perioperative nurse

Perioperative Nurse Career and Job Description

Perioperative Nursing Job Description

Nursing Study Guide on Perioperative Nursing

Perioperative nursing is a field of nursing that involves the provision of holistic care to a patient under surgical management.

The prefix “peri” means “around” or “about”, and the word “operative” refers to operation or surgery. Thus, perioperative nursing has a broad scope that encompasses the three stages of surgical management: (1) preoperative nursing – care before the surgery, (2) intraoperative nursing – care during surgery, and (3) postoperative nursing – care after surgery.

The nurse serves as a valuable member of the surgical team which involves other healthcare providers such as surgeons, anesthetists, therapists, dietitians, etc.

Goals of Perioperative Nursing

The nursing care provided before, during, and after surgery have one or more of the following goals:

  1. To treat a disease or illness through manual removal of the diseased or damaged tissues or organs
  2. To preserve or restore organ function by removing and/or repairing structures such as tissues and blood vessels
  3. To prevent further progression of injury or disease
  4. To visualize the organs and systems inside the body for a more accurate diagnosis
  5. To obtain tissue sample for examination
  6. To enhance appearance, as in plastic surgery
  7. To relieve pain or other symptoms
  8. To harvest organs for donation

Types of Surgical Procedures and Cases

  1. Based on Time, Risk, Extent of Work, Organ Involved, and Type of Anesthesia Used
  • Major Surgery. This usually involves long hours needed to operate on an organ or system. It also often requires a longer hospital stay compared to a minor surgical procedure. Major surgeries usually require the patient to be under general anesthesia. A patient who will undergo major surgery is often admitted as an inpatient for postoperative observation prior to discharge. The risk for complications is higher in a major surgery compared to a minor operation.          Examples: open heart surgery, bowel surgery, and liver transplant
  • Minor Surgery. This usually a superficial operation which do not involve entering a body cavity and takes a short time to perform. A local anesthesia can be used or sometimes there is no anesthesia required to perform it. A patient who will undergo a minor surgery are often treated as outpatient, which means they are discharged on the same day. The risk for complications is lower in a minor surgery compared to a major operation, but it still needs to be discussed by the healthcare provider to the patient for the legal purpose of gaining an informed consent.              Examples: repair of small wounds or cuts, biopsies, and removal of hemorrhoids or hemorrhoidectomy

2. Based on Urgency

  • Emergent. These surgeries should be performed as soon as possible to save the body part, organ function, or life of the patient.
    Examples: severe hemorrhage, tracheostomy, perforated ulcer
  • Urgent. These surgeries are needed to be done ideally within 48 hours of admission.

Examples: tumor removal, coronary artery bypass, gall stones removal

  • Elective. These surgeries are pre-planned and any delay on doing them will not impose immediate harm on the patient.

Examples: hernia repair, aesthetic surgeries such as face lifts and liposuction, Caesarean section (in most cases)

3. Based on Purpose

  • Curative or Ablative. These surgeries intend to treat the disease by removing foreign body (bullet, knife, etc.), stones, diseased tissues, organ, or body part, and others.   Examples: appendectomy, mastectomy, gall stones removal
  • Diagnostic/ Exploratory. These surgeries are performed to confirm a diagnosis. They may become curative; for instance, a benign mass is actually excised during a breast mass biopsy.
    Example: exploratory laparatomy
  • Palliative. These surgeries are for the relief of symptoms with the premise that the disease will not be cured.      Examples: colostomy, salvage cystectomy, neurolytic blockade
  • Reconstructive. These surgeries are done for the restoration of function in malfunctioning or traumatized tissues. They are also often performed to improve the patient’s self-image.

Examples: breast reconstruction, skin graft for burn injuries, cleft lip and palate repair, plastic surgeries

  • Transplant. These surgeries intend to replace an organ that is dysfunctional or diseased. Examples: heart transplant, liver transplant
  • Aesthetic. These surgeries are done to enhance physical features  Examples: breast augmentation, rhinoplasty or nose enhancement, blepharoplasty or eyelid surgery

Phases of Perioperative Nursing

  1. Preoperative Nursing Actions

The preoperative phase starts with the patient’s informed consent which indicates his/her decision to proceed with surgery. It ends when the patient is endorsed to the operating room. The nursing actions during the preoperative stage include:

  • Completion of the preoperative assessment, including checking for allergies, doing focused physical assessment, and getting information on medical history and current medications
  • Phlebotomy for blood tests and checking the blood results
  • Assisting patients in other diagnostic procedures imaging tests, urinalysis, pregnancy test, etc.
  • Verification of informed consent
  • Performing surgeon-specific preoperative orders such as shaving the area involved, shower, bowel preparation, marking, etc.
  • Answering patient and family’s questions about the surgery
  • Developing a plan of care
  • Establishing an intravenous line
  • Administering any preoperative medications as prescribed
  • Monitoring vital signs preoperatively
  • Reporting any changes in patient’s status to the surgical resident
  • Psychological support to patient and family
  • Transfer of patient to the surgery department

2. Intraoperative Nursing Actions

The intraoperative phase begins with the admission or transfer of the patient in the surgery department, and ends when the patient is endorsed to the recovery area. The nursing actions during the intraoperative stage include:

  • Maintenance of aseptic technique and a controlled environment
  • Circulating Nurse: Management of surgical equipment, supplies, and human resources
  • Scrub Nurse: Transfer of patient to the operating table
  • Scrub Nurse: Positioning and draping of the patient on the operating table
  • Scrub Nurse: Accurate counts of instruments, gauze, etc.
  • Scrub Nurse: Assisting surgeons when gloving, wearing sterile gowns and masks, and handing instruments and tools to them
  • Reporting any changes in patient’s vital signs
  • Completion of intraoperative documentation
  • Transfer of patient to recovery room

3. Postoperative Nursing Actions

The postoperative phase starts when the patient is transferred to the recovery area and ends when the patient is endorsed to another clinical area (step-down unit, intensive care unit, or ward) for follow-up care, or discharged to home. The nursing actions during the postoperative stage include:

  • Monitoring of the physiologic status of the patient, such as vital signs, any bleeding, and fluid balance
  • Administration of medications as prescribed and as needed, including drugs for pain relief
  • Maintenance of patient safety
  • Reporting any changes in patient’s vital signs and mentation
  • Assessment of patient’s readiness for discharge to another clinical area or home
  • Completion of postoperative documentation and discharge papers
  • Education patient and caregiver about follow up care, proper wound care, and take-home medications if discharging to home
  • Psychological support to patient and family
  • Arranging patient transport for discharge if needed

Nursing Care Plan for Perioperative Nursing

Possible Nursing Diagnoses

Nursing Assessment

InterventionsRationales
Complete pre-operative assessment using the form provided by the hospital/ institution. The assessment should include:
Name identification (check name band)
Diagnosis (actual or provisional)
Past medical history
Family history
Current medications
Allergy status
Baseline vital signs
To confirm the indication for surgery and to prepare the patient for it.    
Assess patient’s knowledge about the surgery when verifying consent.To ensure that the patient is fully aware of the
Check for the status of peripheral veins prior to cannulation and administration of intravenous medications. If administering oral medications, assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of medication is given through the right route.
Obtain a list of current medications and their doses from the patient or caregiver.The patient’s current medications should be reviewed, especially those that might put the patient at an increased risk for bleeding.  
Obtain blood samples and monitor blood counts including coagulation levels (INR, PT, and PTT).To check for any risk of bleeding and for presence of an infection.

Nursing Planning and Intervention

InterventionsRationales
Preoperative: Perform surgeon-specific preoperative orders such as shaving the area involved, shower, bowel preparation, marking, etc.To prepare the patient prior to endorsing him/her to the surgery department.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking preoperative or postoperative medications. Instruct the patient on how to self-administer oral medications.To inform the patient on the basics of medications, as well as to empower him/her to safely self-administer the medication.
Postoperative: Check the patient’s urine for any signs of infection or profuse bleeding. Collect urine samples as needed.To check for any signs and symptoms of excessive bleeding or infection postoperatively. 
Postoperative: Administer the appropriate pain medication as prescribed.To provide pain relief to the patient postoperatively. 
Educate patient and caregiver about follow up care, proper wound care, and take-home medications if discharging to home.To ensure patient’s safety and to perform proper wound care while at home.   
Complete nursing documentation prior to transfer to another clinical area or before discharge to home.To update patient’s medical records which is important in providing continuous holistic care. 

Nursing Evaluation

InterventionsRationales
Ask the patient to repeat the information about preoperative or postoperative medications.To evaluate the effectiveness of health teaching on medications.
Postoperative: Monitor the cardiovascular and neurological status of the patient.To ensure that the surgery or administered medications did not cause any adverse events to the patient.
Monitor kidney and liver function through blood tests.To ensure that the surgery or administered medications did not cause any adverse events to the patient.
Postoperative: Report any changes in patient’s vital signs and mentation  To ensure patient’s safety and to deal with any emergent complications.
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