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• Perioperative Patient Care Team:

  • Surgeon:
  • Leads the surgical team and performs the surgical procedure
  • Collaborates with other team members for patient's overall care
  • Anesthesiologist/CRNA (Certified Registered Nurse Anesthetist):
  • Administers anesthesia, monitors vital signs, and manages pain
  • Ensures patient's safety and comfort throughout perioperative period
  • Perioperative Nurses:
  • Circulating Nurse: Coordinates activities, manages supplies, ensures aseptic conditions
  • Scrub Nurse/Scrub Tech: Assists surgeon by maintaining sterile instruments
• • Surgical Technologist:
  • Assists in preparing the operating room, handles surgical instruments
  • Perioperative Nurse Practitioner (NP) or Physician Assistant (PA):
  • Collaborates in providing comprehensive patient care
  • Other Allied Health Professionals may be involved in specific procedures
• Professional Credentialing:

  • Education and Licensure:
  • Licensure implies independence after passing state examination
  • Certifications:
  • Documented validation of professional achievement
  • Continuing Education
  • Team Collaboration
  • Quality Improvement
  • Adherence to Standards and Guidelines
  • Credentialing and Privileging
  • Patient-Centered Care
• The Surgical First Assistant:

  • Specialized healthcare professional assisting in surgery
  • Works closely with surgical team, providing support
  • Requires knowledge in surgical anatomy, pharmacology, psychomotor dexterity, procedure knowledge, and surgical site management
• Administration of Perioperative Patient Care Services:

  • Establishing Administrative Roles
  • Magnet Recognition Program for ongoing nursing care excellence
  • Management of Surgical Services
  • Managerial Responsibilities including leadership, quality, safety, staffing, and training
• Key Aspects Highlighting the Significance of the Patient in Healthcare:

  • Patient-Centered Care
  • Health Promotion and Disease Prevention
  • Diagnosis and Treatment
  • Compassion and Empathy
  • Informed Consent
  • Patient Safety
  • Communication
  • Holistic Approach
  • Patient Education
  • Cultural Competence
  • Advocacy
  • Feedback and Patient Experience
  • End-of-Life Care
• Perioperative Pediatrics:

  • Care of pediatric patients in perioperative period
  • Requires specialized skills, knowledge, and considerations
  • Includes preoperative, intraoperative, and postoperative phases
• Aspects of Perioperative Pediatrics:

  • Preoperative Assessment:
  • Pediatric Anesthesia
  • Developmental Considerations
  • Child-Friendly Environment
  • Family-Centered Care
• Family-Centered Care:

  • Involving parents or guardians in the care process and decision-making
  • Providing support and education to parents about the surgical procedure and postoperative care
• Communication with Children:

  • Using age-appropriate language to communicate with pediatric patients
  • Offering explanations and reassurance to alleviate fears and concerns
• Pediatric Surgical Teams:

  • Collaborative efforts involving pediatric surgeons, anesthesiologists, nurses, and other specialists
  • Teams should have expertise in managing pediatric-specific conditions and surgical interventions
• Pediatric-Specific Equipment:

  • Utilizing equipment and instruments designed for smaller sizes
  • Ensuring appropriate monitoring and anesthesia delivery systems for pediatric patients
• Postoperative Pain Management:

  • Involving parents or guardians in the care process and decision-making
  • Implementing tailored pain management strategies for pediatric patients
  • Considering age-appropriate pain assessment tools and medication dosages
• Age-Related Surgical Considerations:

  • Understanding the unique challenges associated with different age groups (neonates, infants, toddlers, school-age children, adolescents)
  • Recognizing anatomical and physiological differences in pediatric patients
• Pediatric Emergencies:

  • Preparedness for potential pediatric emergencies during surgery
  • Having protocols in place for rapid response to complications
• Pediatric Recovery:

  • Implementing a structured postoperative recovery plan
  • Monitoring for complications and ensuring a smooth transition to the post-anesthesia care unit (PACU)
• Pediatric-Specific Procedures:

  • Involving parents or guardians in the care process and decision-making
  • Conducting age-appropriate diagnostic and therapeutic procedures
  • Adapting techniques to accommodate the unique needs of pediatric patients
• Education and Training:

  • Ongoing education and training for healthcare professionals in pediatric perioperative care
  • Simulation exercises for practicing pediatric-specific scenarios
• Nutritional Considerations:

  • Addressing specific nutritional needs of pediatric patients before and after surgery
  • Collaborating with dietitians to optimize perioperative nutrition
• Psychosocial Support:

  • Recognizing and addressing the emotional and psychological impact of surgery on pediatric patients and their families
  • Offering support services such as child life specialists
• Research in Pediatric Surgery:

  • Engaging in research to advance knowledge and improve outcomes in pediatric perioperative care
  • Participating in clinical trials for pediatric surgical interventions
• Three phases of the surgical experience:

  • Preoperative phase
  • Intraoperative phase
  • Postoperative phase
• Scope of perioperative nursing practice includes:

  • Nursing assessment
  • Diagnosis screening
  • Informed consent
  • Physical preparation
  • Preoperative teaching
  • Spiritual preparation for surgery
  • Preoperative medications
• Members of the surgical team:

  • Surgeon
  • Anesthesiologist
  • Surgical nurse
  • Surgical technologist
  • Perioperative nurse
• Perioperative nursing measures:

  • Nursing history assessment
  • Past surgical history assessment
  • Allergy assessment
  • Smoking and alcohol habits assessment
  • Occupation assessment
  • Emotional health assessment
• Effects of anesthesia:

  • Anesthesia reduces or eliminates pain during surgery
  • Anesthesia induces a state of unconsciousness or sedation
  • Anesthesia can cause side effects such as nausea, vomiting, and confusion
• Techniques for preventing and managing postoperative complications:

  • Monitor vital signs regularly
  • Ensure proper wound care
  • Administer medications as prescribed
  • Encourage early ambulation
  • Prevent infection through proper hygiene
• Outcomes a patient can be expected to achieve following a surgical intervention:

  • Relief of symptoms
  • Improved function
  • Recovery and healing
  • Prevention of complications
  • Improved quality of life
• Steps in planning patient discharge:

  • Evaluate patient's readiness for discharge
  • Provide postoperative instructions
  • Arrange follow-up appointments
  • Coordinate home care services if needed
  • Ensure patient understands medication instructions
• Reasons for preoperative medication:

  • Reduce anxiety
  • Promote relaxation
  • Reduce pharyngeal secretions
  • Prevent laryngospasm
  • Inhibit gastric secretions
  • Decrease the amount of anesthetic required for induction and maintenance of anesthesia
• Preoperative medications categories:

  • Sedatives and hypnotics:
  • e.g., pentobarbital sodium (Nembutal), secobarbital sodium (Secobarbital), chloral hydrate
  • H2-receptor antagonists:
  • e.g., cimetidine (Tagamet), ranitidine hydrochloride (Zantac), famotidine (Pepcid)
  • Opioid analgesics:
  • e.g., meperidine hydrochloride (Demerol), morphine sulphate, hydromorphone hydrochloride (Dilaudid)
  • Tranquilizers:
  • e.g., chlorpromazine hydrochloride (Thorazine), hydroxyzine hydrochloride (Vistaril), diazepam (Valium)
  • Anticholinergics:
  • e.g., atropine sulphate, scopolamine (Hycosine)
• • Antiemetics:
  • e.g., metoclopramide (Reglan), droperidol (Inapsine), promethazine hydrochloride (Phenergan)
• Preparation on the day of surgery:

  • Morning bath and mouth care
  • Provide a clean gown
  • Remove hair pins, braid long hair, and cover hair with a cap
  • Remove dentures, foreign materials, colored nail polish, hearing aids, glasses, and contact lenses
  • Take baseline vital signs before pre-op meds
  • Check ID band
  • Check for special orders: enema, gastric tube, IV line
  • Have the client void before pre-operative medications
  • Continue to support emotionally
  • Accomplish the Pre-op Checklist
• Transporting to surgical area:

  • Provision of a comfortable stretcher
  • Provision of sufficient blankets
  • Provision of safety measures
  • Proper identification of surgical patient
  • Proper greeting of the patient
  • Provision of a quiet environment
• Preoperative Checklist:

  • Informed consent
  • Surgeon/nurse conference
  • Laboratory tests
  • Skin preparation
  • Bowel preparation
  • IV fluids
  • Preoperative medications, sedation, and antibiotics
  • Removal of dentures, nail polish, and jewelry
  • NPO status
• General Anesthesia:

  • Produces total loss of consciousness by blocking awareness centers in the brain, amnesia, analgesia, hypnosis, and relaxation
  • Stages of GA:
  • Induction
  • Excitement
  • Operative or Surgical Anesthesia
  • Medullary Depression/Danger
  • Administration of GA:
  • Inhalation of gases and/or volatile agents
  • Intravenous infusion of barbiturates or nonbarbiturates
  • GA Delivery Methods:
  • Laryngeal mask
  • Intranasal intubation
  • Oral intubation
  • Adjuncts to GA:
  • Hypnotics: e.g., midazolam (Versed), diazepam (Valium)
• • Opioid analgesics: morphine sulphate, meperidine hydrochloride (Demerol), fentanyl citrate (Sublimaze)
  • Neuromuscular blocking agents
• Complications of GA:

  • Malignant hyperthermia
  • Overdose
  • Complications to anesthetic agents
  • Complications of ET intubation
• Regional Anesthesia:

  • Nerve Block
  • Spinal Anesthesia
  • Epidural Anesthesia
  • Types of Regional Agents
• Local Anesthesia:

  • Topical Local Anesthesia
  • Infiltration Local Anesthesia