Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Perioperative Nursing

the nurse in the intraoperative phase
  • Perioperative nursing includes those activities performed by the nurse in the preoperative, intraoperative and postoperative phases of surgery.
  • Surgery refers surgical operation or procedure, especially one involving the removal or replacement of a diseased organ or tissue. It is a planned alteration that encompasses three phases collectively called the perioperative period.
  • Perioperative nurses are registered nurses who work in hospital surgical departments and ambulatory surgery units; they work closely with the surgical patient, significant others, and other healthcare professionals throughout the perioperative period.
Phases of the Perioperative Period
  • preoperative phase-->begins when the client decides to have surgery and ends when the client is transferred to the operating room bed
  • intraoperative phase-->begins when the client is transferred to the operating room bed and ends when the client is brought to the postanesthesia area
  • postoperative phase-->begins with the admission of the client to the postanesthesia area and ends with the discharge of the client from the hospital or facility providing the continuing care.
The Desired Outcomes for Surgery
  • The client will be free from injuries related to positioning, retained foreign objects, chemical, physical, or electrical hazards.
  • The client will be free from infection.
  • The client's skin integrity will be maintained.
  • The client's fluid and electrolyte balance will be maintained.
  • The client will demonstrate and understanding of the physiologic and psychologic responses to the planned surgery.
  • The client will participate in a rehabilitation process after the surgery.
Types of Surgery

Surgical procedures are commonly grouped according to:
  • degree of urgency
    • elective surgery-->planned weeks or months ahead and based on the client's choice; performed for client's wellbeing and not absolutely necessary for life
    • emergency surgery-->performed to preserve the client's life, body part, or function
  • degree of risk-->surgery may be minor or major; day surgeries are generally considered minor
  • purpose
Factors Influencing Surgical Risk
  • Age-->very young and very old clients are at an increased risk
  • Nutrition-->Emaciated, malnourished, and obese clients face greater risks
  • Fluid & electrolyte balance-->dehydration, hypovolemia, and electrolyte imbalances put clients at greater surgical risks
  • General health-->infection, diseases of the the cardiovascular and respiratory systems. metabolic disorders, and specific disorders affecting the renal and liver function place clients at greater risks
  • Medications
    • anticoagulants (aspirin and NSAIDS)-->predisposes to hemorrhage; to be discontinued 2 wks. prior to surgery
    • tranquilizers (e.g. phenotiazenes)-->may cause hypotension and eventual shock
    • antibiotics-->aminoglycosides may increase effects of anesthesia and may cause respiratory paralysis
    • diuretics-->may cause electrolyte imbalances
    • antihypertensives-->causes hypotension that may result to shock
    • long-term steroid therapy-->may cause adrenocortical suppression
  • Type of surgery planned-->major surgery poses greater risks
  • Psychologic status-->excessive fear or anxiety can increase surgical risk
Nursing Responsiblilities in the Preoperative Phase
  • Provide psychologic support
    • assess client's fears, anxieties, support systems, and patterns of coping
    • establish trusting relationship with client
    • explain routine procedures and encourage client to ask questions
    • demonstrate confidence in surgeon and staff
    • provide for spiritual care, if appropriate
  • Provide preoperative teaching-->usually done on outpatient basis
    • assess client's level of understanding of procedure and its implications
    • clarify and reinforce teachings given by surgeon
    • explain routine and and pre-op procedures and special equipments to be used
    • teach and explain the importance if the ff: coughing and deep breathing exercises, splinting, turning in bed, leg exercises
    • assure client that pain management will be available after the surgery
  • Physical preparation
    • obtain client's medical history: allergies, medications, surgical procedures, dietary restrictions
    • perform baseline assessment, include VS, height, weight
    • ensure that routine diagnostic procedures are preformed: CBC,PT/PTT, electrolytes,urinalysis, ECG, bloodtyping and crossmatching, CXR
    • skin preparation-->reduces risk for infection
      • let client shower using antibacterial soap if ordered
      • shave or clip hairs and cleanse appropriate areas if ordered
    • administer enema if ordered
    • promote adequate rest and sleep
    • instruct client to remain NPO after midnight as ordered-->prevents vomiting and aspiration during surgery
  • Legal Responsibilities-->Ensure that surgeon obtains informed consent from client before surgery
      • confirm that client understands information given
      • if witnessing consent, specify if witnessing explanation of surgery or just signature of client
        • NOTE: Informed Consent is necessary for each operation performed, including minor ones and should be witnessed by a legally authorized person (another physician, nurse). An adult client (over 18) signs his own consent unless unconscious or mentally incompetent. If unable to sign, relative or next of kin will sign. In emergency cases, telephone or via telegram is acceptable (have a second listener available if securing consent via telephone). For minors undergoing surgery, a parent or legal guardian can sign the consent. An emancipated minor may sign his or her own consent (college student living away from home, married minor, any pregnant female or any who has given birth). For emergency care, consents are not needed provided the following criteria are met:
            • there is an immediate threat to life
            • experts agree that it is an emergency
            • client is unable to consent
            • a legally authorized person cannot be reached
  • Preparation immediately before surgery
    • obtain baseline VS, report deviations from the normal range
    • provide oral hygiene,remove dentures, dress client in clean gown
    • remove nail polish, contact lenses, prostheses, jewelry, hair accessories
    • instruct patient to empty bladder
    • check client's identification band
    • administer pre-op medications as ordered
      • narcotic analgesics-->to relax client, enhance effectiveness of general anesthesia
      • sedatives-->to decrease anxiety and promote sleep
      • anticholinergics--to decrease risk of aspiration, undesirable effects of anesthesia (e.g. bradycardia)
    • elevate side rails and provide quiet environment
    • prepare client's chart, attach operative permit, and complete pre-op checklist
Nursing Responsibilities in the Intraoperative Phase
  • Assess the client's physiologic and psychologic status
  • Review the results of diagnostic tests and lab studies
  • Position the client for surgery
  • Perform the appropriate surgical skin preparation
    • remove soil and transient microbes from the skin using using appropriate antimicrobial agents
    • inspect surgical area for moles, rashes, pustules, irritations, or any broken and ischemic areas, record, and report them to the surgeon.
    • remove hair on surgical area as appropriate-->use clippers or chemical hair-removal agents to lessen risk of disrupting skin integrity
Nursing Responsibilities in the Postoperative Phase
  • Recovery Room Care:
    • assess for and maintain patent airway
      • position on side unless contraindicated or on back with head turned to side and chin extended forward
      • check for gag reflex.
      • maintain artificial airway in place until gag or swallow reflex returns
    • administer oxygen as ordered
    • assess respirations-->rate, depth, quality
    • check VS every 15 mins, until stable and then every 30 mins
    • note level of consciousness
    • assess color and temperature--check capillary refill, and mucous membranes
    • monitor all IV infusions
    • check all drainage tubes and take note of quality of drainage.
    • assess dressings for signs of complications such as hemorrhage
    • provide warmth
    • encourage client to cough and deep breath when artificial airway is removed
    • keep patient flat on bed if spinal anesthesia was usesd->check for sensation and movement in lower extremities
  • Surgical Floor Care:
    • promote and monitor for optimal respiratory functioning
      • coughing unless contraindicated
      • splinting
      • turning in bed every 2 hours
      • early ambulation
      • use of incentive spirometer every 2 hours
    • promote and monitor for optimal cardiovascular status
      • leg exercises every 2 hours
      • early ambulation
      • use of antiembolism stockings as ordered
    • promote adequate fluid and electrolyte balance
      • monitor IV fluids
      • measure I&O
      • irrigate NG tube
      • observe for signs of imbalances
    • promote optimum nutrition
      • assess for return of peristalsis-->bowel sounds, flatus
      • add progressively to diet as ordered, note client's tolerance
    • promote return of urinary function
      • measure I&O
      • report to surgeon if client has not voided 8 hours after surgery
      • assess for bladder distention
      • use measures to promote voiding
    • promote bowel elimination
      • encourage early ambulation
      • provide adequate food intake
      • keep stool record
    • provide pain management
      • analgesics as ordered
      • alternative measures such as guided imagery, relaxaton techniques
    • provide wound care
      • check dressings frequently-->should be clean, dry, and intact
      • observe aseptic technique when changing dressings
      • assess for and report signs of infection: redness, drainage, odor, fever
      • encourage diet high in protein and vitamin C for faster wound healing
      • observe for complications such as wound dehiscence or evisceration
    • provide psychologic support to client and significant others
    • provide health teachings: outpatient consultations, wound care, nutrition, medication regimen, activity restrictions, and possible complications

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