Introduction to Perioperative Nursing

Phases of the surgical experience

*Begins when the patient is informed of the need for surgery; surgical procedure and recovery, and continues until the patient resumes his/her usual activities

*encompasses the three phases

*Begins when the patient is informed of the need for surgery and makes the decision to have the procedure
*Ends when the patient is transferred to the operating room bed

What phase is the period that is used to physically and psychologically prepare the patient for surgery?

Can be lengthy if elective or brief if urgent surgery

What nursing activities are in the preoperative phase?
Patient support
Preparation for surgery

*Begins when the patient is transferred to the operating room bed
*End with transfer to the PACU/ AMU

What nursing activities are in the intraoperative phase?
Patient Safety
Facilitation of Procedure
Prevention of Infection
Satisfactory physiologic response to anesthesia/ surgical procedure

*Begins with the patient’s transfer to the recovery unit
*Ends with the resolution of surgical sequelae
(May be brief or extensive- most commonly ends outside the facility)

Where does the care stop from perioperative nurses?
*No care beyond PACU

What nursing activities are in the postoperative phase?
Support the physiologic systems
Reinforce essential information that patient needs for discharge

Nursing Process through out perioperative period

Assessment (perioperative)
Assessments happen multiple times throughout the process:
*Week/ more before surgery
*Just prior to surgery
*Telephone conversation

Perioperative nurse upon entry to OR: quick physical inspection, review of record (dx testing and assessment from previous encounter)

Diagnosis (Perioperative)
Knowledge Deficit
Increased risk for infection
(individually tailored)

Planning (perioperative)
Starts before the patient is even seen; based off of previous assessments, knowledge of the planned procedure, resources required
(Individually tailored)

Intervention (perioperative)
Nurse provides, coordinates, supervises, and documents care within the framework of accepted standards of care

Evaluation (perioperative)
Evaluates results of nursing care in relation to the extent that expected patients outcomes have been met.

Nursing Process Goal
Provide care to patients and support to their families, using the nursing process to assist patients/families in making decisions and to meet and support the need of patients undergoing surgical or other invasive procedures


Nursing Process Outcome
The patient will achieve a level of wellness equal to or greater than the level prior to surgery


Four domains of the AORN perioperative patient-focused Model
1. Patient safety
2. Physiologic response
3. Behavioral response
4. Health system

Four aspects of patient care addressed in the plan for each patient
1. Physiological
2. Psychological
3. Sociocultural
4. Spiritual

In which setting is perioperative nursing provided?
Office/ Practice
Pre admission testing (PAT)
Field/ Military
Freestanding Clinic (Bone/Joint center, etc)
Radiology/ Cath Lab

Roles of the Perioperative Nurse
Patient assessments
Patient/Family Teaching
Patient/Family support
Patient advocacy
Scrub Nurse
Circulating Nurse
Control the Environement
Coordination of activities
Maintanence of asepsis
Monitoring patient physicological and psychological status
Supervision of ancillary personnel
Communication/ Collaboration

Registered Nurse First Assist

Practices under the direction of the surgeon ans assists the surgeon during intraoperative phase

Members of the surgical team
Sterile team
Non Sterile team

Sterile Team
“Scrub” in ; work within the sterile field
*Primary surgeon
*Scrub person (Selects proper equipment)

Non Sterile Team
Carry responsibilities outside the “field”/ no sterile attire
*Circulating RN
*XRay Techs
*Vender of the product that is inserted
*Lab techs
*Environmental services

Circulating RN Role
*Provides emotional support to patient before anesthesia
*Performing ongoing patient assessment
*Documenting patient care
*Teaching patients and family
*Obtaining appropriate surgical supplies and equipment
*Create/ maintain safe environment
*Administer drugs
*prepare/ dispose specimens
*Communicating relevant info to patient’s family

Scrub Person Role
*Selecting proper equipment for the surgery
*Prepare and set up sterile field
*Scrubbing in, gowning up
*Maintaining a sterile field
*Anticipating surgeon’s needs throughout surgery
*Preparing sterile dressings
*Perform counts of equipment

*First impression
*Positive image
*Proper etiquette
*Professional meetings
*Continuing education

Florence Nightingale and Surgical Services
*Washing hands prevent infections
(Crimean War mortality from 42% to 2%!)

*Clean Technique
-Change the unsanitary conditions
-include handwashing

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