Fundamentals - Practice & Skills, part 29: Perioperative Nursing Care

Hi, I'm Meris. And in this video, I'm going to talk to you about perioperative nursing care. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. If you already have a set and you want to follow along with me, I'm starting on card number 141. Let's get started.

Okay. So perioperative means in the care of the operative or surgical patients, so pre, intra, and post-op. So preadmission testing is going to vary depending on what the patient is having. But what I want to mention is here on card 141, day of surgery. On the day of surgery, we need to confirm that the patient has had their informed consent performed and signed. Perhaps we act as a witness for that. I would very much encourage you to go back and watch the video on informed consent so that you're really familiar with what those topics include. Remember that if your patient has questions about the procedure, you do not answer them. You need to call the surgeon or whomever is doing the procedure that day. That's part of informed consent. It is the provider's job to answer those questions for informed consent.

All right. Let's talk about intraoperative care and anesthesia care. So in the OR, intraoperatively, meaning intra, meaning during operative, so during the surgery, there's a thing called a timeout procedure. And it's called that because, literally, everybody takes a timeout, right? We stop. Everybody stops. And it's for the patient's safety. And during the timeout procedure, the nurses and the physicians, and anybody else on the interdisciplinary team is going to identify the patient. So two patient identifiers. They're going to mark the surgical site, if that wasn't done already, and also verify things like what surgery are we doing today, what are the patient's allergies, that sort of thing, to say, "We're all on the same page, and this is for the patient's safety."

In the PACU - now, PACU stands for postanesthesia care unit, so in the recovery room - it's very important to make sure that the patient is breathing appropriately. They just received the ton of medications. We need to make sure that they are recovering well and readjusting to being awake. So assess that respiratory status frequently, and be prepared to provide the antidote for any of the medications that they may have received, such as naloxone or flumazenil. Now, vital signs should be assessed every 5 to 15 minutes, depending on facility policy. So much more frequently than in the normal acute care setting. Again, this patient is readjusting to being awake, so we need to make sure that their vitals are okay. We're not seeing anything like hemorrhage or any kind of concerning signs or symptoms there. The patient should stay NPO, so nothing by mouth, until the gag reflex returns. They need to be able to protect that airway. And the other thing here is just going to be to prevent hypothermia. Patients do get pretty cold in the OR and in PACU, so we want to make sure that we give them some nice warm blankets to stay cozy and not be too cold. And if you've ever had surgery, you may know what I'm talking about. It can be pretty miserable.

All right. Lastly, let's talk about ongoing postoperative care. So this is outside of the immediate recovery period. You can see we've got a lot of stuff here on this card, so it is important to know. Look for signs and symptoms of hemorrhage and shock. That's going to be our biggest threat to a patient who had surgery. So we need to be looking for changes in vital signs, level of consciousness, are they looking pale, are they shaky, are they diaphoretic, all of those sorts of signs and symptoms. We want to prevent DVTs and assess for them, so we do have a cross-reference here to see card 70. So you can also see my previous video on that. We also have encouraging the patient to participate in activities that encourage oxygenation, card 132. See the video for that. And then we also need to manage our-- excuse me. We need to monitor our patient for signs of infection. Any time we enter the body through an opening, artificial or natural, we are putting our patients at risk for infection. So in those cases, we need to monitor for signs and symptoms. Big ones here are going to be an increase in temperature, increase in white blood cell count. But we may also have things like an increased heart rate. That's going to be our big one there that's going to show up earlier is a heart rate going up along with the temp. We want to look at the surgical site as well for any signs of drainage, redness, or foul odor.

Okay, so I hope that review was helpful for you for perioperative care. If it was, please like this video so that I know. If you have a great way to remember something, or maybe you have a great story from a time you had surgery, I would love to hear it in the comments below. That wraps up our Practice and Skills playlist. So definitely subscribe to the channel so that you are the first to know when new content is freshly posted to our YouTube channel. Thanks so much, and happy studying.