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Online Companion: Fundamentals of Nursing Standards and Practice 2E
Surgery is one of the most common
treatment modalities used in American health care. Surgery is performed to correct
a defect in structure or function of an organ or body part or to provide other
diagnostic or treatment interventions. The phrase perioperative nursing refers
to the client's needs and nursing interventions implemented during three phases
of surgery: before, during and after the surgical procedure. Minor surgical
procedures are performed in ambulatory care centers and physician offices. Major
surgery is performed in acute care hospitals. The health team for perioperative
care consists of the surgeon, the anesthetist and the nurse each of whom has
a specific responsibility to the client. In the preoperative phase, the surgeon
has the responsibility for explaining the surgery to the client, the expected
outcomes and risk factors involved in the procedure, and obtaining the written
consent from the client. The anesthetist has a role to ensure client safety
relative to the administration of anesthesia. A major part of the nurse's time
in the preoperative phase is spent preparing and teaching the client; the nurse
also coordinates the client's care to ensure safety and to avoid delays. When
a surgical procedure is needed because of the client's condition, the type of
anesthesia to be used has to be carefully considered. There are three types
of anesthesia: general, regional and local; these differ in their effects on
the client and methods of administration. Each anesthesia method has the effect
of rendering the client insensible to pain during the surgery. The primary goal
of preoperative nursing care is to place the client in the best possible condition
for surgery through careful assessment and thorough preparation. Assessment
factors include the client's health history, social and cultural history, medication
use, history of allergies, the client's age, and spiritual and psychological
considerations. The client's physical condition is assessed before surgery.
The data from assessment are analyzed and the nursing diagnoses for the preoperative
phase are established. Knowledge deficit related to surgery, Anxiety and Fear
are among the common problems of this phase. Nursing process steps flow from
the nursing diagnoses. One important action that the nurse takes is to verify
that a signed consent has been obtained from the client and that the consent
is based on information that the client understands. Most agencies have a format
for a preoperative checklist that offers a guideline for activities needed in
the immediate preoperative period. The intraoperative phase takes place in the
operating room area. The goal of nursing at this time is to ensure client safety.
The client needs special protection from environmental hazards and from contamination
of the open surgical wound. After the surgery is completed, the client is moved
to the postanesthesia care unit (PACU) until physiologic functioning is stabilized.
The adequacy of the client's airway and adequacy of respiration are of high
priority in PACU care. The client's circulatory, neurologic, fluid and metabolic
state are assessed and monitored continuously; the client's pain is monitored
and treated by intravenous narcotic drugs in titrated doses. After discharge
from PACU, the focus of client care is to restore physiologic functioning, to
promote wound healing and to prevent complications.
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