Phases of Perioperative Care

Phases of Perioperative Care 1. Preoperative Phase o Begins when the client decides to have surgery and ends when they are transferred to the surgical suite. o Key responsibilities: § Preoperative assessment. § Client teaching. § Ensuring informed consent is obtained. 2. Intraoperative Phase o Begins when the client enters the surgical suite and ends when they are admitted to the recovery room. o Focus: Safety, monitoring, and preventing complications during the procedure. 3. Postoperative Phase o Starts in the recovery room and continues until the follow-up appointment. o Focus: Pain management, monitoring for complications, and supporting recovery. Preoperative Care 1. Assessment: o Comprehensive health history: § Medical and surgical history. § Cardiovascular and pulmonary conditions (e.g., CAD, CHF, COPD, OSA, asthma) that may increase intraoperative risk. o Allergies: § Document medication and other substance allergies (e.g., latex, iodine). o Current medications and supplements: § Note anticoagulants, herbal supplements, and medications that may increase surgical risks. § Verify last dose of critical medications (e.g., anticoagulants, insulin). o Tobacco and alcohol use: § Tobacco increases risks like blood clots and poor wound healing. § Alcohol increases bleeding, infection risk, and other complications. o Spiritual and cultural beliefs: § Respect and document preferences that could affect care (e.g., refusal of blood transfusions, fasting requirements). 2. Physical Assessment: o General survey: § Vital signs, weight, height, and overall appearance. o Pain assessment: § Establish a baseline; consider multimodal pain management. o Neurologic system: § Assess orientation, consciousness, and motor function to establish a baseline. Head and neck: § Check hydration (mucous membranes), note any dental issues (e.g., missing teeth), and remove prosthetics/piercings. o Integumentary system: § Assess skin color, turgor, lesions, or irritation. o Cardiovascular system: § Auscultate heart sounds and palpate peripheral pulses. § Assess for edema and document capillary refill. o Respiratory system: § Auscultate lung sounds and identify any respiratory distress (e.g., wheezing, accessory muscle use). o Gastrointestinal system: § Assess bowel habits, distention, and GI symptoms. § Sequence: Inspect, auscultate, palpate, percuss. 3. Informed Consent: o Verify and witness the client’s signature. o Ensure the client is of legal age, competent, and has received all necessary information from the provider. o Consent must be voluntary, with an opportunity to ask questions. 4. Diagnostic and Laboratory Testing: o Common labs/tests: § CBC, BMP/CMP, HbA1c, coagulation studies, and urinalysis. § Diagnostic tests may include chest X-rays, ECGs, or pulmonary function tests. o Purpose: Establish baselines and identify complications. 5. Client Teaching: o Tailor education based on the client’s procedure, anesthesia type, and individual needs. o Topics to cover: § Day of surgery preparation: § Arrival time, visitor policy, and NPO status. § Postoperative expectations: § Pain management, incision care, and activity level. § Techniques for coughing, deep breathing, and incentive spirometer use. § Tobacco and alcohol cessation: § Provide resources as needed. o Intraoperative Care 1. Client Safety: o Prevent injury, infection, and wrong-site surgery. o Use tools like the AORN Comprehensive Surgical Checklist to promote communication. 2. Monitoring: o Continuous assessment of vital signs, oxygenation, and positioning to prevent complications (e.g., pressure injuries). Postoperative Care 1. Monitoring and Interventions: o Pain control: Utilize multimodal therapy to reduce opioid use. o Respiratory care: § Monitor for signs of hypoxia, encourage coughing/deep breathing. o Cardiovascular care: § Monitor for thromboembolism, hemorrhage, or shock. o Wound care: § Observe for signs of infection (e.g., redness, warmth, discharge). o Mobility: § Encourage early ambulation to prevent complications like blood clots or pneumonia. 2. Communication and Handoff: o Utilize structured communication (e.g., SBAR) for accurate information transfer between care teams. Key Considerations for Risk Factors 1. Malignant Hyperthermia: o A life-threatening reaction to anesthesia. o Obtain a thorough family and personal history to mitigate risks. 2. Comorbidities: o Clients with conditions like diabetes, COPD, or CAD may require additional monitoring or preoperative interventions. 3. Psychosocial Needs: o High levels of anxiety/stress can negatively affect outcomes. o Utilize active listening, empathy, and strong communication to support clients. Risk Factors for Surgical Complications 1. Age (≥ 65 years): o Increased risk due to chronic conditions (e.g., hypertension, diabetes, COPD). o Common complications: § Postoperative delirium: Temporary confusion/disorientation (days to weeks). Prevent by identifying risk factors (CGA) and avoiding benzodiazepines/opioids. § Postoperative cognitive dysfunction (POCD): Permanent memory loss and behavioral changes, common in neurocognitive disorders. 2. Obesity: o Risks: Difficult intubation, oxygenation issues, delayed anesthesia clearance, VTE (DVT/PE). o Preventative measures: Early ambulation, anticoagulants (e.g., LMWH). 3. Smoking: o Risks: Breathing issues under anesthesia, slow wound healing, increased infection risk. o Recommendation: Quit smoking before surgery. 4. Fluid Imbalances: o Hypovolemia: Caused by NPO status, blood loss, or anesthesia effects. § Symptoms: Tachycardia, hypotension, confusion, oliguria. § Treatment: IV fluids (crystalloids/colloids/blood). o Hypervolemia: Associated with CHF or fluid resuscitation. § Symptoms: Tachycardia, crackles, edema, hypertension. § Treatment: Diuretics, fluid restriction. Common Surgical Complications 1. Nausea and Vomiting: o Common due to anesthesia or opiates. o Risk of dehydration/electrolyte imbalances. o Prevent: Antiemetics post-surgery. 2. Venous Thromboembolism (VTE): o DVT: Pain, redness, swelling in extremities. § Prevention: Early ambulation, pneumatic compression devices. § Sequential compression devices are prescribed for clients postoperatively to decrease the risk of VTE; client should wear the devices while in bed and sitting in a chair. o PE: Chest pain, dyspnea, tachycardia, hypoxia. § Emergency intervention: IV anticoagulants. 3. Atelectasis: o Collapse of alveoli from anesthesia, common in smokers/COPD patients. Prevention: Incentive spirometer, deep breathing, early ambulation, sparing opioid use. Wound Infections (SSI): o Signs: Redness, swelling, pain, foul drainage, fever. o Risks: Obesity, diabetes, smoking, corticosteroid use. o Treatment: Antibiotics, wound cultures, possible debridement. Dehiscence and Evisceration: o Dehiscence: Wound edge separation; risk factors: infection, corticosteroids. § Symptoms: Open wound, redness, fever, pain. o Evisceration: Protrusion of organs; requires emergency intervention. Ileus: o Symptoms: Nausea, vomiting, absent bowel sounds, abdominal discomfort. o Treatment: NG tube, IV fluids, NPO status. Oliguria/Acute Kidney Injury (AKI): o Common in clients with diabetes, hypertension, kidney conditions. o Treatment: IV fluids, monitor urine output and edema. o 4. 5. 6. 7. Key Preventative Strategies • • • • • Perform a Comprehensive Geriatric Assessment (CGA) for older adults. Encourage early ambulation to prevent VTE and improve lung function. Educate clients about smoking cessation and proper wound care. Monitor and treat fluid imbalances promptly. Teach the use of incentive spirometry and deep breathing exercises to prevent atelectasis.