Question

1. Outline the preoperative nursing measures that decrease the risk for infection and other postoperative complications.

2. Identify various roles of the surgical team members during the three phases of perioperative nursing care.

Answer 1

1. Preoperative care is the before surgery when physical and psychological preparations are made for the operation, according to the individual needs of the patient. The preoperative period runs from the time the patient is admitted to the hospital or surgicenter to the time that the surgery begins. Various measures are taken by nurses inorder to prevent infections and postoperative complications which include

1. Handwashing
2. Clean skin
3. Sterile clothing and drapes
4. Clean air
5. Careful use of antibiotics
6. Controlled blood sugar levels
7. Controlled body temperature
8. Proper hair removal

The following are the most common postoperative complications

• Shock - Shock is the dangerous reduction of blood flow throughout the body. Shock is most often caused by reduced blood pressure.
• Hemorrhage - Hemorrhage means bleeding. Rapid blood loss from the site of surgery, for example, can lead to shock.
• Wound infection - When bacteria enter the site of surgery, an infection can result. Infections can delay healing.
• Deep vein thrombosis - Sometimes blood clotting occurs within deep-lying veins. Large blood clots can break free and clog an artery to the heart, leading to heart failure.
• Pulmonary complications - Sometimes, pulmonary complications arise due to lack of deep breathing within 48 hours of surgery. This may also result from inhaling food, water, or blood, or pneumonia.
• Urinary retention - Temporary urine retention, or the inability to empty the bladder, may occur after surgery. Caused by the anesthesia.
• Reaction to anesthesia - Although rare, allergies to anesthetics do occur.

2. The term perioperative nursing refers to all the activities and responsibilities assumed by a nurse before, during, and after a surgical procedure.

Three phases in perioperative nursing are

a. Pre operative phase : It is the phase when the patient had decided for surgical intervention up to the time of transfer to the operating room. Teaching is an essential thing by nurse to the patient from anxiety and stress for the upcoming surgical procedure. Teaching the patient about deep breathing, turning, splinting, and purse- lip breathing exercises would be very helpful to prevent the patient from developing complications like pneumonia and other respiratory problems as well as circulatory conditions. Meanwhile, preparations during this phase include the process of obtaining the informed consent done by the physician and letting the patient verbalize his/ her fears and utilizing therapeutic communication in letting them understand fully well the procedure they will undergo. Gastrointestinal and skin preparations are also included during this phase and also the giving of prescribed medications, like tranquilizers, sedatives, analgesics, and anticholinergics.

b. Intra operative phase: It is from the time when the patient is received in the operating room to the time the patient is admitted in the recovery room.The surgical team is already in charge of the patient, composing of the surgeon, assistant surgeon, anesthesiologist, holding area nurse, circulating nurse and scrub nurse. The nurse’s responsibilities include the verification of the pre operative checklist, composing of the informed consent, various preparations, and if prescribed medications are given as well as for availability of blood and intravenous access. Knowing the indicated surgical intervention well is beneficial for the nurse to know the exact position and skin preparation to be done. The principles of surgical asepsis are being strictly utilized during this phase and include preparations in terms of layout, health of surgical team, surgical attire, and surgical scrub. The overall goal of the nurse is to ensure patient safety and promote homeostasis, so there is careful dispensing of supplies and instruments and there is strict maintenance of aseptic environment. The circulating nurse is in charge of monitoring the patient’s well being in collaboration with the anesthesiologist and the surgeon, dispensing solutions, supplies and instruments, and documenting the progress of the surgery. The scrub nurse, on the other hand, assists the surgeon by handling instruments and supplies to the surgeon while maintaining surgical asepsis.

c. Post operative phase: It is from the time of admission in the recovery room to the time of follow up evaluation. This is the last phase of perioperative nursing and it is usually as well critical as other phases since the recovery of the patient from the surgical intervention is being monitored. The anesthesia report and the nurse’s notes from the intra – operative phase are being well verified prior to admission to recovery room to make sure that the patient is undergoing as what is expected. Again, the use of nursing process involving assessment, planning, implementation and evaluation are the keys to hastened recovery. The ABCs or airway, breathing, and circulation, oxygen saturation and ventilation, vital signs and level of consciousness are being assessed and given priority. Drainage, fluid status and hydration are also checked. Patient’s ability to move, gag, and discomforts are later assessed to know if the patient is ready to be transferred out from recovery room. And lastly, patient’s safety is ensured by putting the side rails always up.

In all these phases surgical team has a vital role from admision till discharge of patient. So each phase is being strictly monitored by surgical team memebers in order to avoid post operative complications.