OR

• Perioperative nursing


  A registered nurse's planned patient-centered approach in providing care to patients preoperatively, intraoperatively and postoperatively
• Nursing goals


  • Quality improvement
  • Patient safety
  • Teamwork and collaboration
  • Effective communication
  • Timely assessment and deliver intervention
  • Patient advocate
  • Cost containment
• Classification of surgery


  • Seriousness: Major, Minor
  • Urgency: Elective, Urgent, Emergency
  • Purpose: Diagnostic, Ablative, Palliative, Reconstructive/Restorative, Procurement of Transplant, Constructive, Cosmetic
• Surgical risk factors


  • Smoking
  • Age
  • Nutrition
  • Obesity
  • Obstructive Sleep Apnea (OSA)
  • Immunosuppression
  • Fluid and Electrolyte Imbalance
  • Postoperative Nausea and Vomiting
  • Post Operative Urinary Retention
  • Venous Thromboembolism
• Nursing knowledge base


  • Perioperative communication
  • Hand-off communication
  • Glycemic control and infection prevention
  • Pressure ulcer prevention
• Phases of perioperative nursing

  • Preoperative phase
  • Intraoperative phase
  • Postoperative phase
• Preoperative surgical phase: Nursing process and assessment

  1. Determine the patient's expectations of surgery and the road to recovery

  2. Nursing history including information about advance directives

  3. Medical history screening for conditions that increase surgical risks

  4. Surgical history checking for complications in prior surgeries

  5. Maintain normal baseline function
• Preoperative surgical phase: Nursing process and assessment


  • Screen patients carefully
  • Take necessary precautions
  • Collaborate with health care provider
• Preoperative surgical phase: Nursing process and assessment


  • Medications: Inpatient vs. outpatient, Hold WARFARIN
  • Allergies: Medications, topical agents, latex, food
  • Smoking habits
  • Alcohol ingestion and substance abuse and use
  • Pregnancy
  • Perceptions and knowledge regarding surgery
• Preoperative surgical phase: Nursing process and assessment

  • Support sources
  • Occupation
  • Preoperative pain assessment
  • Review of emotional health: Self concept, Body image, Coping resources
  • Cultural and spiritual factors
• Preoperative surgical phase: Physical examination

  • General survey
  • Head and neck
  • Integument
  • Thorax and lungs
  • Heart and vascular system
  • Abdomen
  • Neurological status
  • Diagnostic screenings
• Preoperative surgical phase: Diagnostic & laboratory

  • Hgb - Hemoglobin (Oxygen Level & Blood Replacement)
  • Hct - Hematocrit (Wound Healing)
  • Platelet Count - (Risk for Bleeding)
  • WBC count - (Infection level)
  • PT - (Risk for bleeding / Clotting time)
  • PTT - (Risk for bleeding / Clotting time)
  • Glucose - (Sugar level / Wound Healing)
• Preoperative surgical phase: Nursing diagnosis

  • Ineffective airway clearance
  • Anxiety
  • Ineffective Coping
  • Impaired skin integrity
  • Risk for aspiration
  • Risk for perioperative positioning injury
  • Risk for infection
  • Deficient knowledge (specify)
  • Impaired physical mobility
  • Ineffective thermoregulation
  • Nausea
  • Acute pain
  • Delayed surgical recovery
• Preoperative surgical phase: Planning

  1. Review and modify the plan during the intraoperative and postoperative periods

  2. Setting priorities

  3. Teamwork and collaboration

  4. Preoperative instruction gives patients time to make necessary preparations
• Informed consent


  Surgical procedures require documentation of consent
• Privacy and social media

  Do not discuss confidential patient information in public areas or use social media to convey patient information; posting patient information and photos on websites is prohibited
• Preoperative surgical phase: Implementation

  1. Minimize risk for surgical wound infection: Antibiotics, Skin antisepsis, Clipping instead of shaving hair

  2. Maintaining normal fluid and electrolyte balance: IV fluid replacement, Parenteral nutrition

  3. Preventing bowel incontinence and contamination: Bowel preparations
• Preoperative surgical phase: Implementation (Cont.)


  Preparation on the day of surgery: Hygiene, Preparation of hair and removal of cosmetics, Removal of prostheses, Safeguarding valuables, Preparing the bowel and bladder, Vital signs, Prevention of DVT - Antiembolism devices, Administering preoperative medications, Documentation and hand-off, Eliminating wrong site and wrong procedure surgery
• Preoperative surgical phase: Implementation (Cont.)

  1. Through the patient's eyes: Evaluate whether the patient's expectations were met with respect to surgical preparation

  2. Patient outcomes: Deficient knowledge, Anxiety
• Transport to the Operating Room


  Notification, Transportation, Verify patient's identity, Family, Prepare room for patient's return
• Preanesthesia Care Unit


  1. PCU nurse: Inserts IV catheter, Administers preoperative medications, Monitors vital signs

  2. Anesthesia provider: Performs patient assessment
• Intraoperative Surgical Phase


  1. Nursing process: Assessment, Nursing diagnosis, Planning, Goals and outcomes, Setting priorities, Teamwork and collaboration

  2. Acute care: Physical preparation, Intraoperative warming, Latex sensitivity/allergy
• Intraoperative Surgical Phase: Implementation

  1. Introduction of anesthesia: General anesthesia, Regional anesthesia, Moderate (conscious) sedation

  2. Positioning the patient for surgery

  3. Documentation of intraoperative care
• Intraoperative Surgical Phase: Implementation (Cont.)

  1. Through the patient's eyes: Keep the family informed, Ask family members if they have questions

  2. Patient outcomes: Evaluate a patient's ongoing clinical status during surgery
• Principles of sterile technique

  • All objects used in a sterile field must be sterile
  • A sterile object becomes non-sterile when touched by a non-sterile object
  • Sterile items that are below the waist level, or items held below waist level, are considered to be non-sterile
  • Sterile fields must always be kept in sight to be considered sterile
  • When opening sterile equipment and adding supplies to a sterile field, take care to avoid contamination
  • Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated
  • Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile
  • If there is any doubt about the sterility of an object, it is considered non-sterile
  • Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas
  • Movement around and in the sterile field must not compromise or contaminate the sterile field
• Sterile items


  • Items that are below the waist level, or items held below waist level, are considered to be non-sterile
  • Sterile fields must always be kept in sight to be considered sterile
• Opening sterile equipment and adding supplies to a sterile field

  Take care to avoid contamination
• Sterile barrier


  Any puncture, moisture, or tear that passes through it must be considered contaminated
• Sterile field


  The border of one inch at the edge of the sterile drape is considered non-sterile
• If there is any doubt about the sterility of an object, it is considered non-sterile
• Sterile persons or sterile objects


  May only contact sterile areas
• Non-sterile persons or items


  Contact only non-sterile areas
• Movement around and in the sterile field must not compromise or contaminate the sterile field
• Immediate postoperative recovery (Phase I)


  • Notification and arrival
  • Hand-off: OR to PACU
  • Patient monitoring and assessment
  • Modified Aldrete score
  • Modified postanesthesia recovery score (PARS)
  • DASAIM discharge assessment tool
  • Discharge and hand-off: PACU to Acute Care
• Recovery in ambulatory surgery (Phase II)

  • Postanesthesia recovery score (PARS)
  • Postoperative convalescence
• Nursing Process


  1. Assessment

  2. Nursing diagnoses

  3. Planning

  4. Implementation

  5. Evaluation
• Assessment


  • Through the patient's eyes
  • Airway and respiration
  • Circulation
  • Temperature control
  • Malignant hyperthermia
  • Fluid and electrolyte balance
  • Neurological functions
  • Skin integrity and condition of the wound
  • Metabolism
  • Genitourinary function
  • Gastrointestinal function
  • Paralytic ileus
  • Comfort
• Untoward Incident like profuse bleeding, bring back the patient immediately to the OR
• Nursing diagnoses for postoperative patients

  • Ineffective airway clearance
  • Anxiety
  • Risk for infection
  • Deficient knowledge (specify)
  • Impaired physical mobility
  • Impaired skin integrity
  • Nausea
  • Acute pain
• Planning


  1. Goals and outcomes

  2. Setting priorities

  3. Teamwork and collaboration