Perioperative care

Jana Heřmanova,

Hana Svobodova

Three phases

Preoperative Intraoperative Postoperative

Types of surgery

According to purpose– Diagnostic– Palliative– Ablative– Constructive/reconstructive– Transplant

…types of surgery

According to degree of urgency– Emergency surgery– Elective surgery

…types of surgery

According to degree of risk– Major surgery– Minor surgery

The risk factors

Age General health Nutritional status

Medications – Anticoagulants– Diuretics

Mental status

Preoperative phase

Informed consent– Nature and intention of surgery– Name and qualification of the person performing

surgery– Risks, including damage, disfigurement, even

death– Chances of success– Possible alternative measures– The right of the client to refuse consent

…preoperative phase

Routine tests– CBC– Blood group and crossmatching– Serum electrolytes– FBS (hemocoagulation)– Urea and creatinine– Liver tests (AST, ALT, LDH, bilirubin)– Urine analysis– Chest x-ray– ECG

Preoperative teaching

Information – what will happen, when, expected sensations, discomfort

Psychosocial support to reduce anxiety The roles of the client and the family in

preoperative period, during surgery and after surgery

Skills training

Skills training

Moving Deep breathing Coughing Splinting incision with the hands or a pillow Using an incentive spirometer

Physical preparation

Nutrition and fluids– NPO– Fluids up to 2 hours prior– Light breakfast 6 hours – Heavy meal 8 hours

Elimination– Enema (not routine)– Retention catheters

when neccessary

Hygiene– Shower– Trimmed nails, remove

polish, cosmetics– Remove jewelry, denture

Rest and sleep– Offer sedatives

Valuables– Label and put in

safekeeping

…physical preparation

Medications– Sedatives– Narcotics– Anticholinergics– Antihistamins– Neuroleptoanalgesics

Vital signs

Prostheses– Check and remove

dentures, loose teeth, lenses, etc.

Skin preparation– shaving

Antiembolic stockings

Intraoperative phase

Surgical skin preparation Positioning

– Visualization of and access to the surgical site– Optimal access for assessing and maintaining

anesthesia and vital functions– Protection of the client from harm

Postoperative phase

Clients admitted to PACU (ICU) Discharged to standard unit when:

– Are conscious and oriented– Able to maintain clear airway, deep breathe, cough– Vital signs stable– Protective reflexes (swallowing) – Able to move four extremities– I + O adequate (30ml/hr)– Afebrile– Dressings dry and intact, no obvious bleeding

Ongoing postoperative care - assessment

Vital signsSkin color and temperature – tissue perfusionComfort – level and localization of painDressing and bedclothes

Fluid balance – IV intake, urinary output, amount of drainage

Drains and tubes – color, consistency, amount of drainage

Check suction equipment

Potential problems

Pneumonia Pulmonary embolism Atelectasis Hemorrhage Trombophlebitis Urinary retention

Nausea and vomiting Constipation Postoperative ileus Wound complications

– Infection– Dehiscence– Evisceration

Postoperative depression/delirium

…management

Pain Positioning Deep breathing and

coughing exercise Leg exercises Moving and ambulation

Hydration Diet Urinary elimination Suction Wound care Wound drains and

suction

Tube drain

Penrose drain

Tube drain

Tube drain, gravity drainage

Jackson-Pratt, Redon

Thoracic drainage