NUR 206 EXAM 2 - COMPREHENSIVE OVERVIEW OF
SURGICAL CARE PHASES
Preoperative Care
● Surgery
○ The art and science of treating diseases, injuries, and deformities by
operation and instrumentation
■ Surgery is MULTIDISCIPLINARY
■ Nurses prep and care for the patient before, during, and after
surgery
● Total Surgical Episode = Perioperative Period
○ Perioperative Period
■ Preoperative Period = Time Before Surgery
■ Intraoperative Period = Time Spend During the Surgical Procedure
■ Postoperative Period = Time After Surgery is Over
● Preoperative Phase = Time Before Surgery
○ Can be a daunting time for both the patient and the family
● Common Purposes of Surgery
○ Diagnosis: used to determine the presence and extent of a condition
○ Cure: eliminating or repairing the pathological condition
○ Palliation: the alleviation of symptoms without a cure, ex: tumor in the
spine
○ Prevention: the removal of something that may be an issue, ex:
colonoscopy
○ Cosmetic Improvement: use to alter physical appearance, ex: repairing
a burn scar, breast reconstruction after a mastectomy
○ Exploration: determining the nature or extent of a disease, least
common because many problems can be handled non-invasively
○ Some definitions you should recognize...
■ -ectomy (removal of)
■ -lysis (destruction of)
■ -orrhaphy (repair or suture of)
■ -oscopy (looking into)
■ -ostomy (creation of an opening)
■ -otomy (cutting into)
■ -plasty (repair or reconstruction)
● Surgical Settings:
○ Elective Surgery
■ Carefully planned event
■ Same day admission
■ Acute/chronic medical conditions
■ Same day/Outpatient
■ Minimally invasive (laparoscopic, endoscopic)
■ 24-hour stay after surgery
■ Home with a caregiver
,■ Decreased cost
■ Recover at home
■ Ambulatory Clinic
, ■ Endoscopy clinics
■ Physicians' offices
■ Outpatient surgery units in hospitals
■ May require different anesthetics:
● General: anesthesia affects whole body
● Regional: anesthesia affects around the whole area
● Local: anesthesia affects specific area
■ Decreased occurrence of HAI
○ Emergency Surgery
■ Unexpected
■ Client
■ Support System
■ Higher anxiety and fear because there is not much time to
emotionally or mentally prepare
● Ex: appendicitis or heart attack
● Nurse: Essential Role in Plan of Care
○ Reason for surgery
■ The nurse does not explain the procedure to the patient
○ Co-morbidities
○ Stress response to surgery
○ Results of preop diagnostic tests
■ Makes sure physician has all information needed
○ Risks and complications of the procedure
○ Communication
■ A conversation about medication use needs to take place
○ Documentation
○ Likely to have a different nurse for each stage of surgery
■ Pre
■ Intra
■ Post
● Patient Preoperative Interview
○ Can occur in advance of the surgery
○ Medication directions
■ Anticoagulants
■ Insulin
■ Blood pressure Meds
○ Common language/no medical jargon
■ 5th-grade reading level
○ 1. Obtain health information, drug and food allergies
○ 2. Provide & clarify information for surgery/anesthesia
○ 3. Assess client’s emotional state and readiness for surgery (i.e.
expected patient outcomes)
■ Stress can impair cognition
, ● Nursing Assessment of Preoperative Patient
○ Overall goal…
■ Identify risk factors and plan care to ensure patient safety
● Establish baseline data for comparison in other phases
● Determine patient’s psychological and physiological
status prior to surgery
● Identify and document surgical site
● Identify medications: prescriptions, OTC, herbs which
may impact outcome of surgery
● Review pre-diagnostic results
○ CT, chest xray, blood work
● Identify cultural and ethnic factors
● Has the patient received enough information to make an
informed decision?
○ Has to occur before consent is signed
● Subjective Data: Psychosocial Reactions to Surgery
○ Anxiety of the unknown
■ Lack of knowledge
■ Uncertainty of outcomes
■ Past experiences or stories
■ Conflict with religious or cultural beliefs
○ Common Fears
■ Fear of death
■ Fear of pain and discomfort
● Will have meds and such to help
■ Fear of altered body image
● Don’t judge!
■ Fear of anesthesia
■ Fear of disruption of life functioning
○ Hope – positive attribute/method of coping
○ Past Health History
■ Past hospitalizations
■ Previous surgeries & dates
■ Problems with previous surgery...
■ LMP, # pregnancies
■ Family history
○ Medications (encourage to bring)
■ Rx (including birth control)
■ OTC
■ Herbal products/dietary supplements
○ Allergies
■ Drug intolerance
● Ex: blood pressure med made you dizzy, cholesterol
that makes you cramp
SURGICAL CARE PHASES
Preoperative Care
● Surgery
○ The art and science of treating diseases, injuries, and deformities by
operation and instrumentation
■ Surgery is MULTIDISCIPLINARY
■ Nurses prep and care for the patient before, during, and after
surgery
● Total Surgical Episode = Perioperative Period
○ Perioperative Period
■ Preoperative Period = Time Before Surgery
■ Intraoperative Period = Time Spend During the Surgical Procedure
■ Postoperative Period = Time After Surgery is Over
● Preoperative Phase = Time Before Surgery
○ Can be a daunting time for both the patient and the family
● Common Purposes of Surgery
○ Diagnosis: used to determine the presence and extent of a condition
○ Cure: eliminating or repairing the pathological condition
○ Palliation: the alleviation of symptoms without a cure, ex: tumor in the
spine
○ Prevention: the removal of something that may be an issue, ex:
colonoscopy
○ Cosmetic Improvement: use to alter physical appearance, ex: repairing
a burn scar, breast reconstruction after a mastectomy
○ Exploration: determining the nature or extent of a disease, least
common because many problems can be handled non-invasively
○ Some definitions you should recognize...
■ -ectomy (removal of)
■ -lysis (destruction of)
■ -orrhaphy (repair or suture of)
■ -oscopy (looking into)
■ -ostomy (creation of an opening)
■ -otomy (cutting into)
■ -plasty (repair or reconstruction)
● Surgical Settings:
○ Elective Surgery
■ Carefully planned event
■ Same day admission
■ Acute/chronic medical conditions
■ Same day/Outpatient
■ Minimally invasive (laparoscopic, endoscopic)
■ 24-hour stay after surgery
■ Home with a caregiver
,■ Decreased cost
■ Recover at home
■ Ambulatory Clinic
, ■ Endoscopy clinics
■ Physicians' offices
■ Outpatient surgery units in hospitals
■ May require different anesthetics:
● General: anesthesia affects whole body
● Regional: anesthesia affects around the whole area
● Local: anesthesia affects specific area
■ Decreased occurrence of HAI
○ Emergency Surgery
■ Unexpected
■ Client
■ Support System
■ Higher anxiety and fear because there is not much time to
emotionally or mentally prepare
● Ex: appendicitis or heart attack
● Nurse: Essential Role in Plan of Care
○ Reason for surgery
■ The nurse does not explain the procedure to the patient
○ Co-morbidities
○ Stress response to surgery
○ Results of preop diagnostic tests
■ Makes sure physician has all information needed
○ Risks and complications of the procedure
○ Communication
■ A conversation about medication use needs to take place
○ Documentation
○ Likely to have a different nurse for each stage of surgery
■ Pre
■ Intra
■ Post
● Patient Preoperative Interview
○ Can occur in advance of the surgery
○ Medication directions
■ Anticoagulants
■ Insulin
■ Blood pressure Meds
○ Common language/no medical jargon
■ 5th-grade reading level
○ 1. Obtain health information, drug and food allergies
○ 2. Provide & clarify information for surgery/anesthesia
○ 3. Assess client’s emotional state and readiness for surgery (i.e.
expected patient outcomes)
■ Stress can impair cognition
, ● Nursing Assessment of Preoperative Patient
○ Overall goal…
■ Identify risk factors and plan care to ensure patient safety
● Establish baseline data for comparison in other phases
● Determine patient’s psychological and physiological
status prior to surgery
● Identify and document surgical site
● Identify medications: prescriptions, OTC, herbs which
may impact outcome of surgery
● Review pre-diagnostic results
○ CT, chest xray, blood work
● Identify cultural and ethnic factors
● Has the patient received enough information to make an
informed decision?
○ Has to occur before consent is signed
● Subjective Data: Psychosocial Reactions to Surgery
○ Anxiety of the unknown
■ Lack of knowledge
■ Uncertainty of outcomes
■ Past experiences or stories
■ Conflict with religious or cultural beliefs
○ Common Fears
■ Fear of death
■ Fear of pain and discomfort
● Will have meds and such to help
■ Fear of altered body image
● Don’t judge!
■ Fear of anesthesia
■ Fear of disruption of life functioning
○ Hope – positive attribute/method of coping
○ Past Health History
■ Past hospitalizations
■ Previous surgeries & dates
■ Problems with previous surgery...
■ LMP, # pregnancies
■ Family history
○ Medications (encourage to bring)
■ Rx (including birth control)
■ OTC
■ Herbal products/dietary supplements
○ Allergies
■ Drug intolerance
● Ex: blood pressure med made you dizzy, cholesterol
that makes you cramp
