P"iop"ative n,sing

By: Sir Yamsuan (Top Rank)

Ex: amputations
Main
Sub E. Cosmetic
Supporting - Beautification enhancement
- Correction of defects
Perioperative nursing 2. Time of urgency
- Definition: delivery of nursing care 1. Emergent – to save life w/o delay
à client surgical experience Ex. Bleeding, GSW, stabwound, skull
- Embued by the nursing process fracture
2. Urgent- delay 24-30 hours
Ex. Obstruction
Settings:
3. Elective- planned or scheduled
1. In patient services Repair, cataract
- admitted patient 4. Optional- depends to patients decision
- observation >24 hours 5. Required- few weeks/ months
- post op complications Ex. Thyroid surgeries, cosmetic
2. out patient services
- may be sent home after the 3. Degree of risk
procedure
- location Minor Major
o OR Not prolonged Prolonged
o Ambulatory clinic (local anesthesia) (regional, general)
o OPD Lesser risk Greater risk
Pathologic processà sx (ETOP) Can be done as (+) admitted
OPD
1. Erosion- wearing off surface
2. Tumor- abnormal cell growth
3. Obstruction- impairment of vital fluids 4. degree of extent
(blood, urine, csf, bile)
4. Perforation- Rupture à abdominal Simple Radical
alterations Only affected (+) extension
area is involved
Classification of surgery:
According to:
1. Purpose Phases of perioperative
A. Diagnostic- to make a diagnosis Preop à intraop à post op
(biopsy)
B. Exploratory- extensive way à diagnose 1. pre operative
§ Extent Admitted à endorsed to OR
§ Explore THE BEST TIME FOR HEALTH TEACHING!!
§ Expensive Focus:
a) manual exploration 1. preparation:
b) scopes 1. Physical preparation
Ex: o Laboratories – related to
1) Laparospic surgery bleeding
2) Ex. Lap CBC- hemoglobin lvl
3) Scopic procedures = >12 g/dl (safest),
C. Curative- treatment of the disease o If <12à identify procedure,
o Ablative- removal (-ectomy) amount of blood loss
o Constructive- repair of organ o Amount of blood loss-
(congenital) anesthesiologist
o Reconstructive- repair of damaged o <500 mlà monitoring
organ (-rhapy) hydration
D. Palliative- relief of burden à to make o If >500à procurement of
patient comfortable blood prod
- it is the last treatment option

RN 2024!!!
P"iop"ative n,sing
By: Sir Yamsuan (Top Rank)
- Hematocrit- % of blood loss: plasma - Jewelries (if nakalimutan alisin a
o Indicator for hydration ward, ibigay sa supervisor)
- WBC- infection - Underwear (always remove,
o Pwedeng operation kahit regardless of procedure to
may infection -BQ maintain sterility) à hospi
o If pt reveal elevated wbc 1st
day of post operation- BQ 2. mental preparation
§ EXPECTED inc in 1st – information
24 hours Focus: Health teaching
§ Post 48-72 hours- 2 types:
normal na Process Procedural
- Platelet- possible bleeding What, where, why How
o 7 days free from Close ended Exercises
medication for platelet Experiences Techniques
activation Medication
1. Thrombolytics (ase) Time
2. Anticoagulants (H,W)
3. Antiplatelet (asa, plogrel) Consent
- Legal age: 18
2. CP clearance – evaluative tool to know - Free will
risk stratification - Decision making: Vertical first
Required: - Responsibility of nurse: Witness,
1. >40 year old Verifier
2. (+) Comorbidity
Dx test: 3. Emotional preparations
1. 12 Lead ecg - Prepared: feeling of acceptance
2. Cxr - If not prepared: to listen
3. Laboratories Greatest fear: fear of unknown
3. Fasting- at least 8hrs (X aspiration)
All à prep for anesthesia upgrade 4. Spiritual preparation
4. Bowel preparation- abdominal, colon - Religious beliefs, cultures, norms,
surgeries tradition
- done for 3 days - Respect the beliefs of others
mechanism:
1. diet modification 2. Intraoperative phase
2. laxatives (enema) Endorsed to OR à PACU
5. Intravenous fluid Focus: Sx à Successful
- (+) before initiating bowel prep:
DM NON Members of the operating team:
Dextrose Yes yes - Lead surgeon- leader captain
glucose Frequent single - Assist surgeon- in the absence of
Purpose: the lead they will become à lead
a) Hydration - Anesthesiologist
a. Large bore o Identify Amount of blood
needle loss
b. Gauge 18-20 o Monitor hemodynamic stats
(the smaller the of pt
number, the larger o Will be present in the 1st 24
bore hours
c. Color of IV

6. Removal of:
- Nail polish
- Dentures

RN 2024!!!
P"iop"ative n,sing
By: Sir Yamsuan (Top Rank)
2. Nurses Defining asepsis

Scrub nurse Circulating nurse

Overall in charge Coordinates
sterile area transactions inside
OR
One step ahead Counting of
instruments
Handling Packaging of
instruments instruments
Initiates the Position of hands
completeness of
Medical- downward
preop checklist
Surgical – upward
Document lahat Surgical conscience- moral obligation and
PreOp list liability
- Passport à OR
- Purpose: prevention of negligence
Principles of surgical asepsis
1. sterile person à touches the sterile item
Phases of operation
2. Out of sight, below the waist, above
1. Sign in phase (PreOp) – prep pa sa OR shoulder, back elbow à US! (unsterile)
- (-) patient 3. sterile field
- Before the actual start of surgery Mayo table Back table
- Identifying the patient, case, Primary instruments Anxillary intruments
surgery, person involved Surgical supplies
- Identify the operative site. BCD- 1-2 ft away
- Identify operating OR number
(kung saan sila ilalagay)
2. Time Out (Intra Op)
- (+) patient
- SN à scrubbing na
- Introduction of pt (CN) Back table- CN
- Introduction of surgical team - Pwede hawakan ang sterile basta
members may long forceps, before gamitin
- Inducrion of the anesthesia banlawan muna ng sterile water
o Surgery - If tapos na, soak nalang no need
o Counting instruments (if may 4, 4 ang to wash
sagot (before, during, before closure, - STERILE WATER- use twice
and final counting ang ika 4), Pero if Opening of sterile package- AWAY
1,2,3,5 ang options- 3 talaga by the Drapes: MD – RN: ASSIST ONLY
book) Gloves:
o Skin closure (+) (tapos na ang surgery - If may time: change (both)
then endorse na sa à PACU! - If wala: double gloving (affected
lang)
3. Sign Out Traffic: kept to a minimum
From OR nurseà PACU à Ward Traffic schemes:
CN F-F
o endorse pt à PACU B-B
o specimen handling à PACU à LAB S-S
SN US-US
o Cleaning of instruments/ room OR Lights: Moved by any members of
STERILE
- 1-2 ft away
- Dry

RN 2024!!!
P"iop"ative n,sing
By: Sir Yamsuan (Top Rank)
Sterilization procedures (silk, metal, alloy,
cotton)
Physical Chemical - Asses for
Autoclave Ethylene oxide latex
- 121-123 C - Best allergy
- No sharps sterilization - Allergy to
- Cream/ - 16-18 C tropical
whiteà - Fragile fruits KIWI
brown/ instruments
black - Yellow à 2. NR sutures
blue Absorbable Non absorbable
Flash sterilization Plasma hydrogen NR: When to return
- 132 C - Sharps à ROS (removal of
- 3-10 mins - Soak 30 sutures
- X sharps mins (7-10 days post dis)
- Red/
maroon à
gold/ Anesthesia
yellow Factors in choosing anesthesia:
1. Physical and
Indicator if nag undergo na ng process mental condition
- Changes in color 2. Age Child: general
Adult: regional
Shell life- expiration, when not to use (depends on
Decided by OR supervisor location
Time related Event related 3. Location Above nipple
Corresponding # Sterileà package - general
of days à sterile is intact Below nipple line
Gagamitin if: - regional
1. autoclave- 2wks 1. low manpower 4. Duration <4hrs- LAà RA
2. ethylene oxide- 2. high OR case >4hrs- GA
2mos 5. Patient Choice ng patient,
prefences if applicable
Classification of basic surgical instrument
Different types of anesthesia
1. Clamping/ Forceps (thumb, tissue)
hemostats Kelly (straight, curve) 1. Local Blocks the nerve
2. Retracting Army navy, richardson anesthesia impulse à
(widening) X sensory X motor
3. Cutting/ Blade, scissors, metz
dissecting (+) blade
4. Suturing Sutures, needles FORMS
TOPICAL IV INFILTRATION
Sutures Ligature Gel, patch, - IV, SUBQ
Materials used to Ties that ligaments, ointment, spray,
sew, binding, with blood vessels cream, eyedrops
tissues/ organs USES
Classification of sutures 1. Prior to injection to another
anesthesia
2. diagnostic procedures
Natural Synthetic
(intubation)
Comes from Fine materials
3. Dental procedures
environment
4. Superficial lacerations
(+) allergic Lesser reaction
**Don’t have to do skin testing
reaction

RN 2024!!!
P"iop"ative n,sing
By: Sir Yamsuan (Top Rank)
(+) à medically (ANST) 3. Post operative phase
(-) à Minor surgical (OBSERVE) PACUà DISCHARGE
Legal: after discharge
2. General Produces total loss Moral: after 1 year
anesthesia of consciousness
resulting to à Complications:
condition as of ff:
1. amnesia – anterograde (recent past
1. Hypotension Causes:
2. analgesic- insensible to pain
1. Paralysis of
3. hypnosis- artificial sleep
vasomotor nerve
4. seizure- prone for external stimuli
2. volume loss
- dehydration
Stages of anesthesia - bleeding

1. Induction stage 2. excitement/ Mgt:

- Induction up delirium 1. O2 administration
to the loss of - locà loss of (stimulation)
consciousness reflexes: 2. Position: FOB or
- Drowsy, 1. swallowing supine para maging
dizziness à 2. gag normal
safety 3. eyelid 3. hydration (IVF), if
- no siderails sa dehydrated
OR BP: irreg 4. blood transfusion if
- use soft Priority: bleeding
restraint, 1. airway 5. Vasoactive drugs
Velcro 2. seuizure (dopamine, dobu,
(correct) norepi) – LAST RESORT
3. surgical anesthesia 4. stage of danger 2. Spinal - Rapid movement of
Loss of reflexes à RPà medulla headache csf
respiratory paralysis paralysis à resp. Bà SC or SCà B
BP: regular failure à death = inc ICP
Priority: clearing of
secretion Priority: SIGNS:
1. airway 1. ALOC
2. circulation 2. Projectile vomiting
3. Cushing’s triadà
3. Regional anesthesia brain herniation
2 types:
1. Spinal 2. epidural Mgt:
(subarachnoid) (epidural space) 1. Position:
- lower - lower - Spinal: FOB 8hrs
abdominal abdomen - Epidural: FOB + 1
- groin - labor and pillow for 8hrs
- umbilical delivery 2. DOC:
- lower remedies - (+) epidural 1. Acetaminophen
- (-) catheter à 2. Diuretics (mannitol)
readjustment readjustment - Bolusà FD
- May progress - NO TO SLOW IVP
to GA Focus
abdominal sx - For the first 24 hoursà bleeding, pain
- After 48-72˚-- infection
3. Wound infection Break in aseptic
technique
Sign:
1. fever

RN 2024!!!
P"iop"ative n,sing
By: Sir Yamsuan (Top Rank)
2. foul smelling
Treatment:
- Antibiotic
B4 Initiation:
- Collection of
wound culture
C/S (5-7days)
- While waiting
for result: give
broad
spectrum
antibiotic
- Effective: if
may redolution
of fever
Prior to start:
- Sensitivity
testing
4. Wound healing problems
Wound dehiscense Evisceration
- Partial or total - Uncontrolled,
loss of wound exteriorization
edges (lumabas)
(bumuka) - if lumabas,
- If bumuka, pabalik sa
pahigain sa kama, then
kama cover na with
moist dressing
- if natuyo,pour
sterile water
para di magka
ischemia and
reinforce
another
dressing
Causes:
1. inadequate surgical closure
- sutures
- ebese
2. inc intraabdominal pressure
- vomiting, coughing, straining
3. poor wound healing (DM)
Manifestations:
1. Discharge
2. Sensation “something you want to
give up but you don’t want to let go”
Prevention:
1.Control activities that inc IAP
- GIVE antivomiting (plaril),
metoclopramide, odinsetron
- coughing with splinting
2. Visual/ Daily wound inspection

RN 2024!!!