Chapter 9: Concepts of Care for Perioperative Patients

Key Nursing Diagnoses and Interrelated Concepts

• Gas Exchange
• Pain Management
• Infection Control
• Tissue Integrity

Types of Surgeries

• Diagnostic
• Curative
• Palliative

Phases of Perioperative Nursing Care

1. Preoperative Phase
   • Scanning, IV starts, compliance with prep
   • Informed consent
2. Intraoperative Phase
   • Circulating nurses
3. Postoperative Phase
   • Post-Anesthesia Care Unit (PACU)
   • Monitoring recovery and determining discharge plans

Perioperative Safety and Communication

• National Patient Safety Goals: Developed by the Joint Commission
• SBAR: Communication protocol for sharing critical information
• Surgical Care Improvement Project: Promotes patient safety
• Surgical Safety Checklist: Includes timeouts before procedures
• TeamSTEPPS: Promotes effective team communication for patient safety

Preoperative Phase Details

• Begins when surgery is scheduled; includes teaching, prescriptions, and orders
• Importance of NPO (nothing by mouth) to prevent complications
• Medication review, especially NSAIDs and aspirin

Specific Preoperative Procedures

• General health assessment, medical history
• Checking for allergies (medications, latex, etc.)
• Blood donation and transfusion consent when necessary
• Discharge planning and support system analysis
• Vital signs and baseline tests

Informed Consent

• Responsibility of the provider performing the procedure
• Nurses verify the patient has signed and understands the procedure
• Importance of stopping if patient has questions about risks during consent

Postoperative Phase Management

Immediate Postanesthesia (Phase I)

• Focus on ABCs: Airway, Breathing, Circulation
• Pain control to ensure compliance with recovery instructions
• Use of analgesics versus anxiolytics

Intermediate Phase (Phase II)

• Preparation for discharge from PACU
• Patient stabilization and monitoring

Extended Observation (Phase III)

• Post-discharge needs may be addressed in a care facility or at home

Postoperative Care

Respiratory System

• Airway patency and oxygen delivery
• Ausculating lung sounds regularly

Vital Signs & Modified Aldrete Score

• Monitoring vital signs frequently post-surgery
• Aldrete score used to assess readiness for discharge

Pain Management

• Analgesics, heat/cold application, and non-pharmacologic methods
• Importance of reassessing pain levels post-intervention

Wound and Dressing

• Assessment of surgical sites for signs of infection or complications
• Monitoring types of drainage (sanguineous, serosanguinous, etc.)
• Special attention to signs of dehiscence and evisceration

Gastrointestinal System

• Assessing for bowel sound return and preventing complications
• Managing gastric tubes, drains, and motility

Mobility and DVT Prevention

• Early ambulation and physical therapy coordination
• Use of anti-embolic stockings and pneumatic compression devices

Psychosocial and Family Support

• Recognizing and reducing anxiety in patients and their families
• Incorporating family members into patient education

Discharge Planning

• Drug reconciliation, diet instructions, follow-up appointments
• Ensuring safety and support at home or transfer to appropriate care facilities

Alerts and Critical Values

• Potassium levels (critical for heart function)
• Monitoring for signs of bleeding, hemodynamic stability

Practice Questions:

1. Safe Transfer of Care: History, updates, standardized tools, and minimizing interruptions
2. Critical Lab Values: Low potassium as priority concern
3. Compression Stockings: Role in preventing blood clots