rNUR 110 Ch. 5 Perioperative Nursing
Ambulatory Surgery Centers (ASCs): provide outpatient surgical services not requiring
an overnight stay (independent diagnostic & testing facilities, healthcare provider
offices)
Emergency Surgery
- There may be only one preop assessment & it may take place at the same time as
resuscitation in ED
- For unconscious pt informed consent & essential info (allergies, pmhx) obtained from
family
- Quick visual survey of pt is essential to ID all sites of injury in emergency surgery is due
to trauma
Elderly Patients
- Important factors that need to be evaluated are, disease course v. life expectancy, state
of independence, personal motivation, surgical risk factors v. nonoperative management
- Preop pain assessment & teaching are important in elderly pt
- Following factors are critical for elderly pt periop: skillful preop assessment & tx, skillful
anesthesia & surgery, & meticulous & competent postop & postanesthesia management
- Nurse should incorporate pain management info, pain communication skills when
teaching the elderly about how to obtain greater postop pain relief
Gerontologic Considerations
Structural/ Functional Change Impact
Increased incidence of coexisting disease Higher risks from anesthesia & surgery than younger adult pt
Aging heart & blood vessels Decreased ability to respond to stress
Reduced cardiac output & limited cardiac reserve Increased vulnerability to changes in circulating volume & blood
oxygen levels
Decrease ability to compensate for hypoxia Increased risk of cerebral ischemia, thrombosis, embolism,
infarction, & anoxia
Decrease in % of lean body tissue & steady Anesthetic agents that have an affinity for fatty tissue
increase in fatty tissue (20-90 yrs) concentrate in body fat & the brain. Elderly pt needs fewer &
smaller amounts of anesthetic agents to produce anesthesia &
eliminates anesthetic agent over a longer period of time.
If malnourished/has low plasma protein levels With decreased plasma proteins, more of the anesthetic agent
remains free/unbound, resulting in more potent action
Reduced liver size & potential reduced kidney Decreases rate at which liver can inactivate many anesthetic
function agents & decreased kidney function slows the elimination of
waste products & anesthetics
Impaired ability to increase metabolic rate & Increased susceptibility to hypothermia
, impaired thermoregulatory mechanisms
Bone loss (25% in women, 12% in men) Increased risk of musculoskeletal problems postop
Loss of collagen & muscle, thinning, sagging skin Increased risk of skin complication
Impaired vision/hearing & reduced tactile Increased potential for communication issues, increased risk of
sensitivity skin complications
Increased tooth loss & periodontal disease, Increased risk of airway occlusion due to dental device
increased incidence of dental devices (dentures, dislodgement
partial plates,crowns)
Obese Patients
- During surgery fatty tissues are more susceptible to infection
- Dehiscence & wound infection are more common in obese pt
- Obese pt tend to have more shallow respirations when supine, which increases risk of
hyperventilation & postop pulmonary complications
- For each 30lb of excess weight about 25 additional miles of blood vessels are needed
and this places increased demands on the heart
- This nursing management includes assessment of the cardiopulmonary status &
thorough wound assessments
Patient w/ Disabilities
- Special considerations for pt w/ mental or physical disabilities include need for
appropriate assistive devices, modifications in preop teachings, & additional assistance
w/ positioning & transferring
- Pt w/ disability that affects body position may need special positioning during surgery to
prevent pain/injury
Preoperative Nursing
Preoperative phase: starts when decision to proceed w/ surgical intervention is made &
ends w/ transfer of pt into OR table
- Nursing roles during this phase focus on assessing the pt & developing a plan of care
- Telephone interviews, face to face assessments & computer aided tools are used to
review pt physical, psychological, sociocultural, & spiritual needs
- Goals of preoperative assessment are to reduce pt surgical & anesthetic perioperative
morbidity or mortality
- Medical hx, lab values, & diagnostic tests help providers evaluate a pt
- Preadmission nurses provide preop education to prep pt & family
Informed Consent
Informed Consent: voluntary & written consent from pt is necessary before nonemergent
surgery
- CMS believes that pt or their rep have a right to make informed decisions regarding pt
care
- For the surgical pt a properly executed informed consent for the operation must be in the
pt chart prior to surgery EXCEPT in emergencies
Ambulatory Surgery Centers (ASCs): provide outpatient surgical services not requiring
an overnight stay (independent diagnostic & testing facilities, healthcare provider
offices)
Emergency Surgery
- There may be only one preop assessment & it may take place at the same time as
resuscitation in ED
- For unconscious pt informed consent & essential info (allergies, pmhx) obtained from
family
- Quick visual survey of pt is essential to ID all sites of injury in emergency surgery is due
to trauma
Elderly Patients
- Important factors that need to be evaluated are, disease course v. life expectancy, state
of independence, personal motivation, surgical risk factors v. nonoperative management
- Preop pain assessment & teaching are important in elderly pt
- Following factors are critical for elderly pt periop: skillful preop assessment & tx, skillful
anesthesia & surgery, & meticulous & competent postop & postanesthesia management
- Nurse should incorporate pain management info, pain communication skills when
teaching the elderly about how to obtain greater postop pain relief
Gerontologic Considerations
Structural/ Functional Change Impact
Increased incidence of coexisting disease Higher risks from anesthesia & surgery than younger adult pt
Aging heart & blood vessels Decreased ability to respond to stress
Reduced cardiac output & limited cardiac reserve Increased vulnerability to changes in circulating volume & blood
oxygen levels
Decrease ability to compensate for hypoxia Increased risk of cerebral ischemia, thrombosis, embolism,
infarction, & anoxia
Decrease in % of lean body tissue & steady Anesthetic agents that have an affinity for fatty tissue
increase in fatty tissue (20-90 yrs) concentrate in body fat & the brain. Elderly pt needs fewer &
smaller amounts of anesthetic agents to produce anesthesia &
eliminates anesthetic agent over a longer period of time.
If malnourished/has low plasma protein levels With decreased plasma proteins, more of the anesthetic agent
remains free/unbound, resulting in more potent action
Reduced liver size & potential reduced kidney Decreases rate at which liver can inactivate many anesthetic
function agents & decreased kidney function slows the elimination of
waste products & anesthetics
Impaired ability to increase metabolic rate & Increased susceptibility to hypothermia
, impaired thermoregulatory mechanisms
Bone loss (25% in women, 12% in men) Increased risk of musculoskeletal problems postop
Loss of collagen & muscle, thinning, sagging skin Increased risk of skin complication
Impaired vision/hearing & reduced tactile Increased potential for communication issues, increased risk of
sensitivity skin complications
Increased tooth loss & periodontal disease, Increased risk of airway occlusion due to dental device
increased incidence of dental devices (dentures, dislodgement
partial plates,crowns)
Obese Patients
- During surgery fatty tissues are more susceptible to infection
- Dehiscence & wound infection are more common in obese pt
- Obese pt tend to have more shallow respirations when supine, which increases risk of
hyperventilation & postop pulmonary complications
- For each 30lb of excess weight about 25 additional miles of blood vessels are needed
and this places increased demands on the heart
- This nursing management includes assessment of the cardiopulmonary status &
thorough wound assessments
Patient w/ Disabilities
- Special considerations for pt w/ mental or physical disabilities include need for
appropriate assistive devices, modifications in preop teachings, & additional assistance
w/ positioning & transferring
- Pt w/ disability that affects body position may need special positioning during surgery to
prevent pain/injury
Preoperative Nursing
Preoperative phase: starts when decision to proceed w/ surgical intervention is made &
ends w/ transfer of pt into OR table
- Nursing roles during this phase focus on assessing the pt & developing a plan of care
- Telephone interviews, face to face assessments & computer aided tools are used to
review pt physical, psychological, sociocultural, & spiritual needs
- Goals of preoperative assessment are to reduce pt surgical & anesthetic perioperative
morbidity or mortality
- Medical hx, lab values, & diagnostic tests help providers evaluate a pt
- Preadmission nurses provide preop education to prep pt & family
Informed Consent
Informed Consent: voluntary & written consent from pt is necessary before nonemergent
surgery
- CMS believes that pt or their rep have a right to make informed decisions regarding pt
care
- For the surgical pt a properly executed informed consent for the operation must be in the
pt chart prior to surgery EXCEPT in emergencies
