The term perioperative nursing refers to all the activities and responsibilities assumed by a nurse before, during, and after a surgical procedure. The systematic tool, nursing process, is involved in these procedures to ensure the quality of care that a surgical patient will receive.
Three phases in perioperative nursing
1. Pre – operative phase – It is the phase when the patient had decided for surgical intervention up to the time of transfer to the operating room.
During the pre – operative phase, assessment is done in terms of age of the patient, by which young children and older adults are the most vulnerable to complications; the patient’s nutritional status, wherein post op recovery usually relies; fluid and electrolyte status, because hydration is important to prevent hypovolemia during surgery; presence of infection and other health problems, since it can predispose the patient for sepsis and other untoward conditions post operatively; the holistic bodily functions, clearance from cardio, respiratory, renal, neurologic, hematologic and other pertinent functions prior to procedure is really a routine to avoid life threatening situations during and after the surgical procedure; use of medications like anticoagulants, to prevent hemorrhagic complications; as well as health habits like smoking and sedentary lifestyle, in order to assess the possible needed health teachings suited for the patient.
Health teaching is an essential avenue to hinder the patient from anxiety and stress for the upcoming surgical procedure. Teaching the patient about deep breathing, turning, splinting, and purse- lip breathing exercises would be very helpful to prevent the patient from developing complications like pneumonia and other respiratory problems as well as circulatory conditions.
Meanwhile, preparations during this phase include the process of obtaining the informed consent done by the physician and letting the patient verbalize his/ her fears and utilizing therapeutic communication in letting them understand fully well the procedure they will undergo. Gastrointestinal and skin preparations are also included during this phase and also the giving of prescribed medications, like tranquilizers, sedatives, analgesics, and anticholinergics.
2. Intra – operative phase – It is from the time when the patient is received in the operating room to the time the patient is admitted in the recovery room.
The surgical team is already in charge of the patient, composing of the surgeon, assistant surgeon, anesthesiologist, holding area nurse, circulating nurse and scrub nurse. The nurse’s responsibilities include the verification of the pre- operative checklist, composing of the informed consent, various preparations, and if prescribed medications are given as well as for availability of blood and intravenous access. Knowing the indicated surgical intervention well is beneficial for the nurse to know the exact position and skin preparation to be done. The principles of surgical asepsis are being strictly utilized during this phase and include preparations in terms of layout, health of surgical team, surgical attire, and surgical scrub. The overall goal of the nurse is to ensure patient safety and promote homeostasis, so there is careful dispensing of supplies and instruments and there is strict maintenance of aseptic environment. The circulating nurse is in charge of monitoring the patient’s well being in collaboration with the anesthesiologist and the surgeon, dispensing solutions, supplies and instruments, and documenting the progress of the surgery. The scrub nurse, on the other hand, assists the surgeon by handling instruments and supplies to the surgeon while maintaining surgical asepsis.
3. Post – operative phase – It is from the time of admission in the recovery room to the time of follow – up evaluation.
This is the last phase of perioperative nursing and it is usually as well critical as other phases since the recovery of the patient from the surgical intervention is being monitored. The anesthesia report and the nurse’s notes from the intra – operative phase are being well verified prior to admission to recovery room to make sure that the patient is undergoing as what is expected. Again, the use of nursing process involving assessment, planning, implementation and evaluation are the keys to hastened recovery. The ABCs or airway, breathing, and circulation, oxygen saturation and ventilation, vital signs and level of consciousness are being assessed and given priority. Drainage, fluid status and hydration are also checked. Patient’s ability to move, gag, and discomforts are later assessed to know if the patient is ready to be transferred out from recovery room. And lastly, patient’s safety is ensured by putting the side rails always up.