University of San Agustin

General Luna St., 5000 Iloilo City, Philippines

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COLLEGE OF NURSING, NUTRITION AND DIETETICS
NURSING PROGRAM

M1 Activity 1 Plenary
Activity 1: Perioperative Concepts and Nursing management

Instructions: This is a group activity. Pls. post your output here.

A. Preoperative Nursing Care

1. Describe preoperative nursing measures that decrease the risk for infection and other
postoperative complications.
- One of the nursing responsibilities in perioperative nursing is to abide with the principles of
aseptic technique in order to maintain sterility in the OR for the benefit of the healthcare team
and as well as the patient scheduled for operation or surgery. Nurses should practice and
observe these principles to avoid the spread of microorganisms that may cause infection
especially in the preoperative phase. The following are the preoperative nursing measures and
considerations to prevent the risk for infection:
● Preoperative skin decontamination is crucial to preventing wound infection,
especially in sterile procedures.
● Before surgery, it is advised to take a shower using either plain soap or antibacterial
soap.
● Surgical or OR scrubbing is very important before entering the OR to ensure clean
and sterile hands and forearms.
● Donning surgical gowns properly as well as performing closed gloving is necessary to
ensure sterility of the area.
● Practice the principles of aseptic technique.
● When considered absolutely necessary, hair removal at the surgical site must be done
with clippers preferably before the operation. Evidence suggests that patients who do
not have their hair removed may have even lower rates of SSIs.
● An alcohol-based antiseptic solution based on chlorhexidine gluconate should be used
to prepare the skin at the surgical site in the operating room by skilled professionals,
preferably registered nurses.
● Drapes that are sterile, non-woven disposable, or woven reusable are recommended.

2. Identify legal and ethical considerations related to obtaining informed consent for surgery.
- Information provided in informed consent. The nurse gives the client enough information
relevant to the intervention. Information examples include:
● The client's condition's characteristics.
● The nature, benefits, possible threats, and outcomes of the intervention or operation.
● Suitable alternatives for the planned intervention or procedure.
● What is likely to happen if the intervention or procedure is neglected.

- Communication. As a part of the healthcare team, the nurse attends to the client's
information needs and preferences. The nurse uses clear language to communicate with the
patient. He or she encourages the client or family to talk about worries, concerns, frustrations,
and anxieties as well as to vent their sentiments. The nurse, acting as the client's advocate,
ensures that the client has enough time to think on the course of treatment.
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- Witness of Consent. In order to get informed consent for treatment or a procedure, it is

preferable for a nurse to engage a witness. The nurse must participate in the entire informed
consent process when acting as a witness, from providing explanations to signing the consent
form.

- Documentation. The nurse verifies accurate documentation, which is essential to the consent
process overall. The crucial components are as follows:
● Intervention indications
● The intervention's justification.
● A description of what will happen if action is not taken.
● Post-intervention strategy
● Possible dangers.
● The client's reaction to the justification.

- Right of refusal or withdrawal of consent. The nurse respects the client's right to decline or
revoke consent given at any time, any place, at any time. In these circumstances, the nurse
records the client's decision.

- Consent in Minors. When a minor offers consent, parental engagement is recommended

unless it is not in the minor's best interests to do so. If a minor lacks the capacity, someone
with parental responsibility may offer consent.

- Mentally incapacitated client. Only in emergency instances, where the patient is

unconscious or incompetent and there is no available surrogate decision maker, and the
emergency measures would save death or disability, may the patient's agreement be
"presumed" rather than requested.

3. Discuss patient activities in the Preoperative phase of care.

- Patient is usually placed in “NPO after midnight” followed because anesthetics depress
gastrointestinal functioning and there was a danger the client would vomit and aspirate during
the administration of a general anesthetic. Prior to surgery, patient ensures his/her bladder
remains empty to help prevent injury to the bladder especially upon pelvic surgery. In some
settings, clients are asked to bathe or shower the evening or morning of surgery (or both).
The purpose of hygienic measures is to reduce the risk of wound infection by reducing the
amount of bacteria on the client’s skin. The client’s nails should be trimmed and free of
polish, and all cosmetics should be removed so that the nail beds, skin, and lips are visible
when circulation is assessed during the perioperative phases.In addition, adequate sleep helps
the client manage the stress of surgery and helps healing. All prostheses (artificial body parts)
such as partial or complete dentures, contact lenses, artificial eyes, and artificial limbs and
eyeglasses, wigs, and false eyelashes must be removed before surgery.

4. Explain preoperative assessment and education for older adults.

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- Preoperative assessment is done before moving the patient inside the OR/DR to assess health.
Preoperative assessment is an opportunity to identify and examine a patient’s health
physically and mentally that may lead to complications during surgery. Knowledge and
information are very crucial to older adults during pre assessment in order for them to be
aware of what nurses and physicians will do to them. One of their rights is to know
everything. So during preoperative procedures, nurses must explain the procedures, rights,
medication, and other surgical-related information.

5. Discuss management of nutrition and fluids preoperatively.

- Management of nutrition and fluids preoperatively is very important especially if you will
undergo an abdomen related surgical procedure. That said, nurses must instruct the patient not
to drink water, and void immediately right before surgery. But, in terms of nutrition,
malnourished patients are prone to complications such as reducing the ability to heal faster
and reduce the risk of bleeding, due to their low BMI and lack of nutrients. Nurses must
instruct the patient to eat food rich in vitamins weeks before their surgery, especially vitamin
k to reduce bleeding during surgery.

6. Explain bowel and skin preparation preoperatively.

● Bowel preparation
- Bowel preparation (or bowel prep) cleans and removes waste from the large intestine (colon)
and is usually done before colonoscopy.It involves taking medication that causes frequent,
loose bowel movements to empty the colon.
- The medication is taken by mouth, and typically comes in liquid form. It is best to provide
your doctor with a thorough medical history. Any medication allergies you may have must be
mentioned to the doctor and be sure to include it as well if you've ever had difficulty with a
bowel prep.
- The patient will need to consume a lot of a bowel preparation (laxative) solution to cleanse
your colon and rectum, it may feel queasy after drinking the solution because of its unpleasant
flavor.
- While doing the preparation, anticipate having numerous loose bowel movements with
minimal discomfort. However, some individuals may have nausea, vomiting, bloating
(abdominal swelling), or stomach pain.
- Do not eat solid foods after the bowel prep and the medications to take or stop taking before
your treatment will be advised by the doctor like Aspirin, ibuprofen (Advil, Motrin), and
other medications, as well as some vitamins and herbal therapies, might all increase the risk
of bleeding or interfere with any sedatives you could take to help you relax.
- Before the test, you could be requested to stop taking these. If unable to complete the bowel
preparation as instructed, call your doctor and ask what to do. It could be desirable to
postpone and reschedule the surgery.
● Skin Preparation
- Skin preparation or skin prep is the removal of as many bacteria as possible from the patient’s
skin through shaving, mechanical washing, and chemical disinfection. It helps to prevent
surgical site infections by cleaning the skin, eliminating debris from it, reducing the amount
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of resident and transitory bacteria, and decreasing the growth of microbes prior to surgical
operation.
- On the prep table, a sterile skin prep tray is opened. The prep tray is typically disposable,
although it always includes two or more towels and a tiny basin. for solutions, applicators,
and sponges (not to be confused with the counting sponges on the instrument tray).
- Remove hair with a specific clipping tool in the preoperative area and to offer a preparatory
cleaning of the entire surgical field on the day of the procedure, wipe with an antiseptic
solution (e.g chlorhexidine gluconate) also allows enough time to dry in order to maximize
adhesion and ensure good sterile draping.

7. Discuss immediate preoperative nursing interventions

- - A hospital gown that is untied is worn and open in the back is put on by the patient.
Jewelries and body piercing should be taken off before entering the operating room to prevent
injury (Fogg, 2001). To encourage continence, all patients should urinate right away before
entering the operating room. If a preanesthetic drug is administered the nurse monitors the
patient for any unfavorable drug reaction. Maintaining the preoperative record a preoperative
checklist that contains important components that should be checked before the surgery
(Meeker & Rothrock, 1999). The patient is transported to the presurgical area on a stretcher
greeted by name positioned comfortably 30-60 mins prior to the anesthetic to be administered.
The surgical site maximizes the patient's safety and ensures effective prevention and action
should any inconsistencies be found (Brown, Riippa & Shaneberger, 2001).
- The patient's family can wait in the waiting area in surgery centers while they wait for the
procedure to be completed. There are several reasons why a patient might stay in the
operating room longer than necessary. The surgeon might talk to the family in the waiting
area postoperatively to go over the results.

B. Intraoperative Nursing Care

1. Describe the interdisciplinary approach to the care of patients during surgery.

In the care of patients during surgery, it is uncommon to be under the care of only one health provider.
Thus, an interdisciplinary team of healthcare professionals delivers quality patient care. Nurses must
have the necessary skills and knowledge to work under the interdisciplinary team. With various
healthcare teams consisting of nurses, physicians and other healthcare professionals in the care of
patients during surgery, it is vital that they have a clear and effective communication with one another
in order to build strong work relationships, share resources and solve difficulties. An interdisciplinary
approach of caring involves members from different disciplines working together with a common
purpose, setting goals and making choices for the best possible outcomes for the patient.

During the interdisciplinary approach of care, different healthcare experts offer distinctive
perspectives on a patient’s condition. When treating a patient together, for example during a surgical
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procedure, a team of nurses, a surgeon, an anesthesiologist or cardiologist are likely to notice

symptoms unique to their field of expertise. They can individually address a particular component of
the patient’s illness on their own. But when they work together, they can offer thorough care that
addresses the patient’s varied symptoms, increasing likelihood for a successful recovery.

The combination of interdisciplinary approaches makes faster treatments and reduces errors during the
care of patients in surgery. Operations are made more efficient. Faster treatment speeds up the
recovery of a patient and subsequent hospital discharges, and accurate therapy reduces the need for
additional testing and examinations. As a result of the increased efficiency, hospitals are able to accept
more new patients, and patients also benefit from lower expenses associated with shorter stays.

2. Specify the principles of surgical asepsis.

1. Only sterile items are used within the - When preparing for surgical procedures,
sterile field. all equipment to be used during the
operation should be sterilized and
therefore free from pathogens.

2. Sterile persons are gowned and - The portion of your body covered by a
gloved; gowns are sterile from table gown that allows you to look forward
to chest level in front including and down to the level of the sterile field
sleeves to 2 inches above the elbow. is considered to be sterile. As a result,
only the front of a gown and the sleeves
that extend from the elbow down to the
level of the sterile area are considered
sterile.

3. Tables are sterile only at table level. - Keep at least one meter away from the
table when opening your gown because
if you accidentally contact the table
below the surface level, your gown
becomes unsterile.

4. Sterile persons touch only sterile - For instance, sterile team members must
items or areas. Unsterile persons maintain contact with sterile fields by
touch only unsterile items or areas means of gowns and gowns. On the
other hand, non sterile team members
(circulating nurses) do not directly
come into contact with the sterile field.
The circulating nurse opens the wrapper
on the sterile package to deliver
supplies to the sterile team members.

5. Unsterile persons avoid reaching over - Unsterile team members should never
the sterile field. Sterile persons avoid reach over the sterile field to transfer
leaning over unsterile areas any sterile items.
- In pouring solution into the sterile
basin, the circulating nurse holds only
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the lip of the bottle over the basin to

avoid reaching the sterile area.
- When a surgeon starts to sweat on their
brows, they should turn away from the
sterile field and allow the circulator to
remove the sweat.
- The scrub nurse drapes a nonsterile
table toward the self first to protect the
gown.
- The scrub nurse stands back from the
nonsterile table when draping to avoid
leaning over an unsterile area.

6. Edges of anything that encloses sterile - The margins of wrappers are one
content are considered unsterile instance where sterile and non-sterile
area boundaries are not always clearly
delineated. Peel-open package flaps
should not be torn while opening sterile
products; instead, they should be pulled.
Flip the sterilized contents over and lift
it upward. The circulator should stop
sterile components from slipping over
non-sterile edges.

7. Unsterile persons avoid sterile areas - Unsterile personnel should be aware of

the sterile field's proximity. To avoid
contamination, they must be aware of
their proximity to the sterile area or
field. The unsterile staff should
maintain and observe a distance of at
least one foot (30 cm) from a sterile
field. All circulator activity should be
reduced to a minimum.

8. The sterile field is created as close as - The time that sterile items are
possible to the time of use uncovered and exposed to the
environment, is proportionate to the
degree of contamination. Sterile tables
are assembled prior to the operation
only and uncovering a sterile table for
later use is not recommended.

9. Sterile areas are continuously kept in - Sterile persons must face sterile areas.
view - When sterile packages are opened in an
operating room, or any sterile field is set
up, someone must remain in the room to
maintain vigilance, for example, the
circulating nurse.

10. Sterile persons keep well within the - To maintain sterility, sterile personnel
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sterile area drape the patient at a safe distance from

the operating table.
- To maintain sterility, a sterile person
should turn back when passing by an
unsterile person or area.
- Sterile individuals remain within the
sterile field or area.

11. Sterile persons keep contact with - To avoid contamination, movement

sterile area to a minimum within the sterile area must be kept to a
minimum.
- Sterile individuals should avoid leaning
over sterile tables or drapes.

12. Microorganisms must be kept to an - Sterilization is the removal of ALL

irreducible minimum microorganisms, including bacterial
spores. However, not everything or
every area can be sterilized.
- Since the skin cannot be sterilized,
proper surgical hand washing, gowning
and gloving and application of a sterile
drape prevents the entrance of
microorganisms to the patient’s wound.
- Drapes are not flipped or turned over to
avoid the spread of dust that may cause
contamination.

13. Destruction of the integrity of - Before opening a sterile package that

microbial barriers results in will be used in a specific procedure or
contamination operation, the package should be
thoroughly checked.
- All sterile packages should be placed on
a dry surface to avoid strike-through.
- If any part of the package becomes
damp or wet, it is considered unsterile
and should be discarded.

3. Describe the roles of the surgical team members during the intraoperative phase of care.

The Surgical Team Roles

The Patient The surgical patient undergoes operative

procedures to remove or replace damaged
organs/tissue.
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Surgeon The surgeon performs the surgical procedure,

heads the surgical team and who is specially
trained and qualified. He or she is responsible
for performing the surgery effectively and
smoothly.

Circulating Nurse The circulating nurse supervises the actions of

the surgical team, checks the OR's conditions,
continuously monitors the patient for signs of
injury, and then implements the necessary
interventions to manage the OR and safeguard
the patient's safety and health. A foremost
responsibility includes verifying consent; if not
obtained, surgery may not commence. The team
is coordinated by the circulating nurse, who
ensures cleanliness, proper temperature,
humidity, appropriate lighting, safe function of
equipment, and the availability of supplies and
materials. The circulating nurse monitors aseptic
practices to avoid breaks in technique. They also
monitor the patient and document specific
activities throughout the operation to ensure the
patient’s safety and well-being.

The Scrub Role The registered nurse, licensed practical nurse, or

surgical technologist (or assistant) performs the
activities of the scrub role, including performing
hand hygiene; setting up the sterile equipment,
tables and sterile field; preparing sutures,
ligatures, and special equipment and assisting
the surgeon and the surgical assistants during
the procedure by anticipating the instruments
and supplies that will be required, such as
sponges, drains, and other equipment. The scrub
nurse and the circulating nurse count all needles,
sponges, and instruments when the surgical
incision is closed to ensure that they are all gone
and won't be retained as a foreign body in the
patient.
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The Registered Nurse First Assistant The duties of an RNFA may involve handling
tissue, supplying exposure at the surgical site,
suturing, and maintaining hemostasis. The role
requires a thorough understanding of anatomy
and physiology, tissue handling, and the
principles of surgical asepsis. The RNFA must
be knowledgeable of the surgical objectives,
possess the skills necessary to anticipate
demands and function as an effective team
member, and be capable of managing any
emergency that may arise in the operating room.

The Anesthesiologist and CRNA The anesthesiologist or CRNA assesses the

patient before surgery, selects the anesthesia,
administers it, intubates the patient if necessary,
they also manage any technical issues that arise
during the administration of the anesthetic agent
and supervises the patient’s condition
throughout the surgical procedure.Prior to
starting anesthesia, the anesthesiologist or
CRNA reevaluates the patient's physical status
when they enter the operating room. During
surgery, the anesthesiologist or CRNA monitors
the patient’s blood pressure, pulse, and
respirations, as well as the electrocardiogram
(ECG), blood oxygen saturation level, tidal
volume, blood gas levels, blood pH, alveolar gas
concentrations, and body temperature.

4. Identify the adverse effects of surgery and anesthesia.

Potential Adverse Effects of Surgery and Anesthesia

Anesthesia and surgery disrupt all major body systems. Although most patients can compensate for
surgical trauma and the effects of anesthesia, all patients are at risk during the operative procedure.
These risks include the following:

● Allergic reactions
● Cardiac dysrhythmia from electrolyte imbalance or adverse effect of anesthetic agents .
● Myocardial depression, bradycardia, and circulatory collapse.
● Central nervous system agitation, seizures, and respiratory arrest
● Oversedation or under sedation
● Agitation or disorientation, especially in older adult patients
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● Drug toxicity, faulty equipment, and other types of human error

● Nerve damage and skin breakdown from prolonged or inappropriate positioning
● Hypotension from blood loss or adverse effect of anesthesia Infection
● Thrombosis from compression of blood vessels or stasis

5. Identify the surgical risk factors related to age-specific populations and nursing interventions
to reduce those risks.
Surgical risk factors in Geriatric Population:
● Sleep disturbance due to medications, pain, and change in environment.
● Postoperative delirium which causes confusion and disorientation to geriatric patients. This
may come and go and usually disappears within a week.
● Increased risk of pulmonary edema due to decreased cardiac and pulmonary output and poor
circulation.
● Postoperative cognitive dysfunction (POCD). A serious condition that leads to long-term
memory loss.
● Geriatric patients have a precipitous postoperative decline in physiologic reserve, which can
lead to organ failure.
Nursing interventions:
● Monitor also elderly patients for dehydration, hypovolemia, and electrolyte imbalances.
● Manage environment to minimize sleep-disturbing factors. (e.g. minimize noise, adjust room
temperature as needed, etc.)
● Instruct the patient in the use of pain rating scale to promote postoperative pain management.
● Maintain a safe environment for patients with cognitive impairment such as delirium.
● Allow the patient to express fears and anxiety.
● Careful transfer and repositioning of the patient. Protect bony prominences from prolonged
pressure. Provide gentle massage to promote circulation.

6. Compare types of anesthesia with regard to uses, advantages, disadvantages, and nursing
responsibilities.
Type of Anesthesia Uses Advantages Disadvantages Nursing
responsibilities

1. General anesthesia General - The onset of the - The patient is at a. Close operating room
- the loss of all anesthesia is IV-infused risk of respiratory doors; keep the room
sensation and used for major anesthesia is depression, quiet; stand by to assist;
consciousness. It is operations and pleasant, with no sneezing, initiate cricoid pressure
usually administered long surgical buzzing, or coughing, or if requested.
by IV infusion or by procedures. (e.g. dizziness. The laryngospasm. b. Remain at the
inhalation through a Major abdominal duration of action is patient’s side quietly
mask. surgery, brief, the patient - Postoperative and ready to assist the
Head or neck awakens with Nausea and anesthesiologist as
surgeries, minimal nausea and vomiting, needed.
Eye surgeries, vomiting. The c. Position the patient
Thoracic surgery, anesthetic agents - Depresses the and prep skin only when
and are nonexplosive, respiratory and the anesthesiologist
Neurosurgery.) require little circulatory indicates the loss of
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equipment, and systems. reflexes stage is reached

are easy to and under control.
administer. d. Prepare emergency
equipment to maintain
- Since the patient is airway and provide
unconscious rather mechanical ventilation
than awake and if needed.
anxious, respiration e. Continuous
and cardiac monitoring of the
functions are readily patient’s respiratory
regulated. rate, pulse rate, and
blood pressure.
- It can be adjusted f. Provide safety
depending on the measures (e.g. adequate
length of the lighting, raised side
operation, the rails, etc.) to prevent
client’s age, and injuries.
physical status. g. Assist in
interventions, delegate
tasks when appropriate,
and keep records.
h. Communicate with
the anesthetist and other
members of the team
effectively.

2. Regional a. Observe closely for

anesthesia - pain is signs of autonomic
controlled without the nervous system
loss of consciousness. blockade. Clinical
an anesthetic agent is manifestations include
injected around nerves bradycardia;
so that hypotension; nausea and
the region supplied by vomiting.
these nerves is b. Continuous
anesthetized. monitoring of vital
signs, mobility,
2.1. Epidural - Used to reduce - The advantage of - The greater response, and cognition
anesthesia - this is the pain of labor epidural anesthesia technical of the client.
achieved by injecting and delivery, and is the absence of challenge of c. Ensure that the
a local anesthetic lower limbs headaches that can introducing the patient is well hydrated
agent into surgeries. result from spinal anesthetic agent and remains lying down
the epidural space that anesthesia. into the epidural for up to 12 hours after
surrounds the dura space rather the anesthesia to
mater of the spinal than the minimize headache.
cord subarachnoid d. Provide safety
space. If measures (e.g. adequate
inadvertent lighting, raised side
puncture of the rails, etc.) to prevent
dura occurs injuries.
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during epidural e. Communicate with

anesthesia and the the anesthetist and other
anesthetic agent members of the team
travels toward the effectively.
head, high spinal f. Assist in
anesthesia can interventions, delegate
result; this can tasks when appropriate,
produce severe and keep records.
hypotension and
respiratory
depression, and
arrest.

2.2 Spinal anesthesia - - Uses of Spinal - Reduce nausea and - Nausea and
it requires lumbar anesthesia vomiting, Lower vomiting; severe
puncture through one depend on respiratory headache;
of the interspaces whether it is a complications, and hypotension due
between lumbar disk 2 low, mid, or high early postoperative to vasodilation.
(L2) and the sacrum spinal. Low recovery.
(S1). spinals (saddle or
caudal blocks)
are primarily
used for
surgeries
involving the
perineal or rectal
areas. Mid
spinals (below
the level of
umbilicus or
T10) can be used
for hernia repairs
or
appendectomy.
High spinals
(reaching the
nipple line or T4)
can be used for
surgeries such as
cesarean section.

2.3. Local conduction - Injected into or - Ease pain by

blocks around a nerve offering immediate
group to relief with fewer
suppress or side effects.
lessen pain.
Typically used
for pain in the
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back, legs, arms,

buttocks, neck,
and face.

3. Moderate sedation - Can be used in - The patient is able - Patient may a. Continuously monitor
- involves the IV procedures such to maintain a patent experience side the patient's vital signs.
administration of as endoscopies, airway, retain effects such as b. Assess the patient’s
sedatives or analgesic incision and protective airway headaches, level of consciousness
medications to reduce drainage of reflexes, and dizziness, and and cardiac and
patient anxiety and abscesses, and respond to nausea. respiratory functions.
control pain during balloon verbal and physical c. Secure resuscitative
diagnostic or angioplasty. stimuli. equipment, such as
therapeutic medications, artificial
procedures. airways, suction
supplies, and a
defibrillator, should be
readily available.
d. Provide safety
measures (e.g. adequate
lighting, raised side
rails, etc.) to prevent
injuries.
e. Communicate with
the anesthetist and other
members of the team
effectively.
f. Assist in
interventions, delegate
tasks when appropriate,
and keep records.

4. Monitored - Used for - Provide patient - Patients are at a. Monitor patient’s

Anesthesia care healthy patients comfort, improve risk of respiratory airway and breathing.
undergoing operating depression and b. Prepare emergency
relatively minor conditions, and airway obstruction equipment to maintain
surgical prevent the recall of because their airway and provide
procedures and unpleasant airway is not mechanical ventilation
for some perioperative externally secured if needed.
critically ill events. c. Continuous
patients who assessment and
may be unable to monitoring of vital
tolerate signs.
anesthesia d. Communicate with
without the anesthetist and other
extensive members of the team
invasive effectively.
monitoring and e. Assist in
pharmacologic interventions, delegate
support tasks when appropriate,
(Rothrock, and keep records.
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2014).

5. Local anesthesia - - Used for minor - Simple; - Increases a. Provide safety

surgical economical; patient’s level of measures (e.g. adequate
procedures such requires minimal anxiety. lighting, etc.) to prevent
as suturing a equipment; brief injuries.
small wound or postoperative b. Provide comfort
performing a recovery; measures to lessen the
biopsy. Undesirable effects level of anxiety.
of general c. Assist in
anesthesia are interventions, delegate
avoided; Ideal for tasks when appropriate,
short and superficial and keep records.
surgical procedures.

C. Postoperative Nursing Care

1. Describe the responsibilities of the post anesthesia care nurse in the prevention of immediate
postoperative complications.
Post-operative care is the stage of perioperative care that begins when a patient joins the PACU
(post-anesthesia care unit) and continues until the patient has recovered sufficiently to be transferred
from the PACU and into the appropriate recovery unit or released home.
In phase 1, the patient is waking up from anesthesia and requires one-on-one attention. The PACU
nurse evaluates the patient's state of awareness, breath sounds, respiratory effort, oxygen saturation,
blood pressure, heart rhythm, and muscular strength. During this phase, the patient is being readied
for transfer to phase 2 or to an inpatient nursing unit. During phase 2, the patient's awareness returns
to baseline, and the patient's respiratory, cardiac, and renal functions are stable. In the last phase,
patients who require extended observation and interventions after phases 1 or 2 may be admitted to a
24-hour observation unit or an in-hospital unit. Nursing care is provided until the patient is fully
recovered from anesthesia and surgery and is able to care for himself. Overall, the nurse was
responsible for monitoring vital signs, airway patency, and neurologic state, as well as any potential
problems. One of the treatments is also to analyze the surgical procedure and control pain, as well as
to maintain fluid and electrolyte balance. Lastly, presenting a complete report on the patient's state to
the receiving nurse on the recovery unt, as well as the patient's family.

Here are several issues to be aware of for each bodily system:

● Respiratory problems include hypoxia, aspiration, and laryngospasm.
● Cardiac conditions include hypotension, hypertension, and arrhythmias.
● Hypothermia or hyperthermia are thermoregulatory states.
● Nausea and/or vomiting are gastrointestinal symptoms.
● Neurologic: Difficulties with circulation and sensation, as well as madness or violence.
● Pain, surgical site problems, fluid management, and patient safety are all potential
consequences.
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2. Compare postoperative care of the ambulatory surgery patient with that of the hospitalized
surgery patient.
Outpatient treatment, often known as ambulatory care, does not need hospitalization.
However, inpatient care does require a patient to stay in a hospital overnight throughout
treatment and recuperation. In terms of postoperative care, outpatient surgery is frequently
referred to as same-day surgery (ambulatory). Unless the patient exhibits evidence of
postoperative complications, he/she will be discharged the same day as their treatment. They
will not be required to remain overnight. But before that they must show that they can breathe
regularly, drink, and pee before being released. They will not be permitted to drive soon
following anesthesia-induced surgery. Make arrangements for transportation home, ideally
ahead of time. And it is natural for them to feel lethargic the next day.

While if the patient undergoes in-patient surgery, they will need to spend the night in the
hospital to continue getting postoperative care. They may be required to stay for many days or
more. In certain situations, other patients who were planned for outpatient surgery develop
difficulties and must be hospitalized for further treatment. After they’ve been transported out
of the initial recovery room, the patient’s postoperative care will continue. They will almost
certainly still have an IV catheter in their arm, a finger device that detects oxygen levels in
their blood, and a dressing on their surgery site. They may also have breathing equipment, a
cardiac monitor, and a tube in their mouth, nose, or bladder depending on the sort of surgery
they’ve had.
The medical personnel will continue to check the patient’s vital signs. They may also
administer pain relievers or other drugs through the IV, by injection, or orally. Depending on
the patient’s health, they may ask the patient to get up and move about. Or they may require
assistance with this. Moving will help reduce the patient’s risk of forming blood clots. It can
also help them retain muscle strength. To avoid respiratory issues, patients may be instructed
to practice deep breathing exercises or forced coughing.

The doctor will determine when the patient is ready to be released. Remember to request
discharge instructions from the physician assigned to the patient before leaving. Make plans
ahead of time if the patient requires continuing care at home.

3. Identify common postoperative problems and their management.

Postoperative Problems Management

Pneumonia and Atelectasis Assessment

1. Assess for factors that may increase the risk
of pneumonia and atelectasis.
2. Assess for dyspnea and increased RR.
3. Assess for crackles over involved lung area.
4. Assess for elevated temperature.
5. Assess for productive cough and chest pain.
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Interventions
1. Assess lung and breath sounds.
2. Reposition the client every 1 to 2 hours.
3. Encourage the client to deep breathe, cough,
and use the incentive spirometer.
4. Provide chest physiotherapy and postural
drainage as prescribed.
5. Use suction to clear secretions if the client is
unable to cough.
6. Encourage fluid intake and early ambulation.

Hypoxia Assessment:
restlessness, dyspnea, hypertension, tachycardia,
diaphoresis, cyanosis

Interventions:
1. Monitor for signs of hypoxia.
2. Eliminate the cause of hypoxia.
3. Monitor lung sounds and pulse oximetry.
4. Administer oxygen as prescribed.
5. Encourage deep breathing and coughing and
use of the incentive spirometer.
6. Turn and reposition the client.

Pulmonary Embolism Assessment:

dyspnea, sudden sharp chest or upper abdominal
pain, cyanosis, tachycardia, a drop in blood
pressure

Interventions:
1. Notify the physician immediately.
2. Monitor vital signs.
3. Administer oxygen and medications as
prescribed

Hermorrhage Assessment:
restlessness, weak and rapid pulse, hypotension,
tachypnea, cool, clammy skin, reduce urine
output

Interventions:
1. Provide pressure to the site of bleeding.
2. Notify the physician immediately.
3. Administer oxygen as prescribed.
4. Administer IV fluids and blood as prescribed.
5. Prepare client for surgical procedure if
necessary

Shock Assessment:
Similar to assessment findings in hemorrhage
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Interventions:
1. If shock develops, elevate the legs.
2. If the client had spinal anesthesia, do not
elevate the legs any higher than placing them on
the pillow; otherwise the diaphragm muscles
could be impaired.
3. Determine and treat the cause of shock.
4. Administer oxygen as prescribed.
5. Monitor level of consciousness.
6. Monitor vital signs for increased pulse or
decreased blood pressure.
7. Monitor intake and output.
8. Assess color, temperature, turgor, and
moisture of skin and mucous membranes.
9. Administer IV fluids, blood, and colloid
solutions as prescribed.

Thrombophlebitis Assessment
1. Vein inflammation
2. Aching or cramping pain
3. Vein feels hard and cordlike and is tender to
touch
4. Elevated temperature
5. Positive Homan’s sign

Interventions
1. Monitor legs for swelling, inflammation,
pain, tenderness, venous distention, and
cyanosis.
2. Elevate the extremity 30 degrees without
allowing any pressure on the popliteal area.
3. Encourage the use of antiembolism stockings
as prescribed; remove stockings twice a day to
wash and inspect the legs.
4. Use intermittent pulsatile compression device
as prescribed.
5. Perform passive range of motion exercises
every 2 hours if the client is confined to bed
rest.
6. Encourage early ambulation as prescribed.
7. Do not allow the client to dangle the legs.
8. Instruct the client not to sit in one position for
an extended period of time.
9. Administer heparin sodium or warfarin
(Coumadin) as prescribed.

Urinary Retention Assessment:

inability to void, restlessness and diaphoresis,
lower abdominal pain, distended bladder,
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hypertension, on percussion, the bladder sounds

like a drum

Interventions
1. Monitor for voiding.
2. Assess for distended bladder.
3. Encourage ambulation when prescribed.
4. Encourage fluid intake unless
contraindicated.
5. Assist the client to void by helping to stand.
6. Provide privacy.
7. Pour warm water over the perineum or allow
the client to hear running water to promote
voiding.
8. Catheterize the client as prescribed after all
non-invasive techniques have been attempted.

Constipation Assessment:
abdominal distention, absence of bowel
movements, anorexia, headache, and nausea

Interventions:
1. Assess bowel sounds.
2. Encourage fluid intake up to 3000 mL per day
unless contraindicated.
3. Encourage early ambulation.
4. Encourage consumption of fiber foods unless
contraindicated.
5. Administer stool softeners and laxatives as
prescribed.
6. Provide privacy and adequate time for bowel
elimination

Paralytic Ileus Assessment:

nausea and vomiting immediately
postoperatively; abdominal distention; absence
of bowel sounds, bowel movement, or flatus

Interventions
1. Monitor intake and output.
2. Maintain NPO status until bowel sounds
return.
3. Maintain patency of a nasogastric tube if in
place.
4. Encourage ambulation.
5. Administer IV fluids or total parenteral
nutrition as prescribed.
6. Administer medications as prescribed to
increase gastrointestinal motility and secretions.
7. If ileus occurs, it is treated first nonsurgically
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by bowel decompression by insertion of a

nasogastric tube attached to intermittent or
constant suction

Wound Infection Assessment:

fever and chills; warm, tender, painful, and
inflamed incision site; edematous skin at
incision and tight skin sutures; elevated WBC

Interventions
1. Monitor temperature.
2. Monitor incision site for approximation of
suture line, edema, or bleeding, and signs of
infection (REEDA: redness, erythema,
ecchymosis, drainage, approximation of the
wound edges).
3. Maintain patency of drains, and assess
drainage amount, color, and consistency.
4. Keep drain and tubes away from incision line,
and maintain asepsis.
5. Change dressing as prescribed.
6. Administer antibiotics as prescribed.

Wound Dehiscence Assessment:

increased drainage; opened wound edges;
appearance of underlying tissues through the
wound

Interventions
1. Place the client in low Fowler’s position with
knees bent to prevent abdominal tension on an
abdominal suture line.
2. Cover the wound with a sterile normal saline
dressing.
3. Notify the physician.
4. Prevent wound infection.
5. Administer antiemetics as prescribed to
prevent vomiting and further strain on the
abdominal incision.
6. Instruct the client to splint the abdominal
incision when coughing

Wound Evisceration Assessment:

increased drainage; opened wound edges;
appearance of underlying tissues through the
wound
1. Discharge of serosanguinous fluid from a
previous dry wound
2. The appearance of loops of bowel or other
abdominal contents through the wound
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3. Client reporting feeling a popping sensation

after coughing or turning

Interventions
1. Place client in low Fowler’s position with
knees bent to prevent abdominal tension.
2. Cover the wound with a sterile normal saline
dressing.
3. Notify the physician.
4. Prevent wound infection through strict
asepsis.
5. Administer antiemetics as prescribed to
prevent vomiting and further strain on the
incision.
6. Instruct the client to splint the incision when
coughing

4. Describe the gerontologic considerations related to postoperative management.

The patient must be stable and free from symptoms of complications in order to transfer from
the PACU to the clinical unit or home. The potential for developing complications goes
beyond the immediate postoperative phase and ongoing nursing assessment is essential on the
postoperative nursing floor as well. The PACU should be located near the operating rooms.
There are usually 1.5 to 2 patient care spaces per operating room. Each patient care space is
supplied with a blood pressure monitoring device, cardiac monitor , pulse oximeter , oxygen,
airway management equipment and suction. Emergency equipment and medications are often
centrally located.

During the postoperative period, reestablishing the patient’s physiologic balance, pain
management. To do these it is crucial that the nurse perform careful assessment and
immediate intervention in assisting the patient to optimal function quickly, safely and
comfortably as possible.

Special consideration to the patient’s incision site, vascular status and exposure should be
implemented by the nurse when transferring the patient from the operating room to the
postanesthesia care unir (PACU) or postanesthesia recovery room (PARR). Every time the
patient is moved, the nurse should first consider the location of the surgical incision to prevent
further strain on the sutures. If the patient comes out of the operating room with drainage
tubes, position should be adjusted in order to prevent obstruction on the drains.

5. Describe variables that affect wound healing.

Multiple variables can lead to impaired wound healing, In general terms, the factors that
influence repair can be categorized into local and systematic. Local factors are those that
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directly influence the characteristics of the wound itself, while systematic factors are the
overall health or disease state of the individual that affect his or her ability to heal. Many of
these factors are related, and the systematic factors act through the local effects affecting
wound healing.

Wound healing can be delayed by systematic factors that bear little or no direct relation to the
location of the wound itself. These factors include age, body type, chronic disease ,
immunosuppression, nutritional status, radiation therapy, and vascular insufficiencies.

6. Demonstrate postoperative dressing techniques.

To avoid introducing infections into a wound, an aseptic technique is used when applying or changing
dressings. Even if a wound is infected, an aseptic technique should be used to ensure that no
additional infection is introduced. Preparation:

● Introduce yourself to the patient and explain what you're doing and why you're doing it.
Provide privacy if at all possible.
● Before you begin, make sure the patient is comfortable and the surrounding area is clean and
tidy.
● Examine the patient's care notes to stay up to date on any changes in the patient's condition
and to ensure that the dressing is due to be changed.
● Put on an apron and wash your hands. Using soap and water or a disinfectant and a cloth,
clean the trolley. Begin at the top of the trolley and work your way down, using single strokes
with your damp cloth.
● Place the sterile dressing/procedure pack on the trolley's top. On top of the trolley, open the
sterile dressing pack. Using the corners of the paper, open the sterile field. Open any
additional sterile items required and place them on the sterile field without touching them.

Removing an old dressing:

● Before removing an old dressing, wash your hands and put on non-sterile gloves (to protect
yourself). Use a separate dirty clinical waste bag to dispose of this dressing.
● Perform a wound assessment. This includes performing a visual examination and comparing
and evaluating the smell, amount of blood or ooze (excretions) and the color of the excretions,
and the size of the wound.
● If the site has not improved as expected, the treating physician or senior charge nurse should
be notified so that they can evaluate the situation and consider changing the care plan.

Cleaning the dressing and the wound:

● As per the care plan or the physician's or senior charge nurse's recommendations, ensure that
you have chosen the appropriate dressing type and materials to provide full and appropriate
coverage of the type, size, and location of the wound.
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● Put on sterile gloves and wash your hands. Remove the gloves, re-wash your hands, and put
on new sterile gloves if they become desterilised. This is best practice, but if resources are
limited, safe modifications to this process can be made, such as using non-sterile gloves to
protect the nurse while removing the dressing and then washing the hands with gloves on and
using alcohol gel on the gloves to clean the wound and redo the dressing. This safeguards
both the nurse and the patient.
● Begin in the dirty area and work your way out to the clean area. When doing this, exercise
extreme caution because the tissue or skin may be tender and there may be sutures in place.
Clean the area without causing any additional harm or distress to the patient.
● Make sure you don't reintroduce dirt or ooze by not overusing cleaning materials (such as
gauze or cotton balls). Change them on a regular basis (if possible, only once) and never
reintroduce them to a clean area after they have been contaminated. Check that you have
chosen the appropriate dressing type and materials for the type, size, and location of the
wound, according to the care plan or the physician's or senior charge nurse's
recommendations. Dress the wound as per instruction.

7. Identify assessment parameters appropriate for the early detection of post operative
complications.
● Vital signs - Vital signs should be taken in accordance with local policies or guidelines and
compared to baseline observations taken before, during, and after surgery. Nurses should also
be aware of the parameters for these observations as well as what is normal for the patient
being observed. These observations should not be considered in isolation when assessing
patients' recovery from anesthesia and surgery; the nurse should look at and feel the patient.
This also applies to children, and other signs and symptoms, such as abdominal tenderness or
decreased urine output, may indicate deterioration.
● Level of consciousness - Before being transferred to the ward and throughout the
postoperative period, postoperative patients should respond to verbal stimulation, be able to
answer questions, and be aware of their surroundings. A shift in consciousness can indicate
that the patient is in shock.
● Airway and respirations - If there is a change in cardiac or neurological state, the first vital
sign to be affected is often respiratory rate and function.
● Fluids and Electrolytes - The standard principles of fluid balance in the post-operative patient
are to correct any pre-existing deficits, replace unusual losses (e.g., from surgical drains,
pyrexia), and use the oral route whenever possible because there is frequently a delay in
starting oral intake after surgery.
● Sepsis - Sepsis is the systemic inflammatory response to infection. It is a progressive response
to infection that results in a generalized inflammatory response and, eventually, end-organ
dysfunction and/or failure. A post-operative patient's condition deteriorates dramatically when
they develop systemic sepsis. As a result, early identification and management of patients at
risk of developing sepsis is critical.
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References:

An Overview of Postoperative Care | Nursing Review [Video]. (n.d.). Www.mometrix.com.

https://www.mometrix.com/academy/postoperative-nursing-care/

Antoniadou, A. (2018). Preparing the Patient for Surgery. International Society for Infectious
Diseases. Retrieved from: https://isid.org/guide/infectionprevention/preparing-the-patient-for-surgery/

Berman, A., Snyder, S. J., & Frandsen, G. (2016). Kozier and Erb's fundamentals of nursing:
Concepts, process and Practice (10th ed.). Pearson Australia.

Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14th Edition by Hinkle and Cheever

Bowel preparation: Before your procedure. MyHealth.Alberta.ca Government of Alberta Personal

Health Portal. (n.d.). Retrieved from:
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zb1307

Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's textbook of Medical-Surgical Nursing
(14th ed.). Wolters Kluwer Health.

Immediate preoperative Nursing Intervention. Retrieved from:

https://www.brainkart.com/article/Immediate-Preoperative-Nursing-Interventions_31779/

Markey, D., Brown R., (2002) An interdisciplinary approach to addressing patient activity and
mobility in the medical-surgical patient. Retrieved from https://europepmc.org/article/med/12125898

Nerve Blocks. (2021). Johns Hopkins Medicine. Retrieved September 15, 2022, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks#:%7E:text=Benefits%

Operating Room Staff Roles and Responsibilities . (2022). Retrieved, from

https://www.incision.care/en/blog/operating-room-department

Techniques for Aseptic Dressing and Procedures (2015). Retrieved from:

Techniques for aseptic dressing and procedures - PMC (nih.gov)

Preoperative Nutrition (n.d.) retrieved from

https://teachmesurgery.com/perioperative/preoperative/perioperative-nutrition/

Postoperative Care: Definition and Patient Education. (2016, August 8). Healthline.
https://www.healthline.com/health/postoperative-care#at-home

Postoperative care 1: Principles of Monitoring Postoperative Patients (2013). Retrieved from:

Postoperative care 1: principles of monitoring postoperative patients | Nursing Times

Why Teamwork and Communication are Critical in Nursing (2022) Retrieved from
https://learnonline.eiu.edu/programs/rn-to-bsn/teamwork-communication-critical-in-healthcare/
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What is an Interdisciplinary Team? Definition, Importance and Advantages (2021) Retrieved from
https://www.indeed.com/career-advice/finding-a-job/interdisciplinary-team

GROUP 2 BSN 3B
DIEL, WAYMEL
DINGCONG, VINCENT
DOLAR, MARY JESSLYN
DOMINES, XIOMARA
FAROCHILEN, ROSSANNE
FAUSTO, MARJORIE
GALLEGO, COLEEN
GERMO, KOBE BRYAN
GONZALES, MA. JOVYLYN