virtually no adverse
effects.
The incentive spirometer measures
roughly the inspired volume and offers
the incentive of measuring progress
INCENTIVE SPIROMETRY

173
Incentive Spirometry
SPLINTING WHILE COUGHING

MLNGCeleste, RN, MD 175

SPLINTING WHILE COUGHING

176
LEG EXERCISES

MLNGCeleste, RN, MD 177

POSTMASTECTOMY EXERCISES

178
POSTMASTECTOMY EXERCISES

179
POSTMASTECTOMY EXERCISES

180
Post operative complications
Atelectasis Collapsed Assess breath
alveoli due to sounds
secretions Repositioning
Deep breathing
and coughing
Pneumonia Inflammation Chest physio
of alveoli Suctioning
Ambulation
Thrombophlebitis Inflammation Leg exercises
of the veins Monitor for
swelling
Elevated
181
extremities
ATELECTASIS

182
PNEUMONIA

MLNGCeleste, MD,RN 183

DEEP VENOUS THROMBOSIS

*HOMANS SIGN
184
DEEP VENOUS THROMBOSIS

(+)HOMANS SIGN

185
EMBOLUS: MIGRATION OF A
CLOT

186
PULMONARY EMBOLISM

187
Post-operative Complications
Hypovolemic Loss of
Shock circulatory Determine cause and
fluid volume prevent bleeding
O2, IVF

Urinary Involuntary Encourage ambulation

retention accumulation Provide privacy
of urine Pour warm water
Catheterize
Pulmonary Embolus Notify physician
embolism blocking the Administer O2
lung blood
188
flow
 HYPOVOLEMIC SHOCK

MODIFIED TRENDELENBURG

189
Post-operative complications
Constipation Infrequent High fiber diet
passage of Increased fluid
stool Ambulation
Paralytic ileus Absent bowel Encourage
sound ambulation
NPO until
peristalsis
returns
Wound infection Occurs about 3 Daily wound
days after dressing
surgery Antibiotics
Maintain drain
190
WOUND HEALING
PRIMARY INTENTION

SECONDARY INTENTION

TERTIARY INTENTION

191
WOUND DISRUPTION

MLNGCeleste, RN, MD 192

Post-operative complications
Wound Separation of Cover the wound
dehiscence wound edges with sterile
normal saline
at the suture
dressing
line
Place in low-
Fowlers
Notify MD
Wound Protrusion of Cover the wound
evisceration the internal with saline pad
organs and Place in low-
fowlers
tissues
through wound Notify MD 193
Wound DEHISCENCE

194
Wound DEHISCENCE

195
Wound EVISCERATION

196
INCISIONAL HERNIA

197
INCISIONAL HERNIA

198
INCISIONAL HERNIA

199
 NURSING MANAGEMENT in
the POSTOPERATIVE PHASE
Preventing respiratory
complications
Relieving pain
Encouraging activity
Promoting wound healing
Maintaining normal body
temperature
Managing GI function
Nutrition
Resumption of urinary function
200
MLNGCeleste, RN, MD
To emphasize
The over-all goal of nursing care
during the PRE-OPERATIVE phase
is to prepare the patient mentally
and physically for the surgery
To emphasize
The over-all goal of nursing care
during the INTRA-OPERATIVE
phase is to maintain client safety
To emphasize
The over-all goals of nursing
care during the POST-
OPERATIVE phase are to
promote healing and comfort,
restore the highest possible
wellness and prevent
associated risk
SCRUB OUT !!!