Perioperative Care (Pre-Op and Post-Op)

Perioperative nursing encompasses the care provided before (preoperative), during (intraoperative), and after (postoperative) surgery. Each phase has specific safety priorities and potential complications that nurses must anticipate and address.

---

Preoperative Phase

Goals of Preoperative Care

1. Ensure patient safety through verification procedures
2. Reduce anxiety through education
3. Optimize physical status for surgery
4. Complete required documentation

Preoperative Checklist

NPO Guidelines

Why NPO? Anesthesia suppresses gag reflex and gastric emptying, increasing aspiration risk.

Note: Many facilities use "NPO after midnight" as a standard, though evidence-based guidelines vary.

Informed Consent

Provider Responsibility:

• Explain the procedure
• Describe risks, benefits, and alternatives
• Answer patient questions

Nurse Responsibility:

• Verify the consent is signed
• Witness the signature
• Ensure patient is competent (not sedated)
• If patient has new questions, STOP and notify provider

Requirements for Valid Consent:

• Patient must be competent (alert, oriented, not sedated)
• Consent must be voluntary (no coercion)
• Patient must be informed (understands the procedure)

Preoperative Teaching

• Turn, cough, deep breathe - Prevents atelectasis
• Incentive spirometer use - Maintains lung expansion
• Leg exercises - Prevents DVT
• Pain management expectations - Use of pain scale
• Splinting incision - Reduces pain with movement/coughing

Items to Remove Before Surgery

---

Postoperative Phase

Immediate Post-Op Assessment (PACU)

Follow ABCs:

Vital Sign Monitoring

Assessing the Surgical Site

"Dressing and Drain" Assessment:

Wound Complications

Dehiscence

Definition: Separation of wound layers (partial or complete)

Risk Factors:

• Obesity
• Malnutrition
• Infection
• Coughing/straining
• Poor wound healing

Assessment Findings:

• Patient may report "something popped"
• Increased serosanguineous drainage
• Visible wound separation

Nursing Actions:

• Keep patient calm
• Cover wound with sterile saline-soaked gauze
• Notify surgeon immediately
• Keep patient NPO (may need to return to OR)

Evisceration

Definition: Protrusion of internal organs (usually bowel) through wound opening

THIS IS A SURGICAL EMERGENCY

Nursing Actions:

1. Stay with patient (call for help)
2. Do NOT attempt to push organs back in
3. Cover with sterile, saline-soaked gauze
4. Position patient supine with knees flexed (reduces abdominal tension)
5. Notify surgeon immediately
6. Keep patient NPO
7. Prepare for emergency surgery

Post-Operative Complications by Timeframe

---

Preventing Post-Operative Complications

Atelectasis Prevention

Most common post-op pulmonary complication

Interventions:

• Turn patient every 2 hours
• Encourage coughing and deep breathing
• Use incentive spirometer 10x every hour while awake
• Splint incision during coughing
• Early ambulation
• Pain control (pain limits deep breathing)

DVT/PE Prevention

Interventions:

• Early ambulation (as soon as medically appropriate)
• Sequential Compression Devices (SCDs)
• Anticoagulant prophylaxis as ordered
• Encourage leg exercises in bed
• Adequate hydration
• Avoid crossing legs

Paralytic Ileus

Definition: Temporary cessation of bowel motility after surgery

Assessment:

• Absent bowel sounds
• Abdominal distention
• Nausea, vomiting
• No flatus or bowel movement

Nursing Actions:

• NPO until bowel sounds return
• NG tube to suction if needed
• Early ambulation promotes peristalsis
• Assess for return of bowel function before advancing diet

---

Pain Management

Assessment

Use consistent pain scale (0-10 numeric, Wong-Baker FACES for children)

Non-Pharmacological Interventions

• Positioning
• Ice/heat (as appropriate)
• Distraction
• Relaxation techniques
• Splinting

Pharmacological Management

Key Point: Adequate pain control enables coughing, deep breathing, and ambulation, which prevent complications.

---

On the Exam

The NCLEX frequently tests:

• Informed consent requirements and nurse's role
• NPO guidelines and rationale
• Priority assessments (ABCs in post-op)
• Wound complications (especially evisceration management)
• Timeline of complications (when to expect what)
• Preventing respiratory complications (incentive spirometer)

Priority Tip: In immediate post-op, always assess ABCs first. Airway patency is the top priority. If you see a question about a patient with evisceration, remember: sterile saline gauze, knees flexed, notify surgeon immediately.