Transcript for:
Comprehensive Guide to Perioperative Care

Hi, I'm Meris. And in this video, I'm going to  talk to you about perioperative nursing care. I'm   going to be following along with our Fundamentals  of Nursing flashcards. These are available on our   website, leveluprn.com. If you already have a  set and you want to follow along with me, I'm   starting on card number 141. Let's get started. Okay. So perioperative means in the care of the   operative or surgical patients, so pre, intra,  and post-op. So preadmission testing is going   to vary depending on what the patient is having.  But what I want to mention is here on card 141,   day of surgery. On the day of surgery, we need to  confirm that the patient has had their informed   consent performed and signed. Perhaps we act as  a witness for that. I would very much encourage   you to go back and watch the video on informed  consent so that you're really familiar with   what those topics include. Remember that if your  patient has questions about the procedure, you do   not answer them. You need to call the surgeon or  whomever is doing the procedure that day. That's   part of informed consent. It is the provider's job  to answer those questions for informed consent.  All right. Let's talk about intraoperative  care and anesthesia care. So in the OR,   intraoperatively, meaning intra, meaning  during operative, so during the surgery,   there's a thing called a timeout procedure. And  it's called that because, literally, everybody   takes a timeout, right? We stop. Everybody stops.  And it's for the patient's safety. And during the   timeout procedure, the nurses and the physicians,  and anybody else on the interdisciplinary team   is going to identify the patient. So two patient  identifiers. They're going to mark the surgical   site, if that wasn't done already, and also verify  things like what surgery are we doing today,   what are the patient's allergies, that sort  of thing, to say, "We're all on the same page,   and this is for the patient's safety." In the PACU - now, PACU stands for   postanesthesia care unit, so in the recovery  room - it's very important to make sure that   the patient is breathing appropriately. They  just received the ton of medications. We need   to make sure that they are recovering  well and readjusting to being awake. So   assess that respiratory status frequently,  and be prepared to provide the antidote   for any of the medications that they may have  received, such as naloxone or flumazenil. Now,   vital signs should be assessed every 5 to 15  minutes, depending on facility policy. So much   more frequently than in the normal acute care  setting. Again, this patient is readjusting to   being awake, so we need to make sure that their  vitals are okay. We're not seeing anything like   hemorrhage or any kind of concerning signs or  symptoms there. The patient should stay NPO,   so nothing by mouth, until the gag reflex returns.  They need to be able to protect that airway.   And the other thing here is just going to be to  prevent hypothermia. Patients do get pretty cold   in the OR and in PACU, so we want to make sure  that we give them some nice warm blankets to   stay cozy and not be too cold. And if you've  ever had surgery, you may know what I'm talking   about. It can be pretty miserable. All right. Lastly, let's talk about   ongoing postoperative care. So this is  outside of the immediate recovery period.   You can see we've got a lot of stuff here  on this card, so it is important to know.   Look for signs and symptoms of hemorrhage and  shock. That's going to be our biggest threat   to a patient who had surgery. So we need  to be looking for changes in vital signs,   level of consciousness, are they looking  pale, are they shaky, are they diaphoretic,   all of those sorts of signs and symptoms. We want  to prevent DVTs and assess for them, so we do have   a cross-reference here to see card 70. So you  can also see my previous video on that. We also   have encouraging the patient to participate  in activities that encourage oxygenation,   card 132. See the video for that. And then we also  need to manage our-- excuse me. We need to monitor   our patient for signs of infection. Any time we  enter the body through an opening, artificial or   natural, we are putting our patients at risk for  infection. So in those cases, we need to monitor   for signs and symptoms. Big ones here are going to  be an increase in temperature, increase in white   blood cell count. But we may also have things like  an increased heart rate. That's going to be our   big one there that's going to show up earlier  is a heart rate going up along with the temp.   We want to look at the surgical site as well for  any signs of drainage, redness, or foul odor.  Okay, so I hope that review was helpful  for you for perioperative care. If it was,   please like this video so that I know. If you have  a great way to remember something, or maybe you   have a great story from a time you had surgery,  I would love to hear it in the comments below.   That wraps up our Practice and Skills  playlist. So definitely subscribe to the   channel so that you are the first to know when  new content is freshly posted to our YouTube   channel. Thanks so much, and happy studying. I invite you to subscribe to our channel and share   a link with your classmates and friends in nursing  school. If you found value in this video, be sure   and hit the like button, and leave a comment and  let us know what you found particularly helpful.