Preoperative/Peri anesthesia Nursing Management
Preoperative care: Care given before surgery when physical and psychological preparations are made for
the operation, according to the individual needs of the patient. The preoperative period runs from the time
the patient is admitted to the hospital or surgery center to the time that the surgery begins.
The wide variety of nursing functions associated with the patient’s surgical management. Perioperative
Nursing is the care of a client or patient before, during, and after and operation. It is a specialized nursing
area wherein a registered nurse works as a team member of other surgical health care professionals.
A. Surgical Classification:
• According to PURPOSE
➢ DIAGNOSTIC – to establish the presence of disease condition.
➢
Example: biopsy, exploratory laparotomy
➢ EXPLORATORY – to determine the extent of disease condition.
Example: Exploratory laparotomy, pelvic laparotomy.
➢ CURATIVE – to treat the disease condition.
▪ Ablative – removal of an organ
Example: gastrectomy (partial or full removal of stomach), thyroidectomy, and
appendectomy.
▪ Constructive – repair of congenitally defective organ
Example: Cleft palate repair (palatoplasty), closure of atrial-septal defect.
▪ Reconstructive – repair of damage organ
Example: These includes skin graft, plastic surgery, scar revisions. These are done to
restore function to traumatized or malfunctioninig tissue and to improve self-concept.
➢ PALLIATIVE – to relieve distressing sign and symptoms, not necessarily to cure the
disease
Example: colostomy, debridement of necrotic tissue.
➢ AESTHETIC - To improve of physical features that are within normal range.
Example: breast augmentation.
Identify the type of surgery according to purpose.
Pap Smear – Diagnostic
Tonsillectomy – Curative Ablative
Nephrocapsulectomy - Curative Ablative
Osteoplasty – Curative Constructive
Perineorrhaphy – Curative Reconstructive
Trachelorrhaphy – Curative Constructive
Skin Grafting – Curative Reconstructive
REASONS
1. To cure an illness or disease by removing the diseased tissue or organs.
2. To visualize internal structures during diagnosis.
3. To obtain tissue for examination.
4. To prevent disease or injury.
5. To improve appearance.
6. To repair or remove traumatized tissue and structures.
7. To relieve symptoms or pain.
• According to URGENCY
CLASSIFICATION INDICATION FOR EXAMPLES
SURGERY
Emergent – patient requires - Severe bleeding
immediate attention, life Without delay - Gunshot/Stab wounds
threatening condition. - Fractured skull
- Perforated ulcer
- Intestinal obstruction
- Repair of trauma
- Tracheostomy
Urgent/Imperative – patient - Kidney/ureteral stones
requires prompt attention Within 24 to 48 hours - Removal of gall bladder,
- amputation,
- colon resection
- coronary artery bypass
- Surgical removal of tumor
Required – patient needs to - Cataract
have surgery. Plan within a few weeks or - Thyroid d/o
months
Elective – patient should have - Repair of scars
surgery. Failure to have surgery not - Vaginal repair
catastrophic
Optional – patients’ - Cosmetic surgery
conditions Personal preference
• According to DEGREE OF RISK
MAJOR SURGERY
- High risk / Greater Risk for infection
- Extensive
- Prolonged
- Large amount of blood loss
- Vital organ may be handled or removed
MINOR SURGERY
- Generally, not prolonged
- Leads to few serious complication.
- Involves less risk
Ambulatory Surgery/ Same day Surgery / Outpatient Surgery
Advantages:
- Reduces length of hospital stay and cuts costs.
- Reduces stress for the patient.
- Less incidence of hospital acquired infection.
- Less time lost from work by the patient; minimal disruptions on the patient’s activities and family
life.
Disadvantages:
- Less time to assess the patient and perform preoperative teaching
- Less time to establish.
- Less opportunity to assess for late postoperative complication.
Example of Ambulatory Surgery
❖ Teeth Extraction
❖ Circumcision
❖ Vasectomy
❖ Cyst Removal
❖ Tubal Ligation
SURGICAL RISK
❖ Obesity
❖ Poor Nutrition
❖ Fluid and Electrolyte Imbalances
❖ Age
❖ Presence of Disease (Cardiovascular disease, respiratory disease)
❖ Concurrent or Prior Pharmacotherapy
- Nature of condition
- Location of condition
- Magnitude/urgency of the surgery
- Mental attitude of the patient
- Caliber of the health care team.
